It’s time for the provincial government to get out of the way of smart, cost-effective communication between doctors and their patients.
At a time when surgeons can perform Internet-enabled operations that make the physical distance between the doctor and the patient immaterial, how is it possible that Nova Scotians can’t simply email their physicians to schedule appointments or renew prescriptions?
For eight years, the co-operative sector (co-ops and credit unions) has been quietly pitching a plan to the province’s health-care bureaucracy that would empower physicians to digitally enhance the administration of their practices to allow them to focus on what they do best: help sick people get better. The effort would, at the same time, give patients greater control and greater responsibility for their own healthcare. The response?
Disinterest and disdain. The promise on new approaches and commitment to supporting innovative ideas served up by Stephen McNeil during the election campaign has not materialized. Yet we remain hopeful.
A decade ago, Nova Scotia took a leading role in the effort to digitize X-rays and CAT scans that provide all partners in patient care timely access to critical images. Today, bureaucrats stubbornly refuse to apply the same kind of advanced thinking to resolving simple administrative tasks that result in crowded waiting rooms, delayed diagnoses, errors from mishandled laboratory results and trips to the doctor’s office that waste patient time and unnecessarily drive up travel-cost reimbursements.
Healthconnex is a patient-centric healthcare portal that connects patients and doctors securely online. Patients are able to connect with their doctors and receive services such as online appointment booking, e-consultations and prescription renewals. An iPhone app, recently approved by Apple, will allow patients to leverage sensors and information within their iPhones and deliver additional medical-related information (like heart rate and activity levels) to the doctor.
We believe patients who receive laboratory test results electronically, at the same time as their doctor, represent a critical check that ensures important test results are not overlooked. In response to a recent Harris poll that found one in six people had experienced a medical mistake related to missed and delayed diagnosis, the National Patient Safety Foundation recommended engaging patients on multiple levels to become “co-producers of safer medical diagnosis.”
Patients have a right to their own health information, delivered in ways that the patient and clinician feel is appropriate. Governments are not the owners of an individual’s health information.
Nova Scotians want better control of their health care. A fall 2014 survey carried out by Corporate Research Associates showed public support for access to healthcare services electronically (an online clinic) and a willingness to pay a modest amount for it as an uninsured service, if necessary. In a different survey, employers showed interest for access through an enhanced group benefits plan. We also heard from young doctors keen to deliver services virtually.
Buoyed by the results and still willing to try to cajole the clay feet within the Department of Health into action, we created a new technology platform called “Virtual Wards” that allows patients to be cared for in their own homes, by their care team, rather than in hospital wards. That is consistent with government policy supporting health care that keeps seniors in their home longer. Research shows that the rate of re-admission to hospital is lower when patients are cared for in this way, so we asked the Department of Health to do a pilot project. We offered to cover the entire cost of the program if it didn’t deliver results.
Their response was typical: we like the idea, but we don’t have the medical or technical capacity. We are unfolding our new strategy and are not ready. Let us know what the results are from the other pilots. There are too many data security concerns and potential hidden costs. In other words, they want to be followers and not leaders. This government is a slave to a health bureaucracy that is risk- and innovation-averse.
HeathConnex is owned and financed by the province’s co-operatives and credit unions. We have invested over $5 million (no government money) to develop the system and have 300,000 co-op and credit union members ready to take advantage of the service as a privilege of membership. We have a relationship with the majority of family physicians in the province. We continue to shake our heads in disbelief as the province pays the equivalent of $60 for every 811 call to an anonymous nurse but balks at paying $35 to doctors who know the patient file and are willing to do e-consults.
We are offering a people-owned and financed solution. Our participation in health care should not be restricted because we are outside “the public system.” We refuse to be painted as a big, bad private-sector player who wants to rape and pillage the health-care system just to line shareholders’ pockets.
In the coming weeks, the Atlantic Institute for Market Studies (AIMS) will be hosting a number of public meetings focused on ensuring Nova Scotians have a larger role in their own health care, including greater access to their own information. This should be an unnecessary debate, but we are ready to make the case again.
Some patients in California have been able to email their physicians since 2004. Isn’t it time we had the same opportunity in Nova Scotia?
Dianne Kelderman is president and CEO of Healthconnex. Dr. David Zitner is a family physician and a professor in the Dalhousie University faculty of medicine.