Don't opt out: click here to learn more about our work.

Bridging the technological divide in Canadian health care

Electronic Medical Records and patient care

Bridging the technological divide in Canadian health care

In Canada, a battle rages in health care. On one side stands a relatively stagnant health care system, already expensive but comparatively effective, with a legacy of poor technology integration. On the other side, investment in technology has the potential to not only reduce costs but also produce better patient care.  

Initially, further tech-focused investment would make health care even more expensive for the government. In Ontario alone, health care spending equates to 43.2 per cent of all provincial expenditures. Across Canada, health care amounts to about 11 per cent of gross domestic product (GDP), or $4,919 per year per person, as of this year. As a percentage of our GDP, we have the fourth most expensive social health care system of 28 comparatively wealthy countries, falling short of only Switzerland, France, and Norway. However, our above-average spending nets above-average results.

Compared to other wealthy nations, Canadians experience an above-average quality and quantity of health care. Canada consistently ranks highly on the majority indices that measure efficacy, despite having fewer physicians, long wait-times, and less equipment. Canada is ranked first at preventing and reversing debilitating illness, and also boasts above average cancer survivorship rates, above average healthy-age expectancies at 73.2 years, and above-average life expectancies at 81.9 years. These accomplishments have been achieved with our existing low-tech system. For example, we are without a consistent system and centralized database for recording personal medical information or automatically communicating medical files, at times even at the same hospital.

The adoption of Electronic Medical Records

To learn more about Canada’s relationship to health care technology, I investigated Canada’s partial adoption of Electronic Medical Records (EMRs). I spoke with Dr. Muhammad Mamdani, Director of the Li Ka Shing Centre for Healthcare Analytics Research and Training at St. Michael’s Hospital in Toronto; corresponded with Christina Christodoulakis, a PhD candidate in computer science at the University of Toronto; and interviewed Davey Hamada, a registered nurse in British Columbia.

According to Mamdani, “there seems to be a general consensus that the adoption of tech [into health care] is a good thing.” Christodoulakis’ U of T-based research reflects this: she found that in Canada, about seven per cent of tests are ordered because practitioners are unaware of already relevant results. A central database of EMRs that is used and updated consistently would solve this problem. The benefits of EMRs include improved speed of finding records, prevention of handwriting illegibility, aid in the early identification of diseases, assistance in targeting services based on risk, help with long-term monitoring of patients, and improved immunization consistency.

Hospitals and smaller family practices have been slowly and irregularly integrating EMRs for the past 30 years. Most of these earlier databases were designed by software engineers with little input from medical professionals. This meant that their software was not functional for practitioners — sometimes queries were too rigid or irrelevant information was readily displayed while critical information was hard to find. According to Christodoulakis, “some physicians reported that they sometimes stop using EMRs because hunting for menus and buttons disrupts the clinical encounter and hinders doctor-patient interaction.”

At present, software packages from different manufacturers seldom work together. Mamdani explained that “often patient records have to be printed out and delivered by mail.” This slows down the treatment process and further clogs the system. This lack of electronic communication also exists within institutions, where medical professionals print records for hand delivery. The poor integration of software and communication often opens the door for third-party organizations to perform patchwork to mend discontinuous records together, as is the case with Alberta Netcare and ConnectingOntario. But it is important to note that privatizing health care record management can carry serious consequences for patients and the health care system as a whole.

Though records are currently scattered among hard copies and various software, it is possible to unite the system. As Christodoulakis’ research notes, adopting or changing EMR systems requires “training, maintenance, IT support, system upgrade and data storage, governance and migration costs,” often too expensive a barrier for small and medium-sized institutions. Based on an estimate from 2010, the financial cost equates to $10 billion. But integration of an efficient database of medical records is just the tip of the iceberg.

Addressing the divide

According to Hamada, “health care providers have been in many ways slow to adapt to the technological boom.” He explained, “This is in part due to our education, which is lacking in any content regarding technological innovation and also the lack of foresight in the institutions that we work for.” Hamada’s workplace has not adopted EMRs, seldom uses software beyond email, and the state-of-the-art equipment he uses runs on an operating system that has not been supported since 2014.

