Why digital connectedness matters in the health-care system

The lack of digital connectedness in Ontario’s health-care system can waste time, re-traumatize patients, and lead to errors. This podcast focuses on the need to share medical information between health-care professionals and departments. 

Transcript

Spotlight on Health – Digital Connectedness

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Georgia Balogiannis: In this podcast the Ontario Medical Association looks at current issues of interest in health care. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us. I'm Georgia Balogiannis for the Ontario Medical Association.

The lack of digital connectedness within Ontario's health care system can lead to wasted time and wasted resources. This podcast focuses on why linking physicians’ medical record systems is imperative for good health.

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Balogiannis: Antonia Palmer is executive director of the Kindred Foundation, which funds oncology research and clinical trials and supports children and young adults with cancer. She relates her experience of navigating the health care system as her son battles cancer.

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Antonia Palmer: So, when Nate was two years old, he was diagnosed with stage four, high-risk neuroblastoma cancer. It's a very difficult cancer to treat. He had multiple rounds of intensive chemotherapy, surgery to remove the tumour, we had to have the entire kidney removed. He had a megadose chemotherapy with stem cell transplants. He then had radiation and then five cycles of immunotherapy of which the main side effect is intense pain. He unfortunately relapsed in the brain.

Nate, when he relapsed, he had emergency surgery to remove the tumour, multiple rounds of craniospinal radiation, so radiation to the brain and to the spine, with simultaneous chemotherapy. Then after that, he was finally declared cancer free. And, in total, Nate was in treatment for five years, and it was continuous treatment. He's now 14 years old and because of all of that treatment, he has a myriad of long-term effects. He has all sorts of challenges which require him to be followed by a huge team of specialists. So, just recently, he was diagnosed with thyroid cancer.

When you have a child with a complex medical condition, your child is going to be cared for by multiple specialists and in multiple different areas in, potentially, in multiple hospitals. It is really the caregiver, the parent, who is in charge, who is really trying to make sure that all of the different pieces come together.

And when you're taking your child to all of those different appointments, you have to retell that story and your child's story each time. That could bring back all sorts of blame and guilt and trauma. And if that is something that can be reduced, if there can be that better sharing of information, that has the potential to reduce some of that trauma. And that is a really important thing for parents and caregivers. It is that community of care and all of those members of your child's community of care having access, and centralized access, to the one accurate medical history of your child.

Children with complex medical conditions and cancer that, really and truly, the days of just being treated within your home hospital are long gone. We have, now, so many precision and individualized therapies that can only be given at certain hospitals. It is almost a given that a family will need to travel at some point for their child during their child's cancer treatment. So, as we're thinking about how we create this common hub, we really need to look towards how do we create that to make sure that we ease the flow of information.

He's had to grow up very quickly in this world and he's a fantastic self-advocate. He's also an advocate for other kids with cancer and couldn't be more proud of him.

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Balogiannis: Dr. Chandi Chandrasena is the chief medical officer of health for OntarioMD, an OMA subsidiary established to help Ontario physicians transition from paper chart to electronic medical records. She also practices family medicine in Ottawa.

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Dr. Chandi Chandrasena: We need to have all our digital information integrated and seamless because otherwise we're putting barriers in every step. If patients have to repeat themselves every time they see a specialist through their health care journey, it adds a barrier and stress to them. If physicians had to depend on the patients to give a history, then that acts as a barrier. If we had an integrated system that was seamless, we would actually save resources, time, and at the end of the day it would be much better patient care.

Pharmacists, the nurses, everyone needs to sit there and kind of see how it fits in. They haven't really come together, we're all individual silos. This is incredibly important from a physician point of view, but also a patient point of view.

I remember I would go into the office, I would work my regular hours, then I would go home — I would look after my kids, I would put them to bed, and every night I would work from eight until midnight catching up on all the notes, the administrative work, the forms, the consults, the referrals, the labs — this is the reality of all family docs.

It's really COVID that really put this rocket fuel on this, right? So, before COVID we'd been talking about this for a long time, but it was a slow train, and changes were being made but it was really COVID that accelerated it. And so, now we're really feeling it; “Hey, how come we don't have this?” Well, it's not that we don't have it, it's that we have it but we just need to do it in an orderly fashion.

