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.