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.
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