Clinicians “all alone” when integrating digital health advances: Larsen

When it comes to interoperability and linking health data and the promise of digital health, we still have a long way to go despite the continual hype, and the wholesale adoption of virtual care seen during the first year of the COVID-19 pandemic. Furthermore, many innovative breakthroughs in this area are being driven by the private sector rather than coming through the publicly funded system.

These and other provocative statements marked the first of this season’s virtual series of digital health webinars hosted by the Sandra Rotman Health Centre for Health Sector Strategy.

Attended by many of Canada’s leading experts on digital health, the session marked the end of a relatively quiet period for discussions of digital and virtual health care in Canada. The high-profile OntarioMD conference will follow later in the week with the Canada Health Infoway partner conference and Digital Health Week taking place in November.

Setting the stage for the discussion was Dr. Darren Larsen, a family physician who has had many high-profile roles coordinating digital care in Ontario and recently worked for both Accenture and Telus Health.

“There is actually no ‘there’ yet when it comes to this conversation around digital health, especially as it relates to care in the community and the work we’re doing as physicians and nurses and care providers,” Dr. Larsen said.

While 90% of physicians in the community and all doctors in hospitals now use electronic medical records (EMRs), he said, community physicians are not sharing data and have no incentive to do so. However, he said  there have been many significant advances in Ontario which allow community doctors to see what is happening to their patients in hospitals.

As for virtual care, he noted while “even though 90% of family physician offices were opened during the pandemic, there was a lot of care done virtually for so many reasons that we all understand.” But he added, the predominance of virtual care “is definitely tapering off now” because of the need to still provide in-person care for many medical services.

With reduced government funding for virtual care services, he said, much of the impetus for this type of care is being driven by the private sector and this is creating discord. What is concerning, Dr. Larsen said, is that many standalone private virtual care clinics are focused on high-volume, low complexity care which is counter to the type of high-complexity, lower volume care many primary care patients now require post-pandemic.

For digital care overall at least in Ontario, Dr. Larsen said “clinicians, sadly, are on their own when it comes to integrating digital tools in their practices. We have to bear a 100% of the cost of these things, we have to figure out if they’re going to integrate with our EMR systems or not … and the EMR companies are not very interested in tagging on products that dive there way into their databases and architecture. for so many reasons.”

“There’s very little trust, sadly, between us as providers, and some of the digital companies that are out there (with) really spectacular products.”

At this event, moderator Will Falk, in addition to peppering panelists with erudite questions played the role of the frustrated, engaged patient. He noted that as a patient, he has had to coordinate the sharing of information between his physiotherapist and his family physician and he likened it to being a telephone operator connecting different phone lines.

Dr. Larsen noted that in the current health care environment “patient expectations are changing and tolerance to private pay is changing.”

A perspective from the private sector was presented by Sonya Lockyer, president and CEO of the Lifemark Health Group, now owned by Shoppers Drug Mart, which offers community rehabilitation, workplace health and wellness and medical assessment services. She talked about organizations such as Shoppers creating (with patient consent) “micro ecosystems” including 600 affiliate primary care clinics that allow patients to see their own data and create one view of their health as well as providing insights into care.

“The real opportunity, of course, is to not just create these micro ecosystems within a high performing family health team, but also to push even broader into the public system at large,” Lockyer said.

“The private sector is willing and able to share and understand, but there isn’t a warm reception on the other side,” she said, noting that to date governments are not willing to mandate that all practitioners in a region are coordinatd in delivering care whether they work in the public or private sector.

Zayna Khayat, VP of client success and growth at Teladoc Health Canada and a senior advisor with Deloitte, said that with much of the innovation in digital health occurring in the private sector there is a need for more partnerships and innovative thinking on how care is funded and delivered.

The real promise of digital health, she comes from “really new models of care, new operating models, and new business models, which allow you to pay for things differently and have different characters do different things and get paid for it.” In fact, she said, Deloitte has estimated that 85% of everything being done in healthcare today will shift to these new models.

