By Tara Kiran
Technology has revolutionized how we live, play and work. We don’t think twice about using an app to make a restaurant reservation, tracking a parcel’s expected delivery date on-line or chatting with an on-line agent to answer questions about a product we want to purchase.
In many ways, technology has also revolutionized medicine. We have developed new drugs, designed new devices and surgical techniques and have a larger and more precise range of imaging options to help diagnose problems.
But when it comes to how health care organizations communicate with patients, we are still practicing as if it’s 1980.
Most clinics only book appointments by phone, often with long waits on hold. Family doctor and specialists communicate by fax. Patients usually have no way to track the status of their referral. Appointment bookings are often conveyed to patients via mailed letter, sometimes by phone, but seldom by email or text message.
There are, of course, practices that have managed to integrate technology into their workflow. But these are exceptions.
According to recent international surveys, only six per cent of Canadians reported viewing health information such as tests or laboratory results online. Four per cent said they emailed their regular practitioner with a question. And only one in 10 physicians reported offering patients the option of making appointments online.
Our patients deserve better.
For the last few years, our Family Health Team has been working with patients to understand how we can improve the care we provide. We do regular surveys, involve patients in specific initiatives and have even held a day-long event to get detailed feedback on improving the typical clinic visit.
The feedback has been consistent. Patients are grateful for the compassionate, comprehensive care we deliver. But they have also given us thoughtful suggestions for doing even better. Specifically, they have told us over and over again that we need to improve how we use technology to communicate with them.
First, our patients have told us they want to be able to book appointments on-line. Second, they want to be able to track the status of their test and specialist referrals the way we can track the delivery status of a package on-line. Third, they want to be able to access their own records, particularly their test results, on-line.
The views of our patients are consistent with those of Canadians more broadly. Most Canadians want these electronic communication options but few receive them. Research shows that being able to access their own records is empowering for patients and improves communication with their health team.
So, what’s the hold up?
Some say, medical culture needs to change. But, in our case, physicians and staff are ready to try something new. Our clinicians told us that better use of technology for appointment booking and test result communication would make things more efficient for them too.
Is it a lack of innovation? Not really. For the most part, the technological solutions have been developed.
For us, the trouble is integrating these technologies into our workflow.
Meeting our patient recommendations would mean engaging with three separate vendors, purchasing their solutions and incorporating them into our existing system. We already use an electronic medical record. Our appointment calendars are electronic. Our lab tests come in electronic format. Yet the software we use does not enable on-line booking or two-way secure messaging with patients. The software doesn’t allow patients to access their records or view the status of their referrals.
Online booking, secure messaging and the ability for patients to track their referrals and access their own records should be mandatory built-in functions in all electronic medical records. Almost three-quarters of Canadian physicians use electronic medical records. Having these functions standardly available within electronic medical records — without having to negotiate or pay for add-ons — would help us advance patient communication into the twenty-first century.
We need political leadership to move us forward.
Quebec is leading the way and recently pledged that patients in their province will soon have access to their medical records through a password-protected portal. Some Canadian hospitals already offer this, but they are the minority.
There are, of course, many factors influencing technology adoption in healthcare, from how we pay doctors to privacy rules governing health information. But making it easier for interested practices to integrate e-communication in their workflow is one way to help us move forward.
Tara Kiran is an expert adviser with EvidenceNetwork.ca, a family physician and researcher in the Department of Family and Community Medicine, St. Michael’s Hospital, University of Toronto, and an adjunct scientist at the Institute for Clinical Evaluative Sciences.
