Healthcare in 2019: Patient bill of rights, medical devices, a shift from hospitals to communities

In 2019, Canada will see a continued shift of care outside the hospital and into the community. This move to community care has historically been slow; mainly because acute care falls under the purview of hospitals, which are by far the largest players in the healthcare market and naturally focused on their own needs. Expect to see an increased focus on moving from a physician-focused model toward greater community care.

In moving the care model from the hospital to the community there is an associated need for more patient engagement – in particular, patient centred applications. This means a renewed focus on technologies such as remote patient monitoring, e-referrals, and community medication reconciliation (which ensures medication information is communicated consistently across transitions of care). Together, these things bridge gaps in the healthcare system and empower patients to play a more active role in the management of their personal health. The patient centric model, which recognizes there are multiple players in a patient’s care journey, will also see general physicians moving into the role of “quarterback” to move a patient’s care forward in the right direction.

In the decision Mcinerney v. Macdonald, 1993, the Supreme Court of Canada made it clear that the information in a patient’s medical record belongs to that patient. Patients have a right to see the content of their record at any time and for any reason, subject to certain exceptions (e.g. if there is likelihood of harm to the patient). However, in 2019, as questions build about more complex data ownership, data monetization and data governance, we will see a more cohesive lobby for an official patient bill of digital rights.

There are many uses of health data, and AI is one of them. After an investigation into the problems with medical devices this year, Canada’s health minister has vowed to strengthen oversight of certain devices such as pacemakers, implants and insulin pumps. AI has the capability to track and report on these devices and identify issues more quickly than what we’re doing today. But for AI to work, it requires access to data. Primary care, acute care and device registries will provide the data sources to discover issues with devices and implants. In 2019, we will see more pressure on Health Canada to regulate data on medical devices. We predict there will also be regulatory changes around medical devices as technology progresses.

Health organizations struggling with ballooning budgets will see little relief, especially as we move to cloud-based technologies that require implementation from a broader, systemic perspective. We anticipate smaller provinces and health authorities will struggle with the difficulties and costs of acquiring new technology given their size and available resources. As a result, they will move towards cooperative, inter-provincial efforts. For example, Atlantic provinces may make combined decisions about purchasing.

Finally, Blockchain is a promising technology that is currently near the top of the hype cycle. As the healthcare system evolves with it, there will begin to be a clearer view of its costs and benefits. The key benefits from blockchain at the moment are its ability to ensure a reliable single source of truth – that anyone who touches data is entering it into a record that is permanently encrypted in a much more robust way than we’ve had in the past. Blockchain allows for improved controls on data access by the right parties and is a very attractive as a model for storing clinical data. However, there are some potential downsides, including how to re-engineer existing systems, the significant increase in the amount of raw computing power required and the requirement that all participants use the blockchain.

The ideas I have discussed exist at the intersection of communication, healthcare and technology.

Digital health has the ability to change the quality of patient care for all. But for disparate healthcare systems to realize their full value, integration of information across the medical and care community is necessary.

Dr. Chris Hobson is a former family physician with 15 years of experience and two decades as the Chief Medical Officer at Orion Health, a global provider of health information technology.