This article is the fourth in a series exploring what a literature review reveals about the digital burden in primary care, why it matters and how we can rethink the relationship between clinicians and technology.
In May 2025, more than 40 clinicians and patient partners from across Quebec spent a day together in a room that looked nothing like a typical health-system meeting. Sticky notes lined the walls. Service blueprints covered the tables. There were no PowerPoint decks imposing a predefined solution. Family physicians sat beside pharmacists, physiotherapists, nurse practitioners and patient partners. For hours, they mapped the invisible workflows of primary care – every click, every handoff, every form. By the end of the day, one message was unmistakable: clinicians and patients are rarely asked in a meaningful way to help design the tools they are expected to use every day.
This was the Care for Tech co-creation day, an initiative supported by the Quebec College of Family Physicians, a section of the College of Family Physicians of Canada. After two years of work, the lesson is uncomfortable but clear: the solution to the digital burden described in the first three articles of this series is not more technology. It is a different way of deciding, developing and implementing the technology we already have.
Consulting is not co-creating
Our literature review confirmed that clinician involvement in design and decision-making improves usability and satisfaction. Yet in practice, clinicians and patients are more often consulted than included from the start – asked to fill out a survey, sit on an overseeing committee sometimes late in the process, or test tools after the key choices are already made. The gap is not primarily technical. It is a gap in governance.
This matters because technology now shapes every dimension of primary care – continuity, coordination, first contact and comprehensiveness – and has an impact on the five objectives of the Quintuple Aim – patient experience, outcomes, costs, clinician well-being and equity. When the people who deliver and receive care are treated as end-users rather than co-architects, digital systems reflect the priorities of processes that matter to vendors, administrators or policymakers, not the realities of the clinic or results important to patients and clinicians. The output is predictable: tools that look good in a demo but fail in a Tuesday afternoon appointment.
Design thinking: Putting humans back at the centre
Design thinking offers a different path. In practice, it means observing with empathy how people actually work, defining problems with humility from their perspective, and prototyping and testing solutions iteratively – with the very people who will use them. Its application in health care is well documented.
For primary care, the appeal is clear. Workflows here are not linear or standardized – they involve constant task-switching, relationship-building and complex reasoning under time pressure. Generic digital tools rarely fit this reality. Human-centred service design, grounded in design thinking methodology, puts the human back at the centre of the design process – not as a tested subject, but as a partner. It also means confronting a question the Care for Tech report flags as a blind spot in the literature: as AI enters primary care, what must remain to human judgment, and what can safely be delegated to the machine? Clinicians and patients must help answer that – not have it answered for them.
More resources alone will not solve the capacity problem in primary care: workforce shortages and training gaps cannot be resolved overnight. Investment in well-designed technology, co-created with the teams who use it, is one of the few levers that can genuinely expand team capacity – but only if it fits real workflows and answers real human needs.
Testing the approach in its own method
The Care for Tech project itself used a service design approach. Over more than 16 hours of virtual and in-person working sessions, a cohort of more than 40 clinicians and patient partners – from different regions of Quebec, different practice settings and different levels of comfort with technology – engaged in a rigorous co-creation process, facilitated by the service design cooperative Meilleur Monde and guided by an advisory committee. Family physicians worked alongside pharmacists, nurse practitioners, physiotherapists, nurses and patient partners, with parallel consultations involving digital health experts, vendors and policymakers.
The method made something clear: when clinicians and patients are given the time and structure to contribute as partners rather than respondents, they produce concrete direction.
A shared vision and a call to action
Through field interviews with clinicians, patients, primary care leaders and decision-makers, the Care for Tech cohort surfaced the concrete burdens pulling clinicians away from care and the systemic barriers blocking better technology in primary care. The co-creation work that followed – an in-person day anchored by input from an expert panel – translated that diagnosis into five Guiding Principles and, most importantly, three Action Pillars. A clear call for action for what digital transformation in the service of primary care must look like:
- Liberate health data for the common good – through participatory governance, genuine interoperability at the technical, semantic and human levels, and transparent patient access to their own data.
- Elevate digital standards – through provincial certification for quality and value, best practices in accessibility, usability and co-creation, and procurement that rewards clinical contribution and sustainability.
- Develop leadership and a technoclinical culture rooted in practice – by strengthening digital literacy, equipping clinicians and patients to steer digital transformation, and growing AI expertise in primary care that protects human judgment and patient agency rather than displacing them.
Practical tools, not just recommendations
Care for Tech didn’t stop at principles. The process produced usable artifacts: a detailed map of activities in primary care, a service blueprint that matches needs to possible technology solutions at each step of the workflow, an “ideal scenario” showing what well-designed digital support could actually look like in a clinic, and a list of the technologies primary care teams say they need. These are not wish lists. They move the conversation from principles to practice — a starting point, grounded in real clinical workflows, for developers, decision-makers and health-system leaders ready to build differently.starting point, grounded in real clinical workflows, for developers, decision-makers and health-system leaders ready to build differently.
What happens next depends on governance
Primary care is already digital. The question is no longer whether we invest in technology, but how we govern its development and implementation. If the digital burden is to ease and we are to reap the benefits, decisions about what to build, what to procure and how to implement cannot continue to be made without meaningful ongoing participation at all levels from clinicians and patients – the people who live with the consequences.
Human-centred service design is not a cure. It is a discipline – one that insists technology is not an end in itself. Service design starts with the human at the centre of real clinical work — and builds the tools around that, not the other way around. Every hour a clinician spends fighting poorly designed non-interconnected interfaces is a valuable hour lost to listening, thinking and caring. Every patient who gives up on a portal is weakened. Poorly designed technology is not just frustrating. It is costly – in clinician time, in burnout, in care delayed or lost, and in medical errors. We cannot afford to keep building it this way.
Clinicians and patients are not simply users to be consulted. They are indispensable partners – co-architects of a digital transformation that serves care, not the other way around. The Care for Tech report and its tools are freely available at soignonslatech.ca for anyone ready to start.
The authors are involved in Soignons la tech (Care for Tech), a national initiative funded through a competitive grant launched by the Canadian Medical Association in collaboration with Scotiabank and MD Financial, to address administrative burden in health care. The initiative is led in collaboration with the Collège québécois des médecins de famille. Dr. Élise Boulanger is the owner of a primary care clinic (Clinique Indigo). The authors declare no other financial or commercial conflicts of interest related to the content of this article.
