(This article has been translated into French.)
Compared with other OECD countries that have universal health care systems, Canada ranks among the lowest for health system performance, although it spends more on health care delivery than many OECD countries. One can envision, if it were set up anew today, that a publicly funded Canadian health system would be enabled by human-centred digital tools. And, in fact, Canadians are eager to adopt digital health solutions that could dramatically improve the system. Such tools would validate two of the pillars of the Canada Health Act: accessibility and portability. In this piece, we highlight the reasons why digital health care technology is needed, and we present several ways we can make better use of our health care data. By improving the accessibility and national portability of health care services we can make our system more patient-centric.
If we look to other geographies and their approaches to the challenges facing health care, we see that digital health solutions are high on the agenda. The European Health Parliament’s Committee on Robotics, AI and Precision Medicine is promoting the development of these technologies under three main themes: availability, affordability and accessibility. Medicaid in the US is specifically looking to digital technology to address rural populations. Mercy Virtual, a US hospital with no beds, serves a population of 750,000 by leveraging technology.
To realize a consumer-driven health care system that truly enables equal access and portability for all Canadians, some pivots will be required. The federal, provincial and territorial governments would need to tackle the current fee structures to fairly compensate physicians for remote and virtual services. But first, the federal government should lead development of a national strategy for the adoption of health care innovations, and a policy framework for the adoption of digital health care solutions. Without such interventions at the federal level, the consumer experience will continue to change very slowly.
Income is a determinant of health, and over the past 20 years in Canada, as income inequality has increased, so has health care inequality. Unequal experience of health care is also affected by population density: While 19 percent of Canadians live in rural areas, only 8 percent of physicians practice in those areas. Furthermore, we have accepted unequal health care outcomes, particularly in areas with lower population density. A recent study found that the mortality rates following strokes were higher than those in than urban academic hospitals and higher than the Canadian average.
The way people experience health care in Canada is inconsistent, especially with regard to access to online appointments, test results and virtual consultations. Because of privacy concerns, management of health care data is specific to the provider. As a result, the data is kept in disparate places, so frequently the data must be re-entered. As well, in the absence of portals and online access, citizens and families are managing their own health information, often turning to the Internet. Furthermore, the system lacks accountability, because it does not consider consumers’ experience of data access management as an important criterion and therefore does not evaluate it.
More consumers are using self-service digital health tools and driving a form of disruption to the system. Websites continue to be the most commonly used technology. A 2018 study of seven countries (not including Canada) found that use of the Internet of Health Care Things solutions like smart scales and wearables, and use of social platforms such as online communities has increased, nearly doubling since 2016. Most consumers are willing to share data from wearable health devices with their doctors and nurses (90 percent) or with other health care professionals (88 percent). Compared with 2016, more are now willing to share wearables data with online communities or other app users (up from 38 percent in 2016 to 47 percent in 2018). And 38 percent of the people surveyed have accessed their electronic health records.
In Canada, according to a 2017 survey, almost 9 out of 10 health care professionals agree that accessible, secure information-sharing between individuals and health care professionals would have a positive impact on patients’ health outcomes. But physicians are not consistently compensated for signing patients onto on-line portals (where they are available), for virtual visits or for virtual-care provision.
A number of key factors will have to be addressed at national, provincial and territorial health tables to create an environment where the current model can incorporate digital health tools. There are structural biases in the system, such as fee structures for physicians that favour providers over patients. This can result in negative patient experiences like long waiting times, telephone tag with the provider, anxiety over unknown results, or process updates not well communicated. While the journey toward a fully patient- and family-centric approach to health care will be long, there are measures that governments could initiate to accelerate the process.
First, governments must adjust the fees paid to physicians so that they are compensated adequately and fairly for the preparation and execution of visits with patients and family members that are conducted through virtual consultations, tele-visits, e-consults and online chats. While some provinces, such as British Columbia and Alberta, have implemented pilots or revised fee structures, there is no consistent, pan-Canadian strategy. In provinces where physician billing structures have been modified to allow for virtual consultations, interprovincial licensing and regulations might prohibit physicians from being able to employ these modifications across provincial borders. In order to accommodate their patients’ demands for better ways of communicating with them, health care providers may then resort to digital communication (text messaging, photos and emails) in an unsecure environment.
Second, the federal government should develop a national strategy on the adoption of health care innovations. In the business sector, governments are currently encouraging and supporting an entrepreneurial culture by establishing incubators and accelerators. By building on this as part of a nationally designed vision for the future of health care, governments could encourage novel solutions for the health care field. When seeking to improve consumers’ health care experience, the strategy should focus on the patient, caregiver and family, rather than on the system and institutions. To this end, a thorough study of patients’ experience would reveal a wealth of opportunities for realizing efficiencies through digital health applications.
Third, the federal and provincial governments should collaboratively design a policy framework for the effective adoption of secure digital health solutions. It is time to enable new technologies to provide secure data oversight, such as cloud solutions and blockchain. This could pave the way for shared policies and standards that will allow us to take full advantage of the significant data generated by our single-payer health care system.
Cloud solutions can enable communication infrastructure that is critical to advancing this agenda. Past concerns about privacy and security related to hosting data in cloud servers outside of Canada have largely been resolved by cloud providers building infrastructure here to house the data. Innovations such as value-based care (where health care providers are paid based on patient outcomes), population health management (the proactive management of health of a defined population), and digital or mobile-user demand would require more storage infrastructure, which only the cloud can provide efficiently and affordably.
Observing how digital tools have impacted sectors ranging from financial services to education, it is likely that health care will not be immune to these disruptive technologies. Canadians are forging toward a new way of using digital tools and devices for personal health care purposes, leveraging mobile apps, websites and wearables to harness personal health data wherever it is available. They are already driving a consumer-centred approach to health care information management.
Canadians are proud of their publicly funded system. With national cohesion and leadership, we can better ensure a digital future and improve adherence to the goals of portability and accessibility of health care. National policy-makers have an obligation to ensure that the transition toward this end is consistent and fair for all.
This article is adapted from Canada Next: 12 Ways to Get Ahead of Disruption, a Public Policy Forum report consisting of 12 papers on disruptive challenges and opportunities facing Canada.
This article is part of the Nimble Policy-Making for a Canada in Flux special feature.
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