Canada is still ‘flying blind’ when it comes to using technology to deliver health care

Hey there, time traveller!
This article was published 13/07/2021 (1905 days ago), so information in it may no longer be current.

Although it can sometimes seem as if digital technology has fully saturated every aspect of our lives, there are plenty of sectors that, in fact, barely use it.

There’s a pretty wide spectrum, from early adopters such as finance, professional services and media, to industries like agriculture and hospitality that could be considered holdouts.

Until recently, the health-care industry has generally occupied a position on the lower-tech end of the scale. Things are changing quickly, however, especially over the past 15 months, which saw the pandemic accelerate the digitization of health care.

“It’s not that the technology advanced profoundly during the pandemic,” says Dr. Michael Anderson, a researcher at the Waakebiness-Bryce Institute for Indigenous Health, part of the Dalla Lana School of Public Health at the University of Toronto. “I think it’s the management and social structures that changed. All sorts of things have been possible from a technological perspective for a long time, but there wasn’t ever the willpower.

“The human component was very slow to change,” continues Anderson, who is also chief medical officer at Verto Health, a health-care technology company. “Necessity unlocked the potential that was already there.”

Despite a flurry of modifications to the way certain services are delivered, and several attempts to upgrade data collection and management during the pandemic, many analysts and stakeholders are warning that we have a lot more to do — and that the need is urgent.

“We likely, as a country, have the worst health data system in the OECD,” says Steven J. Hoffman, professor of global health, law, and political science at York University, referring to the Organisation for Economic Co-operation and Development and its 38 member countries. “I think we derive great strength from being a federation where health care can be tailored differently according to each province’s needs, but there are certain downstream consequences of that approach that have not allowed us to have the kind of national public health system that we desperately need to address public health emergencies of various kinds.”

Strangely enough, we saw this coming long ago. After the 2003 SARS outbreak in Canada, the federal government invested in an initiative to implement Panorama, a national health data surveillance system. Unfortunately, spiralling costs and unexpected hurdles (including defective software from the contractor, IBM) sank the project, prompting some provinces to opt out. The long and the short of it was that when SARS-CoV-2 hit, Canada was hardly any better prepared than it had been nearly 20 years earlier.

“A lot of the time, what this means is that we’re flying blind,” Hoffman says. “I’ll give you an example. We don’t actually know how many people have died in Canada from COVID-19.”

That seems like a basic thing we ought to know. We won’t, however, have publicly available, confirmed national “excess death” data for two years. Since data has been the backbone of epidemiology ever since chemist John Snow mapped out a cholera outbreak in 19th-century London (to help prove that it was spread through contaminated drinking water), this is a serious problem.

Good data isn’t only useful in managing infectious disease outbreaks, though; this is about more than the pandemic. Data is also an invaluable public health tool for evaluating health inequalities among different populations. And on an individual level, the lack of a national, streamlined digital approach has left patients frustrated, and made it harder for physicians to make diagnoses and treatment plans.

“Our records are conglomerates of files that are somewhere between all the different doctors and other health care professionals whom we have seen, and the hospitals and clinics that we’ve visited,” says Hoffman. “Today’s technology should allow us to bring that all together and let citizens access their health information as easily as we access our bank accounts, yet we’re very far from that reality.”

Patients would have an easier time navigating their own health-care journey and, at the same time, it would help physicians give better care. As it stands, it’s often easier for a family doctor or a specialist to order a second test like an MRI or CT scan than it is to track down one that was administered at, say, a hospital a couple of weeks earlier. And if they can locate it, the results are often delivered via fax.

The challenge of tracking the medical history of even a single patient, especially if it’s someone with a complicated case that involves a team of doctors with different specializations, is so difficult that there’s an increasing “signal-to-noise” challenge, explains Anderson.

“Our modern systems are databases that can be used to store endless data, but endless data just gives me endless noise,” he says. “I need to find the signal in that and that’s not something you can do manually. That’s why I think we need to find a way through digital tools to detect the signal, so we don’t miss important things in the increasingly complicated management of cancer treatment.”

These are all slightly different issues and represent different priorities for different stakeholders. They all, however, could be answered by an ambitious multi-platform, hybrid health-care system that utilizes artificial intelligence to help sort through the data and improve access for patients.

The pandemic might have brought these issues to the forefront, but figuring out appropriate digital strategies is key to the long game. If the stakeholders can agree, it’s an invaluable tool that can make health care better for everyone.

If asked to list a few good things about this country, a lot of Canadians would list universal health care. A proper, cohesive digital strategy that helps fix health inequality could be a piece in the puzzle for trying to set a better course for the future.

Now we have to see if we have the political will to make it happen.

Christine Sismondo is a Toronto-based writer and contributor to the Star. Follow her on Twitter: @sismondo