Mark Goldberg

Fox Group Dispatch

Driving innovation in healthcare

Earlier today, Paul Lepage [President, TELUS Health] spoke at the Toronto Board of Trade about “Hearing the patient: How people, innovation and technology are transforming healthcare.”

A number of times in the past, I have written about opportunities for improvement that we should be able to implement in Canada’s healthcare system, such as:

At the Board of Trade, Paul shared some of the things TELUS Health has learned from its work in digital health solutions:

  • Surveys show patients want digital health solutions, but there is a gap between patient expectations and the solutions available to them.
  • Patient appetites for more digital health solutions are validated by looking at usage patters on today’s solutions.
  • Mobility is key

While the past 5 years have seen physician adoption of electronic health records double from 40% to over 80%, he suggests that “if we want to really drive transformation in healthcare, we need to get the different parts of the ecosystem to talk to each other, collaborate, and evolve the way patients and all healthcare providers interact.” TELUS Health has been involved with the Canada Health Infoway to deliver a national electronic prescription solution, trying to tackle the challenges of prescription errors and costs for prescription renewals. And TELUS Health has introduced MedDialog, a secure messaging platform for healthcare providers, enabling them to communicate and conduct digital patient consultations, sharing notes and providing referrals.

How do we drive more innovation in healthcare? He described drivers for TELUS Health that really could apply in any market:

  1. Ensuring funding for companies:
    • Since 2001 TELUS Ventures has invested in over 50 companies and has close to 25 in its portfolio today
    • TELUS Health plans to invest over $750M over the next 5 years
  2. Market access
    • TELUS Health is creating an ecosystem for smaller companies, leverage its customer base via the TELUS Health Exchange
  3. Availability of talent
    • TELUS Health has about 2000 people working on health IT
    • TELUS Ventures Bench provides companies in the TELUS Ventures portfolio with access to TELUS leaders with varying skillsets to act as advisors
  4. Appropriate regulatory frameworks
    • Making sure that the healthcare systems encourage the right behaviours to drive innovation
  5. Tolerance for failure
    • Recognizing healthcare is complex and evolving, like the regulatory and political context in which it operates
    • Innovative firms extract the “tuition value from failure”, celebrate it, and move on

In the past year, with friends, colleagues and family members, I have had too many interactions with healthcare providers in clinics, hospitals and doctors offices in Canada, the US and Israel. In his talk, Paul Lepage referred to innovations in health IT being deployed by Clalit Health Services in Israel, a leading group that is now delivering more than 60% of their pediatric consultations on-line. I have seen first hand the excellence in service delivery at Clalit.

Some of the ways we do things make me shake my head and wonder if executives at our hospitals are taking enough time to observe first hand how patients are being treated from the time they enter the campus. As I have said about communications companies, if employees and executives aren’t being treated like the general public, change the way you handle internal accounts immediately. Hospitals, retailers, communications firms alike need to see how your customers are being handled.

Each negative interaction represents an opportunity for innovation in our healthcare system. Each innovation represents an opportunity for improved processes and systems. Each improved process represents an opportunity to deliver better patient outcomes with significantly lower costs.

As Paul said in his concluding remarks, to drive innovation goes beyond technology. It requires changes in people, policies and processes. Implementing those changes may be the biggest challenge in transforming delivery of healthcare in Canada. Indeed, finding the leadership, recruiting and retaining the people to effect those changes, may be the biggest challenge for Canada’s national innovation agenda.

Wringing efficiencies from improved e-Health

Sometimes, you just have to shake your head at the inefficiencies that plague our health care system.

My wife’s doctor called, asking her to get one of her blood tests redone. They asked her to stop by the office to pick up a lab order to take to the lab. I suggested that she call them back to ask if they could fax the form to us to save a trip. The receptionist said “the form is here for you to pick-up.” After a few rounds of “yes, but could you fax it to me”, my wife made the 45 minute round trip, only to be told (by a different receptionist) that yes, it could have been faxed. That would have been better for the environment, less stress for my wife driving in rush hour traffic and more time with visiting grandchildren.

Faxing the lab order would have given my wife the benefit of 35-40 year old technology.

Of course, one might ask why we need paper at all. Why isn’t there a digital requisition sent from the doctor to the lab of our choice?

