by Matthew Kennedy (Guest Submission)
The lack of a unified healthcare operating system is an urgent issue facing the healthcare sector. Dr. Tam's recent report, "A Vision to Transform Canada’s Public Health System" (The Chief …, 2021) discusses how, "the national data landscape is fragmented across jurisdictions, governmental organizations, and community-level data owners” (p. 58, para. 2). Moreover, in a statement of the report, Dr. Tam says, "Our pandemic response was hindered in part, by significant gaps in our public health surveillance and data systems" (Public Health Agency of Canada (PHAC), 2021). These gaps in our healthcare systems are dangerous. If I were to hazard a guess - based on my experience working as a public health case/outbreak investigator from November 2020 to present in a long-term care/retirement home team – I would say we are currently 80% inefficient. I would even argue that it could be declared a logistical emergency (a type of internal crisis, a ‘code brown’).
A simple example of inefficiency is how often I copy/paste data from one place to another. I must perform this action X number of times per day because of our disparate, disconnected systems. If this type of delay occurred in other sectors, like an automotive assembly line, it would cost thousands of dollars per minute. Consequently, when staff are busiest, their efficiency is at its worst because they spend more time processing data from one place to another. It is an inverse relationship: when it is most important to be focusing on real-time data/events, users of the healthcare operating system are processing mundane tasks. Rationally, the healthcare system ought to invest in a single system to recover the costs of an inefficient one – and that means investing in a system that eliminates these mundane tasks with computer algorithms (similar to investing in an automotive assembly line to quickly and cheaply produce more vehicles).
Multiple logons are another example of discontinuity of care that impacts efficiency. I have 10+ logons working in public health. As a result, instead of unifying our disparate systems, we are asking a skilled workforce in short supply to manually communicate between them. Per the CNA (2009), registered nurses have shortages of 60,000 full time jobs and Winsa (2021) reports "Hospitals across the province currently have a vacancy rate of 10 to 12 per cent for nurses, according to the Ontario Nurses’ Association". Keep in mind, that shortfall is with the contemporary healthcare operating system. I argue that if we had a more efficient system, we could operate with 20 percent fewer staff (freeing up labour for bedside care) and complete 80 percent more work. One of the reasons the automotive sector transitioned to assembly lines was that it required fewer skilled labourers; investing in a computer algorithm that functions as an assembly line ought to produce greater efficiency with fewer professionals.
The contemporary healthcare operating system cannot manually cope with the massive spread of viral pathogens and therefore needs to be unified to be competitive. Massive spread is typically referred to as ‘surges’. These surges are insurmountable because the input is greater than the output. In my sector, it takes 3 or more employees to process data for 1 client. Moreover, the maintenance of that data (quality control) may require even more people. If the ratio were 1 employee to >1 client, the odds would be more favourable – ideally tens, hundreds, or thousands of times more favourable.
In order to be competitive, the healthcare system must overcome its complacency. When healthcare systems were first implemented, they worked in isolation – and at the time that may have been sufficient. Present day however, it is neglectful for provincial, federal, and local systems to not integrate their care. By definition, using separate systems for electronic health records is to not be integrated. The healthcare sector needs to respond to its apathy and it needs to begin with simple steps, like calling a code brown. The larger step is overcoming the complacency of fragmentation which has long been endemic to the healthcare sector.
When the spread of SARS-CoV-2 reached a precipice, the Director-General of the World Health Organization (WHO; 2022), Dr. Ghebreyesus, declared a pandemic and cited alarming levels of spread, severity, and inaction in a situation assessment. Now the healthcare system is on a precipice and needs to raise awareness of the impossibilities that lay ahead of it by calling a code brown. Such a message should communicate that homeostasis of the healthcare system is affected by the efficiency of computer algorithms, and that a timeline for correcting it is to be established by the person calling the code.
*The above is the writer’s personal opinion and does not reflect that of any public health or healthcare institution.
References
CNA. (2009). Tested Solutions for Eliminating Canada’s Registered Nurse Shortage. Retrieved from https://hl-prod-ca-oc-download.s3-ca-central-1.amazonaws.com/CNA/2f975e7e-4a40-45ca-863c-5ebf0a138d5e/UploadedImages/documents/RN_Highlights_e.pdf
Public Health Agency of Canada. (2021). Statement from the Chief Public Health Officer of Canada on the CPHO Annual Report 2021: A Vision to Transform Canada’s Public Health System. Retrieved from https://www.canada.ca/en/public-health/news/2021/12/statement-from-the-chief-public-health-officer-of-canada-on-the-cpho-annual-report-2021-a-vision-to-transform-canadas-public-health-system.html
The Chief Public Health Officer of Canada’s Report on the State of Public Health in Canada. (2021). A Vision to TRANSFORM Canada’s Public Health System. Retrieved from https://www.canada.ca/content/dam/phac-aspc/documents/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/state-public-health-canada-2021/cpho-report-eng.pdf
WHO. (2022). WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. Retrieved from https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
Winsa, P. (2021). An Ontario nursing shortage has been predicted for years. Now, it’s turned into a ‘mega crisis’. Retrieved from https://www.thestar.com/news/gta/2021/09/26/an-ontario-nursing-shortage-has-been-predicted-for-years-now-its-turned-into-a-mega-crisis.html