Highlights from the Atlantic Region Virtual Conference

Now in its third year, Digital Health Canada’s 2021 Atlantic Region Conference took place virtually on Monday, October 4, 2021 from 12PM to 4:30PM ADT. Nearly 100 digital health professionals from across Canada participated in an afternoon of learning and networking, with a focus on activities in the Atlantic provinces. If you were unable to attend the Atlantic Region Virtual Conference, you can purchase access to the recordings of the presentations highlighted below in the Digital Health Canada store.

Digital Literacy in Healthcare: Equity and Access 

Presenters: Natasha Deshwal, Family Physician, Bedford Basin Women’s Health Clinic Inc.; Haley Armstrong, Senior Specialist, Engagement, Canada Health Infoway; Joanne Donahoe, Executive Director, Mental Health and Addictions, Health PEI; and Kevin Standing, Patient Experience Advisor, Patient Experience Advisor. Moderated by Gillian Sweeney, VP, Clinical Information Programs and Change Leadership at NLCHI and Atlantic Conference committee member.

Digital health literacy—a dominant topic these days— is defined by Canada Health Infoway as “the skills needed to search, select, judge, transform, communicate and use online health tools and information”. How can we raise digital health literacy levels across Atlantic Canada and how will that impact health?

Mental Health – Panelists agreed that virtual care had improved access to mental health and addiction services during the pandemic, as they continued to provide much-needed services in mental health and addictions counselling through telephone and Zoom consultations.. Client satisfaction surveys revealed that 100% of patients who participated in tele-psychiatry were satisfied or very satisfied.  Virtual care helps overcome travel, child-care, and scheduling barriers for some patients.

The one good thing to come out the pandemic has been a robust move forward with virtual care for patients. But it’s not for everyone, and some patients miss the face-to face with clinicians. We are still learning, but we have seen the value in increasing funding available for mental health and virtual healthcare. With any change there are growing pains and learning curves, but there are a lot of positives, especially in the mental health space.

Cellphones – Computer access is a challenge for many, but almost everyone has a cellphone. People go to their phones first. Canada Health Infoway is working through a patient digital health literacy program and making sure things are accessible by phone, but are also printer-friendly for those who are less comfortable with technology. But cellphones are a great tool for sharing this information. The cell phone offers a great opportunity to share info, and people learn in different ways: some people need to read instructions, some like to hear them. The cell phone provides those options. Our systems have to be built with this in mind.

Clinician and patient challenges – Does my patient have sufficient privacy? Do they have access to a computer or screen? Can we help them gain access? Do they have high-speed internet (90,300 homes in Nova Scotia do not have access to high-speed internet). Do they have access to a private space or will someone else be able to hear this conversation? Are all the programs built into our EMR? We must make sure we aren’t asking clinicians to do extra tech or login work that would take them away from their patients. Finally, we have to make sure all tools are available to all physicians. And that all physicians are compensated for the extra time involved in charting virtual visits and emails and the work that goes into preparing for them. If we want physicians to join us in the digital health landscape, we have to make sure we have invited them into the discussions involved.

Digital health literacy levels – As with any fast transformation, we are going to see spots of missing knowledge or a discrepancy in knowledge across the board. Not all Canadians are starting at the same literacy level and this needs to be acknowledged and addressed. To raise the collective literacy levels for patient/family caregiver communities, minority populations, marginalized communities, seniors, and people living in rural communities w\we need to first address awareness by sharing information about tools that are available for all Canadians. Then we can start to work on raising literacy levels to where individuals feel confident and take more agency to use tools and make more educated decisions for themselves.

Moving forward – We are a work in progress. It doesn’t make sense to wait until we have something perfect and totally mapped out and then decide to implement. We need to try things and assess afterwards what worked and what didn’t. We need to make regular check-ins to see what is working and pivot and ask – are we meeting your needs? We need to make sure that all the people at the table are the people who will be affected: patients, physicians, and especially, government – healthcare is highly legislated. Are we bringing to the table enough of the people who make the legislation? The policies sometimes come out after the horse has left the barn, and we need to bring those individuals into the discussion.

Internet capabilities are not consistent across the provinces. Some patients and providers are not comfortable with the use of telehealth. Speed of internet, access to technology, varying skills sets, forms that need to be signed – these all have to be worked through quickly. Constant evaluation is important to manage things like fear of the unknown, fear of technology. Patients with psychoses might not be comfortable on screen. We have to be careful that we don’t leave some vulnerable groups behind in the rush to online or virtual technology.