For Hamada, adapting to changing tech is easy. But at his workplace, a recent change in the process of ordering porter services, or facility managers, continues to confuse many despite having support hotlines available throughout their upgrade. Mamdani and Christodoulakis both confirmed that some health care professionals are resistant to the technology making its debut in the health care system.

This is in part because people dislike change and re-learning concepts, but also due to a lack of transparency in data use. Hamada reports that at his workplace, data is collected but its use is a mystery. “In order for nurses to see data as a positive thing, there needs to be greater transparency and involvement around changes made based on evidence,” he said.

Mamdani, a renowned leader in health care, has emphasized facilitating communication between disciplines throughout his career. He integrates tech, economics, and data science into his team, and advocates for strong leaders to continue to bridge the technological gap. He believes that this systemic divide will continue to exist until teams learn to find a common language and talk to each other.

Mamdani’s team includes a few data scientists who work closely with health care professionals to build a data-friendly culture. Their research has been able to predict, with 80 per cent accuracy, the length of patient stays. Data science facilitates communication with the whole team and allows a more unified progression for the patient’s care. His team has also been able to predict trends in staffing, which saves approximately $200 million for St. Michael’s Hospital and could save up to $800 million for others.

Technological change, along with all of its benefits, comes with a very real cost. In Hamada’s workplace, the technology remains in the shadows because qualified health care professionals excel at what they are best at — taking care of people. The numbers show that Canadian health care is effective, even without consistent EMRs or databases that communicate. The cost of tech disturbs that status quo. But a centralized database would likely reduce redundancies in health care and improve efficiency. Advanced analytics has the strong potential to push our health care system to better look after us, especially as our population ages.

Improving outcomes and better integrating the health care system into the digital world is an important pursuit — but it must be checked with an emphasis on people and care over all else. In an ideal application, technology would and should improve our ability to take care of one another.

The Varsity has reached out to Campus Health Services, which declined the interview request, as well as the Gerstein Crisis Centre.

UC Follies’ B-Side rocks the Stage at Hart House this November

The show’s creator discusses making a show about records in the digital age

UC Follies’ <i>B-Side</i> rocks the Stage at Hart House this November

From November 30 to December 1, the UC Follies will be at Hart House for a two-night performance of B-Side: A Rock Cabaret. The show is a grand musical experience that will take you back in time with classic rock records you love and lesser-known songs for you to discover and fall in love with.

The Varsity wrote to Jocelyn Kraynyk, the show’s creator, about her inspiration for the show, nostalgia for rock music, and listening to records in the world of online streaming.

TV: So many people listen to music digitally, on Spotify and Apple Music — why did you decide to create a show about records instead?

JK: The simple answer as to why I created a show inspired by records is that I find digital means of listening to music passive. Don’t get me wrong, I am in love with my iPod and I might actually die without my Apple Music, but I think it’s important to acknowledge how easy it is to become complacent about listening. Many a time, I have found myself in a playlist loop where I don’t realize I’m listening to music that I don’t really like or care about. With records, the act of listening becomes so active. You carefully choose what record you want to listen to. You engage with the music in the ceremony of putting the record on and the needle down. If your mind is focused on other things, the record waits for you to reengage at the halfway mark. I think that level of immersion lends itself well to a theatrical endeavour.

TV: Where did you get your inspiration for B-Side?

JK: I was so thrilled when the Follies asked me to create a show and I celebrated by going to my favourite record shop and picking up a heap of new music. When I got home, I put on my new Pat Benatar and rocked around my living room basking in the amazing vocals and bopping tracks. Two things happened while I listened to that record: 1. I found a couple songs that I had never heard before but fell totally and completely in love with, and 2. I heard songs that I forgot that I loved and it felt like coming home. That is how I found the concept for this show — thanks Pat. For me, B-Side is all about celebrating the songs of amazing artists that don’t get the same amount of play as other classic rock, as well as celebrating better known songs that were put on the B-Side of their record. Some of the songs in this show are ones few people will know — but everyone will love — some are songs everyone will know and can sing along to, and some are songs that people will hear, be flooded with memory, and fall in love [with] all over again. 

TV: How did you choose what songs to include in the show and why did you choose rock music?

