Dr. Brian Day @DrBrianDay Twitter

  • Past President Canadian Medical Association
  • Past President Arthroscopy Association of North America
  • Honourary Associate Professor University of British Columbia
  • 2014 Doctors of BC Don Rix Leadership Award

Dr. Day stresses importance of healthcare IT

Apr 07, 2008

Canadian Healthcare Technology

CMA president backs physician IT, sees the need for new approaches.

Dr. Brian Day notes that family doctors and specialists are essentially small business owners who face a free market for expenses and a fixed market for earnings. No wonder they're slow to invest in computers.

Dr. Brian Day, an orthopedic surgeon and award winner for his research and innovations in arthroscopic surgery, has been called "Dr. Profit" for his outspoken advocacy of privatizing more of the Canadian healthcare system. Agree with him or not, Dr. Day speaks of what he knows. After BC government funding cuts had drastically reduced his operating hours in the 1990s, Dr. Day founded the Cambie Surgery Centre in Vancouver, a for-profit hospital which sees about 5,000 private patients a year. Day is both the Centre's medical director and one of its 40 shareholders. Less well known about this soft spoken, Liverpool, England-born advocate is a career-long passion for what computers can do for healthcare. CHT Contributing Editor, Andy Shaw, recently visited President Day in his Vancouver consulting office.

CHT: Dr. Day, judging from what I see on your desk, and unlike how other Canadian physicians are sometimes described, you're clearly not a Luddite when it comes to computers?

Day: That's true. I started with computers back in the 1970s. It was a Radio Shack Tandy. Then later, together with Myles Clough, who was a resident, we wrote a paper on electronic medical records (EMRs) in 1980. I also had a summer student when we graduated to an Apple II He got so intrigued he went down to Bellevue (in Washington state, the headquarters of the world's largest software company) and has since retired as a Microsoft millionaire. Maybe I should have gone with him. And a few years back, I was CEO of a company that was going to develop EMRs but that did not work out. So, I guess I have just been ahead of my time.

CHT: 'What about your peers in Canada? By comparison to countries in Europe and elsewhere, where the uptake of computers by physicians is 90 percent or better, Canadian doctors are trailing the pack aren't they?

Day: Well, we just did a national physician's survey of the CMA, and 26 percent of our doctors now have electronic medical records. That's progress, but it's not good enough. Another survey from the OECD (Organization for Economic Cooperation and Development, with 30 member countries) tells us that our spending on IT in our hospitals is only a third of the OECD average. So we are backward in our spending. Our governments have just not fully recognized how important to healthcare information technology is. But I have to add that the CMA has clone so. Our subsidiary, CMA Holdings, has a company called Practice Solutions that offers an electronic medical record system to doctors. We've also been talking to major software and communications companies about the possibilities for collaboration in this area. So as an organization, the CMA is definitely interested in FL

CHT: What about from the family physicians point of view? What's the barrier in their eyes?

Day: It's partly an economic one. Physicians in Canada, for the most part, are small businesses that are placed in a very awkward position. On the one side, as small businesses they are exposed to a free market when it comes to their expenses — but they face a relatively fixed market for their earnings. Now, for them to upgrade their offices to an EN4R requires both a capital expense and additional ongoing operating costs. The major benefits of that expense will go to the government and to patient care rather than to physicians. So there is no financial incentive for them. Governments here and there have come up with some financing to encourage doctors to invest in IT, but they need to step solidly forward and offer consistently available financing.

CHT: Does it work that way elsewhere?

Day: Yes. In Britain, for instance, family physicians are not paid on a fee-for-service basis. They don't operate a private office as doctors do here. The facility in which they practice is owned by the health authority. So when they get new information technology it is funded for them. And that springs from an understanding on the part of government there that it is cheaper to invest in information technology than not to invest in it.

CHT: Why is IT such a good investment?

Day: For one thing, we have 24,000 avoidable deaths a year in our hospitals, many of which might be the result of lack of information, lack of data, and mistakes made in transferring information. All that leaves caregivers without the knowledge they need to give proper care. For example, a big story in the Vancouver papers here recently told how the paper record of positive test results in a mammogram had gone missing for two years. That's an information transfer issue and we're performing very badly on that particular score at the moment without IT.

CHT: The universal EHR supposedly will fix problems like that. What's your view of the pan-Canadian EHR?

Day: There are three components to any health record: one is the hospital or institutional record; then there is the doctor's office record; and also there is what Microsoft and others are pushing — the patient-based record. So the main challenge in Canada is to somehow get those three talking together and brought in line with each other. The CMA wants to get involved and help make that happen. One part of that challenge that we can help with is that there is a lot of distrust amongst physicians right now over the confidentiality issue. They are concerned that patient information, particularly any stored on line by an application service provider, can be hacked into.

CHT: As a physician yourself how do you feel about that?

Day: If I have a history of heart disease and I happen to be on vacation in Paris, France, it would be good, if I have a sudden chest pain, that the cardiologist over there can look at my ECGs and other records. So we're wondering if there is a role for the Canadian Medical Association here — because of the distrust I mentioned. What people are worried about most is who stores the information. It may be that a body like the CMA could be involved as the "storage vault" or a central storage agency. I think doctors and patients may not trust government, and they may not trust a private technology company to store their information, but I think they are likely to trust the CMA.

CHT: Claude Castonguay's report has just come out in Quebec. Its recommendations suggesting greater privatization of the healthcare system have hit the headlines across the country. But less noticed was its calling for more IT in healthcare. What do you make of that part of the report? Did it say anything new?

Day: Well Andy, Castonguay's report was supposed to be de-politicized through having each provincial political party involved equally in preparing the report. Unfortunately, after its release, it has become politicized. The report rejects the status quo. Some of the media ignored significant and important proposals. Filling the "IT gap" was one of those, but other recommendations, such as patient-focused funding, dealing with the reality of unsustainable cost increases, and calls for increased accountability and responsibility were significant and constructive recommendations.