October 31, 2022

Notes from the 2022 Atlantic Region Conference

WRITTEN BY Digital Health Canada

By Event Correspondent Tanja Keselj, BCompSc, MHI, Senior System Analyst, IT Project Management Course Instructor, Member of Integrated Access and Flow Network Council, Nova Scotia Health

Digital Health Canada Atlantic Chapter Conference, held in Halifax on October 4th, 2022, was the first in-person Digital Health conference since the pandemic started.

It was a wonderful day where enthusiasm from both speakers and the audience was evident.

During the event, timely-themed Digital Health Literacy – The Patient and Provider Experience, speakers shared their diverse experiences and vision for the future.

Research shows that poor usability is the number one reason for low adoption rates of information systems. Usability is an umbrella term and encompasses anything that contributes to a good user experience. User-friendliness, speed, ease of flow, minimal amounts of clicks or screens, and meaningful default values, are some of the concepts we should consider when building digital solutions. Good usability is extremely important for users who fall in the patient or provider category. Solutions that do not make providers’ work easier are a cause of frustration. As Dr. Marsha Fearing said: “do not make a mouse click that will make a doctor quit medicine.” Digital Health Canada chose this important and time-appropriate topic as there is less and less tolerance for solutions that do not fix pain points, that take too long to load and operate, and that are too complex to understand and navigate for both patients and providers.

In his opening remarks, Mark Casselman, Digital Health Canada CEO, pointed out that we are living in a time when Canadians are engaging with the digital tools within the healthcare space more than ever, that there is a great momentum happening now where we have an opportunity to weave traditional health care with modern digital tools on our journey to provide the best possible and innovative health care for Canadians.

Keynote presentation – Digital Health Literacy and all-technology enabled practices by Dr. Krista Jangaard, President & CEO, IWK Health, and Dr. Christy Bussey, Interim Chief Medical Information Officer, Nova Scotia Health was truly inspirational. Both doctors shared their albeit very different career paths, but both shed light on the importance of always finding innovative ways for maximizing output with the resources we have. Their conditions were never perfect, but they both looked for and found ways to improve outcomes. Whether it is getting an excellent medical school prep education in a small town in Newfoundland or making sense of hand-written 12 pages per shift of notes and using that data to plan and improve health care for mothers and newborns in Nova Scotia. Dr. Bussey received high school Math, Physics, etc. courses via TV from a teacher in St. John’s, NL. There is an innovative solution! I like how the presenters included all technology-enabled practices in their title. For a solution to be innovative it does not have to be a cutting-edge technology not yet been tried anywhere in the World. It should also make sense from a cost-benefit analysis point. Last but not least, the TV solution was user-friendly, a high school student did not need any extra training.

Dr. Jangaard told a story of success which can be our guiding star. Even though she had to do her research in times when everything was on paper, even though data providers were busy as they are today, figuring out that people will be motivated to dedicate their time and effort if they get something useful in return, was a brilliant and timeless idea. That is exactly what Dr. Jangaard did. She provided reports, the data that made clinicians’ work easier, enabled them to provide better patient care, helped them plan resources and improved inventory management.

Dr. Jangaard summarized in one sentence what physicians do – integrate and synthesize all information including what they observe, and also test results. In today’s times of rapid technology development, those of us in the business of supporting digital health should also be able to efficiently integrate and synthesize all available all-technology information. As an example of moving forward with what is available, in some cases, as Dr. Jangaard mentioned, the data does not have to be perfect or clean, and it should not be an excuse to just do nothing and wait for perfect conditions.

Dr. Bussey illuminated a big truth that stares all of us in the face. Health care is lagging behind other industries. Take for instance the financial industry: efficient and user-friendly applications like online banking, 100% compliant with security and privacy laws and industry best practices, applications which users embraced and adopted on a mass scale because they are both easy to use and make their lives easier. Technology exists – why cannot we make clinicians’ jobs and patients’ use of information systems easier?!
Dr. Bussey revealed that health care leaders should follow and learn from successful leaders from other industries, and also a need to look into each initiative critically – some initiatives are good by themself but they do not necessarily move us closer to system improvement.

Cyber Security and Digital Literacy in Health Care; Balancing Security vs Functionality by Paul-Charife Allen, Director, IT Security Risk Management & Digital Infrastructure, Nova Scotia Health illustrated a delicate balance, an eternal teeter-totter of security vs functionality. He gave an example of a house without any doors or windows or an unplugged printer, both of which are very secure but also completely useless. We need to protect every device, application, and every piece of patient-identifiable data.
Security Risk Management’s first and most important step is about knowing risk exists. Luckily, no organization has to figure out and keep up with everything by itself. The National Institute of Standards and Technology (NIST) provides a comprehensive cybersecurity framework, a sure guide for maximizing compliance.
Organizations should build up their Cyber Security Resilience – the ability to bounce back and fix problems fast. To achieve this, one of the essential steps is the monitoring of all systems and detecting problems. In terms of Risk Management in big health care organizations, it is not always clear which team retains the risk, although it is often assumed it is the IT team.

