Coming out of the pandemic, the Quebec health system is faced with several administrative, organizational, human and technological challenges. We often hear that the system is cracking up, that access to a doctor is more complicated than ever and that the promises offered when introducing solutions using information technology (IT), such as the Health Dossier, did not materialize.
However, recent history teaches us that the adoption of innovative IT solutions advantageously improves access to health care resources, day-to-day management or the quality of services offered to beneficiaries. The organization of the COVID-19 vaccination is a very good example of the effective use of IT platforms in a global organizational effort. In this context, how can we ensure that best practices in community medicine are preserved while remaining on the lookout for opportunities to improve the service cycle offered by information and communication technology (ICT) solutions?
As a general practitioner and entrepreneur, I would like to share a vision of the challenges faced by health care workers and the impact of new information and communication technologies (NICT) on the medical sector. The practice of medicine is constantly evolving. We must keep successes and failures in mind, to ensure that the needs of patients remain at the forefront of every intervention.
Systemic and Human Issues:
Three Major Challenges
The media have talked a lot about the workload of general practitioners. The government encouraged frontline resources to adopt several measures, including the introduction of the Electronic Medical Record, expected to improve access to services by improving the efficiency of caregivers. Yet the latter have said emphatically from the start of this discussion that they are working at their maximum capacity. Why then, despite the introduction of targeted technological, systemic and administrative solutions, are there still so many orphaned or underserved patients? The debate is on. As a food for thought, I see at least three major challenges facing our field.
Community medicine and red tape:
The issue of access to health care is not limited to a statistical debate. The introduction of IT tools and other innovations, such as the Health Window or the Electronic Medical Record, effectively offers enormous potential for optimizing services and should have contributed, along with other measures, to solving the access problem. The field is certainly in transformation. But the daily life of general practitioners has also changed considerably over the years. The “family doctor” fills out many more forms than before, records more medical information and receives an increasing number of requests from insurers, pharmacists and the CSST.
Doctors must remain versatile and able to practise their profession in an atomized care environment: hospitals, CHSLD and practices. Significantly, with the aging of the population and the increase in clienteles suffering from mental health problems, Quebec general practitioners now spend more time with each patient. In Quebec, 48% of physicians spend more than 25 minutes per consultation with their patient. This proportion is only 18% in Canada and 7% in Ontario. Having said that, I would like to point out that certain social development factors, such as work/family balance, also have an impact on the number of clients taken care of.
Access and digital management technologies are one of many tools that will ensure sustainability of the health care system. But it is imperative that they tie in with organizational and operational solutions, such as the Electronic Medical Records. This is a difficult evolutionary process to implement in a system made up of many diverse linked cells, modulated according to the specific clienteles.
Between related tasks, professional mobility and the aspiration for a more balanced lifestyle, general practitioners are key players who must contribute to adopting digital solutions to humans and not the other way around. Therefore, the collaborative model should be favoured between designers of ITC/NITC solutions and practitioners. How do we free the doctors from their related tasks? This is one of the challenges that will help refocus the patient at the heart of the health care system.
Societal and generational issues:
The Quebec health care system is also faced with an issue that few organizations encounter: stakeholders must provide uniform service to the entire population, regardless of age or social status. From this perspective, technology adoption is desirable, for the reasons I discussed above, but not everywhere and not just anyhow.
For example, we must preserve easy access to services for people in the third and even the fourth age. However, the level of technological adoption is uneven in these segments of the population. Some recipients never had an email address and have always operated over the phone or in person. Others, such as clients living in poverty, have difficulty accessing technological resources that would allow them to use the ICT tools deployed to facilitate their access.
However, more and more elderly patients have sufficient mastery of these access technologies. The use of technologies such as smart phones and connected objects is very high in Quebec. Many people are therefore looking for remote consultation options. Does the IT offer make it possible to serve these clienteles well? Not yet completely.
The Quebec health care system must adapt to these varied conditions and offer a hybrid access infrastructure. In the rush to adopt certain technologies, patients’ real needs could be overlooked. For instance, asking a patient who does not have an email address to register at an immunization site with their email address creates a difficult threshold to access.
Managers must adapt access methods according to patients’ constraints. The enthusiast in me thinks that there is a way to digitize management operations of the system itself, while developing access technologies that consider the asymmetric adoption of technologies.
IT and interoperability:
Health services rely on a constellation of stakeholders who must collaborate as effectively as possible. It is therefore necessary to consider in the equation the NICT solutions which allow the actors of the health care system to constitute more efficient e-health care groups. The chain of collaboration between general practitioners, medical specialists, pharmacists, private services (radiology and others) and laboratories must be efficient. Interoperability between public and private services is a major issue that deserves our full attention.
One may wonder why a pharmacist must renew a prescription by fax, when sending the electronic medical record directly through a messaging system would be faster and simpler. Once again, we are often confronted, both patients and professionals, with red tape that impedes the efficiency of services. Is it because the public system is archaic or just too big to quickly adopt obvious IT proposals? It’s not false. Could communication between private and public bodies be improved? Certainly.
But by adopting collaborative approaches, like ensuring that the pharmacist acts as a conduit between the doctor and the patients, innovative solutions using connected objects or other e-health tools can improve the service delivery without disrupting the system. Adoption of automated prescription renewal procedures or email prescriptions and door-to-door delivery procedures is already well underway. This makes it possible to reduce pharmacy visits for patients and the administrative burden for doctors.
Companies have also developed “re-prescription” technologies in recent years, which automate refills under certain conditions. Likewise, a patient can now ask their pharmacist questions directly, through online platforms. These solutions significantly improve service delivery. Another company is working to facilitate navigation and better orient the trajectory of health care services by developing a collaborative directory of health resources in the province. With this approach, it becomes easier to assign the right resource to the right patient at the right time.
We should also mention the collaborations between public network stakeholders and private entrepreneurs to develop new interoperability solutions promoting data sharing. We might also consider the recent concerted effort to use unified communications and infrastructure protocols like the FHIR. Before, each silo used its database and cared little about the interconnections needed by other software that added value to patient health. The goal is to eliminate wasted administrative time with collaborative technologies. Obviously, the emergence of electronic medical records raises questions about digital security and data confidentiality. But today, a constellation of solutions is being put forward. It is a very dynamic and promising field.
IT and Health: Preparing for the Future
I often ask myself: how can ICT-NTIC solutions help stakeholders in the health care system to better serve the patient? I have tried to qualify three major challenges that should serve as avenues for reflection and, I hope, provide some answers.
Innovation in ICT is certainly a way of the future. More and more companies are developing IT tools to facilitate access to health professionals, help with prevention, improve collaboration between teams of stakeholders and make the management of the health care system more efficient. The hospitals themselves have innovation centres. The network is in constant transformation and adapts to new medical, technological, and social realities. The solutions are multiple and innovative. Unfortunately, I’m running out of space to say more. Next time, I would like to talk about specific IT innovations on which I am collaborating, and which will make it possible to face multiple health issues with ingenuity, intelligence and sensitivity.
Sharing of information and sharing of resources: IT is an essential key to maximizing the power of the Quebec health care system.