A few weeks ago I attended the BC Health Information Management Professionals Society (BCHIMPS) Annual Fall Educational Symposium, themed “Breaking the Box: Unleashing Innovation Beyond Traditional Models of Care.” It got me thinking about technology and disruption.
In most industries, some amount of technological disruption is taking place, with the needs of users influencing such changes. In health care, however, disruption is not necessarily a desirable outcome. Disruption is what “big bang” health projects produce, and they tend to go badly.
I have noticed however that many of the innovators in health care that are making the boldest strides are the ones that have been deeply involved in the patient experience themselves. The common goal shared by many of the participants and speakers alike is to continue and elevate the standard of care in our health system — not to disrupt it.
Lorie Corcuera, Founder and CEO of SPARK Creations, engaged the audience with some interesting exercises demonstrating our emotional reaction to change, and it’s clear that we have varying levels of comfort with it. Change, even incremental change, is not easy to come by when you’re dealing with health information systems, patient data, and technology. Updating the tools that our health system uses is a sizable endeavor, with stakeholders and decision-makers split across regional, provincial and federal boundaries, complicating change and often slowing the momentum that all parties wish to make.
At the same time, the status quo is not serving the needs of patients or clinicians. Using the same vendors and the same procurement processes only seem to continue to create inefficiencies, contrary to the desired outcomes of saving time for caregivers and improving patient outcomes. Presently over 50% of the province’s budget is spent on health care, up from $17B in 2015-16 to now over $21B. Canada-wide, costs exceed a quarter of a trillion dollars annually.
As the population continues to age, with the number of Canadian Seniors expected to double in the next 20 years, those figures are expected to increase with time. Leaders like Tracee Schmidt, Executive Director, Strategic Partnerships Office, Ministry of Citizens Services are working to transform procurement processes to make this easier. And Adam Jagelewski, Executive Lead, Impact investing, MaRS Discovery District presented interesting concepts in outcomes-based funding models.
There are encouraging innovations taking place right here in BC. I was impressed by the pilot implemented by Margarita Loyola, Director of Virtual Care Transformation for Island Health. Improving health options for patients in remote areas around Port Hardy, Virtual Care creates a bridge between patients and caregivers, providing virtual face-to-face experiences without requiring patients with mobility issues to leave their homes, or those in remote locations to travel to medical centers.
The system monitors patient pulse and respiratory rates, variations in temperature and circulatory flow, and analyzes facial strain and discomfort by regular and thermal cameras, sending data from home health care monitors back to their EMR (electronic medical records) systems, and pushing out information to patients via videoconference and chat. Island Health has made some very interesting strides in this area of remote/virtual health, and we hope to see the expansion of such successful programs.
Architecting a Solution for the Future
This is not an issue that is being ignored. Major “big-bang” projects like the Clinical + Systems Transformation (CST) project have been underway for years, and have begun to go live in greater Vancouver, generally taking health authorities onto the Cerner EMR system. As Ron Quirk, EVP of Digital Innovations Services and Innovation for PHSA pointed out, most of Canada is using either Epic or Cerner. These EMR systems handle roughly 50% of the country’s needs, and the rest is handled by “other systems.” From my work in BC Health Authorities, I know that those “other systems” number in the thousands. It’s inconceivable to replace them all with a single monolithic solution, so the disparity of data and applications can only be expected to continue unless a hybrid integration strategy is employed to unite them.
What’s needed from my perspective is for some technical expertise from outside of the legacy vendors to look at the problem of health information systems holistically. The passage of data to a clinician at the moment of treatment must be simplified. In the current environment, it often takes multiple clicks and logins to as many as four different systems to access a patient’s medical information, a stressful process that adds minutes to care visits already only measured in minutes.
All of this significantly eats into the time caregivers are actually able to spend with each patient and reduces the number of patients they are able to see. And there is evidence and murmurings that the new monolithic solutions in many cases are making this caregiver experience worse. We can only hope that the kinks get worked out over time.
A Massive Undertaking
A fascinating look into the future of the BC health system was presented at the end of the conference by Dr. Douglas Kingsford, CMIO, Provincial Digital Health Initiative, BC Ministry of Health, and Carol Rimmer, Director, Technology and Operations, CPQI, Doctors of BC. The province’s vision has been evolving, and still many parts of the plan are preliminary or in draft form. Existing networks of systems such as the Clinical Data eXchange (CDX) implemented by Interior Health Authority, and CareConnect, implemented by Vancouver Coastal Health are being leveraged as key parts of the solution. Much of the connectivity required by these health networks for true interoperability is still marked as “future” however. This could be a very long way out indeed if we are to wait for upgrades to all of these systems to support FIHR or other interoperability standards, which may have changed again by the time they are implemented, and which certainly will only be implemented by a subset of the existing IT systems in place in the overall Canadian health system.
The solution, as I see it, is to establish an evolutionary plan that allows interoperability with existing applications as they stand, using hybrid integration technology to adapt protocols and convert information sources without requiring risky “big-bang” deployments or expensive vendor modifications across thousands of applications. Without some kind of accounting for the existing tech and an incremental approach to integrating new solutions, any policy that aims to make wholesale changes will come with considerable expense, years of time to implement and will never quite meet the demands of a modernized health system.