Helping Canada Prepare for the Genomic Revolution by Dr. Marsha Fearing, Physician Leader, Canadian Market, MEDITECH
Dr. Marsha Fearing, a Harvard-educated physician, and geneticist delivered a mind-blowing and, for those of us who are not geneticists, a truly eye-opening presentation, a talk which to me opened this new window ajar, provided a peek into a whole new world of possibilities. It would take pages to list all the excellent points Dr. Fearing communicated if I have to choose one, it is the role of modern molecular genetics research in pharmacogenomics, and its contribution to precision medicine. This concept is all about how a patient’s genetic makeup influences how they respond to treatment. 87% of people have more than one genetic mutation that influences how they respond to medications! Some drugs come off the shelf in their therapeutic form, while others need to be turned into their therapeutic form by our bodies. This drug metabolism happens in our livers, certain enzymes act as agents that transform drugs from their off-shelf form into a therapeutic, useful state. If we are lacking those enzymes we are not getting any therapeutic value. Dr. Fearing informed us that this is especially present in psychiatric drugs, especially in depression and anxiety treatment! Perhaps, it is not a stretch to say that we all know people who suffered from either depression or anxiety and also had a hard time finding something that helps. This spoke to me, as I have friends, whose child was put on different medications and one after another did not work. This research is truly a game changer.

Along with offering this brief genetics research overview, most importantly, Dr. Fearing went further and offered a clear step forward in the digital solutions space. The best solutions are often simple. The beauty is that we have an ability to see real, tangible improvement right now. Dr. Fearing showed us that to improve outcomes right now, we do not need anything more complicated than drug-to-drug interaction decision-support systems. It is pretty straightforward to implement an application that alerts that drugs A and B do not go together. Along this logic, we can implement applications that show us that drug A and genetic mutation B do not go together, drug A does not work on people with genetic mutation B.

Dr. Fearing also mentioned that there are 4-5 new genetic mutation discoveries every week. At this point, it is practically impossible for any physician, not even a geneticist who specializes in this domain, to keep up, to hold all this information in their heads – comprehensive decision-support systems are crucial.

Dr. Fearing strongly emphasized the importance of usability like serving different data to different physician specialties (user roles), ensuring appropriate flow of information like pathologist output feeds into oncologist input data interface.

Precision medicine is real, tests will get cheaper and faster. On a large scale, it is evident at this point that the next scientific revolution is all about biology. If health authorities do not step in, patients will seek genetic testing elsewhere.

COVID-19 Immunization Response in Newfoundland and Labrador presentation by Leah Carey, Provincial Program Manager – Community Health, NLCHI provided an overview of how Newfoundland and Labrador leveraged their seasonal flu information system to implement province-wide COVID-19 vaccination. They had to take in about 3,000 additional staff. Their online booking system proved to be a welcomed application, largely because they made sure they convey all important information while presenting it in the most simplistic view. They implemented a solution with usability in mind, including a pre-appointment email with all necessary instructions. Their vision for the future is to implement data validation at the point of data entry – flag errors before the data is saved into the databases.

Ashley Dinn, Program manager of Virtual Care and Registry Integrity Unit, NLCHI delivered a presentation: NLCHI Virtual ERs experience. Due to necessity, due to the scarce and spread out population of Newfoundland and Labrador, video conferencing has been part of health care for about 40 years. They now have 15 virtual Emergency Rooms and only 5 more to onboard for the near future. Virtual ERs are staffed with a nurse, a respiratory therapist; and equipment like an e-stethoscope, examination e-camera, and e-carts.

Alain Landry, Program Manager, Legacy of Life and Critical Care Organ Donation, and Amy Laybolt, Senior Analyst, Clinical Specialty Services (IM/IT) both of Nova Scotia Health presented Implementation of Presumed Consent & System Reform of the Organ Donation Program in Nova Scotia. Nova Scotia is the first jurisdiction in North America to legislate presumed consent. Part of Mr. Landry’s mandate is to promote donation, and he also talked about the importance of reporting, and how they wanted to see the data about every death in Nova Scotia and determine if it was a missed organ donation opportunity. Amy Laybolt led the Legacy of Life Program on its IT journey from not having anything at all to adopting a modified instance of the Regional Tissue Bank information system in preparation for an increased volume of organ donation referrals in light of a new legislature.

The Prince Edward Island team gave a presentation named Virtual Care in Prince Edward Island: Insights and Innovation from health PEI’s Virtual Care Project Coordination Centre. Meghan Van Gaal, Policy Coordinator, IT Shared Services and VCPCC; Connie Murno, Senior Consultant, Barrington Consulting and VCPCC; Kara Griffin, Implementation & Change Lead; Sheila Lund-MacDonald, Virtual Care Policy Analyst, VCPCC, all of health PEI shared how they explored patients digital needs and helped improved digital health literacy. They started small and looked where they could have the most impact by engaging various stakeholders like patients, families, and providers.

Dr. Ajantha Jayaberathen, Director of Coral Shared-Care Health Centre delivered a presentation Health Equity and Geo-View – Making visible dependency, diversity, social determinants of health and barriers to healthcare access. Dr. Jayaberathen is a physician and a researcher with an interest in integrating various non-medical information i.e. environmental and socio-demographic data with medical patient data. Dr. Jayaberathen’s view for the future is that every physician instead of just a patient’s address should be able to see a map with different potentially useful information that in some cases might change recommended treatment or flow of care.

Currently, largely invisible factors like the patient’s distance from the doctor’s office or pharmacy, radon, and arsenic concentration levels at the patient’s home, are not available to physicians but geo maps exist and those maps can be utilized to close knowledge gaps and identify patient vulnerabilities. Combined data from Statistics Canada, the College of Physicians and Surgeons of Nova Scotia, and The National Consortium on Child Poverty, integrated with GIS can already be used i.e. for planning where to introduce new services to areas that need them the most.