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Law TiMes • May 30, 2011 A prescription for reform W hat's wrong with our health-care system? Th e answer, of course, depends on who you ask. Doctors complain of too much bureaucracy. Nurses complain of overwork. Gov- ernments complain about the cost and a shortage of doctors. What's interesting to note about the latter is that some 25 per cent of doctors in Ontario today qualifi ed outside of Can- ada. Programs to bring their qualifi cations to Ontario stan- dards are actually boosting the numbers of doctors practising. Th at's good news for the most part, but challenges remain in en- suring the system — much like the legal system — doesn't col- lapse under its own weight. Appraisals of the state of both the legal and health-care systems depend on your perspective. While in my 30s, I had no idea the health system was overbur- dened. Th e few procedures I had were executed in what seemed like a couple of weeks. Ask me today, and I'll com- plain about the fi ve-month wait just to get an MRI as a prelude to knee surgery. Of course, I'm not facing a life or death situation. For patients diagnosed with cancer, the real nightmare is try- ing to navigate the health-care system to see the right doctor of- fering the right treatment at the right time. For some people, the struggle starts at the outset when the possibility of cancer is raised but not defi nitively confi rmed. No one wants to hear that it could be cancer but it's going to take a few months to fi nd out for sure. It's not just the number of doctors that matters. It's sending the right problem to the right doctor with the right specialty because sending wrong patients to the wrong doctors is also caus- ing backlogs. Spine specialists, for example, say most of the patients coming to see them are being er- roneously referred, something that wastes everyone's time. What the system needs, it seems, is a more eff ective triage process that brings in an inter- esting phenomenon known as patient navigation, the fastest- growing job category in the United States. Th e concept is simple enough. Patient navigators are trained to understand the health-care sys- tem's workings and how to re- move barriers to access; ensure forms and referrals are compliant; and get their clients to the right doctor or treatment facility. Dr. Harold P. Freeman pio- neered the whole idea some 20 years ago. Today, the Patient Navigation Institute in his name off ers a three-day intensive pro- gram for about $1,500. As well, jurisdictions such as Canada and Britain are getting on board. Here in Ontario, there's Inside Queen's Park By Ian Harvey a Cancer Care Ontario pilot project in play that's setting up a training program for future patient navigators. Th ere are similar programs in Vancouver and Nova Scotia. "Th ere are two areas [patient navigation] is being used in Canada, one for cancer patients and also for aboriginal people to navigate the system," says Sanjay Cherian, who leads Accenture Inc.'s health-care management consulting practice in Canada. "For aboriginal people, it's be- cause the federal government pays for health care, but it's delivered by the provinces. Th ere's a bit of disconnect because of that and hence the need for navigation." In cancer treatment, the value is immediately obvious, he notes, because the disease isn't an isolated one. It aff ects entire families, and the repercussions can be fi nan- cial, emotional, and physical, all of which drives the need for cer- tain diagnosis, speedy treatment, and ensuring patients and their support groups are up to speed on the latest medical information concerning the disease. Cherian says those going into patient navigation gener- ally come from fi elds like social work and nursing. He notes that rather than adding a layer of complexity, there are compelling arguments that they can make the system more effi cient. It's already clear that no government, certainly not On- tario's, can continue to throw money at health care. At the same time, whoever forms the next government at Queen's Park this October will have some tough decisions. Conservative Leader Tim Hudak's announcement last week that he'll match the Liber- als' long-term funding commit- ments to health care by raising spending by $6.1 billion over four years is comforting but it may not address the core issues plaguing the system. Innovations on how to spread the load across the system, such as patient navigation, accelerating deployment of electronic health records, and reviewing what medical issues require hospital care and what can be dealt with in private clinics, may make stal- wart defenders of public health care quiver in their surgical boo- ties but they could be the only prescription for survival. Ian Harvey has been a journalist for 34 years writing about a diverse range of issues including legal and political aff airs. His e-mail address is ianharvey@rogers.com. COMMENT PAGE 7 Protecting IT systems April attack shows need for better security BY NICHOLAS DEWKINANDAN For Law Times either replaced, modifi ed or, worst of all, stolen. Th en in May, Sony Corp. announced that I its PlayStation network experienced a breach of customer information that resulted in third parties obtaining it. Imagine having your case fi les compromised and all of your hard work for your clients left open. In the fi eld of infor- mation technology, net- work security consists of provisions and policies adopted by the network administrator to prevent and monitor unauthor- ized access, misuse, modifi cation, and denial of the computer network and resources. Secu- rity is a very important aspect of a computer network. Minor instances of security vulnera- bility can result in a heavy loss of critical data. Keeping the computer on a well-secured network is a big responsibility for IT manag- ers. Th ere are many measures and prevention methods available to minimize the harm from a threat and also