Dov Klein, VP of value-based care at Ontario Health, and the final speaker on the panel talked of the desire in Ontario to develop a system focused more on outcomes and in preventing patients from requiring acute-care services. He also hinted as changes to come for the Ontario Health Teams providing primary care in the province.

Sept. 8, 2023: Social media and medicine update

Ottawa during the spring smoke event

Gather around and warm yourself by the glimmering sparks of evidence-based science in the ruined infrastructure of the platform previously known as Twitter as we provide the 2023 version of the professional use of social media by physicians and in medical education.

Well, things might not be quite that bad, but for the first time in 11 years of speaking to first year medical students at uOttawa I was not telling them that use of social media can definitely be of benefit to them professionally and that the platform previously known as Twitter is their best option.

To quote Mark Carrigan, a lecturer at the University of Manchester: “I believe Twitter can now be a dangerous place for many academics, particularly if they are from minoritized groups.”

While some of us have been hanging on grimly to our presence on X (the platform previously known as Twitter), hoping the situation will change for the better rather than continue to get constantly worse, many prominent physicians, patient advocates and others have fled X for other platforms such as Mastodon or threads. And things seem to be getting worse.

Earlier this week, moderators of one of the only remaining compelling and inclusive medical and healthcare tweetchats #hcldr announced that it would be winding down. Medical and health tweetchats of distinction have been discontinued but in this case the situation seemed sadder. As one of the #hcldr co-hosts Joe Babaian (along with Colin Hung) wrote in a blog announcing the move: “We all know what a hugely different place Twitter is … The vehicle is damaged.”

In my presentation to uOttawa students I discussed the many ways Twitter (now X) has declined over the last couple of years and how many alternatives have arisen in an attempt to replace it. However, as others have pointed out these alternatives have not successfully filled the void for those interested in medicine or healthcare, especially academics.

“We’re in a situation now where it’s not clear that any of the alternatives (to Twitter) will become the alternative. We’re entering a more fragmented landscape where the path to visibility and promotion is going to involve maintaining a presence across a whole range of platforms,” Carrigan wrote, adding that this will require a relatively sophisticated understanding of the platforms and a strategy for using scheduling software. “Any lingering sense of Twitter as a democratising space where academic hierarchies can be levelled, further falls apart under those conditions.”

His views were echoed more forcefully by Professor Inger Mewburn, director of researcher development at The Australian National University who wrote a blog titled: The enshittification of academic social media.

“Telling academics they can achieve career success by using today’s algorithmic-driven platforms is like telling Millennials they could afford to buy a house by eating less avocado on toast,” he wrote in the July 10 blog. “It’s a cruel lie because social media is a shit way to share your work now. Basically, it’s no longer true that you can build a substantial audience by doing Good Work and telling people about it. Today you can talk about your research on social media platforms all you want, but hardly anyone will hear you unless you pay cash money because Algorithms.

Mewburn closed his blog with tips for academics and students and some of these aren’t half bad such as noting social media can be social and a good place to have fun and chat with people and that you should always “own” your own content rather than just produce it on social media platforms. He also urged teachers not to use social media as tools in their classrooms as it may exposure students to the toxic elements that now seem to define much of the social media landscape.

In the face of all of this doom many continue to maintain that X and social media platforms are in general are vitally important places for physicians and others to maintain a presence if only to challenge the politically motivated misinformation about medical and health issues that continues to cost people lives. As Dr. Teresa Chan, the inaugural dean of the medical school at Metropolitan University in Toronto told me earlier this summer: We need to be on social media because the world is on social media. We have to learn to fight misinformation – not be part of it!”

Tim Caulfield, Canada Research Chair in Health Law and Policy and a leading debunker of health misinformation had a similar message for those attending the Canadian Medical Association Health Summit in Ottawa in August. After tracing the leading role social media has had in spreading life threatening falsehoods, he told physicians they had a critical role to play in challenging this information.

X may now be a lousy place to network with your colleagues and associates and grow academic credibility by sharing links to your studies. But if you are of an altruistic bent and believe that advocating for science-based knowledge is important it might be worth hanging in there until the entire platform shatters under mismanagement or falls off a flat earth.