The digital health revolution

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CoverCanadian hospitals are amongst the most crowded in the developed world.

In fact, among member countries, the Organisation for Economic Cooperation and Development reports that at 93 per cent, hospital occupancy rates in Canada in 2009, the latest year for which data is available, are second only to Israel, whose occupancy rates are 96.3 per cent.

And yet health care leaders in Canada, such as Dr. Chris Simpson, President of the Canadian Medical Association (CMA), maintain that adding more beds to the system is not what is needed to bring down hospital occupancy rates.

In his inaugural speech as incoming CMA President, Dr. Simpson provided, in my opinion, one of the most rational and humane reasons why when he stated:

“We put people to bed instead of putting them in a care environment that lifts them up and restores them and helps them live a dignified life.” 

Bottom line:  We need to figure out how to get people out of hospital beds and into more appropriate care settings in the community.

To this end, I believe Canada is on the cusp of a second wave of health care efficiencies, fueled by digital health innovation.

Remote patient care (RPC) serves as a shining example of how to move patients from hospital to community safely and effectively, all the while fostering health system efficiencies.  It enables patients to remain under observation from home, rather than from a hospital bed, thanks to devices installed in their homes that enable clinicians to monitor their progress remotely.

A new Ernst and Young study commissioned by Canada Health Infoway, Connecting Patients with Providers: A Pan-Canadian Study on Remote Patient Monitoring, explores the current state of RPC as well as emerging solutions and critical success factors for deployment on a larger scale.

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The study identified approximately 5,000 Canadians enrolled in 19 Remote Patient Care programs across seven provinces and territories and found that RPM:

  • Improves patient satisfaction
  • Boosts patient compliance
  • Reduces condition deterioration
  • Improves quality of life of patients
  • Decreases burden on friends and family who serve as caregivers
  • Reduces Emergency Department visits and hospitalization
  • Reduces costs to the health care system

Remote Patient Care ties in nicely with digital health advances that have already proven their value in Canada.

While much work remains, the government of Canada’s $2.1 billion investments in digital health over the past decade have more than paid for themselves.

For instance, telehealth, drug information systems, diagnostic imaging systems and physician Electronic Medical Records (EMR) have produced an estimated $10.5 billion in benefits between 2007 and 2013 alone.

As of June 30, 2014, 99 per cent of Canadians have at least one hospital clinical report or immunization record available in electronic form in a repository, for access by their authorized clinicians.

More than 17,000 community physicians have access to EMRs.  There are also EMRs in ambulatory care settings providing more than 20,000 clinicians, many in hospitals, with access to the patient information they need.

And yet, we have only scratched the surface.

Fortunately, Canadians have demonstrated an eagerness to leverage digital health to become more active participants in their care.

A Harris/Decima survey commissioned by Canada Health Infoway reveals 89 per cent of Canadians feel it is important that they personally have full advantage of digital health tools and capabilities.

And yet, only six per cent to 10 per cent of Canadians can access them.

This needs to change.

Investments in technology made by the private sector have transformed the customer experience and resulted in empowered customers who are all too happy to run their errands from their computers and smart devices.

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Such investments result in happier customers by making day to day transactions much more convenient.  It also helps enhance business efficiencies, which positively impact the bottom line.

Accordingly, I believe that providing digital health tools for Canadians will go a long way towards helping patients be more informed about their own health, better equipped to manage chronic illnesses, and better prepared to receive care at home or in the community.

As we have observed with other digital health investments, time will ultimately tell where the bulk of the benefits and efficiencies will emerge once Canadians are equipped with digital health tools.  But I believe a reduction in hospital crowding, will be among the most welcome.

DIGITAL HEALTH: A PATIENT’S PERSPECTIVE

I want to say digital health saved me but it didn’t. It did, however, go a long way to restoring my physical and mental wellbeing.

For 15 years I suffered debilitating arthritis, my world so narrowed that a trip from living room to bathroom was a painful experience.  As my world grew smaller my depression deepened. I ate too much; drank more than was good for me.

In mid-2011, I had my first of two knee replacements. Six months later I underwent the second. It was the latter that went horribly wrong. I got a stubborn post-operative infection that took nine operations, six months in hospital and a further two with home care to get over — including a month on crutches, with a concrete spacer in the joint cavity.

Early in the spring of 2013, while I was still on my way to recovery, my doctor invited me to take part in a digital health records pilot project in Nova Scotia. I even consented to be filmed for a government video.

At first I used the new system tentatively, to book online appointments with my doctor, a welcome relief after the usual practice of hanging on a phone line, waiting to leave a message. Now I can indicate the times when I’m available!

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Soon I was entering my family history and tracking my medications, blood pressure and efforts to lose weight. Then my doctor began sending my test results electronically, with a note to indicate all was well, a change in diet was in order, or a visit to her office was recommended.

I embraced this new technology. I bank online. I shop online. I files taxes and even pay parking tickets online. Why not converse with my health care providers through a safe, secure website from the comfort of my armchair?

Gradually I noticed a change in my attitude towards my health. I started online tracking of my nutrition and, for the first time since being a chubby child, I became more concerned with eating healthful foods than following fad diets. I got into the habit of recording my daily exercise and soon found I disliked a day when I had nothing to input. (And, may I add, I’m well aware, as I now wear digital watch and arm bracelet to track my diet and exercise that I’m looking for a pat on the back for a job well done from a computer app!)

As my health improved, so did my determination to face my senior years equipped with knowledge about my health needs. Today I prepare for medical appointments, armed with questions, whether I’m visiting my G.P., a heart specialist (family history) or dermatologist.

Digital health records may never cure cancer, heart disease, diabetes, dementia or any of the other hazards facing the elderly. But an informed senior is better able to handle medical issues and so become a partner with his/her health care providers. As a baby boomer living in a province with an aging population, I believe knowledgeable patients will be less of a burden on the health system.

Today I swim, lift weights, and just signed up for scuba diving lessons. Crazy? Probably! This is the North Atlantic, not the Caribbean. But my G.P. concurs.

Digital health records aren’t going away. It’s the future of healthcare in this country. And I for one love it. As I visit family in Ontario or British Columbia, I know that if I become ill or have an accident my health records are a mere mouse click away.

Alexa’s a freelance writer and editor with an interest in patient-centred healthcare.

REMOTE PATIENT CARE

Remote Patient Care programs allow for the electronic transmission of patient data (e.g., symptoms, vital signs) from a patient’s home to a health care provider for monitoring and support over a specified time period.

In October 2013, Canada Health Infoway commissioned Ernst & Young LLP (EY) to conduct a pan-Canadian study, Connecting Patient with Providers: A Pan-Canadian Study on Remote Patient Monitoring (RPM), which showed that RPM programs in Canada are progressing from pilots to established solutions.

  • The study found evidence that RPM reduces emergency department visits and in-patient hospitalizations and bed days, and increases patient satisfaction and quality of life
  • Larger scale programs have demonstrated considerable economic, system-level benefits through decreased utilization of health system resources
  • Nearly 5,000 Canadians are enrolled in formal RPM programs and pilots
  • Canadian RPM programs have been growing at a rate of 15 to 20 per cent annually since 2010
  • One per cent of Canadians in 2014 used medical devices that captured and transmitted data electronically to their health care providers for chronic disease or post-surgical discharge monitoring – representing significant opportunity for growth
  • Four Critical Success Factors were identified to support the appropriate design, implementation and uptake of RPM programs in Canada: engagement and collaboration, patient recruitment and retention, benefits measurement, and integrated care and care-coordination
  • The study suggests that even greater benefits may be realized, for both the patient and the health care system, through larger scale implementation