JK: Listening to hundreds of classic rock songs to find the perfect setlist was torture — just kidding, I was in my glory. I love that shit. I ended up deciding to centre this show around songs that explore young love and relationships – the good, the bad, the ugly, the horny. It connects every song and performance and reined me in — if I didn’t have that connecter, the show would be hours long instead of the sleek 55 minutes it is now. B-Side has an unclockable flow and energy. It’s dynamic. It’s energetic. It’s magnetic and it demands to be seen!

As an artist and a consumer, I love the feeling of nostalgia. For me, it serves as escapism and when I perform or listen to music from or reminiscent of the 60s, 70s, and 80s. The flow and intensity of it allows me to let go and live in its palpable energy. That feeling is what I want for my audiences and that is why I gravitate towards rock. 

TV: What is a song or performance in the show that stands out to you? 

JK: As far as what song or performance stands out, I’m going to give a pageant answer: every single song and performance stands out. When creating this show, we wanted to make sure that every performer got their moment to shine, and shine they do! We have been incredibly fortunate work with this incomparable group of people. Every single one of them owns the stage and I challenge anyone watching not to be warmed to the core by the joy and energy that radiates off of them when they sing. They are a beautiful unit. Hart House is an intimidating space. It is huge and can be daunting for performers — I say this from experience: that stage is scary — but we don’t fear the stage, we dominate that stage. The passion and excitement from our cast fills the theatre from the dressing rooms to the very last row. 

 

We want to hear age

Examining the record resurgence

We want to hear age

On my fifteenth birthday, I was gifted a record player and a vinyl of Arctic Monkeys’ fourth album Suck it and See. At the time, I was participating in a trend that was decades in the making. Record players and vinyls were all the rage, and they continue to be so to this day. But after collecting the rest of the Arctic Monkeys’ discography, as well as some of Sufjan Stevens’ and Father John Misty’s, I had to retire my record player, effectively leaving my small yet expensive record collection as nothing more than mere album art.

The fact of the matter was that the music sounded worse coming from my cheap orange vinyl player: songs skipped, background instrumentals were out of tune, and melodies were distorted. I couldn’t help but be confused by the vinyl craze. I wondered why people were looking to progress in most facets of their lives, but regress in their music.

And I was not the only one bewildered. The vinyl trend has inspired many a thinkpiece, documentary, and heated discussion. It has perplexed those that see music as a sum total of instruments, rhythm, and vocals, but has placated those that take into account experience and historical context.

We are not a society of Luddites. We don’t shed earnest tears over the first edition of the iPod or the initial version of Windows. We want our technologies to develop faster, harder, and more often.

So why is it that a person who has the newest Apple products probably also has an extensive record collection? Is it some kind of blinded dissonance or is there something more behind the trend?

SHANNA HUNTER/THE VARSITY

Liam Baldwin, a graphic design student at York University and owner of a record collection numbering in the 100s and passed down through the generations, explains in an email why he loves listening to vinyls: “You get a really pure and visceral listening experience, with a good quality turntable, speakers and 180 gram vinyl, you can catch every little detail in the recording.”

And it’s these little details that make records so appealing: the ability to catch any flaw or imperfection makes for an authentic listening experience, one free of the sterility of modern, mass-produced, digital music. One can only imagine that this all stems from classic rock vinyls.

You don’t need need to dig deep to find statistics that corroborate this record resurgence. In Nielson Music Canada’s 2017 report, record sales saw a 21.8 per cent increase, which also marked the seventh straight year of growth.

Blair Whatmore, assistant manager at Sonic Boom, Canada’s largest independent record store, observes that “the last five years have been really great for the sale of vinyl records; they’ve come back in a huge way.”

When asked about the types of records that are most popular, Whatmore confirms the relationship between medium, age, and genre: “People are always after classic titles records that originally came out on vinyl and were intended to be heard on vinyl.” She explains, “People are always interested in getting copies of those because that’s the way the artform was designed to be heard. We do well with classic releases from the 60s and 70s and 80s.”

This pattern stands out on the charts as well. Of the top ten bestselling records in 2017 in Canada, only Kendrick Lamar’s DAMN. was of the hip hop genre. All the rest were either pop or rock. This illustrates the intrinsic and nearly subconscious association between genre and medium.

Rock and pop dominate the vinyl charts partly because of the aesthetic that surrounds records — you know the kind: a Joy Division vinyl spinning somberly on a player, framed à la Wes Anderson — and partly because rock albums were initially intended for the vinyl medium.

