This article is a part of the ‘Technology, transformation and health care” series created in partnership with AMS Healthcare. These solutions-focused articles will focus on emerging technologies and their potential for transformational change in our health-care system.
As a registered nurse, an associate professor at the University of Saskatchewan and a researcher focused on patient-oriented health informatics, Tracie Risling was excited to move to Alberta in 2021 for a position at the University of Calgary. Two years earlier, the province had launched Connect Care, an Alberta-wide electronic medical records (EMR) system.
But even now, says Risling, “in some ways, it’s still dis-connect care because, as of yet, it is not connected back to the primary-care practices.” Connect Care enables health data sharing between providers who are part of Alberta Health Services, she says, but “not to the primary care offices and practices.”
Across the country, even provinces like Alberta that have invested heavily in updating their health informatics systems have yet to create (EMR) systems that connect the acute-care system with primary-care clinics in their provinces.
This lack of data connecting the acute-care system with primary-care clinics not only creates more administrative work for health-care workers, but also results in poorer health outcomes for patients, sometimes with fatal consequences. Greg Price, a mechanical engineer living in Alberta, died of testicular cancer in 2012. A year after Price initially brought up concerns with his doctor, he was referred to a specialist who didn’t contact him for three months. By that time, Price’s cancer had spread to his abdomen. In the last three months of Price’s life, he saw 11 doctors, with little to no communication between them.
“That’s about a disconnect between primary care and acute care,” says Risling. “That story tells the problem and the risks that occur in disconnected care.”
Justin Wolting, manager of product development and innovation for the eHealth Centre of Excellence, a not-for-profit organization that develops digital health tools and services, says the information health-care professionals need to provide good care is often siloed into systems that don’t communicate with each other.
“We often are using things like faxing, old technologies, in order to communicate back and forth, which can result in lost information and miscommunication and ambiguity,” says Wolting.
Wolting says there are numerous stories of people showing up to a clinic or hospital and being surprised that the nurses and doctors don’t have access to past test results. By streamlining referral and consulting systems and automating data entry, the developers and engineers at eHealth are aiming to ensure that as patients move through the health-care system, their information follows them.
Enter eHealth’s Sharon bot, an automated computer program that synchronizes and shares care-plan information between primary-care and home-care providers. “These were two sort of disparate systems that had the same information in two different places but weren’t talking to each other,” says Wolting.
But for that information to be shared effectively, data in EMRs needs to be standardized. The methods physicians use to input information into EMRs was adapted from the patient notes physicians take with pen and paper, thus many EMR systems have an open text box to input patient symptoms, diagnoses and care plans. Wolting says that though this may seem intuitive for physicians, it’s a nightmare for coding.
When data is standardized, patients with the same diagnosis can easily be grouped together, sorted and searched; it’s also easier for physicians to keep track of which patients have received care or outreach following tests. Additionally, toolkits that assist physicians with patient care and decision-making can be automatically loaded onto a patient’s profile.
“Standardizing your data is really the bedrock,” says Wolting. “Everything you need builds off of that.”
However, physicians are often strapped for time with patients and already spend an average of 10 hours a week on administrative tasks. Expecting staff to go into medical records after appointments to clean up data would only add to that administrative workload.
To solve this issue, eHealth developed the Cody bot, which goes into EMR systems after-hours and cleans up patient data. Wolting likens Cody to the robotic vacuums that clean the house when no one is home.
“Putting a bot in there is just so efficient and that can help alleviate a lot of those problems.”
Wolting says bots like Cody have been proven to reduce manual data entry for clinician offices. In one family health team, the bot saved staff 87 hours of manual data entry when updating patients’ medical records with their COVID immunization information.
“A lot of those tasks, especially the ones that are repeatable back-end pieces, are an administrative burden to clinicians and to their staff right now,” says Wolting. “Putting a bot in there is just so efficient and that can help alleviate a lot of those problems.”
Without updated vaccination data available on patients’ EMRs, Wolting says it would be difficult to identify patients who are considered high risk and thus strongly encouraged to be boosted or vaccinated. Information about a patient’s age, medical history and past vaccinations is crucial. Likewise, once antiviral treatments like Paxlovid became available, having easy access to patient information is necessary to determine which patients are good candidates for treatment.
Another aspect of eHealth’s pandemic response was inputting guidelines regarding long COVID into their EMR tools. Wolting says there was an immediate need for physicians to understand the myriad symptoms patients were dealing with.
“It was really important to get this information back into the EMR and give providers a tool to be able to understand and document some of the symptoms they were seeing from patients,” says Wolting.
Now, eHealth is working on another issue exacerbated by the pandemic: a delay in preventative care. With family physicians shifting their practice online and medical settings seen as areas of potentially high transmission, many people avoided seeking health care during the pandemic and are now years overdue for regular screenings and tests. Reaching out to hundreds of patients via phone or email is both time consuming and labour intensive, adding yet another task to heavy administrative workloads.
To help alleviate this backlog, eHealth and East Toronto Health Partners are developing a bot that will scan patients’ EMRs and identify those overdue for colorectal, cervical and mammogram screenings.
“The bot can send a direct message to a patient, and it prompts them to book an online appointment with their provider to come in for their test,” explains Wolting.
There are some challenges to implementing these systems into primary-care practices. The resources available to physicians and administrative staff vary considerably between practice types. Many practices also have their own established workflows so the technology needs to be flexible. EMRs that are poorly designed or don’t effectively fit into existing workflows have been found to contribute to physician burnout.
An often-overlooked piece of the puzzle is digital literacy. Risling says that many health-care professionals aren’t given enough training in digital health technology when they’re in school and don’t necessarily understand how to integrate this tech into their practice or how to advocate for its use.
“You can have the greatest interoperable technology in the world, but if people won’t pick it up, embrace it, understand how it works, and integrate it smoothly into workflows and help patients to understand its value and use it, then it’s not even scratching the surface of what it potentially could do for everyone involved,” says Risling.
Risling is hesitant to recommend an “app for that” approach to our health-care system’s persistent interoperability issues. Instead, she would like to see an all-in-one approach that produces something like a health data dashboard.
“What’s the path of least resistance to the best-connected digital health outcome?” she asks. “Every time we’re interacting with someone who is having an impact on our health, ideally, they should all be connected.”