2020: The state of digital healthcare

As we mark the start of a new decade, I wanted to share my first blog of the year, in which I look at the state of digital health in Canada and make some predictions for what lies ahead.

Canadian healthcare is on the verge of significant change. Several initiatives and strategic forces will have a profound effect on how healthcare is delivered in this country and across the individual provinces in the coming years.

The big picture challenges facing our health system continue: long wait times, controlling escalating costs, lack of care coordination and fragmented care delivery, are still the main issues. Inappropriate medication duplication, an ongoing opioid crisis, the rise in chronic disease and the aging baby boomer cohort round out the list.

What stood out for Orion Health in 2019 was our interoperability survey of 150 digital health professionals across the country, which included an insight filled report on the Health of Interoperability in Canada. The report uncovered the progress and challenges digital health experts have seen with respect to interoperability including their perspectives on barriers, funding and perceived health system benefits to be derived from improved interoperability.

In 2019, Orion Health also became a founding partner of Canada Health Infoway’s, ACCESS 2022 program, demonstrating Orion’s commitment to providing solutions to Canada’s disconnected healthcare system and achieving the goal of improved efficiency and efficacy for every patient’s journey through the system.

With 2019 in the rearview mirror, here are my thoughts about what’s in store for digital healthcare in Canada during 2020 and beyond.

Patient-centered care is a movement focused on placing patients in the centre of all goal setting and decision making, treating patients with dignity, and ensuring proper coordination of their care. It is not possible to deliver patient–centered care without high quality interoperability. We will see a continued focus on increasing the capabilities of patient engagement tools including personal health records, patient portals and remote patient monitoring (RPM). RPM enables patients to play a more active role in managing their personal health and chronic disease from the comfort of their home. In the right context, as part of an overarching care coordination solution, RPM has been shown to significantly reduce hospital readmissions and improve outcomes. 

Including patients’ individual, unique goals as essential elements of their medical record will take time and indicates an important change in culture from the purely problem-oriented medical record. This will prioritize outcomes that matter to patients and is aligned with long-standing nursing theory and practice.

Increased patient access to data – In 2020, we’re likely to see a more cohesive lobby for an official patient bill of digital rights. This should both improve access by patients to their data and restrict the rights of other groups to access patient data inappropriately. Most jurisdictions already have patient ombudsmen and a stated strategic commitment to patient centered care, along with an understanding that digital health records are a key element in operationalizing the strategy.

Patients are becoming increasingly eager to see all the information that their healthcare providers see. In the US, there’s been a significant move toward “Open Notes” whereby the patient has full access to everything the physician and other providers have written without limitation. Expect this thinking to strengthen in Canada in 2020.

Helping physicians make sense of it all – Ensuring patients receive the highest quality of care in a digital world means giving physicians the data they need in a timely fashion. Despite waves of digital transformation across hospitals and the community, it’s still not easy for clinicians to find the data they need, when they need it. This is especially true for patients with complex conditions that involve multiple providers in their care. Additionally, clinician burn out is a significant problem across North America and the evidence increasingly points to the burden introduced by the EMR as a major cause for that burnout.

Province-wide EHRs on the other hand, aggregate all the patient’s data from across the province into a single record and focus on providing rapid access to the relevant information for the current patient. They reduce the effort needed to make sense of the patient’s clinical picture and thereby alleviate some of the causes of clinician distress.

In 2020 and beyond, we will see greater focus on presenting complete, meaningful and relevantdata to clinicians with respect to each individual patient. Smart searches, analytics and predictive modelling across aggregated clinical data can significantly help the move from ‘big data’ to ‘actionable data’. This is the next logical step toward achieving the vision of more effective and efficient patient-centric care.

Artificial intelligence moves into care – We cannot discuss the future of Canadian healthcare without addressing the role of AI. Going forward, AI, machine learning and deep learning will help predict all manner of adverse events that today are left to physician intuition and judgement. It has already had major impact and benefits in use cases such as predicting surgical outcomes, adverse events like sepsis, and determining optimal staffing levels in emergency departments. AI, however, is only as good as the underlying data used to train and implement the algorithms. Hence an increased focus on the quality, timeliness and overall governance of data is likely to go hand-in-hand with the desire to introduce AI more closely in the care delivery process.

Measuring and delivering value – As healthcare providers struggle with an ever-aging population and increased chronic disease, the sustainability of healthcare systems will hinge on the ability to deliver value for taxpayer money being spent. New models are evolving that reward providers for working in teams, and for improving the quality of care they deliver to the population – examples include the Primary Care Networks in Alberta and Ontario Health Teams. While these efforts are still at an early stage, it’s reasonable to expect that cost pressures and related forces will cause the model to expand rapidly across Canada.

Moving care into the community – Provincial governments are increasing their spending and focus on the huge range and diversity of care offered in the community, including primary care and community clinics, with the aim of reducing the rate of hospital admissions and managing patients effectively in the community.  Expect to see an emphasis on better managing patient transitions in care from hospital to community, and in preventing readmissions, as obvious areas for improvement.

Canada saw progress in 2019. Many of the digital building blocks for healthcare transformation already exist, and now it’s a case of using them in the right way to deliver value for patients and a sustainable health system. The next decade heralds some fundamental changes to our healthcare system. If we are to maintain a sustainable system, it’s critical that we support physicians and empower patients to participate meaningfully in their care.

With another year behind us, and one that saw considerable progress in digital health, I want to wish you all a happy and healthy new year.