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A physician’s perspective: E-health

“The phrase ‘if it ain’t broke, don’t fix it,’ makes me shudder,” said Dr. Stewart Cameron. “We should always be looking for ways to improve what we do and how we do it.”

Dr. Cameron is a family physician at the Dalhousie Family Medicine Clinics in Halifax. His career has included stints inBritish Columbia and Nova Scotia, as well as 12 months on the North Island of New Zealand. It was during his time in New Zealand that he saw the potential of electronic medical records (EMRs) for transforming health care.

“There are a number of innovative aspects to New Zealand’s health-care system – and they get results,” said Dr. Cameron. “In particular, New Zealand had much more advanced electronic medical records than we do.”

Dr. Cameron brought what he’d learned about EMRs back to Canada with him and looked for opportunities to put that knowledge to work. He got involved with MyHealthNS – the secure portal that allows patients and physicians to share and review health information online – at its earliest stages. He joined the project steering committee and then participated in the pilot project that saw MyHealthNS tested by 30 physicians and about 6,000 patients.

“I’m always intrigued by real innovation,” he said. “We don’t often see it from government   – we’re too accustomed to changes that involve saving money. But I was impressed by what they were trying to do with this personal health record.

“I saw a tremendous opportunity for patient engagement – the opportunity to give patients access to information, to get involved in and take ownership of their own health.”

Dr. Cameron was thoughtful about which patients he invited to participate in the pilot project. “I carefully selected patients who I thought would find value in the program.”

One of the patients that Dr. Cameron invited to help test MyHealthNS was Richmond Campbell, who ended up serving as a member of the MyHealthNS steering committee as well as participating in the pilot project. Mr. Campbell has an autoimmune disorder, which results in unusually low levels of platelets, causing excessive bruising and bleeding. Managing his condition involves monthly blood tests.

“Before MyHealthNS I’d have the test, then phone Dr. Cameron’s office for the results,” said Mr. Campbell. “Because they’re busy, I’d often have to leave a message. The nurse would then look up my results and call me – but it would often take a few calls for us to connect. Now I can check my results on my own.

“I love the convenience of having access to my test results accessible on my phone, particularly when I’m travelling,” he said.

MyHealthNS isn’t just about convenience, though.

“Using MyHealthNS encourages patients to be partners in their own care,” said Mr. Campbell. “Having access to my test results and personal health information brings with it an awareness of the importance of being involved in my own health.”

In fact, patient involvement can be helpful on multiple levels. Dr. Cameron uses the program’s “manual release” capability, which means he reviews everything before making it available to his patients. He can write notes explaining results or asking the patients to schedule follow-up appointments. And sometimes, the patients write back.

“One of my patients read a consultant’s report on MyHealthNS and contact me to correct it. When I consulted the specialist, he said, ‘Yes, I made a mistake there and confused two patients,’ and he was able to fix the error. That’s high-level patient engagement.

“Feedback from patients is clear: they love using MyHealthNS,” said Dr. Cameron. “But the reality is that it means more work for physicians: learning something new, changing their work routines, and potentially spending more time on administrative tasks.”

“I don’t have a huge practice, so reviewing the results and sending secure messages to my patients about their results only takes about half an hour a day. I review the results and then release them with a note to the patient – using the secure messaging capability – with a brief note,” said Dr. Cameron. “But physicians with a huge practice might choose not to do that, because it would be too time consuming.

“We have to appreciate the fact that there’s still no fee schedule item for using this technology. Physicians in the pilot project received an honorarium for the time they committed, but they told us we needed to have this extra work reimbursed on an ongoing basis.

“We need to come up with a payment model that supports this type of work.”

MyHealthNS is helping to improve patient care and access, but it’s just a first step. For now, doctors can use the website to share test results and some consults with their patients; the true value won’t be realized until the full functionality – including e-referrals and e-booking – are available.

“One aspect of MyHealthNS that I’m really excited about is the communications module. This allows physicians to communicate with their patients for health promotion – for example, a doctor could send everyone in their practice a message to say, ‘It’s time to book an appointment for your flu shot,’” says Dr. Cameron. “But we have to work out the best way to use this function – it’s got to be used judiciously, because we don’t want to just be creating spam.”

While Dr. Cameron acknowledges that there’s still work to be done to make MyHealthNS fully functional, he also celebrates how far the project has come.

“I really think that Nova Scotia is to be applauded for taking this on. We’re the first province in Canada to tackle online personal health records – and we didn’t just run a pilot project, we actually followed through,” said. Dr. Cameron. “So many projects fall victim to ‘pilot project paralysis,’ where things stagnate after the pilot project is over. This didn’t. I’m proud to have been a part of the group that made it happen.”

Act now

Email each political party and ask them to make e-health a priority.