Putting a Quality Lens on Health Technology
A growing body of evidence from Canada, the U.S. and the United Kingdom is providing compelling evidence of improved quality outcomes as a result of using health information technologies (HIT), and Health Quality Ontario has identified HIT as an enabler of quality care.
Evidence from these jurisdictions has shown that electronic medical records and other forms of HIT can improve patient safety, improve patient outcomes and make providers more effective and efficient, as well as aid faster adoption of evidence to practice. These technologies can also facilitate quality care by providing better data on which to base clinical, policy and funding decisions.
Digital health technologies can also make care more patient-centred by providing tools for patients to be more directly involved in their care through the use of patient portals and other resources to give them more direct access to their own health information and their care providers.
Quality Matters: Realizing Excellent Care for All also identifies HIT as a key enabler to provide better and more coordinated health care. But this document, prepared for Health Quality Ontario and released last spring, adds that quality must take top billing “as we enable patients and clinicians to connect virtually, and use technology to support a better patient experience and better health outcomes.”
Quality Matters goes on to discuss how HIT can make the health care system more cohesive through the use of electronic medical records and secure online patient portals. But, the document cautions that lack of discipline can blunt the impact of these new technologies on clinical outcomes or cost.
“Arming all clinicians with iPads will not translate into better quality care if it is cumbersome for information to be entered at the right time and place,” the document states. This points to an important issue currently causing much cognitive dissonance in the health care – especially the medical – community.
Despite the growing body of evidence showing how HIT can improve health quality, the literature and social media are full of accounts of how use of electronic medical records and other digital technologies are placing an increasing burden on physicians and even contributing to the growing number of cases of burnout.
A New England Journal of Medicine commentary from 2015 is representative of this in noting not only “hours consumed by onerous data entry unrelated to patient care (and) workflow disruptions” but also “the tension between the push to digitize medicine and the sanctity of the doctor–patient relationship.”
That article concludes that “technology will support and improve medical care only if it evolves in ways that help, rather than hinder, us in synthesizing, analyzing, thinking critically, and telling the stories of our patients.”
Examples of how health information technologies are having this positive impact on patients in Ontario are not hard to find.
- The Ontario Telehealth Network is effectively using remote monitoring to help patients with chronic heart failure better manage their condition.
- Many hospitals are using different types of online patient portals to give patients direct access to their health information and improve communications with those providing care.
- North York General Hospital has been internationally acknowledged for its use of the computerized physician order entry of data to improve patient safety and outcomes.
If we acknowledge that technology can have both positive and negative impacts on the quality of health care, depending on how it is configured and used, then it is important to ensure HIT is designed and implemented in a way that accentuates the positive while reducing the negatives. Bringing a quality lens to digital innovation can do that.
In considering Ontario’s ehealth agenda, Health Quality Ontario feels there is an opportunity to link this agenda strongly to the quality agenda by developing a standard approach to the meaningful use of technology.
As Health Quality Ontario Board Chair, Dr. Andreas Laupacis, and a colleague wrote in a recent issue of the Canadian Medical Association Journal, “there is a sense of urgency for the Canadian health care system to consider more thoughtfully how it can best prepare for a radically different future in which technology will play an increasingly fundamental role in the lives of the health care community and the patients we serve.”