‘What do I do with these CDs?’: Benefits and challenges of implementing electronic health records in Canada

Primary and emergency care providers, highly trained professionals skilled at using up-to-date technology to help care for patients, still rely heavily on a distinctly 20th-century device: the fax machine.

“It’s 2024. We’re digitally connected in almost every other aspect of our lives. Why not for something as important as our health and well-being?” said Dr. Rashaad Bhyat, a family physician in Brampton, Ont. and clinical lead at Canada Health Infoway, a digital health care organization.

While 93 percent of primary care physicians across Canada use electronic medical records (EMRs), less than 40 percent of these providers can share clinical updates digitally, according to the Commonwealth Fund’s 2022 Global Health Policy Survey of Primary Care Physicians.

The lack of interoperability — the ability to securely share information between different systems — is one of the biggest factors that has kept the fax machine humming well into the smartphone age, Bhyat said. For the most part, even email is off the table, because many GPs have not integrated secure messaging into their clinic management systems.

With overburdened health care systems across the country, there is an urgent need to provide doctors and patients with the ability to digitally access and share data, he said. According to a report published by Infoway last year, a modernized connected care system has the potential to eliminate more than two million unnecessary clinic visits and 500,000 emergency room trips, saving nearly $700 million a year. Increased connectivity will also lead to more hassle-free referrals, faster test results and more comprehensive consultations, the report says.

But to implement digital access widely, infrastructure needs to be improved across the board to ensure that patient data remains in their own hands – and not in the clutches of cybercriminals.

Piecing together the puzzle of digital healthcare

When it comes to digitally connected health systems, Canada is playing catch-up. Denmark launched its national patient portal in 2003, but more than 40 percent of those living in Sweden had signed up to access their electronic health records by 2017, a buy-in level Canada has yet to reach.

In the UK, the National Health Service (NHS) app gives patients access to GP records, and while the US does not yet have a national portal, the country implemented the 21st Century Cures Act in 2016, federal legislation that set standards for data collection and sharing. For its part, Canada’s federal government has only taken the first steps to improve connected care, introducing Bill C-72, which would ensure jointly agreed standards, last June.

Abhi Kalra, executive director of Infoway’s connected care program, said seamless connections at the national level reduce barriers, in part because of the complexity of Canada’s federal and provincial systems. Each province and territory operates its own unique health system, and each of these 13 systems reflects the issues that seem most pressing to that region.

Interoperability is not always at the top of the priority list, he said. “Each jurisdiction knows its own pain points, so there are bound to be different priorities,” Kalra said. “A province may want to focus its resources on reducing wait times or hiring more specialists, then return to digital access and data infrastructure modernization two years later. Change is coming slowly, he said, adding that provinces now recognize that interoperability is “necessary to promote an efficient, connected health system.”

Some provinces, such as Quebec, Nova Scotia and Prince Edward Island, have established portals that allow patients to check lab results, track hospital visits and track prescriptions and appointments. However, other provinces are still working on developing similar devices. ConnectingOntario, for example, provides patient summaries that can only be accessed by health care providers. In addition, networks of affiliated hospitals, such as the University Health Network (UHN) and Unity Health, allow patients to access information from clinics that are part of their independent system.

Kalra said Infoway has worked with federal, provincial and territorial governments to develop a 10-year plan for a nationwide EMR platform. In less than two years, Infoway’s pan-Canadian roadmap has set standards for data collection and sharing between different healthcare providers, to ensure that medical records are kept securely while allowing patients to access this data more easily.

Bill C-72, once passed, would require these standards to be met by all IT companies providing health care services in Canada if a province or territory does not have its own similar requirements.

Innovation to access information

The shift toward giving patients access to their own information is as much cultural as it is technological, said Rishi Nayyar, co-founder and CEO of PocketHealth, a startup that has developed a cloud-based medical imaging system.

“I think in the past the industry felt it was in the best interest of patients to be in the dark,” Nayyar said. “The worry was that they would find out they had a diagnosis without a doctor to comfort them, or they would take it the wrong way and do something dramatic.”

The startup started with minor injuries. In 2013, Nayyar’s brother Harsh, then a Google software engineer in the San Francisco Bay Area, twisted his ankle playing tennis. After an X-ray and MRI, the radiologist gave him two CDs.

“(My brother) called me and said, ‘What am I going to do with this?’ I have a MacBook Air,” said Nayyar.

