So what’s the hold up?
A version of this commentary appeared in the Medical Post, Longwoods and the Moncton Times and Transcript
Eight in ten Canadian adults want online access to their own health information yet fewer than one in 10 currently have it, so says a new study published in Healthcare Papers. The gap is just as wide for other patient online services, such as booking appointments, e-visits, or requesting prescription renewals or refills online; Canadians want them all, but most aren’t getting them.
So, why not, when it seems we can do virtually everything else online these days?
Take something as seemingly simple as e-visits. Email, even secure email, is a well-established technology that is used by millions of people every day. But offering secure e-visits for patients has proven to be complex. For example, where in-person visits are required by fee schedules, law, or professional practice guidelines, adoption is likely to be slower. In settings where e-visits become common, they tend to be recognized as a clinical service, often with dedicated time allocated to them. This means changes to workflow and practice patterns. Likewise, updates may be needed to professional practices, patient education, and privacy policies to ensure that e-visits are safe, effective and used appropriately.
Canada is not without success stories, but they are in pockets, not yet widespread. For example, more than 360,000 British Columbians have signed up to access their lab results online. Thousands of patients at the Sunnybrook Health Sciences Centre in Toronto use the hospital’s MyChart system to access their records. And Nova Scotia’s personal health record demonstration project in Halifax was oversubscribed by both patients and clinicians.
But Canadians want more, and so do providers.
I can testify to some of the benefits of patient online services from personal experience. A few years ago I lived in Denmark where my ophthalmologist prescribed an antibiotic for an eye infection. Unfortunately, it didn’t work. When I called her office for follow up, I learned that she was away so I sent a secure email to my family doctor asking him to suggest an alternative. He replied less than an hour later.
In that time, my doctor looked at my electronic health record, saw what his colleague had prescribed, and e-prescribed a different antibiotic that I could pick up at the local pharmacy. I don’t know how much this changed my long-term health outcome, but the speed and simplicity – plus the fact that I didn’t have to stumble blindly around the city trying to find a new doctor’s office – was priceless.
There is, in fact, a growing consensus on the value of digital health solutions for consumers and we are starting to see some traction. For example, at this summer’s General Council of the Canadian Medical Association, Canada’s doctors voted to support the creation and use of secure electronic communication between patients and health care providers. A number of provinces are also planning online portals for patients. But there is much work ahead.
The Conference Board of Canada drew on survey data to estimate that if Canadians had had the option to consult with their physicians, access test results and request prescriptions renewals electronically, they could have avoided nearly 47 million in-person healthcare visits and saved almost 70 million hours in 2011.
There is evidence that consumer health solutions can strengthen quality of care, patient outcomes, access to services, efficiency and equity. But achieving these benefits is not guaranteed. The right policy and regulatory environment needs to be in place. Implementation approaches need to take into account differences in patients served, care environments, the broader digital health infrastructure and approaches to realize anticipated benefits.
The patient online services most in demand connect individuals with their health care teams. This means that they need to be user-centric, designed with patient safety and privacy in mind, integrated into clinicians’ workflows and workload, and made consistent with regulatory and legal frameworks.
It will take thoughtful, well-aligned efforts to close the gap between desire for and availability of patient online services, making benefits widely available not just for a lucky few served by early adopters. Individuals and organizations will have to hold hands in a collective, collaborative effort, not something at which the health system always excels. But the strong and growing consensus on the importance of harnessing the power of digital solutions to improve health and health care suggests that progress is within reach.
Jennifer Zelmer is an advisor with EvidenceNetwork.ca and Executive Vice President at Canada Health Infoway, a national not-for-profit organization charged with working with partners to accelerate the development, adoption and effective use of digital health across Canada.