To use Infoway’s vernacular, we are seeing a digital health *movement*. Canadians are driving this change to make healthcare more patient-centred, accessible and more modern, like every other sphere.
I like this point of view – that the transformation we are seeing is not a single event or even a series of events, but a solid, albeit gradual, march toward a health system for the digital age. While some may quip that the pace of change in healthcare is more akin to the movement of a snail or a sloth than an actual march, the fact is it is moving, just not at the pace of the rest of the digital world.
I like that the concept of a movement is not a project, although there are many projects that need to be executed, and executed well. A movement implies that systemic change is needed. Such change is certainly enabled by digital tools and their related projects, but that in and of itself is not enough. In order to affect a system, or even make healthcare a system, structural and process change, as well as integration, is necessary. But more importantly, there needs to be a cultural and attitudinal change: that “we the people” (to borrow from my last article) need to be an integral part of driving the movement.
The vision for a consumer-focused, digitally enabled, integrated health system is not new. When I got involved in healthcare in the ‘90s, we were looking at implementing systems in hospitals and doctors’ offices, but we also had a view toward how standards would allow data to be exchanged to enable coordination of care and reduce duplication of tests. These ambitions are not new!
So what is new now?
Well, there is momentum for one. Incentives are emerging – think Ontario Health Teams in Ontario – and technology is maturing. And, lastly, vendors are adopting universally accepted standards for data exchange.
What a rich platform upon which to finally be able to execute on the digital enablement of a modern healthcare system!
But we are missing a couple of pieces:
- Money. Certainly the system is financially constrained, especially when there is neither new/explicit money for IT implementation, nor relief in the funding formulas for the implementation and operational impact. Incentives and penalties can work, though as they have under the U.S. Meaningful Use regulations.
- Legislation. There have been many attempts to force standardisation through legislation, but few have worked. This approach is highly unlikely to work anywhere there is decentralised health system, like in Canada.
- Leadership. I am not sure this is as much a barrier as it was in the recent past. There is no question in my mind that the wind was taken out the sails a few years back, but I am pleased to see that is now ancient history.
- Human Capacity. This is what I want to drill down into in this article. We have a unique opportunity right now to blend a few things to the benefit of Canada and Canadians. The obvious is the integration, improvement and consumer-centric nature of the health system and the benefits to patients and system sustainability. But we also have the ability to positively impact job creation and economic development. Thus supporting a more systemic and sustainable benefit to our country.
As I have posited above, we are seeing a great deal of movement to develop digital tools, whether new EMRs in hospitals and doctors’ offices, EHRs to link the data, PHRs to enable patient access to their integrated records, or virtual care tools like e-consults and remote health monitoring to enable efficient and convenient access to care.
While I believe technology is not the barrier to broad deployment, and assuming the other barriers I outlined above are not hard impediments, then the constraint becomes the human capacity to
implement these tools, train the providers, manage the change, and optimise the processes.
Right now with the plethora of new EMR implementations in hospitals, we can observe two things:
- the technology we are using is coming from the U.S.; and
- the people with the experience to implement those systems are also coming from the U.S.
I have seen many Canadian services firms seize the opportunity and partner with U.S. services firms, and in so doing offer a proposition to our hospitals that blends deep understanding of the Canadian healthcare system with deep understanding of how these U.S.- based EMRs work. This is good, but, I contest, insufficient.
I believe we have the opportunity to proactively build human capacity in Canada on the back of these projects.
So what could a made-in-Canada solution look like?
Well, it would mean that professional services firms would be willing to see the rising tide that will lift all firms, and not just their own; that they accept that there is more than enough work to go around; and that they are confident in their value proposition in terms of methods, tools and track record such that “owning” all the talent as well is unnecessary.
It would also mean that hospital systems that are embarking on their implementation, conversion or upgrade journeys believe in the long-term value of access to a pool of local, trained talent that they can access when needed, and that they see that left unchecked, the war for talent will escalate and become increasingly more expensive.
For academia, it would offer a place for students to acquire real world experience.
Here’s my proposal:
- We (although I am not sure who “we” is) establish an EMR Transformation Centre. Perhaps to be pragmatic we start in Ontario. In this Centre, we combine people who have skills, people who need skills, applied training curricula, proven methods and tools, and on-the-job skill development. The people could and should come from professional services firms, hospitals and universities.
- We take established training and tools from the U.S., and Canadianize them. We bring experienced talent from the U.S., combine it with local talent that knows and understands the Canadian healthcare world, and we develop deep Canadian expertise based on that combined knowledge. This training would be available to new grads, work-term students, new consultants and clinicians who want to develop EMR-related skills. We would use hospitals to provide on-the-job training for these folks, where they shadow experienced clinicians, provide at-the-elbow support for go-lives and support clinical transformations.
Of course, the obvious questions are:
- Will professional services firms collaborate?
- Will hospitals support this through their staffing and procurement strategies?
- Can we attract funding to launch the venture?
- And last but not least, can we sustain it?
I don’t pretend to have all the answers here, but I put it to the readership: Is this idea compelling enough to engage in a fulsome dialogue on how to make it happen? All thoughts and feedback welcome – I have pretty tough skin!
Let me leave you with this … *carpe motus* … seize the movement!