Time was, access to adequate healthcare was viewed as an issue for emerging regions. Rising healthcare costs, however, have combined with demographic shifts to confront the developed economies as well with the need for new approaches to service delivery.
Healthcare expenditures have followed a steep upward trajectory in most countries over the past several decades, showing no sign of slow down even through the most recent recession. According to the most recent (2012) OECD estimates, Canadian healthcare spending as a percentage of GDP was 5.4% in 1960 and 11.4% in 2010, while in the U.K., corresponding figures were 5.9% in 1960 and 9.6% in 2010. In the U.S., cost spirals have been more dramatic: from 5.1% of GDP in 1960, U.S. expenditures have risen to 17.6% in 2010. And further strain on healthcare is expected from population aging, a phenomenon that is affecting virtually all regions, but developed nations in particular which have experienced an increase in longevity and a decline in fertility: while an older population consumes more services, it has fewer taxpaying contributors to maintain funding levels. To try to keep pace, governments have experimented with administrative reforms aimed at expanding access, improving productivity and reducing spending in healthcare systems (2012 report from the Canadian Institute for Health Information (CIHI)) - President Obama’s politically risky Patient Protection and Affordable Care Act and ongoing debate in Canada over public/private funding and delivery of healthcare are good examples.
But given the magnitude of these challenges, is it time to reform or transform? Increasingly, both public and private sector organizations are looking to ehealth as a means of generating the new efficiencies needed to create sustainable health systems. For governments, ehealth often begins with EMR intitiatives, the implementation of electronic medical records systems aimed at more effective, more secure storage and sharing of patient information. But ehealth extends EMR as the explosion of innovation in devices, apps, data management, collaborative tools and the networks that draw these together to reduce waste and improve patient outcomes attests.
The foundation for change in healthcare lies in communication technologies that support the rapid transfer of information between patient, practitioner and healthcare institutions. As Telus CCO Joe Natale noted at the 2013 Canadian Telcom Summit held in Toronto this June, not only is there a funding crisis in Canadian healthcare (by 2030, healthcare will consume approximately 75% of total government budgets), there is also telecom investment designed to enable better patient control of their health, improved outcomes and cost savings. In Natale’s view, Canada already has a stable telecommunications network that can serve as the basis for digital healthcare: the country has world class wireless networks that provide coverage for 99% of the population and heavy coverage for two thirds of citizens.The point is to innovate on top of this ''technological spine'' to create "wireless medicine," he added, as did a Canadian cardiologist who transformed his smartphone into an ECG device for in-office as opposed to hospital monitoring of patients’ heart health, and the transfer of data results for analysis via wireless networks. In the telehealth future, Natale claimed, "the doctor will prescribe more apps than medicine" to empower patient self-service. Currently, a huge resource challenge for healthcare is management of chronic diseases such as diabetes: according to Natale, approximately 67% of increases in healthcare budgets are consumed by chronic disease. Remote patient monitoring through the virtual integration of devices such as blood pressure monitors and glaucometers, on the other hand, has been shown to produce a 40% reduction in returns to doctors offices - an enormous savings in terms of patient time and cost for in person consultations.
Other initiatives that Telus is working on include the Telus Pharma Space, an online platform that allows pharmacies to better collect and manage medical and prescription histories and patients to renew prescriptions online. Close to 900 pharmacies across countries have now signed on to Pharma Space, which now features a mobile option that lets patients track and instantly share their records - with the six physicians that the average patient typically on release from hosptial. Another TELUS project is Personal Health Records, a healthcare application that has been customized for patients diagnosed with mental health issues which integrates a broad range of services such as online repositories for patient history, medication records, applications for mood monitoring and connectivity to communicate this information to practitioners. According to Natale, 20% of Canadians have mental health issues, and applications such as this have huge potential to reduce visits to the hospital and to reduce patient anxiety.
TELUS is not alone in innovating on top of communications networks. Cisco is also applying a solutions oriented approach to healthcare, and has marshalled its expertise in UC, wireless, switching and routing and security in the development of solutions to connect nurses, locate mobile devices within institutions, secure transfer of medical data and bridge health information and clinical systems with telephony. For Cisco, opportunity for healthcare administrators, practitioners and patients lies in ‘connected healthcare’ solutions that draw on Cisco assets as well as services provided by a growing partner ecosystem to resolve unique problems. In Canada, for example, servicing sparsely populated geographies with adequate healthcare has proved expensive, while shortages of medical staff in rural and remote regions - particularly in the north - has resulted in less than ideal patient care. To address these issues, Cisco has worked with a number of organizations, including the Ontario Telemedicine Network, building the networking backbone and implementing collaborative UC, videoconference and call centre technologies to enable remote care (32,000 patient consultations per year) and reduce costs (a reduction of $8 million per year in provincial medical travel expense).
Recently, Cisco has taken telehealth one step further, placing an integrated Cisco and partner telehealth offering on the bus for roll out to remote locations. On display at the Cisco Connect Toronto 2013 event this month, the bus is the product of a relationship between Cisco, which has provided the collaboration technology, and community partners Big Silver Inc., owner and operator of the bus, and SouthShore Broadcasting, which enables broadcast services from the vehicle. The CareConnectHere wellness bus combines a mobile examination space, high speed connectivity, Cisco videoconferencing technology, IP enabled biometric diagnostic peripherals and JEDMED management software from additional partners to enable on-site patient care and real time access to medical records and diagnostic opinion from one or several specialist practitioners. With its own generator, the bus acts as a self-contained mobile healthcare pod, requiring only a WiFi for delivery of healthcare - as well as other services. As the accompanying video shows, designed for the Essex County/Chatham-Kent region of Ontario, the first bus will provide access to a suite of other information services (such as consular) that Cisco is building out for the migrant worker agricultural community.
Are patients ready for telehealth? The answer, according to a Cisco Customer Experience Report focused on health care released this spring is a resounding yes. The study examined consumers’ and healthcare decision makers’ views on sharing personal health data, in-person medical consultation versus remote care, and on the use of technology for recommendations on personal health. Interestingly, while the study showed some discrepancy between consumer and healthcare decision makers’ confidence in provisions made for the protection of consumer data, the majority of consumers are comfortable with having electronic health records stored in the cloud, approximately three quarters of consumers are open to a virtual doctor visit, and 40% indicated they would be interested in interested in receiving automatic recommendations about doctors, hospitals, medication via their computer or mobile devices.
The participation of private sector organizations in the delivery of healthcare has forever been contentious. Beyond considerations around equality of care, concerns have been raised over the delivery of critical medical and private information over commercial networks. Michael Kedar, of MobilExchange Services, for example, has argued repeatedly that medical data requires transfer over large, dedicated government managed networks to ensure the appropriate prioritization of traffic - potentially through integration with existing emergency response networks. Similarly, the competitive raison d’etre of private providers raises eyebrows: with the acquisitions of PS SUITE EMR in March 2013, Ontario’s largest EMR provider and a subsidiary of the Canadian Medical Association, and Wolf Medical Systems in Western Canada and KinLogix in Quebec in 2012, TELUS is now Canada’s largest EMR provider. How does one ensure universal access to records and interoperability between healthcare solutions in a world marked by competing offerings? Natale suggests adherence to standards, an approach that has proved nebulous in the tech environment. On the other hand, speed to market, and area in which private sector excels, may be the defining criteria - with existing solutions and tech capabilities already in place, redefining the wheel would seem the ultimate in inefficiency.