“Most QI (Quality Improvement) programs don’t incrementally ascend, but often fail. Many QI projects never work out at all and of those that do, almost all have real failures, along the way. But failure is not bad and contains within it the seeds for future improvement.”
Dr. Joshua Tepper, former president and CEO of Health Quality Ontario and now CEO of North York General Hospital
Those committed to bringing a patient portal to the residents of Nova Scotia should take heart from these recent remarks by Dr. Tepper. While he was talking about quality improvement initiatives, the comment speaks directly to the Nova Scotia situation and is probably more relevant than people would acknowledge to all aspects of digital health and health technology innovation.
Surely, nothing seemed better set up for success than the MyHealthNS portal intended to allow patients to communicate with their physician virtually, receive laboratory results, book appointments, and allow physicians access to Econsultations and Ereferrals. Canadians have overwhelmingly indicated that this – in some ways more than anything else – is what they want from digital health.
Yet despite government backing and strong early support, MyHealthNS has enrolled only a small number of Nova Scotians. And while the initiative is by no means dead it must, to date, surely be judged a failure.
The reasons behind this are informative and speak volumes about the importance of local variables and the challenges of bringing change to a complex system such as health care.
The MyHealthNS story was told recently by Dr. Stewart Cameron, a family physician and advocate of the portal, at the Canada Health Infoway (@Infoway) 2018 partnership conference in Montreal. A very, very abridged version of that follows:
MyHealthNS was piloted in 2012 with about 30 family physicians and 6,000 patients. Results were overwhelmingly positive and a full provincial roll-out of the portal was initiated in 2016 (and again in 2018 and again in?).
Two important points:
- Enrollment in MyHealthNS is done through family physician offices which made it easy to authenticate patient identities but has had negative consequences leading people to question whether this is the right model.
- Physicians involved in the pilot project noted that the portal must be integrated with their EMRs to be successful and that a payment model was needed to remunerate physicians for using the portal. In fact, one physician involved in the pilot saw their income drop as a result of participation.
Fast forward to this year.
In February 2018, only 13,782 patients were registered with the portal out of a provincial population of approximately 1 million people (that figure is now up to about 20,000, according to Dr. Cameron). Of these only 10% had accessed the portal at all in the month prior the evaluation in February. Additionally, only 250 practitioners had registered with the portal and of these only 35% were using the portal actively.
The reasons behind these poor numbers can be traced to two key reasons:
- Payment for physicians for enrolling patients or using the portal is still not part of the master fee agreement although physicians can now receive a stipend for involvement.
- While the portal is now integrated with most EMRs in the province, one major system is not integrated directly. Further, many physicians are currently migrating to different EMRs and are reluctant to take on the extra burden of enrolling patients in the portal during this time.
Of course, with physicians acting as the gatekeeper for patient enrollment it is obvious their reluctance to be support this initiative actively is a huge barrier to success. At a time when family physicians are under increasing stress and many suffer from burnout, embarking on such an initiative must produce tangible, immediate benefits to attract them.
Not only are family physicians reluctant to enrol their patients (which must be done face to face or by phone) but many residents of the province currently lack a family physician and so have nobody to sign them up.
What must have been a source of frustration for Nova Scotia delegates to the Infoway meeting was that the same meeting heard how Quebec has already signed up 300,000 people to their portal in a short time using a direct enrollment model.
MyHealthNS has failed to date but that is no indicator of future failure as long as those involved with the project learn from their experiences to date. In the words of Dr. Cameron: “This is going to happen. It’s inevitable.”
(Image courtesy, the Government of Nova Scotia)