ARTICLE

The evolving role of the patient and the future of digital health

 

The evolving role of the patient and the future of digital health

Rashaad Bhyat, MD, Mike Figurski, MD, and Asim Masood, MD

 

An increasing number of physicians are using electronic medical records, and core electronic health record data continue to become more available. However,  digital advances are also allowing patients to be more engaged in monitoring their own health. In response, physicians’ roles will change, often toward a coaching or partnership model.

 

KEY WORDS: digital health, electronic health record, electronic medical record, communications, patient-physician relationship

 

Note: Mention of proprietary names and products does not constitute their endorsement by the authors or publishers.

 

The story of digital health in Canada has taken many twists and turns over the years, but slowly, surely, we are approaching a point of critical mass. Rates of adoption of the electronic medical record (EMR) for all physicians rose from 23% in 20061 to over 80% in 2017.2 In some provinces, adoption rates for primary care physicians exceed 85%.2

 

In addition, the availability of core electronic health record (EHR) data continues to advance. Core repositories of important health information (including laboratory, diagnostic imaging, and drug information data) form the backbone of each province’s and territory’s EHR. Physicians can access more of this data in a timely fashion than ever before, although there is quite a bit of variability in the clinical settings in which these data are available.3

 

As physicians, we have more information available to us to inform our clinical decision-making than in the past. It’s not perfect, but it has improved. However, the story of digital health in 2018 really centres around the evolving role of the patient.

 

Increasingly, generations of Canadians favour text, instant messaging, and video (e.g., Zoom, Skype, Facetime, and social media video chats) as a means of communicating and want to interact with their physicians in similar ways.4 We know from annual tracking surveys that Canadians are keenly interested in accessing their own health care information.5 From our experiences with our own patients, friends, and family, we know how important it is to have timely access to health information at a time of crisis or increasing medical need. At some point in our lives, we are all patients, even doctors.

 

Entrepreneur Leonard Kish famously described the engaged patient in 2012 as “the blockbuster drug of the century.”6 Although this may be hyperbole, there is increasing evidence that patients actively engaged in their own health care may have improved health outcomes.7 Engagement can take many forms, including patients actively accessing their own health records and patients communicating with their health care providers in more modern ways.

 

As physicians, we must look beyond the hype of new technologies, and recognize that a paradigm shift is occurring with regard to patients’ access to their health information and patients’ desire to interact with physicians in modern ways. This shift has been accelerated by rapid changes in information technology that have made it possible to hold a very powerful super-computer literally in the palm of one’s hand. Top

 

The underlying technology is not the most challenging part of these changes. At our presentation in April 2017 at the Canadian Conference on Physician Leadership, for example, Dr. Mike Figurski and a patient in his practice demonstrated a fairly straightforward electronic visit.

 

Dr. Figurski leveraged secure two-way video communication technology built on an open-source platform to create a remote clinical consultation experience on a basic laptop. His patient emphasized how critical it was to her to have had remote access to both her medical records and to her physician at a time when she needed it most.

 

Like Dr. Figurski, innovative physicians and other health care entrepreneurs are redefining the realm of the possible in terms of how clinicians, patients, families, and those in the broader circle of care might interact with one another. Some are redefining the modern EMR, while others are enabling unique remote patient monitoring and telemedicine solutions, or creating modern digital platforms to interact with patients (e.g., Input Health, CloudDx, Healthmyself, Avocare, Mousecall MD, and others).

 

Change itself, however, is tough. For physicians to adapt to an evolving patient role and new expectations, significant change is required — change to policy around remuneration structures and practice models and change to support structures for physicians (such as Peer Networks8 and physician education). Navigating change is often the “elephant in the room” as physician leaders and health care system decision-makers discuss the potential adoption and integration of new technologies. Sometimes the process of change can be enhanced by using tools such as Infoway’s Change Management Framework.9 Top

 

As we approach 2020, patients will have increasing digital access to their health data, allowing greater engagement in their health. As patients’ roles evolve, so too will physicians’ roles, shifting toward a coaching/partnership model for some patients.

 

To realize the true transformative potential of engaged patients and aware physicians, all stakeholders in our health care system should recognize the need to support effective change processes. Physician leaders, acting as champions of change, will have an important role to play in highlighting and addressing this need.

