Balancing regulation and innovation
Key is to balance regulation and progress, College of Physicians and Surgeons says
The College of Physicians and Surgeons of Alberta says it is taking steps to get a better handle on a number of emerging health technologies that could prove dangerous to patients if they aren’t properly regulated.
Software that can analyze diagnostic scans, wearable medical devices that generate real-time data, and “precision medicine” that tailors specific treatments to an individual’s genetic makeup are among the innovations the college may need to address in the years ahead.
“You want to make sure you are not over-regulating to a point where you inhibit the innovation that’s there,” college registrar Dr. Scott McLeod said in a recent interview. “But you still have to be cautious that the public is being protected. And some of these technologies could potentially have harm.”
Assistant registrar Susan Ulan, who is leading a six-month research project for the college, said the work so far shows that a number of other jurisdictions around the world are ahead of Alberta in the use of digital technology.
As an example, she said U.S.-based health group Kaiser Permanente is now conducting more than half of its patient interactions through digital means, such as email and video conferencing, instead of faceto-face appointments.
Alberta physicians have been slower on this front, in part due to concern over patient privacy, and in part because the doctor compensation model doesn’t really reward it.
However, McLeod noted the trend is starting to pick up speed, in part because a number of international health companies are now marketing their services to Canadians, including the ability to interact with doctors in other countries.
On the positive side, this can provide patients the opportunity to get advice from experts who were previously unreachable. Yet such doctors operate beyond the authority of the college, making it difficult to ensure they have the proper credentials, McLeod said.
Another innovation raising eyebrows is the emergence of small, wearable devices that can keep track of health-related indicators, from heart rate and blood pressure to sleep time and activity levels. The technology holds the potential to help patients move to a healthier lifestyle. In fact, more than half of doctors are now recommending some kind of phone app to patients that are often used in conjunction with the devices, Ulan said.
But the devices’ increasing prevalence raises questions as to whether the college may need to set some rules on how they are used to make treatment decisions, and how the data is stored and protected.
An open question is whether data generated by the equipment should be included in a patient’s official medical record, and whether the government should be able to use it for “big data analytics” projects that examine health trends for entire communities or regions.
Other technologies gaining interest include the concept of precision medicine, which eschews standard practice in favour of treatments designed for each individual patient.
As an example, inflammation in the body is usually treated with powerful steroids, which is essentially like “swatting flies with a sledgehammer,” said Dr. Jon Meddings, dean of the Cumming School of Medicine at the University of Calgary.
He said it’s far better for doctors to learn, if possible, the exact cause of the inflammation and apply therapies that attack that specific problem.
Similarly, precision medicine holds considerable promise for treatment of different types of cancer, rather than subjecting all patients to chemotherapy and radiation.
There have also been recent advances in pattern recognition software, in which computers can analyze diagnostic scans to find evidence of disease or abnormalities.
And even speech recognition technology is gaining a bigger foothold, with some jurisdictions allowing staff to use it to document their patient notes that go into official health records.
Dr. Norman Yee, a family doctor in Calgary who sits on the college’s council, said the biggest impact of the emerging technologies may be the relationship between physicians and patients.
That relationship has traditionally been imbalanced because physicians have been the keepers of patients’ information, he said.
But as more patients start insisting on email communication, reach out to foreign doctors, gain online access to their health records and increasingly use apps, that imbalance is disappearing.
“We are now at a critical time of patient and consumer medicine such that more patients in the next several years are going to be able to call their own shots,” Yee said.
As such, he said, physicians, along with the professional rules that govern them, will need to adapt to the trend rather than resisting it. This is where the college has a vital role, in engaging both the public and the profession on what the expectations should be.
“What do you do when a patient walks in with their own genomic analysis they had done?” Meddings said. “The physician isn’t responsible for that and may not even understand it, so how does that get used and interpreted?
“I think that’s where the college has to think carefully, because their role is to make patients safe.”
You want to make sure you are not over-regulating to a point where you inhibit the innovation that’s there.