Yoel Robens-Paradise recently joined Gevity as our Vice President, Canada-West, B.C.  Prior to joining the company, Yoel was an executive for the Lower Mainland Health Information Management and Biomedical Engineering services comprising 1,700 staff at 36 sites across Fraser and Vancouver Health Authorities, the Provincial Health Service Association and Providence Health Care. He was also co-sponsor for the Clinical and System Transformation Project, Canada’s largest electronic health record enabled transformation, and sponsored the PHC Lower Mainland Services of Information Management Technology, Laboratory, Pharmacy and Medical Imaging.

A father of four teenagers (two 14-year-old twin girls, and a 17- and a 19-year-old boy), Yoel is a year-round cyclist who regularly braves the traffic and the elements to ride his bike to work. He is also an international news junkie and, like many of his Gevity colleagues, an avid traveller.

We spoke to Yoel about why he made the leap to the private sector, how he hopes to harness his extensive public sector experience to continue to move the dial on digital health initiatives and how he foresees the future of electronic health records unfolding.

Q: You had a 25-year, successful and highly respected public sector career. Why did you decide to come to the private sector? And why to Gevity specifically?

YRP: I’ve always thought of myself as having the soul of an entrepreneur. In fact, I was once called a maverick and I thought it was meant as a compliment, although it turns out it was intended as an insult. I also realize that as an early adopter of many technologies, including voice recognition and document scanning, I depended on private sector delivery companies to develop these products and solutions. I chose Gevity specifically because I was super-impressed by Gevity’s leadership and values. I think the company’s desire to make a positive impact is genuine. Their vision of themselves as part of the broader corporate community and their commitment to quality work aligns with my own commitment to being a values-based leader. I’m hoping that by leveraging Gevity’s skill set I will have the opportunity to tackle some of the persistent challenges the healthcare system faces from a different angle and perspective.

Q: The Clinical Systems Transformation is a huge, multi-year project across three B.C. health organizations: Vancouver Coastal Health, the Provincial Health Services Authority and Providence Health Care. Can you expand a bit on your role in this initiative as cosponsor and lead for digital health informatics, the challenges the initiative faces from your perspective and the benefits it will enable?

YRP: The CST is a very multifaceted, transformational strategic initiative that is being implemented not just across three large healthcare organizations but across a variety of service levels, including rehab, acute, cancer and ambulatory care, as well as at smaller regional facilities. Importantly, it needs to also integrate with community services and many downstream systems. Once implemented, it will bring a host of benefits. The most important ones are for patients – it will improve the safety, quality and consistency of care they receive. Clinicians will be able to share patient records electronically and enter medication orders directly into the clinical information system, and there will be common clinical and process standards, and a closed loop medication process, which will also contribute to improved patient safety.

It has currently been implemented at only one of the three organizations so far (Lion’s Gate Hospital), though – it has yet to be implemented and deployed at the largest, most complicated sites.

A big challenge the initiative faces is that the three organizations implementing the system had not previously shared significant technology or clinical decision-making structures, so that’s a complicated undertaking from an information governance perspective and there is a huge amount of work to be done. It goes without saying, but it is also critical that we find ways to decrease the costs of deploying and managing these systems, or it will undermine our public health system’s sustainability. This is an area where I think Gevity can play an important role.

Q: What are the lessons learned so far that you think other jurisdictions might benefit from?

YRP: They are not that unique, to be honest. For example, it’s essential to conduct a full stakeholder analysis at the beginning of any large project like this and to ensure clinical leadership is driving and championing the initiative from the very beginning. That means getting clinical leadership input on the selection of software and solutions and supporting the high touch needed for clinical involvement in project design. The other lesson learned is that if you are going to radically change current clinical processes, you have to be able to demonstrate clear patient benefits; in my experience, most clinicians are willing to sacrifice some workflow efficiency if they believe it will eventually pay off for their patients. If you promise to also improve workflows, prove it – avoid empty or wishful promises.

Q: From your perspective, how does B.C. compare to other Canadians provinces/territories in terms of digital health? Is it more advanced or on par? Has the province taken any unique approaches you think other regions could benefit from?

YRP: It’s not necessarily a lot further ahead or behind. In certain areas, such as our patient lab and pharmacy systems, B.C. has done well, but we’re not ahead of the pack. We’ve also done well on report distribution solutions, which is something I championed, but even there we could be doing so much better. We need to establish better integration between hospital and family physician systems with actual information transfer to get clinical content into physicians’ EMRs. I believe that we could advance considerably if there were a federal or provincial mandate to do so.

The B.C. experience in consolidation of service areas across organizations is very unique and it was a successful way to both standardize services and decrease costs as we transition to more provincial-based structures. While challenging and complex, in my experience, many of the Health Information Management service’s achievements would not have been possible had we not consolidated across the Lower Mainland. I would be thrilled to put my learnings to good use across the country.

Q: Information governance is perhaps one of the most important components of a digital health initiative in that managing and protecting personal data is key to ensuring patients have confidence that the system can be trusted with their personal health information. What are the information governance challenges in such a complex landscape of regional, provincial and federal data privacy requirements? How do you see this field evolving in Canada?

YRP: I agree that maturing our industry’s information governance is foundational. Put simply, without it, Canadians can’t be sure that the healthcare industry is properly managing their information and this will undermine its collection, use and, ultimately, the quality of care itself. I see two main challenges: one is organizational, and the other is systemic or policy-based.

Organizationally, we have created silos within care levels like hospitals and across the continuum of care that do not align with future use models; even within organizations, unclear accountability across IT, clinical and business leaders undermines management of health information over its full life-cycle.

More fundamentally, our health system’s organization of health information has evolved as a transactional output of each care provider’s services – it is “institution-centric.”  This makes sense if the goal is to manage the system’s operations. However, if the health information’s purpose is to support an individual’s health, broadly speaking, then it needs to be person-centric and this is a completely different paradigm.

Let me give you an example: Let’s say you live in Toronto and you get care from the University Health Network, for example, and the provincial or federal government or UHN creates an EHR for you. We then realize we need you to enter additional information, such as daily dietary and exercise information.  Or perhaps you are seeing a non-traditional provider such as a naturopath; you and your care provider would want to include that information too. And maybe you need to give access to a family member and a social worker. What I’m saying is this has to be your system and your record; you need to be the centre of it and have it built around you and be under your control. Right now, we’re building systems that are institution-centric, so we have to figure out how to architect them to be a component of a person-centric system or it won’t meet the whole range of your needs and privacy/access expectations. I believe what exists now will evolve over time to become more person-centric, and having more mature, common information governance frameworks will help enable this digital transformation.