 

References

1.Schoen C, Osborn R, Huynh PT, Doty M, Peugh J, Zapert K. On the front lines of care: primary care doctors’ office systems, experiences, and views in seven countries. Health Aff (Millwood) 2006;25(6):w555-71. DOI 10.1377/hlthaff.25.w555

2.Do you use electronic records to enter and retrieve clinical patient notes in the care of your patients? CMA workforce survey, 2017. National results by FP/GP or other specialist, gender. Ottawa: CMA; 2017. Available: https://tinyurl.com/ybt4qnrb

3.Gheorghiu B, Hagens S. Measuring interoperable EHR adoption and maturity: a Canadian example. BMC Med Inform Decis Making 2016.

https://doi.org/10.1186/s12911-016-0247-x

4.Bhyat R, Gibson C, Hayward R, Shachak A, Borycki EM, Condon A, et al. Implementing informatics competencies in undergraduate medical education: a national-level “train the trainer” initiative. In Shachak A, Borycki E, Reis SP (editors). Health professionals’ education in the age of clinical information systems, mobile computing and social networks. New York: Elsevier; 2017:347.

5.Connecting patients for better health: 2016. Toronto: Canada Health Infoway; 2016. https://tinyurl.com/y9983gg6

6.Kish L. The blockbuster drug of the century: an engaged patient. Health Standards; 2016 Aug. 28. Available: https://tinyurl.com/ybdfzg6k

7.Health policy brief: patient engagement. Bethesda, Md.: Health Affairs; 2013. Available: https://tinyurl.com/abev24j

8.Clinical peer network. Toronto: Canada Health Infoway; 2018. Available: https://tinyurl.com/y99mmvx6

9.A framework and toolkit for managing ehealth change: people and processes. Toronto: Canada Health Infoway; 2013. Available: https://tinyurl.com/ybvpxjjq

 

Authors

Rashaad Bhyat, MD, is a family physician and clinician leader on the Access Digital Health team at Canada Health Infoway.

 

Mike Figurski, MD, is a family physician and CEO of Vistacan, a health software company.

 

Asim Masood, MD, is an emergency department physician and the chief medical information officer for the William Osler Health System. Top

 

Correspondence to:

rbhyat@infoway-inforoute.ca

 

 

This article has been peer reviewed.

 

The evolving role of the patient and the future of digital health

Rashaad Bhyat, MD, Mike Figurski, MD, and Asim Masood, MD

 

An increasing number of physicians are using electronic medical records, and core electronic health record data continue to become more available. However,  digital advances are also allowing patients to be more engaged in monitoring their own health. In response, physicians’ roles will change, often toward a coaching or partnership model.

 

KEY WORDS: digital health, electronic health record, electronic medical record, communications, patient-physician relationship

 

Note: Mention of proprietary names and products does not constitute their endorsement by the authors or publishers.

 

The story of digital health in Canada has taken many twists and turns over the years, but slowly, surely, we are approaching a point of critical mass. Rates of adoption of the electronic medical record (EMR) for all physicians rose from 23% in 20061 to over 80% in 2017.2 In some provinces, adoption rates for primary care physicians exceed 85%.2

 

In addition, the availability of core electronic health record (EHR) data continues to advance. Core repositories of important health information (including laboratory, diagnostic imaging, and drug information data) form the backbone of each province’s and territory’s EHR. Physicians can access more of this data in a timely fashion than ever before, although there is quite a bit of variability in the clinical settings in which these data are available.3

 

As physicians, we have more information available to us to inform our clinical decision-making than in the past. It’s not perfect, but it has improved. However, the story of digital health in 2018 really centres around the evolving role of the patient.

 

Increasingly, generations of Canadians favour text, instant messaging, and video (e.g., Zoom, Skype, Facetime, and social media video chats) as a means of communicating and want to interact with their physicians in similar ways.4 We know from annual tracking surveys that Canadians are keenly interested in accessing their own health care information.5 From our experiences with our own patients, friends, and family, we know how important it is to have timely access to health information at a time of crisis or increasing medical need. At some point in our lives, we are all patients, even doctors.

 

Entrepreneur Leonard Kish famously described the engaged patient in 2012 as “the blockbuster drug of the century.”6 Although this may be hyperbole, there is increasing evidence that patients actively engaged in their own health care may have improved health outcomes.7 Engagement can take many forms, including patients actively accessing their own health records and patients communicating with their health care providers in more modern ways.

