Ottawa fumbles efforts to improve health care

Just about everyone — from political leaders to clinicians and certainly patients — agree that health care in Canada is in desperate need of reform and modernization. How is it then that we struggle so badly to accomplish what all of us know needs to be done?

Two recent examples provide an excellent study on how this country has adopted a one step forward, two steps back approach to health-care reform.

First, federal Health Minister Marjorie Michel announced Wednesday she was creating the National Advisory Panel on Preventative Health Services, a group of health-care experts who will make recommendations on how to “strengthen disease prevention and help ensure timely, effective and responsive care for all Canadians.”

The problem here isn’t the creation of the panel; the real concern is that this group has been struck to replace another group, the Canadian Task Force on Preventative Care, which was disbanded a year ago following controversy over breast cancer screening.

The controversy erupted when the first task force did not, as expected, recommend mammograms for women starting at age 40, 10 years earlier than the current age of 50. Instead, it said that women could ask for the test at age 40 but noted there was a lack of compelling evidence supporting a firm recommendation to get the test done earlier.

The federal government faced heavy criticism for the task force’s recommendation, and shut it down shortly thereafter. Can the new advisory group do a better job of meeting the expectations of government and the general public?

It’s not clear that a new group with a slightly different name can repair the underlying problem when it comes to cancer screening: the trend among health-care professionals to recommend that screening be pared back to avoid false positives, exposing patients to more invasive and riskier procedures.

The new group, for example, recommended the prostate-specific antigen test (PSA) should be not be employed for men of any age unless they have been previously diagnosed with prostate cancer, or who have other related symptoms. This is largely consistent with peer-reviewed studies published in leading medical journals.

Even so, the recommendation caused quite a bit of concern among men, many of whom believed it was counterintuitive to the advice they repeatedly get on the importance of early detection.

However, Ottawa did not pull the plug on the task force after its prostate cancer screening advice. Why did the health minister react after it published breast cancer screening recommendations and, further, why did she wait a year to strike a new group?

No clear answers. But whatever the reason, the reality is this: efforts at early detection of cancer have been hampered by a lack of definitive screening protocols.

That brings us to example No. 2, the implosion of a national initiative to encourage physicians and pharmacies to embrace digital information sharing.

Michel recently decided to withhold $50 million in scheduled funding for the Canada Health Infoway, which was charged with encouraging physicians and health-care facilities to get rid of paper and hand-written records and orders and adopt digital technology. One of CHI’s initiatives, PrescribeIT, encouraged health-care professionals to “axe the fax” when ordering prescription medication for patients.

A series of stories in the Globe and Mail this spring detailed how the organization was plagued with problems and apparent mismanagement of federal money, including an outrageous decision to pay its now-former CEO nearly $900,000 in annual salary. Concerns also arose about the fact that only five per cent of all prescriptions were being ordered through PrescribeIT.

Notwithstanding the internal problems at CHI, an independent non-government organization, the low uptake of digital prescriptions and other health records is a chronic failure in Canada, right up there with struggling efforts to cut down on unnecessary diagnostic tests and procedures. The waste and inaccuracy in the health system is rampant, and efforts to get everyone to use modern electronic tools have fallen short.

Put both examples together, and there are very compelling concerns about the ability of our health-care system to modernize so that it can manage the increasing volume and complexity of needs.

The country desperately needs clear and effective guidelines for early detection of chronic diseases including cancer, and buy-in from within the system to make use of leading-edge technology in order to improve the quality and speed of care. What we’re actually getting is infighting on screening standards and the unconscionable reliance on outdated administrative methodologies and tools.

There are many more examples of this wasteful and pointless resistance against reform and modernization, such as the inability of provincial governments to reduce demands on physicians for wasteful and, in many cases, redundant paperwork. There have been baby steps toward a solution in Manitoba, but the progress is minimal.

Is there any reason to be optimistic that Ottawa is finally getting a handle on screening standards and the digitization of health records and prescriptions? The false starts on both files certainly justify skepticism.

On the other hand, Canadians have little choice but to hope for adoption of modernization to forge the health-care system needed for the future. The alternative is too awful to contemplate.

» Dan Lett is a Winnipeg Free Press columnist.