Better health care needs better technologies

The use of technology to deliver health care in Alberta seems… stalled. So I was pleased to be able to attend a conference in Edmonton with the theme of 'Accelerating Technology Adoption in Health Care'. The conference was well-structured, looking first at the international perspective, then narrowing the focus to the national perspective, the provincial perspective, and finally the perspective of the local care-giver.

John Conly, a professor in the Departments of Medicine, Pathology and Laboratory Medicine and Microbiology and Infectious Diseases at the University of Calgary, gave us the international perspective. He spent a sabbatical year studying what Switzerland —€” an acknowledged leader in health care technology — has done to promote adoption. Conly found that the Swiss have evolved cultures of both developing new technology through pure research and commercialising new technology through partnerships between research and business groups. In addition to this, Swiss health care centres actively seek out innovators, rather than passively waiting for innovators to come to them. The Swiss government supports innovation, but does not dictate its use or direction. Switzerland also has well-developed infrastructure, something Conly stressed was an essential precursor to the wide adoption of any new technology. In Alberta, the SuperNet is a vital element of such an infrastructure, but unfortunately, many speakers noted that it is badly underutilised.

We were given the national perspective by Jim Micholson of Canada Health Infoway. Since its inception in 2001, this organization has had the mandate to accelerate the development of electronic health records in Canada. Early efforts to establish a pan-Canadian standard foundered on the inability to reconcile differing privacy legislation in each province. To make any movement forward, Canada Health Infoway had to allow the development of similar electronic health records in each province; similar, but not necessarily interoperable. Recently, Alberta has adopted the HL7 v3 global standard, which is semantically much stronger than the previous HL7 standards, and will help to improve interoperability. Micholson confessed that stakeholder engagement was much slower than expected, and that efforts to integrate technology into clinical workflow has been hit and miss. I agreed with his point that the goal should be to create new and improved workflows that take advantage of technology, not to merely automate existing workflows. In all, it seemed that progress on the national front was slow and compromised, but moving in the right direction.

Provincially, Don Juzwishin guides Alberta Health Services (AHS) in his role as Director, Health Technology Assessment and Innovation. His goal is to establish AHS as "the single portal of industry engagement". This monolithic, centralised approach seemed oddly out of alignment with most of the other presenters, who saw success in distributing innovation and development as broadly as possible. However, one speaker noted that the National Health Service in England also uses a centralised model, and does so successfully.

A common theme that emerged from almost every presentation was the need to have well-developed business models. At first, I dismissed this as a narrow commercial interest, but as the point came up again and again from different groups, I listened more carefully. Health care is a highly regulated industry filled with competing requirements and complex funding arrangements. Bringing anything new into this arena is very difficult, very expensive, and very risky.  But there are few repeatable models for how ventures can be funded, let alone how they might be profitable. Thus, there are few incentives for an innovator to enter the field. Government can play a strong role here supporting innovation, as the Swiss do, and easing the bureaucratic overhead. Hand in hand with this is the need for government to streamline bureaucracy and actively engage with innovators.

Given that the risks are so great, what can be done to maximize the odds of success? All agreed that rigorous, evidence-based analysis has to be applied to any innovation, in order to identify ideas with the best chance of success in the field. "Fail fast", as one speaker put it. This analysis requires a deep understanding of the problems to be solved, and a collaboration of clinicians, technologists, and commercial and government sponsors.

The use of technology to deliver "mobile health" was seen as an area of exciting growth. Managing health, rather than merely treating diseases, allows us to move away from large, expensive medical centres —€” "mainframe health care", as Steve Arritelly, the Director of the Health Research and Innovation Lab at Intel, put it —€” and instead use technology to bring health care to patients in their own homes. Arritelly illustrated the use of very simple sensor networks to monitor the activity of an at-home patient. Unobtrusive monitoring of events, like when a door is opened, or when the television is on, reveals much about the activity and social well-being of a patient. If an unhealthy pattern emerges suddenly, or grows over a period of weeks, health care professionals can be alerted, and a home-visit can be made. As a population, we are living longer, and this means our disease time is also getting longer. Rather than waiting for disease to become acute, it's much cheaper to manage disease in its earliest stages while patients are still healthy enough to participate in the management.