Digital Health, the Pandemic, and the Opportunity to Transform Healthcare that we Cannot Miss

The Ontario healthcare system has been presented with an opportunity to transform itself during the pandemic. There are three significant and time-sensitive challenges that currently lay ahead of us. Each has a solution that if executed correctly, could become a very valuable digital health asset for the province, or even broader. These challenges are access to acute care, vaccine distribution, and service availability.

Access to primary and acute care

Access to emergency services has always been a challenge but it has become more apparent during the pandemic. CHEO was first to open a virtual entry point to their ER. Interest spread and since then several other hospitals released a similar process for their ER. This sounds like a win on the surface. It triages patients and might encourage hesitant ones to seek care. It also allows the ER to manage flow for increased safety.

I support these efforts, but there are two significant issues. First, these efforts should be linked up to one single patient interface. This way it doesn’t duplicate efforts across the province, improves patient experience, and creates a way to establish a digital relationship with many patients that can be leveraged elsewhere (read on). Second, these efforts should be able to redirect the patient back to their family doctor where appropriate with an actual appointment, predicated of course on a working relationship between the hospital and primary care.

This can become the starting point for a single patient portal for the province. It helps patients book appointments with their primary care clinic, or seek care through a local ER, be it physical or virtual. Triaging can be augmented through remote monitoring or video, and care kick-started through pre-visit materials and questionnaires. These ideas in themselves have been around for a while, and are all technically possible to solve. However, the pandemic has presented an urgent need that could attract the funding and broad cooperation required to achieve this.

Vaccine Distribution

There are two things November is known for: cold rain, and people scrambling between clinics and pharmacies chasing small, unpredictable inventory of flu shots. Execution of the flu shot campaign had to be better during the pandemic, both for population health reasons and as diligent preparation for the distribution of the COVID-19 vaccines. This year has proven no better than others, with vaccine providers uncertain about upcoming deliveries and if there would be enough for their patients.

The province must invest in a solution to manage inventory, pre-register patients, notify them in accordance with the provincially established pecking order, and maintain records of vaccination accessible to the patient. In fact, it could have done this months ago as there are companies based in Ontario that offer solutions for this already. Why haven’t we procured something, or set the data standard for different apps to build on? We could have leveraged the 6.6 million COVID-19 tests we’ve carried out to offer patients to register and be notified about the vaccine availability.

Investing in this piece of digital infrastructure is more important than ever and must be built. This would be easily scalable to other vaccinations such as childhood and occupational immunizations. Not only that, it would give patients access to their data, which could be made comprehensive.

Service Availability

Due to the pandemic, many clinics and services had to close, reduce hours, or restrict in-person availability at some point. Patients did not have an easy way to find out this information, leading to stories of patients delaying seeking care even if services were actually open to them. As a family doctor, it presented challenges as we didn’t know if services have remained open. Consider all the labs, imaging facilities and other health care providers we rely on to help our patients. It was a challenge, and remains so despite whatever information we have managed to gather.

Given that both patients and health care workers are struggling to navigate changes to service availability, it becomes more urgent that the province stitch together a single service directory that is actively kept current. This could soon be leveraged to advance e-consults and enable e-referrals, even blending the two into one process. The value of this is improved access to needed care, wait time data collected at source (as we did with ConsultLoop), and the safety benefits and patient inclusion opportunities that a digital process affords.

Weaving it Together

The pandemic has presented three significant challenges that not only call for a digital health solution, but could make the case for immediate provincial investment due to how urgent they are. The digital infrastructure created would provide incredible benefits: patients connected to care and their data at a single source; digitized options for booking appointments, making referrals and requesting e-consults; the vaccine distribution and management solution we’ve needed for over a decade. These assets would be more valuable if accessed through one common entry point, and even more so if the data were available with appropriate permissions so that third-party software could be built on it.

Of course, each solution involves a deep working relationship with primary care and patients, two groups who have been traditionally excluded from digital health planning. Building these relationships and executing on these ideas would take our healthcare system forward by decades, and expand the horizon of care models, quality and inclusion we can hope to achieve. This is possible if we collaborate a lot more as health system stakeholders, and establish organizational ownership of this endeavour.

This is not a time for action to be delayed because we can’t take a first step. The COVID-19 vaccines are imminently arriving, and with it, political interest will be lost. Ontario needs central leadership on these issues to create consensus and inclusion, to own the strategy, and to just start. Without this, we will falter. The bungled 2020 flu vaccine roll-out was a preview of what the future holds if we don’t see action.

We are in the midst of tremendous opportunity for digital health, and by direct relation, the health system and the quality of care it provides the people of this province. We must make the case for investment in these digital assets, and rally around a cohesive strategy to get results. Ideas are the easy part. The hard part is execution. It is incumbent on the provincial government to promote leadership on this matter, and ensure the success of what can be a generational achievement in health.

The future of our healthcare system — its financial sustainability, the quality of services it provides, and the manner in which it improves or exacerbates inequity — is hanging in the balance. We have enough lessons of good intentions that have gone awry. Now is the time to get it right.