Gigabit internet access to every home isn’t going to improve the efficiency of health care delivery if we can’t get basic processes moved online.

I continue to wonder if the people in charge use the same abusive processes that we regular folks endure.

Maybe our grand e-Health strategy is trying to do too much at once. Like I have said before about smart cities, “Building a smart city means creating a culture that works to make the community a little bit smarter every day.”

There are huge opportunities for cost savings and improved accuracy if we can commit to fixing one silly paper process at a time.

Adopting technology to manage your health

While 89% of Canadians believe digital health technology will lead to better care, at least 85% report missing out on technology that would help them take more control of their personal health. That is one of the findings of the TELUS Health Digital Life survey, released yesterday.

Canadians ranked personal banking (75 per cent), social media (51 per cent) and shopping (50 per cent) among the most important things they do online, while fewer than half of Canadians (48 per cent) ranked access to personal medical records as one of their top online activities.

Only 15 per cent of Canadians reported conducting any kind of health-related activity online. At least half are unaware of electronic services that are available to them through medical offices, health clinics, labs or pharmacies in some parts of the country. Just 14 per cent of Canadians surveyed have viewed lab results online and 61 per cent reported that they didn’t even know that it was possible to do so.

It has been a number of years since I wrote about eHealth initiatives, somewhat surprising since so many members of my family are involved in all segments of the health care sector.

How can we increase adoption of digital technologies among health care providers and users?

Hélène Chartier, Vice-President, Go-to-Market, Strategy & Enablement at TELUS Health says:

We see three main contributing forces that need to work in tandem to accelerate the adoption of Health IT tools: First, the public sector will require strong political will and openness, not only to redefine success but also to collaborate with the private sector. Second, the industry needs to be agile and open to adopting third party innovations quickly and effectively, redefining traditional partnership models and giving way to more “coopetition.” Third, for individuals, patients and consumers, a mix of awareness, education and self-empowerment is required to shift people’s behaviors to focus on proactive healthcare and how they hold our healthcare system and themselves accountable for better outcomes.

The Digital Life survey found 80% of Canadians agree that electronic medical records (EMRs) provide accurate information to doctors about their patients, and 75% believe EMRs help doctors diagnose patients more effectively and more efficiently. Seventy-one percent feel that EMRs allow for safe and secure sharing of medical information between patients, pharmacists, other doctors and specialists. More than 4 out of 5 respondents agreed health information should be shared digitally between doctors and pharmacists, and three quarters agree that electronic prescriptions would help reduce medical errors.

Regional results are available for Western Canada and Quebec. According to the CRTC’s 2015 Communications Monitoring Report, Quebec has lower than average adoption of internet, yet the Digital Life study shows Quebec has Canada’s most active users of digital health technology.

At 90%, Canadians in Western Canada are just behind Ontario (92%), in believing digital health technology will lead to better care, while in Quebec, 85% share that optimism. Still 21% of Quebecers reported some kind of online health-related activity, 50% better than the national average of just 15%. Nearly four times as many Canadians believe in the value of digital health technology as the number that actually make use of them.

When we look at increasing Canadians’ adoption of digital health technologies, it may be worth exploring what factors are driving higher rates of their use in Quebec. There is a certain “je ne sais quoi” that needs to be understood.

Powering health modernization

TELUS is teaming up with Microsoft to launch Health Space, letting Canadians securely manage and store their personal health information.

Microsoft Canada president Phil Sorgen is quoted saying:

This marks the first international deployment of Microsoft HealthVault, which accelerates the move toward an online, patient-centric healthcare system, and which will improve the health and wellness of our country’s citizens.

A couple months ago, I wrote about Walmart’s entry into e-Health, powering the upgrading of doctor’s offices.

Phil Sorgen is delivering the keynote address at the end of the first day of The 2009 Canadian Telecom Summit on Monday June 15.

A Walmart approach to eHealth

WalmartLast week, I wrote about the slow pace of adoption of electronic health records by Ontario’s private physicians.

A colleague pointed out a recent article in the NY Times about Walmart marketing a digital health records system through its Sam’s Club division, which recently announced its exit from Canada.

The Walmart system is bundling Dell’s computers with an application from eClinicalWorks.

will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year

The Times story says that health technology suppliers have found it costly to sell to small physician offices because even though they represent a large market, they are scattered. Enter Sam’s Club.