There is a common thread that brings together doctors, nurses, dietitians, health informatics experts, and other health care team members in our health care system. At the heart of the great work that health care professionals do is the need to have an interconnected, high quality health care system to serve the needs of patients, families, and caregivers. One element of an integrated health care system is the ability for stakeholders such as primary care providers, specialists, public health experts, and patients to provide input in the development of digital health technologies that promote shared decision making between patients and providers. The BC Ministry of Health and several private health technology companies in BC have made great strides in inventing new digital health technologies to support professionals and patients.[1-3]
Key players in the digital health space should consider how their aptitudes, attributes, and interests could allow for public-private partnerships to advance integrated team-centred care in BC.
The Institute of Medicine defines a learning health system as one in which “science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience.” As health technology and digital platforms develop, the ability to connect the right people and put the patient first along their journey from their primary care provider, hospitals, specialists, emergency medicine, acute care, and community care settings is the first step to a high quality, integrated, learning health system. An element that is missing in these innovative, entrepreneurial health technology designs is the need to embed shared decision making between key people in our health care system, which includes patients, primary care providers, policymakers, researchers, and the entire care team. A recent survey identified that Canadians experience low levels of health-related shared decision making. Thus, effective digital health technologies have the potential to foster enhanced collaboration between health professionals and patients.
Health systems integration or interconnectedness is a key element of high-quality learning health systems. The aptitudes and attributes of our health care professionals in adapting to changes proposed by Big Data and patient-facing digital health technologies will cause a paradigm shift to create a connected to learning health care system. Providers can also appreciate that such digital health solutions can bridge the knowledge gap between patients and providers. Patient reported experiences (PREMs) and patient reported outcome measures (PROMs) are common indicators reported by the Canadian Institute of Health Information. If physicians had access to real-time PREMs and PROMs, then this could significantly enhance their clinical practice. Digital health technologies, including electronic health records (EHR) and electronic medical records, provide a solution for connecting doctors virtually to support the modern delivery of health care to rural and remote parts of BC. Technology is only a tool to help connect to the right people on the care team. Professionals on the front line are the true strength of BC’s health care system. From a human resource planning perspective, a single health care platform to plan their clinical workflow, share records, monitor diagnostic laboratory results, and allow for physician billing is valuable for, first and foremost, the patient, then professionals and policymakers. Initiatives such as Connect Ontario is a web-based digital health platform that provides information such as a patient’s medical and physical history, dispensed medications, laboratory results, and hospital visits.
For an international example, Germany decided to approach the issue of EHRs by passing a federal health policy. In 2018, the German Federal Minister of Health Jens Spahn passed a law that required there to be only EHR called “Terminiservice-und Versongungsgestez.” This translates into English as a single EHR across the country, built for the people by the people, regardless of what state they live in and governed by the Appointment Service and Care Act. This aligns with the portability principle of the Canada Health Act; it ensures that when patients move across provinces in Canada physicians can easily transfer records. German physicians regularly share insights across German states. Canada can learn from Germany’s experiment. Designing digital health technologies at the national level will require clinical leadership from all Canadian provinces, with doctors, provincial policymakers, respective patient partners, digital health informatics experts, and health services researchers, to be at the decision-making and health technology implementation table. How can we do things differently in Canada to ensure that our health care system is patient-centred? What would be best for our patients and doctors? We are optimistic about a future in which Canadian physicians can apply integrated health technologies to work with their patients to create a high-quality, learning, and patient-centred health care system.
—Vidhi Thakkar, PhD
—Claudia Lai, PhD
—Karen Davison, PhD, RD, CHES
1. BC Health Information Management Professionals Society. Province of BC digital health strategy (draft). Accessed 10 December 2019. www.bchimps.org/resources/Documents/2019%20Spring%20Conference/HLTH%20AD....
2. Input Health. Connect with your patients. Accessed 10 December 2019. https://inputhealth.com.
3. Telus Health. Leveraging technology for better health outcomes. Accessed 10 December 2019. www.telus.com/en/health.
4. Friedman CP, Wong AK, Blumenthal D. Achieving a nationwide learning health system. Sci Transl Med 2010;2:57cm29.
5. Haesebaert J, Adekpedjou R, Croteau J, et al. Shared decision-making experienced by Canadians facing health care decisions: A web-based survey. CMAJ Open 2019;7:E210-E216.
6. Institute of Medicine of the National Academies. The learning health system and its innovation collaboratives. Accessed 10 December 2019. www.nationalacademies.org/hmd/Activities/Quality/~/media/Files/Activity%....
7. Canadian Institute for Health Information. Patient-centred measurement and reporting in Canada. Accessed 10 December 2019. https://www.cihi.ca/sites/default/files/document/visioning-day-paper-en-....
8. European Society of Cardiology. About digital health. Accessed 10 December 2019. www.escardio.org/Education/Digital-Health-and-Cardiology/about-digital-h....
9. E-Health Ontario. Connecting Ontario clinical viewer. Accessed 10 December 2019. www.ehealthontario.on.ca/en/for-healthcare-professionals/connectingontario.
10. Medica Magazine. Electronic health record: Transparent patient? Accessed 10 December 2019. www.medica-tradefair.com/en/News/Topic_of_the_Month/Older_Topics_of_the_....
This post has not been peer reviewed by the BCMJ Editorial Board.
Vidhi Thakkar completed her PhD from the Institute of Health Policy Management and Evaluation, University of Toronto. She has worked in the health system with provincial ministries of health, hospitals, universities, and Cancer Care Ontario. Vidhi currently teaches Health Informatics Data Analysis at McMaster University.
Claudia Lai completed her PhD from the Institute of Health Policy Management and Evaluation, University of Toronto. She is a health services researcher with experience in public and academic environments. Prior to moving to research, she worked as a senior pharmacist at the Ontario Ministry of Health and Long-Term Care, and as a drug information specialist at the Ontario College of Pharmacists and Ontario Pharmacists’ Association.
Karen Davison, PhD, RD, CHES, is a faculty member in the health science program at Kwantlen Polytechnic University, and a research fellow of the North American Primary Care Research Group. She is an associate editor for BMC Public Health and an academic editor for PLoS One. Karen is a co-principal of a health consulting company that provides health education, research, and counseling services.