I’m Getting Excited for e-Health!

By Dr. Trevor Jamieson

As the lead for Virtual Care at the Women’s College Hospital Institute for Health System Solutions (WIHV) and the Medical Director for IT Implementation and Innovation at St. Michael’s Hospital in Toronto, I spend a lot of time thinking about the future of healthcare technology – especially from the points-of-view of patients.

Back in 2014, a group of us at WIHV held a symposium where we defined “virtual care” as “any interaction between patients and/or members of their circle of care, occurring remotely, using any forms of communication or information technologies, with the aim of facilitating or maximizing the quality and effectiveness of patient care”. As our local experience with virtual care has grown, through technological assessments of small and medium sized enterprises building innovative tools for the system (stop by RF02 on May 28 at 11:33, by the way, to see my colleague at WIHV, Bailey Griffin, present on our assessment framework) and through our multi-center evaluations of patient-facing tools,

I have grown to appreciate that fully realized “virtual care” provides three core things: 1) Access, 2) Integration, and 3) Advanced Analytics.

While access, for many good reasons, especially in the geographically challenging Canadian landscape has been the first-mover of the three, and while data analytics, thanks to the ubiquitous presence of Googles and Amazons, has captured the imaginations of nearly everyone, it is heartening to see more and more people tackling integration – perhaps the most challenging of the three.

While data interoperability may be the first thing that comes to mind when one talks integration, “integration” to me represents something much more. When you provide a patient-facing virtual care tool to a patient, whether it’s a device to facilitate administrative tasks like scheduling, a tool for greater communication with their healthcare team, or a tool do real-time measurement and feedback, you are no longer in the comfortable confines of hospitals, clinics and institutions – you are truly in the patient’s space now.  The patient exists in this complex intersection of home, community, ambulatory and (multiple) institutional services, and they travel between them continuously. They exist as well at a complex intersection of healthcare and non-healthcare existences – and relatedly, healthcare and non-healthcare technologies (and their non-healthcare technologies typically have a big head start!).

I’ve often used the analogy of smart homes like Samsung’s SmartThings, Amazon’s Echo, Google Home, Apple’s HomeKit or “works with Nest” to describe what I see this integration looking like someday – a seamless “workflow” supported by connected smart devices that support a tailored and personalized existence. I would be remiss if I only applied this vision to patients – clinicians too face similar challenges with workflow integration and will too benefit, in my view, from a similarly personalized existence.

At eHealth, I’m seeing multiple presentations and posters that are tackling aspects of contextual integration: in e-Poster session 1 on May 28, we have posters on a smart homes concept for inpatient psychiatry by Cheryl Forchuk and the use of novel tools to streamline clinical workflows by Gloria Clark-Trithart; e-Poster session 2 contains a talk on smart hospitals by Zoltan Szalay;  and I’m also curious about Amrit Brar’s talk on the use of a digital proximity-based app for identifying patient risks in RF01 (Innovation is No Longer an Option in Digital Health).  PS02 (Patient-Centric Solutions), including presentations on using secure communication to drive connected care and the move towards “convenience” in healthcare delivery has also piqued my interest. On May 29, we have posters about home monitoring (Heather Harps, e-Poster 3), real world insights about patient experience using an app (Renee Willmon, e-Poster 3), a personalized mobile platform for pediatric emergency departments (Patrice Roy, OS17), and patient interfaces to enhance transitions (Marzena Cran, OS20).

Integration to me is about moving towards a seamless existence linked by devices, data, and, of course, people, as those in the system transition perpetually across the boundaries of traditional silos (with home and community being the most traveled).  Doing this means getting us closer to what “health” has always meant – as something that is less defined by diseases and treatments, and something that is more defined by function and interaction, and, well, a uniquely experienced existence. I truly believe virtual care – by providing access, by integrating the patients’ (and clinicians’) many existences into a unified whole, and by leveraging data intelligently – is the path to follow to get us there.