Digital health: The flying car of health care reform


Building a flying car is now relatively easy – it’s building the floating road for it to drive on that’s causing all the headaches.

Flying cars have been a mainstay of science fiction and futuristic thinking almost since the advent of the automobile itself. And for some, the prospects of digital health having a significant impact on how we deliver health care seem to stretch back almost as far – and the divide between our wishes and reality almost as wide.

Remember the information superhighway at the beginning of the millennium and how this was going to transform the Canadian health care system by using the internet and nascent electronic medical record (EMR) technology to make it easy for physicians to deliver and patients to receive the health care they needed? Remember the promise behind the hundreds of millions of dollars invested through Canada Health Infoway (@Infoway) in building the infrastructure to deliver digital care.

Well, the superhighway never materialized, and most Canadians still cannot access their medical records electronically nor can most communicate with their physician in any manner other than face-to-face.

As we approach another Canadian Digital Health Week next week (#thinkdigitalhealth) it is worth noting that, integrating digital health into the mainstream of Canadian health care remains in many ways the flying car of health care reform – always part of our future but never our present. I know this is an overly simplistic and pessimistic picture and it is true that some digital innovations such as PACS (picture archiving communication systems) have transformed how health care (specifically medical imaging in this case) is organized.

But the reality is that transforming our health care system through the use of digital health tools and platforms has been a long, slow slog.

And if one listens to Australian health quality expert Dr. Jeffrey Braithwaite (@JBraithwaite1) this should be no surprise. Dr. Braithwaite was recently a keynote speaker at the Health Quality Transformation conference and the Quality Improvement and Patient Safety Forum in Toronto and he had tough messages for those wishing to implement widespread system change.

His view is that health care is a complex, adaptive system with several interdependencies. As a result, change does not occur in a linear or predictable fashion meaning you can’t just dedicate funding and lots of effort and assume it will change something. For those who have seen have the launch of major initiatives to implement digital health this must surely resonate. Time after time we have seen pilot projects using digital technologies that have had early promise but fail to stick. In other cases – such as the use of EMRs in primary care – we have seen widespread implementation efforts that have seen an incredible backlash from the physicians who are supposed to be using them.

Digital health care will – eventually – transform how we deliver or receive care but as Dr. Braithwaite points out, probably not in ways we anticipate and not without a lot of effort.

Regarding implications for digital health, Dr. Braithwaite had one other point of significance and that is the importance of listening to physicians and others working on the front lines of care. He talked about work imagined – how policy makers and external observers think the health care system works versus how work actually gets done. Physicians can tell you exactly how and why EMRs are not having the desired impact and are making their lives miserable.

Listening to them and making changes in how EMRs are designed, function and are integrated into practices must surely have a positive impact. The same is true for virtual visits or e-mail communications between doctors and patients– mandating that it occurs will almost certainly not be successful unless both patients and physicians are consulted on how it can happen in a way that works for both.

Image courtesy of Pal-V



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