Obvious but not Easy

The budgets provided to Nova Scotia’s Health Authorities in recent years have contained almost no increases even though they are subject to considerable pressures from inflation, aging demographics, and the constant demand for new and expensive treatments. This emphasizes the reality that the public purse is not going to pay for treating every ailment, and the treatments that it does provide will continue to be rationed. Perhaps this will allow health care leaders to more publicly acknowledge the challenge that they face: choosing which maladies to treat and doing so as cost effectively as possible.

It is with this backdrop that Capital health will on June 28th be hosting “A Conversation About Technology as a Catalyst for Transforming Health Care.” No doubt there are many excellent ideas emerging as creative minds develop new tools and techniques. But there is considerable opportunity for improvement available from very familiar existing technologies.

Consider the way that appointments for diagnostic tests or specialist visits are typically arranged. The referring physician having decided that an appointment is needed, his office makes contact by phone or, more frequently, by fax . Then the patient finds out about the appointment by mail , if the post office is not on strike and the patient is not out of town. The patient is often not made aware why the test or visit is being done. If the date and time are not possible for the patient the whole cycle has to be repeated. Actually getting the work done happens weeks or months after the need for it was determined.

This is almost laughably inefficient in an era when large crowds can in a few hours be summoned to demonstrate in Tahrir square for democracy or to clean streets in Vancouver, when Masai cattle herders in Kenya pay their bills with cellphones, or when call centers in India guide aging boomers in fixing their computer problems. The opportunity to reduce frustration while saving time and money by using elementary internet tools is obvious.

There are obstacles, although the hurdles are rather low:

1. Because the internet is vulnerable to hackers there are potential risks to patient privacy. But other professions, perhaps most notably lawyers, have overcome this problem. It is likely that most patients, given the chance , would gladly take the risk. In any event the problem has already been faced in areas such as Alberta that employ electronic medical records, a much more ambitious undertaking than what is proposed here.
2. There is at present no mechanism for physicians to get paid for informing patients via email. Would it not save the system money , and aid physician productivity, if they could receive some fraction of what they receive for an office visit?
3. Sometimes the physician can pick up important information during incidental conversations. Fair enough , but an email to explain why a test is being done is better than no communication at all. And incidental conversations can also take place electronically.
4. Some physicians might have to make small investments in new technology.

Getting this to work well requires very little systems work. (But easy extensions of the idea are obvious. For example a patient email reply acknowledging the appointment; an automated reminder email to the patient the day before including a boarding pass look alike that could save time at registration; an automated note to the patient confirming that results had been forwarded to the family physician).

Saving money on administration will be good for patients because it will free up scarce funds for care giving. Yet one suspects that this topic will not easily find its way into the discussions on June 28:

1. This is not a topic that can be addressed by physicians and other care givers on their own. In fact much of the work has to be done by lawyers, policy makers, and information systems experts.
2. Instead of involving new ideas and technologies, which are fun, this involves administration, which is tedious.
3. This will require real change on the way things are done , which is hard. Using email instead of fax will have to be encouraged, then incented, then required over a multi-year transition. It will take more than gentle coaxing to implement change. Government policymakers will need to provide support for the transition but also to become progressively more insistent.

Such a development, which has already happened in other provinces and would clearly benefit patients, can only occur if it is energized by thought leaders in the Health Care System.

Appendix A

Source: Government of Nova Scotia – Estates and Supplementary Detail