Rishi Nayyar, Founder of PocketHealth (attached)

In 2016, the brothers saw their opportunity and founded PocketHealth. In addition to cloud-based video hosting and sharing capabilities, the platform includes features such as Report Reader, which helps explain medical terms, and Ask My Doctor, which offers patients personalized questions to ask their doctors. PocketHealth can instantly upload and share medical imaging and patient results with caregivers, streamlining communication between patients and doctors, Nayyar said.

Eight years later, nearly 2 million people and 800 hospitals and imaging centers across North America have created accounts with the Toronto-based startup.

Security concerns and potential protections

According to experts, access is one of the two buzzwords in eHealth, which involves the use of digital technology to deliver healthcare – the other is security. Last fall’s ransomware attack on five hospitals in southwestern Ontario, where more than 325,000 patient records were stolen, was just one of many examples of threats targeting healthcare systems around the world.

Patient records can easily be exploited by bad actors in identity fraud, said Jennifer Quaid, director of the Canadian Cyber ​​Threat Exchange (Getty Images/Viorika)

Ransomware attacks in the global healthcare sector nearly doubled from 2022 to 2023. Because they collect sensitive personal information and require constant access to that information, healthcare facilities can be particularly lucrative targets for cybercriminals, said Jennifer Quaid, executive director of the Canadian Cyber ​​Threat Exchange (CCTX), a cybersecurity partnership with 180 members of the private sector.

In May, hackers shut down Ascension, a US nonprofit that oversees 140 hospitals and 40 nursing homes, and a June attack on UK-based pathology provider Synnovis delayed medical operations at several major London hospitals.

Cyber ​​gangs like Black Basta, the Russian ransomware group that shut down Ascension, have started practicing double blackmail – they demand money to decrypt the data and again not to release the data.

Some groups have also begun demanding ransom directly from patients by threatening to publish their sensitive data on the dark web, Quaid said. “EMRs are a goldmine for cybercriminals,” she said. “These records have OHIP (Ontario Health Insurance Plan) numbers, social security numbers, credit card information.

Patients are not always aware that a third party is tracking their information. A 2023 study by Toronto-based cybersecurity firm Feroot Security found that up to 86 percent of the healthcare and telehealth sites they analyzed were transferring data to Big Tech without user consent.

Bad actors can easily exploit this information in identity fraud, said Quaid, who describes the EMR as a “very tempting target.”

There are some relatively easy steps healthcare organizations can take to prevent attacks and protect patient information, she said. First, it’s important to identify what information is critical to operations and protect it accordingly, ensure systems are up-to-date and that people use multi-factor authentication, she said. Staff should also be trained to recognize fishing attempts. And organizations should have a plan in place if the worst happens and there is a breach.

PocketHealth’s Nayyar said he believes the benefits of data ownership can help offset the vulnerabilities of large healthcare organizations. When Windsor Regional Hospital, one of five healthcare facilities in southwestern Ontario hacked last fall, was forced offline, most operations and treatments had to be postponed.

For patients who had previously enrolled with PocketHealth, however, their care could continue with few interruptions. That’s because these users had access to their own data and could quickly share it with their doctors, Nayyar said: “It shows that we really are in the era of the empowered patient.”

Healthy patients, healthy doctors

Connected care can also help reduce physician burnout, Bhyat said. Many GPs see up to 50 patients a day, meaning every minute counts. But according to a report from the Canadian Federation of Independent Business, doctors in this country collectively spend up to 18.5 million hours a year on unnecessary administrative tasks, the equivalent of 55.6 million patient visits annually.

Bhyat said patient empowerment can also be a boon to doctors’ own well-being. He sees many people with chronic conditions, such as diabetes, COPD or cancer, who require constant and complex care.

“Coordinating that care shouldn’t require filling out duplicate forms and going through multiple logins,” he said. “It’s very frustrating to have to go through a billion clicks just to write a good reference and send it.

Bhyat said this frustration can lead to burnout and stress, forcing some to cut back on clinical time or switch to another specialty. A survey by the Ontario College of Family Physicians last year found that two-thirds of doctors in the province plan to change or leave the profession in the next five years. But with Canada in need of more family doctors, modernizing the country’s EMR system may be just the one prescriber needs to take on the most important — and rewarding — part of their job, he said.

As Bhyat put it, “Ask any doctor and they’ll tell you they’d rather spend more time with their patients and less time trying to find a lost mane.

Howard Akler writes about technology for MaRS. CTVNews.ca has partnered with MaRS to highlight Canadian innovations in healthcare

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