Conversely, hip hop, rap, and R&B dominate the streaming charts. According to Forbes, of the top five most streamed albums in the US in 2017, only Ed Sheeran’s Divide didn’t fall into the hip hop or R&B genre. If you were to see a vinyl spinning, you’d expect to hear Joy Division or The Doors, not Kendrick Lamar or Drake. The former incorporate the fractured sound of vinyl records into their aesthetic. The relationship between outcome and production is therefore synergetic.

Even when modern musicians reference and sample old music, they keep the fractured sound. A recent example of this can be found in Kanye West and Kid Cudi’s collaborative song “4th Dimension” from their album Kids See Ghosts, which opens up with a sample from Louis Prime’s 1936 “What Will Santa Bring.” The sample is crinkly and warped; it offers the tell-tale aged sound that is the crucial juxtaposition to the modern, electronic melody that closely follows.

Kanye doesn’t digitally restore the track because it would lose its personality and authenticity. Imperfection is what makes it interesting.

Listening to records is no different than watching a black and white movie in its original monochrome version. We want to see age and we want to hear age. This is what motivated the original record resurgence — our desire to resurrect the sounds of generations past from an archived graveyard, our desire to hear the same sounds as those in the 50s and 60s.

Modern albums selling out on records is just the aftermath; a trend inevitably stretching its influence to the current and the popular. “I think that part of the reason they’ve become so popular again is that there’s a generation of people who have grown up and didn’t have the CD format; there was never a physical element to music at all,” Whatmore explains. “So I think that the resurgence of vinyl is partly due to that generation of people being able to curate something; curate their collection of records, a reflection of their taste and what they love.”

There is novelty in listening to an album from start to finish — a practice nullified by the very concept of playlists — and in collecting limited edition vinyls and album covers. The physicality of holding a record and putting it on a player adds more to the listening experience than clicking on an icon on your computer screen. So does having a physical collection of the albums that you feel best represent and inform you.

But to say that streaming is killing music — and that records are resurrecting it — is facetious at best. Whatmore says that streaming music may actually boost record sales: “We’re reaching a point now where people enjoy buying music, and they’re streaming music because it is a good way to sample something and learn about new things before you commit to buying them.” Baldwin echoes the same sentiment: “I’ve probably found some of my favourite artists through streaming services [from] which I then went on to buy their album on vinyl.”

The resurgence of record players isn’t happening independent of streaming and digital mediums. There’s a lot of overlap and concurrence; they feed off of and help progress one another. Despite the resurgence, however, records still have a long way to go before they are wholly mainstream again.

The landscape for record stores is anything but conventional. Many record stores in Toronto operate in conjunction with other businesses, oftentimes with ones that have a similar niche or customer set. Vinyl Vault is open on the second floor of Sonic Bar & Café, a Chinatown bar, and Female Treble is open in Eyesore Cinema, a video store on Bloor Street.

Yearning to relate to older generations has been a recurring theme in this article; however, the practice of buying and listening to vinyls in the 60s and doing the same now, is different in intention.

Back then, vinyls were solely for utilitarian purposes: they were used to play recorded music. Now, vinyls have a more complex reason for existing. They are not only meant to play music, but they’re also meant to transport us to a time before iPods and Spotify. For better or for worse, they bring back the sound of two generations ago — imperfect, fractured, yet nevertheless, authentic.

The past is never just the past. Be it by the underground or the mainstream, old fashions and trends are absorbed and repurposed to fit into our modernity; we bring back clothes, makeup, and hairstyles, and refurbish them to meet our needs. Take Polaroids as an example. The ability to hold, shake, and touch the picture is just as significant to the experience as the vintage and raw aesthetic. They’re experiencing a resurgence that stems from the same reasons as that of records: people like the physicality and the authentic feel to them.

SHANNA HUNTER/THE VARSITY

It is easy to blame the record resurgence on hipsters, and to colour record-buying as nostalgic idiocy motivated by those who love 90s indie movies a little too much. But there’s an obvious desire hidden behind the trend: the need for imperfection and authenticity.

In a couple of years, when I can afford a better, state-of-the-art record player, I’m sure my vinyls will be put to good use once more.