All the players need to sit down and we need to look at the overall plan. We have some tools that are already in play. But now I think we need to sit down and go, okay, well, how do we integrate these together? And I think now we have to start looking nationally, because we've always looked provincially but, as you know, patients don't stay in one province. And that's something that we haven't traditionally looked at.

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Balogiannis: Justin Bates is the CEO of the Ontario Pharmacists Association.

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Justin Bates: We've long advocated for more digital electronic tools to ensure that there is that seamless transition of care and continuity of care. And it should be part of the standard of care in terms of the system having that access to a one patient, one record.

A central repository is so critical to ensuring that we reduce medication errors, that we have a holistic view of the patient as they go through their journey in the health care system.

I think our sector within health care is single-handedly keeping the fax machine business around, when you think about it. You know, my kids who are teenagers have never heard of what a fax machine even is. That just tells you how antiquated that technology is, and it's not very secure or efficient.

The pharmacy assistant or technician would enter the data, you have to transcribe that into the pharmacy management system software, but you do introduce the potential of human error when you're having to put that information in. So, having electronic, you know, makes perfect sense. And, in today's world where we're doing banking online and everything seems to be electronic, I find it still shocking that we don't have the solution implemented on both ends that, if we're looking at scope of practice and what pharmacists and physicians are doing, they can't do their job to the best of their abilities unless they have the tools — tools to be able to see and access information.

You need access to the whole picture of the patient in order to do it as safely as possible. So, I think that connectivity and the information being shared back to the physician is also important — it creates efficiencies, puts in more safety measures, and allows for health care providers to have a holistic view of that patient's health care. And it's in everyone's best interest to have an efficient and safe system particularly for medication management.

This is a slow rollout. The technology is there, it's just the will and the money to implement it and working collaboratively with each sector to make sure it's done successfully.

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Balogiannis: Dr. Mariam Hanna is a pediatric allergy, asthma and immunology specialist in Burlington.

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Dr. Mariam Hanna: Netcare in Alberta is 10 steps ahead. You can figure out patient compliance just from looking on Netcare, whereas here it's the stone ages in Ontario. I trained in Alberta, I showed up here in Ontario and I said, "What are you talking about?"

You see the challenges of implementation. I don't think Netcare was easy from day one, but the utility of it now is huge. Yes, tons of work. However, now that they are up and moving, they can't imagine their workflow without it.

You know, I know it's going to be painful. And every doctor I talked to here, they're like, it's good idea, but it's going to be a lot of work. However, just the prospect of what we can accomplish by doing this is huge; you're looking at a larger population here in Ontario, health information is created I don't know how quickly, the how much health information we create with every single interaction and encounter — so, to get all that moving into one system.

When I saw the uptake of virtual care during the pandemic, it's not perfect, however it made me extremely optimistic as to the population and physicians’ readiness to take on e-health. Just showing that that is doable. Will there be obstacles to it? I am sure. Will it make us better physicians, and will it utilize better health care dollars? I think so.

In the long term, I can't imagine it doing the opposite because we will be so much better informed. I just think it's an implementation hurdle to get through, but it's not impossible. And I think the longer, also, that we don't attempt, the worse off we're going to be.

I will schedule most of my consults to be about half an hour. I can even spend a full 30 minutes just in discussion, going through history, what has been done, and our next steps. We are relying almost 100% on patient recall. And this is where things can get lost or duplicated, or simply take time. By the end of that 30 minutes, that patient's chart isn't done, right? The encounter isn't done. There's still an hour's worth of digging around for either me or my admin or my nurse, or schedule the next appointment and then get them back.

Parents are so amazing in that some of them keep meticulous records because they are totally understanding that these systems don't communicate. So, they will come with folders, folders with every single thing as a hardcopy. And I find that the more medical encounters that patients have, or families have, the more likely that they are that they have a spreadsheet somewhere. So, they're communicating to you that they realize that our health information does not interact, and unless they put it in a binder that they bring from one visit to the next, you guys won't know.

My first goal is to get them an encounter where they have the answers by the end of it and to make their time efficient and my time efficient.

I have a day where I have blocked off – administrative day. I wouldn't need my administrative day if things were done, right? Like, then it would be another clinical day.

I hope that this is on people's radar and agenda and that they don't shy away from technology and the utilization of technology that, I think, that people are honestly going to be shocked at how much of a discrepancy and how far behind we are in health technology and health utilization. It's a priority in my books.

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Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. To learn more about the Ontario Medical Association, please visit oma.org.

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