Unquestionably, advancements in information technology have a proven significant positive impact on how care is delivered and how information is shared for Canadians. Given the scale and complexity of our healthcare systems, adoption of new technology is often quite slow compared to other industries.
With all the buzz around new technologies like AI and blockchain – while certainly deserved for their potential impact – are we too focused on the “next big thing” while neglecting necessary improvements that could be made immediately to optimize the value we derive from our existing healthcare IT?
Many of the important health system problems that exist – such as long wait times and poor care coordination – are at least partially a result of information gaps between care providers. As a clinician, it’s hard to take effective action for a patient if you only have part of the information you need.
To solve a problem, you have to understand it. The most important person in the health system is the patient and we wanted to understand these issues from the patient’s perspective. That is why we conducted a survey – the Orion Health Chronic Care Index – of over 1,500 Canadians. We were particularly interested in Canadians with chronic conditions because they interact with the healthcare system most frequently and often with several care providers. Here is a breakdown of respondents and their chronic conditions:
- Arthritis: 15%
- Diabetes: 9%
- Mental illness/addiction: 8%
- Heart (Cardiovascular) Disease 5%
- Chronic Respiratory Disease 4%
- Osteoporosis 4%
- Neurological conditions 2%
- Cancer 2%
- Other 7%
We sought to understand their experiences with and perceptions of the healthcare system, especially as it relates to care coordination, care transition, and the role of technology. Here is a summary of the standout findings and my interpretation of them:
- One-in-five Canadians with chronic conditions have experienced medication errors or duplications. Medication errors put patients unnecessarily in harm’s way. They are preventable and given the risks associated with taking the wrong medication, there is no room for error. With shared electronic health records that include complete information about a patient’s medications, often called the “best possible medication history” practitioners have access to the information they need to significantly reduce the chance of a medication error.
- Nearly half of Canadians with chronic conditions (47%) have had to repeatedly describe their condition, symptoms and medications every time they visited a care provider. Anecdotally, we’ve heard from patients that they had to answer the same question so many times they thought they must be giving the wrong answer!
Inefficiency and redundancy aside, patients with chronic conditions often have a long history of encounters with providers, of problems, medications and labs. As an entirely understandable result, they are more likely to accidentally omit important medical information or report it incorrectly. Accurate, complete information is key to decision-making, especially in health.
- Sixteen per cent of Canadians report they have undergone unnecessary repeat procedures. I expect many of these would fall under medical imaging procedures, such as MRIs or CT scans, and hopefully not repeat surgeries. Regardless, repetitive procedures are unnecessary, frequently expensive and not only clog the system, but ultimately do nothing to improve the patient’s health.
- While nearly all respondents (92%) believe they need to play a part in managing their own condition, a quarter (27%) believe they do not have the appropriate tools to do so. There is now a strong movement for patients to have access to their individual medical record, and the ability to contribute their own information in the firm belief that this would positively impact care. A commonly recommended mechanism would be via a patient portal plus the ability to upload data from patient’s devices, or answer questionnaires and email the provider. Clearly, there is still a gap in terms of where patients would like to have access and lack the tools.
- Those with lower income, (defined at <$40k annually) were significantly more likely to report at least one chronic illness (51%) vs those with incomes $80K+ (34%). This, along with several other data points, supports and confirms the idea that social determinants significantly influence the health of populations and we need to find creative ways to help such patients. Again, being actively involved is important and any technologies we choose to offer need to be inexpensive and preferably commodity items
What this means
The Index confirmed that patients see significant room for improvement in their chronic disease care especially when it comes to information-sharing. Redundancies and inefficiencies are a shortfall of the system as a whole, and do not reflect the work of individual practitioners. Every misdiagnosis, redundant procedure and unnecessary question adds to wait times and reduced quality while also adding to total costs of care.
Now to circle back to my main point – solutions for these problems exist and yet they are not used widely or to their full potential. For example, longitudinal electronic health records provide a complete and up-to-date patient profile for care providers to better understand a patient’s history and condition. The information needs to be acquired, aggregated and made accessible, otherwise it cannot be used to better treat the patient.
Accessible information is key to care coordination. With practitioners working in their own offices, hospitals, the community and other specialized facilities, it is important to have a means of sharing information seamlessly so practitioners can diagnose and treat their patients – with up-to-date and accurate information. Complicating matters is the fact that countrywide, our healthcare system is a patchwork with each province running its own system.
At Orion Health, our approach is different because we don’t use healthcare budgets for costly rip-and-replace solutions. We leverage existing technologies and allow disparate health systems to communicate with one another, giving practitioners access to complete patient records.
The problems I have discussed exist at the intersection of communication and technology, when patients are being treated by multiple practitioners or being transitioned from a hospital, for example, back into the community. The findings show that a sizable portion of Canadians with chronic conditions believe that care providers need a better means to share information.
For disparate healthcare systems to realize their full value, integration of information across the medical and care community is necessary.
Dr. Chris Hobson is a Family Physician with 15 years of experience and is the Chief Medical Officer at Orion Health, a global leader in population health management and healthcare integration solutions.