prevent a major attack. Typically, a computer network can suff er an attack through a number of ways such as viruses, tunnelling, hacking, and cryptography attacks. Prevention is the fi rst step any business should implement. An anti-malware program that in- cludes virus and spyware detection should be updated regularly and scan all of the network devices, e-mails, open ports, servers, and client computers as frequently as possible. Server soft- ware should be checked for updates as well. Windows-based servers, just like systems for home use, get updates. On internal net- works, unnecessary network-shared drives should be controlled, user accounts that are no longer in use should be purged, and wire- less access points should be encrypted to the extent that the password to get onto them is hard to guess. At the same time, compa- nies should impose restrictions on access to the network so systems are used for business rather than personal tasks. Th e law fi rm attack revealed in April started with a simple virus program. It was an unde- tectable program that embedded itself into the Windows computer system. A computer virus is a small program or an executable code that, when executed and replicated, sometimes per- forms a harmful function on a computer. Th e attack in April was twofold: a domain name system redirection and an intrusion on networks to gain access to data. A virus can Letter to the Editor PROFESSOR ADVOCATES LIMITED PRIVILEGE FOR ACCOUNTANTS I appreciate the important coverage in the May 16 edi- tion of Law Times given to the report released by the Canadian Bar Association on solicitor-client privilege (see "Alarm sounded on solicitor-client privilege"). Th e story unfortunately incompletely states my posi- tion on the extension of privilege to accountants. I've specifi cally advocated for only a limited form of privilege for accountants and, in particu- lar, for audit working papers. Th e Canada Rev- enue Agency practice of making broad demands for this information from accountants about their opinions and clients' subjective intentions has put Canada out of step with approaches taken by the United States, Britain, and New Zealand, all of www.lawtimesnews.com n early April, a few law fi rms in Toronto had their systems compromised by an overseas hacker. Networks were left open and data was destroy information stored on the network and consume memory on a computer while destroying the overall performance of the sys- tem. A Trojan, a form of a virus, can destroy a system's critical data and also open access to it so hackers can obtain information. A fi rewall helps control the fl ow of data traf- Speaker's Corner fi c in and out of a network. Th ese devices are a frontline defence for any network. Th ese should be checked and confi gured properly to ensure software applications can access network drives and limit outside data access. Ensuring employ- ees have access only to the resources needed to do their jobs and noth- ing else will help protect a network. It's also possible to confi gure fi rewalls to block non-business-related web sites. Make sure there are no open or forwarded ports that aren't required and eliminate those that don't provide access needed for the business. Having strong passwords that are hard to guess will also help ensure local security. Pass- words should be unrecognizable, which means no phone numbers, birth dates, pet names, words that occur in a dictionary or people's names. A strong password will have upper- and lower-case letters, a number, and, if the system allows, a punctuation mark. In addition, don't let multiple people use the same username and password combination. All employees should have a unique account and password that they must change frequently. Another important note is to make sure that updated anti-virus and anti-malware pro- tection is installed and running on every ma- chine. If people can log on remotely, ensure the off -site computers are also protected. Th ere's a lot of malicious software that goes unnoticed because it doesn't actually harm the system it's on; instead, it captures every keystroke the user types and sends it to the potential hacker. Having regular backups is important, but that won't protect you from hackers. However, if a hacker damages data or your computers, backups let you get running again quickly. Also, keep the backups in a secure location because someone with access to them can get all of the information on them, including things like cli- ent information and even system passwords. To stay secure and safe while working online, it's important to do research on materials before clicking, opening or installing them. A simple Internet search can always provide details on something new. Always ask your IT professional before installing anything onto a work computer. It's always best to be safe than sorry. Nicholas Dewkinandan is an account executive at Interface Technologies in Toronto. which have had legislation recognizing a lim- ited form of privilege for accountants. In addition, those countries and Australia have limited the ability of tax authorities to seek disclosure from auditors only in well- defi ned and special circumstances. Unlike their Canadian counterparts, authorities in those countries have recognized the need to craft a balance between the corporate governance pri- ority of preserving the ability of auditors to help ensure open and transparent fi nancial reporting and pressures on them from tax authorities want- ing a road map to client intentions. I set this argument out in detail in a peer- reviewed article in the Dalhousie Law Journal in 2005. Professor Adam Dodek's report for the CBA refers to it in setting the stage for the necessary and important debates to follow. I'd invite Law Times readers to delve more fully into the position than the article's summary provides. Paul Paton, professor of law, University of the Pacifi c McGeorge School of Law, Sacramento, Calif.