ABSTRACT
Digital health has become an increasingly essential component of a high-performing health system. Changes to health care delivery during COVID-19 highlighted the need to enable digital health and modernize health information systems. Canada needs a national approach to digital health to enable our health care system to operate effectively in the 21stcentury. The current siloed approach limits the ability of patients to benefit from digital health and of health institutions to integrate digital tools. A unified approach to digital health will enable Canada to offer a health care system commensurate with the expectations of all Canadians. This paper details five policy positions to promote this unified, digital health infrastructure in Canada. 1. Patient Data Access is Essential: Patients should own their own data. They must be given access to their data upon request in a computable format, without charge or delay. 2. Data Movement and Data Sharing is Imperative: Digital data sharing is both a key component of digital health and a crucial enabler of digital health, but it is currently poorly supported. Canada must develop a uniform data interoperability strategy aligned with international standards. 3. Digital Health is Care: The provision of digital health is now embedded in our health care delivery. Canada must formalize the inclusion of digital health as an essential element of our public health system. 4. Digital Health must be Inclusive: All Canadians are entitled to an equal opportunity to participate in digital health. 5. A Federal Approach is Critical: We need a national, collaborative approach to solve the innovation drag caused by our approaches to evaluation, procurement, and privacy/security. Our current siloed approach disadvantages the Canadian health care system, the Canadian population, and Canadian industry. We suggest tangible next steps that leverage data to improve care, promote digital health care for those who need it most, and help Canada become a world leader in digital health innovation that directly benefits Canadian residents and grows our digital health industry.
ABSTRACT
BACKGROUND: Comprehensive multi-institutional patient portals that provide patients with web-based access to their data from across the health system have been shown to improve the provision of patient-centered and integrated care. However, several factors hinder the implementation of these portals. Although barriers and facilitators to patient portal adoption are well documented, there is a dearth of evidence examining how to effectively implement multi-institutional patient portals that transcend traditional boundaries and disparate systems. OBJECTIVE: This study aims to explore how the implementation approach of a multi-institutional patient portal impacted the adoption and use of the technology and to identify the lessons learned to guide the implementation of similar patient portal models. METHODS: This multimethod study included an analysis of quantitative and qualitative data collected during an evaluation of the multi-institutional MyChart patient portal that was deployed in Southwestern Ontario, Canada. Descriptive statistics were performed to understand the use patterns during the first 15 months of implementation (between August 2018 and October 2019). In addition, 42 qualitative semistructured interviews were conducted with 18 administrative stakeholders, 16 patients, 7 health care providers, and 1 informal caregiver to understand how the implementation approach influenced user experiences and to identify strategies for improvement. Qualitative data were analyzed using an inductive thematic analysis approach. RESULTS: Between August 2018 and October 2019, 15,271 registration emails were sent, with 67.01% (10,233/15,271) registered for an account across 38 health care sites. The median number of patients registered per site was 19, with considerable variation (range 1-2114). Of the total number of sites, 55% (21/38) had ≤30 registered patients, whereas only 2 sites had over 1000 registered patients. Interview participants perceived that the patient experience of the portal would have been improved by enhancing the data comprehensiveness of the technology. They also attributed the lack of enrollment to the absence of a broad rollout and marketing strategy across sites. Participants emphasized that provider engagement, change management support, and senior leadership endorsement were central to fostering uptake. Finally, many stated that regional alignment and policy support should have been sought to streamline implementation efforts across participating sites. CONCLUSIONS: Without proper management and planning, multi-institutional portals can suffer from minimal adoption. Data comprehensiveness is the foundational component of these portals and requires aligned policies and a key base of technology infrastructure across all participating sites. It is important to look beyond the category of the technology (ie, patient portal) and consider its functionality (eg, data aggregation, appointment scheduling, messaging) to ensure that it aligns with the underlying strategic priorities of the deployment. It is also critical to establish a clear vision and ensure buy-ins from organizational leadership and health care providers to support a cultural shift that will enable a meaningful and widespread engagement.
Subject(s)
Patient Portals , Caregivers , Data Accuracy , Health Personnel , Humans , OntarioABSTRACT
Institute staff members are subject to a strict conflict of interest policy. The COVID-19 pandemic has forced the health system to re-evaluate the costs of physical contact (CoPC) because of the material risk of viral transmission to providers and fellow patients, the scarcity of personal protective equipment (PPE), and increased cleaning costs. In this context, the pandemic represents an opportunity to substantially redesign healthcare delivery in Canada, making it more patient-centric and cost-effective, while substantially reducing the costs of physical contact borne by patients and healthcare providers alike. The COVID-19 pandemic has forced the health system to re-evaluate the costs of physical contact (CoPC) because of the material risk of viral transmission to providers and fellow patients, the scarcity of personal protective equipment (PPE), and increased cleaning costs. Virtual models of care have been developed to meet these challenges;however, these models need to be situated in an approach to care that is equitable and oriented toward enhancing the health of populations.1 Doing so requires co-designing long-term solutions with patients, building trust among providers, and working with governments to establish sensible policies that will ensure the sustainable use of virtual care long-term.