Beyond the fax machine
Chief Medical Officer, Vice-president and Chief Strategy Officer
Canada’s physicians, nurses and pharmacists are among the best in the world, but poor communication tools are hampering their ability to work together.
A recent survey of 150 Canadian physicians conducted by TELUS Health revealed that phone (85 per cent) and fax (65 per cent) are the top two means physicians use to share patient information and critical medical data with other healthcare professionals.
Healthcare providers need strong foundations and comprehensive tools to achieve a higher standard of care that is safer, more accessible and better attuned to the need of their patients.
This continued reliance on outdated tools makes for unnecessary inefficiencies and stress for clinicians who are already overwhelmed by demand.
The average elderly patient, for instance, sees seven physicians (five specialists and two primary care physicians) across four different clinical settings. And physicians caring for patients interact with as many as 229 other physicians at 117 different practices each year.
For patients, the impacts are more immediate. These include long wait times to see a specialist, gaps in continuity of care when consulting with other healthcare providers and delays in clarity on how to treat relatively minor ailments. The result is delays, preventable errors and an enormous clerical burden for the healthcare system.
Recognizing the fundamental need of secure communications
In my view, secure communications between healthcare providers is a basic, fundamental requirement if we are to achieve the much-needed improvements to the way Canadians receive – and should expect to receive – care, notably:
- Reduction of errors and adverse events
- An Australian study (1998) of primary care physicians indicated that 50 per cent of all adverse events, such as pharmacological management or diagnosis, were associated with communication difficulties.
- In a Health Canada survey of healthcare facilities, colleges and associations, 25 per cent cited communication and documentation errors as the main issues impacting patient safety or healthcare errors.
- Efficiency gains
- A study from St Joseph’s Healthcare in Hamilton to identify wait times for specialist referrals and barriers to getting timely appointments showed that up to 21 per cent of requests for consultation receive no response from specialists’ offices.
- As stated in a white paper written on behalf of the Champlain, South East and Central East LHINs, it is estimated that between 25 per cent and 40 per cent of referrals may be avoided if primary care physicians and specialists have an effective means of communication to collaborate on patient cases.
- Improved safety and better continuity of care
- Allowing physicians to store communications electronically in the EMR chart would reduce the need to store the same information in multiple locations and enable providers to access the patients’ full medical history.
- Any service that avoids conventional email or text messages would ensure that all patient data transmissions follow privacy and security best practices.
Powerful communication can only happen when it is connected to the patient’s medical record. This makes sure all physician communication is received in the full context of a patient’s history, and a log of the communication becomes part of the patient’s chart. Care continuity requires that message threads not be lost or forgotten.
The challenges are clear and significant but, fortunately, the environment and conditions to address them are improving:
- The Canadian Institute for Health Information (CIHI) reports that 73 per cent of primary care physicians use electronic medical records (EMR) to maintain patient clinical notes. This number is rising slowly but steadily.
- Some start-ups have made strides in enabling improvements. The Toronto and New York-based ‘Instagram for doctors’, Figure 1, enables medical practitioners around the world to share images of patient ailments and seek the opinions of others. Its online mobile tool reached the one million mark in 2016 and medical images have been viewed more than 1.5 billion times on its platform.
- In 2015, PetalMD, a cloud-based application used by over 30,000 physicians, launched a mobile app that allows physicians to immediately exchange messages with their colleagues in a secure manner, regardless of where they work.
- The MedDialog messaging service recently launched in Canada (by TELUS Health) is designed to support seamless information exchanges between healthcare providers directly from the patient’s chart without any interruptions to the physicians’ workflow. It lets physicians process referrals, eConsults and send messages electronically. No more reliance on paper, telephone or insecure channels such as email, texting and fax.
Delivering 21st Century patient-centered care
When a secure way to connect and communicate with other physicians is enabled among the patient’s care team, including primary care providers, specialists and the patients themselves, communications will no longer be a sporadic, disjointed and unreliable chain of telephone calls, fax and letters in the mail. It can help redefine Canada’s healthcare system to one of truly integrated care that fully engages patients as partners in the care process.