Atlantic Region Provincial Update

Presenters: Mary Slade, Director of eHealth Clinical Programs, Newfoundland and Labrador Centre for Health Information; Ashley Miller, Chief Medical Information Officer, Nova Scotia Health and IWK Health; Karen McCaffrey, Acting Executive Director, Health PEI; Jennifer Sheils, Chief Information Officer, Horizon Health Network

Representatives from the four Atlantic provinces are focused on expanding their digital health and virtual care systems and resources to assist citizens in becoming active participants in their healthcare management. Each province is working diligently to implement tools that will provide improved solutions for both patients and providers to access health documents and communicate securely. One item of focus seen across the provinces is the goal of implementing a digital health record system to ensure that a patient’s records can be accessed by all providers involved in the patient’s treatment.

All reported common experiences throughout the COVID-19 pandemic, noting that the pandemic response created a climate for some solutions to be implemented faster than they may have been implemented pre-pandemic, as decision-making had to be expedited. This expedited decision-making also created a dramatic shift in perception around the potential risks involved in virtual/digital healthcare management. Conversations about digital health in Canada prior to the pandemic focused primarily on risks surrounding privacy. With the onset of the pandemic, the conversation changed to determining how providers can continue to provide the greatest access to care, with digital solutions being at top of mind. All panelists agreed that virtual/digital opportunities are key in providing more patient-centered access to healthcare and look forward to expanding the digital and virtual health offerings in their provinces.

Opening the Digital Front Door for Patients

Presenters: Andrea Tait and Michael Craig, Orion Health

Orion Health’s Digital Front Door is a comprehensive virtual consumer engagement strategy and solution that provides access to healthcare services and opportunities to interact with healthcare providers. While it is a unified, user-friendly hub, it may look different in different jurisdictions. The platform allows users to integrate in a cohesive way with tools that already exist, with focus on health and wellness supports. Digital Front Door goals include:

  • Transitioning appropriate interactions to digital
  • Patient-centric health
  • Empowering the consumer
  • Personalize the healthcare experience to incorporate aspects of existing care record
  • Utilize machine learning, artificial intelligence, and analytics
  • Improve health equity and access
  • Simplify the challenge of navigating disjointed complex health systems
  • Provide effective and efficient health system access at the time and place convenient to the consumer
  • Provide access for specialized home-based programs (i.e. palliative care)

AI-powered components of the Digital Front Door include:

  • Symptom checker
  • Online chat
  • Wellness support
  • Best practice workflows
  • Telehealth
  • Scheduler
  • Call centre
  • Digital human
  • Health information
  • Disease management tool
  • Access to health information
  • Services navigator

Benefits of Digital Front Door include:

  • Secure hub for all care interactions
  • Improves consumer experience
  • Maximizes value of existing technology
  • Enables efficient use of healthcare resources
  • Helps address gaps in health equity
  • Streamlines end-to-end journey
  • Addresses the Quadruple Aim (Improving the patient and caregiver experience; Improving the health of populations; Reducing the per capita cost of health care; and, Improving the work life of providers.
  • Leverages jurisdictional assets (i.e., electronic health record, scheduling, eReferral, provider registry, etc.)

Digital Front Door is a journey and will continue to evolve over time; clients can choose to start with a few things and add functionalities over time. New Zealand client example: the client chose specific area/component that was a priority for that population as a starting point; they targeted scheduled surgical patients and post-op patients; used the Digital Front Door to interact with and track the patient transition.

Change and Resiliency in Healthcare

Speakers: Dr. David Petrie, Emergency Physician and Trauma Team Leader, QE2 Health Science Centre; Dr. Kendall Ho, Emergency Medicine Specialist and Lead, University of British Columbia; Dr. Shannon MacPhee, Associate Professor, Department of Emergency Medicine, IWK Health Centre and Dalhousie University.

Health care systems work as ecosystems and are constantly adapting to coevolve. Triple benefits exist to investing in resilience: better disaster response, less disruption of service or provider burnout, sustainable and resilient health system recruitment. Readiness in healthcare systems, staff structure and system capacities are very important and were stretched when managing the Covid response. There are gaps as patients transition between emergency care and primary care. The COVID19 pandemic has unleashed innovation particularly in primary care with the rapid adoption of patient centred approaches such as virtual care. Situational awareness is essential to system resilience. As leaders we must create diverse conditions for the emergence and enable change to avoid collapsing the system. We need to also understand who governs the rules around change and the system. Evaluation is very important, and the system needs to be scrutinized closely to identify if we need to improve the system or remove the system.

Relationships and understanding the behaviours that drive the systems is essential, how do we contribute to it, how do we bring our own antimony to it. How do we make sense of what others do, and the interdependence of it? The joint vision of how we improve, by using the data as a results-driven strategy, will help us to learn together, and grow a resilient health care system.