A veteran of the Canadian military says the Nova Scotia government’s decision to commission a comprehensive electronic medical record system is a prime opportunity to ensure veterans in the province receive improved access to health care.
Health Minister Michelle Thompson announced the $365-million contract with Oracle Cerner Canada last month. The one patient one record system is expected to begin a staged rollout in two years. It will cover both the provincial health authority and IWK Health Centre, and will be accessible by paramedics.
The system is intended to allow health-care providers across the province real-time access to a patient’s medical records. Along with improving patient movement within and management of the system, it will also mean patients won’t have to recount their medical history each time they go to the hospital or interact with a new provider.
That latter point in particular is why David MacLeod, a veteran and veterans’ rights advocate, wants the system to be designed in a way that allows it to either communicate with or incorporate the service health-care records of veterans.
“Re-explaining your injury is, obviously, re-traumatizing often and you need to avoid that whenever possible,” he said in an interview.
MacLeod said people leaving the military can face long delays in accessing their service health-care records, which means an added challenge when they are seeking treatment as a civilian. In his own case, it took 18 months before he had all of his records to share with his doctor.
“Just getting the damn documents is a bit of a nightmare,” he said.
“It’s very time consuming, it’s incredibly frustrating, and it can be really hard on your health because it can be a delay in you getting health care.”
Enabling the civilian and military records systems to connect would lead to better health care for veterans because civilian doctors would have a clear and complete picture of a veteran’s history, said MacLeod.
Documentation outlining what issues are related to military service could also lead to cost savings for provinces because it would help clarify what can be billed to Veterans Affairs Canada, he said.
Challenges to making changes
Spokespeople for Nova Scotia’s Health Department, Veterans Affairs Canada and Canadian Forces Health Services said there have been no discussions about finding ways to connect the various systems.
A spokesperson for Nova Scotia’s Health Department said the new system will be designed to add enhanced features over time, and will have the capability to share records with other health organizations.
But even when the system is fully operational, it would not change existing restrictions that apply to accessing federal records, which require consent of the patient, Khalehla Perrault said in an email.
The one person one record system “will technically be able to exchange health information with any clinical information system that is based on data standards, which are at present a provincial and national focus.”
Connecting systems from different organizations and government jurisdictions poses challenges, a Veteran Affairs spokesperson said in an email.
“To adhere to the requirements of the Privacy Act, significant security and privacy analysis would need to be undertaken,” Marc Lescoutre said in an email.
An option for consent at release
A spokesperson for Canadian Forces Health Services said there is “long-term intent” for the military records system to integrate with the provinces and territories, but it is not yet possible because of the many different electronic health records systems being used.
Alicia Gagnon said in an email that privacy and security regulations are the main hurdles in making a connection, along with the “lack of inter-provincial standardization of issues management.”
But MacLeod said there could be an easy way around concerns about privacy and system connectivity.
In a submission he made in 2019 to the Desmond Fatality Inquiry, MacLeod argues that military members intending to release in or into Nova Scotia should be given the opportunity to sign a consent form that would allow a complete copy of their medical file to be made and directly transferred to the province’s health department.
The province could then digitize that file and incorporate it into the provincial records systems.
Such a step would lead to better health care because civilian providers would have a full picture of a veteran’s history. MacLeod said the step could also help to prevent tragedies such as the Desmond case. Lionel Desmond was struggling with PTSD when he killed his wife, Shanna, his daughter, Aaliyah, and his mother, Brenda, before taking his own life.
One of the issues identified during the inquiry was the difficulty civilian health-care providers faced in obtaining access to Desmond’s full medical history.
“It had devastating ramifications to his family and to him, and right now there’s no clear path to ensure that a service health-care record enters the one person one record system,” said MacLeod.
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