Thoughts From the 2019 Infoway Partnership Conference

Darren Stevens November 28, 2019

At the 2019 Infoway Partnership Conference in Ottawa, the consensus among health care professionals seems to be that there is a strong appetite for moving forward with health technology. 

While there seems to be plenty of agreement that digital health initiatives are the way of the future, exactly how we get there was not clearly stated. As a company, we had an opportunity to present our own examples of how to move forward with new technology systems and our talk was well-received. Rather than focus on what we had to say, I want to highlight some of the other bright points that were shared, as well as some of the challenges that still need to be solved before these desired systems changes can take root. 

I was encouraged by the announcement that happened while we were there — that Ontario is expanding virtual and digital health care, with their new Digital First for Health strategy. The program will provide more virtual care options in the province and they’re investing $3 million to compensate physicians for virtual health care consultations. 

Blockchain and the Future of Health Care

Don Tapscott, Executive Chairman of the Blockchain Research Institute, presented a compelling argument in favour of using blockchain to protect patient data. When fielding questions from the audience, he admitted that it’s an idea that faces issues with scalability and interoperability. While he argues that centralized data poses risks of being hacked in ways that blockchain would not at least one conference-attendee raised a fundamental concern that blockchains are immutable; there is currently no way currently to remove patient data from a blockchain, a regulatory requirement in most jurisdictions necessary for the freedoms of personal privacy. 

Patient Data Has Caught FHIR in the US

In the United States, health authorities have made tremendous progress in the availability of patient data using the FHIR (pronounced like fire) protocol. The most common use of this is in Apple’s Health app, which uses FHIR, where patients can access their medical data alongside the health data collected from the app. As Ryan Howells, Executive Director of the CARIN Alliance pointed out in his presentation, in the US, all health care providers must support FHIR under US Health and Human Services (HHS) mandates proposed in February 2019.

In a private health care model in the US, this change was made possible by making it law that service providers make the data available. Since their clinicians are for-profit, it made the system easier to adopt once the law was in place — the cost was bore by the providers. In Canada, making the sharing of data into law would also mean that the infrastructure required to share that data would have to be funded as well. The costs involved are significant, and with no clear one-size-fits-all format for the sharing of that info, and the hesitance of clinicians to release it, change will still be slow, and the systems likely to be fragmented, unless they take a different approach to accessing it. 

The Circle of Care

Another central theme of the conference was consent models; thinking about how data can be anonymized for app vendors, the ability for patients to decide who is their circle of care and the ability to revoke that authorization if need be. The ideas that were shared were creative and we all seem to have accepted that patient control of data is the future. 

Taking the concept from idea to reality, especially with the current systems, is not without its challenges and complications. 

Solutions for the Way Forward

When it was time for our own presentation, we discussed a theme that seemed to be a crux of the conference; how to integrate these systems. Our talk, “Big Bang vs. Hybrid Integration” seemed to be well received, as we demonstrated how a hybrid integration platform can help to bridge all of these complicated information systems and control the passage of data in a secure way, to only the stakeholders who are authorized to receive it. A 40-minute Q&A period was the proof I needed that our message was resonating. 

My favourite question from the audience was “This is all too beautiful, how can it be true?” We talked about how to tie in privacy models, ensuring that physicians have only access to the data that patients have authorized with their circle of care guidelines. 

A hybrid integration strategy allows everyone to go and chip away at their own areas of interest. Individual health authorities and departments can use the systems they need without having to integrate with another large vendor’s big bang project. 

My Key Takeaways

The most exciting part of the conference for me was to see how private companies like Apple have enabled capabilities across systems with the FHIR protocol. How quickly a law has enabled capability among systems. Given the 1000s of health information systems within Canada, such an uplift would be tremendously risky and expensive for Canada. But there is an evolutionary way forward, to expose those application’s APIs, whatever form they are, and transform them externally into the FHIR protocol. To get the systems they currently have, to support the new protocol and enable the type of connectivity they are seeing the United States. 

Infoway is mandated with a tremendously large task to undertake to unite the country’s health care systems, it seems that some strategies from companies from the private sector, such as some that were presented at the conference, may have some solutions that can help them deliver that vision. 

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