Digitizing Canadian Healthcare

As COVID-19 has swept across the country, it’s also left behind a trail of shuttered businesses and mounting job losses. To say that this pandemic has adversely impacted our economy would be putting it mildly. However, the one silver lining amongst all of this is that our healthcare system is now, once again, under the spotlight. 

The last several months have done a good job of showing us the cracks in our systems — from a lack of hospital capacity to insufficient supplies of PPE. For a system that has already been suffering from increasing wait times, while also supporting a rapidly aging population, this pandemic is something of a wake up call. 

Even as we’ve rushed to put out the immediate fire, we are already starting to look ahead and ask important questions about the future of our healthcare system. Understandably, there is a ton of emphasis on not just making the system more efficient, but also on making it robust enough to handle the next pandemic. And this is precisely where Canada’s health tech startups could play a vital role.

Historically, our system has endured a lot of bureaucracy and hasn’t taken as much advantage of technological advances as some of our other peers. Even from my own personal experiences, there is still a wariness among Canadians in the uptake of technology when it comes to health data. But this is perhaps exactly why there is a lot of room for impact in this space.

While other sectors such as retail, finance and even education are making tremendous strides by leveraging more technology, healthcare still lags. In the health space specifically, discussions usually centre around the impact Big Data and Artificial Intelligence. 

And while there is a lot of opportunity to be unlocked through Big Data and Artificial Intelligence, these are not the only ways we can make our system more effective. Even discarding these major sectors, there is still a ton of interesting work being done in this space. Here are just a few of the areas where better technology adoption can make a difference. 

1. Virtual Care

This is perhaps the most obvious sector impacted by the pandemic, and also the easiest to wrap one’s head around. Up until now our healthcare system has been extremely resistant to the adoption of virtual and telemedicine solutions. According to a 2015 Canadian tele-health report, about 0.5% of all billable services provided in Canada are virtual, compared to almost 14% in England. 

Part of the reason is cultural of course. There is a general skepticism towards the effectiveness of virtual consultations and examinations — even amongst tech savvy millennials like myself. There is just a certain level of reassurance that comes with an in person visit to the doctor’s office that is harder to replicate virtually. 

But there are also systemic factors that play into this. For one, we’ve so far lacked payment models that allow patients to consult with their physicians remotely — most making it an absolute requirement that the services be rendered in person. And in places where this is possible, the set of services covered is fairly limited and/or the physician must agree to render their services for a much lower fee than an in person consultation.

Interestingly, the private health sector seems to be doing a much better job at moving services online. Employer sponsored insurance plans, for example, offer a wide range of virtual health services. Cognitive behavioural therapy is an excellent example of one such service, with a ton of companies offering the benefits of talk therapy from the comfort of their homes. 

The uptake for these services has also been positive, indicating that there is a willingness among patients to try virtual solutions if given the opportunity. 

For example, while 41% of Canadians said in a survey that they are open to video consultations with their doctor, only 4% of the providers responded that they have the technical capabilities of doing so. This clearly puts the onus on health providers instead of patients.

The bright side to all of this is that COVID-19 has already ushered change across the country, in new funding, liberalization of regulations and shifting attitudes. With quarantine in full swing, virtual access to healthcare providers has turned into a necessity rather than a luxury, forcing providers and governments to adopt to the changing reality almost overnight. 

2. Health Literacy and Self Management

Related to the idea of virtual care is that of health literacy and self management. Patients are increasingly able to get access to sophisticated health devices — or even rely on their smartphones — to monitor their health from the comfort of their homes — or in some cases. Patients are able to conduct many routine tasks such as monitor their blood pressure, sugar levels, or even their EKG without having to visit their doctors in person.

This allows us to find out when something’s wrong much faster, and also allows us to play a more active role in managing our own health. As smartphones become more powerful, and technological advancements bring down the price of electronics even further, we will no doubt be able to offer patients with even better accessories to put them in control of their health and perhaps even automate basic diagnostic services, alleviating some of the pressure on our system. 

In order to see how this could work, you need only take a look at the massive rise in wearable fitness trackers over the last few years. We are already starting to see the effects of giving people more control over their health.

But again, this relies on a certain level of technological familiarity and trust in the system. If we are empowering people to take control of their own health, and health data, we want to make absolutely certain that the tools we are giving them are reliable, accurate, and most of all, secure. 

3. Interoperability and Administrative Costs

The healthcare system is not one single monolithic organization. It is comprised of hospitals, clinics, general practitioners, specialists, walk in clinics, long term care homes and many more entities that all work together. And at the centre of it all is you, the patient. 

As patients navigate the system, their health data should ideally follow them seamlessly between providers. However, in a 2018 survey, only 16% of physicians surveyed said that they could electronically share patient summaries with physicians outside their own practice. 

Obviously this is important from an efficiency standpoint. But in a lot cases, ensuring proper exchange of information among health care providers has a direct impact on the overall health of the patient. 

We also has inefficiencies at the administrative level. Even today, a majority of healthcare providers lack basic services such as the ability to book an appointment electronically. Up until recently, majority of the physicians lacked the ability to electronically transmit prescription data to pharmacies, relying instead on handwritten notes and faxes (though it should be pointed out that thanks to large investments in the Canada Health Infoway, this is now changing).

Part of the reason for this gap is that our information technology systems aren’t up to snuff. Over the last ten years we’ve done much better in moving away from paper, but we continue to have problems with the integration of our digital systems. Just because the hospital and the family doctor’s office both use computers doesn’t mean that those computers talk to each other. — Dr. Danielle Martin, Better Now

On the positive side, we have done an excellent job when it comes to the adoption of EHRs. While there is still work to be done, we have been gradually improving the adoption of EHRs across the country. 

But it would be amiss to talk about all these technological advances without addressing the major concern underpinning the discussion — the privacy and security implications. There are understandable concerns with making our personal health data available to any entity, be it the government or private companies, and these concerns should not be taken lightly. There are important conversations to be had not just at the technical level, but also a deeper philosophical question about how this sensitive data must be handled.