Dr. Kathleen Ross could not see the ultrasound that brought a pregnant patient to the hospital because the imaging clinic had already closed that day. But if she had, she never would have sent her home.
When she accessed the patient’s ultrasound the next day, Ross discovered the patient had an abnormality in her uterus that put her and her baby at risk.
“I called the patient back in, and they went on to have a procedure to reduce their risk of preterm delivery. But that could have happened the day before had I had access to that information,” said Ross, a B.C.-based family physician in primary care obstetrics.
The lack of communication between health centres — hospitals, family doctors, specialists and diagnostics — is commonplace in Canada. Digitizing the health-care system so health centres are no longer siloed but instead communicate with one another seamlessly “can save lives,” said Ross, who is also president of the Canadian Medical Association.
This week, Quebec unveiled its 2024-2025 budget, which allocates $902.5 million over five years for accelerating a digital shift in the health-care system. This goal echoes Quebec’s 2022 health reform plan that looks to upgrade information systems and technology in health care, such as phasing out fax machines.
The pandemic was a “wake-up call” for Quebec to prioritize modernizing their health-care system, says Samer Faraj, who holds the Canada Research Chair in Technology, Management & Healthcare at McGill University’s faculty of management.
“This system that relied quite a bit on paper and faxes and walking down the hall type of setups needed to be co-ordinated in a more digital fashion that allowed a faster response to crises,” said Faraj.
A digital system lets patients have better access to their files and health professionals to better co-ordinate patient care, he said.
Currently, each health-care centre has its own database and platform to manage patients’ records, says Dr. Howard Bergman, professor in the departments of family medicine, medicine and oncology at McGill University. The different systems do not interact.
“If I’m seeing a patient in a hospital, even if I had his permission, I can’t see his file,” said Bergman.
Health professionals must call other health professionals and ask for information on a patient’s health records. This can prove difficult. “Try getting somebody — nurses are on the road, and doctors are busy.”
Doctors usually have to rely on a patient’s memory of the treatment they received with other health professionals, said Faraj.
These information silos also happen within hospitals, making it difficult to co-ordinate treatment among departments, said Faraj. “There is seldom a good overview” on whether a department has room for more patients and how other doctors are approaching a patient’s treatment.
‘A single space’
The idea behind a new digitized health-care system is to have a centralized digital platform where every Quebec patient’s information can be accessed, said Faraj.
Upgrading the digital health-care system in this way will require strong security protocols. In 2020, the Jewish General Hospital and health agencies in Montreal’s west end were affected by cyberattacks.
Health-care professionals are still reliant on outdated technologies such as fax machines “because there is not a secure way to transfer digital information in most parts of Canada,” said Ross.
“However, [faxing] is also quite inefficient,” she said. Clinicians must manually type the necessary information into the fax machine for every patient whose file is being shared. Health-care workers deal with many files in a day.
Faraj says “a well designed system should be able to manage the risk in a reasonable way.”
And the advantages of a digitized health-care system are clear. Faraj says patients’ digital files could include more personal details, such as a patient’s genetic predispositions to disease or pollution levels in their neighbourhood. With all health practitioners having access to such information, doctors could provide better advice and identify future health concerns.
The burdens on clinics and their patients who travel from remote regions for health care would also be lessened, says Ross. Patients would no longer have to trek their health files or coordinate with doctor’s offices in different parts of the country to receive care.
‘Pockets of excellence’
There are already “pockets of excellence” across the country where digital health systems are at work, says Ross. Provincial pharmacare plans and systems to track pharmaceuticals are some examples.
Artificial intelligence has also helped decrease administrative burdens in the health-care system, said Ross. Medical AI scribes, which automatically turn audio into text, are used by some practitioners to enable them to better focus on patients during an appointment, rather than typing.
“Tasks which are able to be automated in health care can and should look to incorporate AI to try and reduce the amount of time taken to do data entry,” said Ross.
There is a lot of hype around AI, but it is important to keep the health professionals involved with any digital innovations, said Faraj. Two hospitals in Montreal implemented an AI system to organize surgery schedules, but both rolled back the system after it did not meet workers’ expectations.
The system was not organized with input from people who had been doing the scheduling, and could not easily move appointments after cancellations. Doctors also disliked the AI’s optimized surgery schedule because it did not consider all of a patient’s health information. That data is not readily available on a digital platform, said Faraj.
It is crucial to involve health-care providers with digital innovations, said Faraj. But ultimately a holistic and modern digital upgrade will take time.
“Digitization is not a magic button you push,” said Faraj. It is a “long term, difficult road that you have to take and that involves a lot of management and organizational change.”
