E-Mail Communication In Health Care: Where’s The Standard?

The debate on the use of e-mail communication between doctors and patients has been receiving a lot of attention lately. A recent WSJ article takes a look at the discussion from both sides of the fence. Dr. Kvedar, founder and director of the Center for Connected Health in Boston,  proposes that use of e-mail in the doctor’s office creates accessibility, openness, and improved communication with the patient. “I believe that patients understand the risks of email communication, and are willing to bear those risks in exchange for the more timely, useful and personal care that email can help bring about,” said Dr. Kvedar. He points out that privacy concerns are going exist with any communication system, and e-mail can be more effective than other methods at connecting with patients.

Not everyone agrees with that assessment. Dr. Bierstock,  founder and president of health-care IT consulting group Champions in Healthcare, argues that while basic patient-doctor communication might increase, there is too much risk of missing something through e-mail. “Providing care includes an ability to interpret body language, facial expressions and other silent forms of communication that allow doctors to assess patient reactions to information about their health,” Dr. Bierstock explains. “Online communications eliminate the ability to interpret these important signals.”

The argument for increased efficiency might be tempting, agrees Dr. Sadaty in his response to the WSJ article. Dr. Sadaty is a medical practitioner who at one point utilized e-mail in his practice. He stopped because he still had reservations about its overall usefulness in providing patient care. “There is an aspect of the doctor-patient interaction that that cannot be duplicated through the email process,” Dr. Sadaty explains. He describes how missed diagnoses, ineffective use of communication, and confusion all factor against perceived benefits.

Is e-mail communication, a mainstay of practically every other service provider, unfit to use as a resource between patient and doctor? Or is the solution simply increased e-mail encryption, compliant with jurisdictional privacy laws, to put doctors at ease regarding PHI and other confidential information? The issue of patient privacy & liability might be causing doctors to be more reserved about e-mail use; after all, potential lawsuits are no laughing matter.

As a company aiming to improve communication in health care, Cliniconex is focused on understanding the unique needs of both the provider and the patient. In this era of connectivity, there are unlimited possibilities when it comes to improvements in health care through communication. In order to make progress on this front, one must analyze both the pros and the cons of each communication tool  and see how they hold up against the industry’s standards.

Health Care Summit in Victoria – Premiers Discuss Evolution of Health Care Funding

“Finance Minister Jim Flaherty abruptly announced last month that Ottawa will guarantee health-care funding increases of six per cent until the 2016-17 fiscal year. After that, the annual increase will be tied to the nominal GDP, the monetary value of all goods and services produced within the country annually, including inflation. Funding increases of at least three per cent will be guaranteed.”


There has been recent controversy regarding future federal funding for provincial health care services. It is important to monitor policy changes, as they may affect how the market views privatization in health care, and we may see different provincial interpretations of what future health care delivery will look like.

A few highlights:

-The federal government  maintains that it is up to the provinces to administer health care, and thus appears unwilling to have the federal government “lead” the provinces in any innovation or reform. This leaves us with many fragmented approaches.

-At this health care summit, the idea of a future health care system that utilizes more private, for-profit health care service hasn’t been ruled out by the premiers. If the federal government wants the provinces at the helm of change, we might see different intepretations of the Canada Health Act (thus, a change in the infrastructure of health care delivery)

-There is concern that poorer provinces will end up with poorer care. As Nova Scotia Premier Darrell Dexter said, “Equal funding is not necessarily equitable funding.”

-Many premiers have expressed concern that the aging population’s cost to health care will steadily increase over the next few years. If this new round of funding is essentially a “flat rate” that doesn’t account for this growing cost, we may see a reduction in services available.

Innovation in Mobile Healthcare Apps

The market is inundated with mobile healthcare applications; there is an entire section dedicated to health care for professionals in the iPhone app store. For innovators looking to improve doctor/patient relations or patient adherence to treatment, there are a number of health portals, monitoring apps (i.e., for diabetes management), and other health information tools available to both physicians and consumers. As communication-based apps continue to expand within health care, how will the future of these apps look? Will we be seeing more patient-centric disease management tools, or more applications aimed at assisting physicians with their diagnoses, prescriptions, and up-to-date medical knowledge & breaking news? Dr. James Aw, medical director of the Medcan Clinic in Toronto, weighs in on the future of medical apps.

What Does the NHS IT Debacle Mean for Canada?

Recently, the U.K.’s centralized electronic health record program was acknowledged to have failed in its entirety and was scrapped.  Introduced in 2005, the £12 billion (about $20 billion CAD) program was created to move the U.K. health care system toward a single, centrally-mandated EHR. In what has been called the largest civilian IT project ever, the program has been criticized as being a waste of taxpayer’s money and failing in its core objectives.  With their government facing severe fiscal limits, U.K. taxpayers could no longer afford to take a “wait-and-see” approach.

To shed some light on what this means for Canada, we took at look at OECD’s data on national health expenditures and life expectancy at birth. We got the idea from The Baseline Scenario.

First of all, most of the data is relative to the OECD median life expectancy or health spending. The exception is the OECD trend, which is absolute and shows that over the period, OECD countries spent more and gained longer life expectancy. So, in absolute terms, the median is drifting upwards towards the right.

If a country stays clustered around the zero crossing for the axes (where the OECD median is), that country’s health expenditures are rising and health is improving for the population. This is the case for the U.K.  Their relative expenditures increased earlier but then drove aggressively back towards the OECD median. When money becomes tight, programs get cut. With about two-thirds of the IT program’s multi-billion dollar cost already spent and no foreseeable end in sight, the long-criticized NHS program was an easy target. The proposed alternative is to favour cheaper regional options chosen by the hospitals and GPs.


So here’s the thing for Canada. We’re in much better fiscal shape than the U.K., having escaped relatively unscathed from the latest recession. So we may be able to afford a little more time with our healthcare IT projects. Given current world economic stress, it might be inevitable that our healthcare spending will be aggressively driven back towards the OECD median.

The warning signs are there that Canada’s EHR initiatives could be likely targets. As the April 2010 Auditor General’s report points out, there have been modest advancements made, but not without significant criticism.  In what has been painted as a “dismal” picture, the initiative has taken flak for its comprehensive plans that are depicted as muddled, uncoordinated, and loosely interpreted by individual provinces.  While some provinces have seen more centralized EHR development than others (I.e. Alberta’s Netcare EHR), there is a long road ahead to reach the goal of pan-Canadian interoperability. Questions of timing, quantifiable progress, compatibility, benefits, and ultimate costs are burdening the initiative.

Infoway’s EHR effort needs to show progress and achieve stated outcomes.  And it needs to do it quickly. As U.K. health care has shown us, there isn’t time for the “wait-and-see” approach. Canada needs quantifiable results in the short-term, or the program will become a leading candidate for future budget cuts.