 

As physicians, we must look beyond the hype of new technologies, and recognize that a paradigm shift is occurring with regard to patients’ access to their health information and patients’ desire to interact with physicians in modern ways. This shift has been accelerated by rapid changes in information technology that have made it possible to hold a very powerful super-computer literally in the palm of one’s hand. Top

 

The underlying technology is not the most challenging part of these changes. At our presentation in April 2017 at the Canadian Conference on Physician Leadership, for example, Dr. Mike Figurski and a patient in his practice demonstrated a fairly straightforward electronic visit.

 

Dr. Figurski leveraged secure two-way video communication technology built on an open-source platform to create a remote clinical consultation experience on a basic laptop. His patient emphasized how critical it was to her to have had remote access to both her medical records and to her physician at a time when she needed it most.

 

Like Dr. Figurski, innovative physicians and other health care entrepreneurs are redefining the realm of the possible in terms of how clinicians, patients, families, and those in the broader circle of care might interact with one another. Some are redefining the modern EMR, while others are enabling unique remote patient monitoring and telemedicine solutions, or creating modern digital platforms to interact with patients (e.g., Input Health, CloudDx, Healthmyself, Avocare, Mousecall MD, and others).

 

Change itself, however, is tough. For physicians to adapt to an evolving patient role and new expectations, significant change is required — change to policy around remuneration structures and practice models and change to support structures for physicians (such as Peer Networks8 and physician education). Navigating change is often the “elephant in the room” as physician leaders and health care system decision-makers discuss the potential adoption and integration of new technologies. Sometimes the process of change can be enhanced by using tools such as Infoway’s Change Management Framework.9 Top

 

As we approach 2020, patients will have increasing digital access to their health data, allowing greater engagement in their health. As patients’ roles evolve, so too will physicians’ roles, shifting toward a coaching/partnership model for some patients.

 

To realize the true transformative potential of engaged patients and aware physicians, all stakeholders in our health care system should recognize the need to support effective change processes. Physician leaders, acting as champions of change, will have an important role to play in highlighting and addressing this need.

 

References

1.Schoen C, Osborn R, Huynh PT, Doty M, Peugh J, Zapert K. On the front lines of care: primary care doctors’ office systems, experiences, and views in seven countries. Health Aff (Millwood) 2006;25(6):w555-71. DOI 10.1377/hlthaff.25.w555

2.Do you use electronic records to enter and retrieve clinical patient notes in the care of your patients? CMA workforce survey, 2017. National results by FP/GP or other specialist, gender. Ottawa: CMA; 2017. Available: https://tinyurl.com/ybt4qnrb

3.Gheorghiu B, Hagens S. Measuring interoperable EHR adoption and maturity: a Canadian example. BMC Med Inform Decis Making 2016.

https://doi.org/10.1186/s12911-016-0247-x

4.Bhyat R, Gibson C, Hayward R, Shachak A, Borycki EM, Condon A, et al. Implementing informatics competencies in undergraduate medical education: a national-level “train the trainer” initiative. In Shachak A, Borycki E, Reis SP (editors). Health professionals’ education in the age of clinical information systems, mobile computing and social networks. New York: Elsevier; 2017:347.

5.Connecting patients for better health: 2016. Toronto: Canada Health Infoway; 2016. https://tinyurl.com/y9983gg6

6.Kish L. The blockbuster drug of the century: an engaged patient. Health Standards; 2016 Aug. 28. Available: https://tinyurl.com/ybdfzg6k

7.Health policy brief: patient engagement. Bethesda, Md.: Health Affairs; 2013. Available: https://tinyurl.com/abev24j

8.Clinical peer network. Toronto: Canada Health Infoway; 2018. Available: https://tinyurl.com/y99mmvx6

9.A framework and toolkit for managing ehealth change: people and processes. Toronto: Canada Health Infoway; 2013. Available: https://tinyurl.com/ybvpxjjq

 

Authors

Rashaad Bhyat, MD, is a family physician and clinician leader on the Access Digital Health team at Canada Health Infoway.

 

Mike Figurski, MD, is a family physician and CEO of Vistacan, a health software company.

 

Asim Masood, MD, is an emergency department physician and the chief medical information officer for the William Osler Health System. Top

 

Correspondence to:

rbhyat@infoway-inforoute.ca

 

 

This article has been peer reviewed.