Our nation is often defined by our passion for hockey, our taste for beer, and our universal health care system. There is little question that Canada’s hockey prowess endures; our beer remains cold. But our healthcare system? Overburdened. And totally ill prepared to endure the coming tsunami that threatens to submerge it.
The perfect storm of an ageing, demanding baby boom population combined with the increased incidence of multiple chronic conditions, expensive technologies and new drugs is converging to effectively capsize an already challenged system. It is a global problem. And one Canada must urgently tackle.
Projections are that by 2030 health care spending will consume 80% of provincial budgets. Chronic disease represents some 80% of healthcare system interactions and more than 70% of healthcare expenditures. Of those aged 65+, 80% report suffering one or more chronic conditions.
Baby boomers have been the drivers of everything from pablum to disposable diapers. Soon, over 24% of our population will by 65+ and once again this cohort will be a driver of change. This time to a people-centred, participatory, e-patient model of care.
Consider this: Canada spends more than most developed countries on healthcare but the 2010 Commonwealth Fund International Health Policy Survey concluded that Canada has the least effective, least safe, least co-ordinated, least timely and least patient-centred care amongst the nations surveyed.
The same report noted that 80.3% of Canadians use Internet regularly and 40.7% of Canadians aged 65+ engage in online activity. IPSOS Reid predicts consumer trends will see massive increases in Internet usage (Statistics Canada 2010).
According to the Ivy Centre for Health Innovation and Leadership, “Although Canada ranks amongst the top 4 OECD nations in knowledge creation, it ranks dead last among OECD countries in the transfer of new knowledge to innovative health care technologies and solutions”.
As a former CEO in the financial services sector, I know that consumers embrace the convenience, speed and accessibility of their banking records and funds – wherever in the world they may find themselves. Imagine life without a bankcard that can be swiped to allow fund transfers and payments, or instant cash in local currency when travelling abroad? Stock research and trades from an iphone, bill payments online, mobile flight check-ins to avoid airport line ups, instant messaging to stay connected with loved ones, cloud computing that allows instant syncing of calendars and sharing of information, face-time and social networking for support and emotional connection. These technologies have become de rigueur and have helped to make our lives easier, while keeping us engaged and feeling connected. We are more empowered. Knowledge is at our fingertips.
In everything that is, except healthcare.
The fact is, our 20th century medical worldview did not conceive of 21st century technological realities.
We must now embrace the information technologies that other sectors of the economy have
successfully implemented in order to enhance, at the core, the very patient engagement that will be vital in transforming the system to truly participatory medicine and which in turn will create efficiencies both in delivery and costs while improving quality and outcomes.
People-centred, participatory medicine is a critical paradigm shift that will be instrumental in addressing a system severely strained by the impending demographic and epidemiological convergence of ageing population and multiple chronic conditions.
It’s been said that publicly funded health care is one of the few industries that can ignore – even fail – its customer without risking the collapse of the business. Successful business leaders know their very survival is based on putting customers first. In order to sustain a universal health care system, we must now take the same approach by putting patients first and engaging them to become both active participants and self-managers of their chronic conditions.
A mandated system-wide patient-focused model will effectively inspire innovation, demand accountability, promote adoption of technology and foster collaboration while improving quality care, outcomes and cost reduction; permitting the shift to a more health-first based system of prevention, wellness, and self-management of chronicity by designing everything around the needs of the patient and providing the tools that support participation.
There is a growing body of research that demonstrates that participatory medicine reduces hospital admissions, shortens length of stay, reduces primary care visits, improves safety, promotes self-care and facilitates teamwork.
We must adopt innovation and health technologies along the continuum of care in order to engage people, create meaningful customer experience, improve quality and outcomes and create sustainable effective delivery of health care, as well as management of health and wellness. We must truly empower patients and their families to become active partners in the health care journey rather than helpless observers.
We must design and implement innovative ways to interconnect providers, patients and services while providing the tools and technologies (i.e. Bluetooth-enabled monitoring) currently held in the exclusive domain of our provider-centred system – only accessible in institutional environments – in order to change the paradigm from dependence to independence.
Imagine a connected platform, powered by technology, that effectively enables data to be shared in meaningful ways across the spectrum of one’s care and that includes remote heath monitoring, surveillance, electronic health records, coaching and navigation; coordinating and engaging the health ecosystem for the benefit – both physical and psychological – of the patient.
Participatory medicine is a major shift from the prevailing paternalistic attitude that ‘father knows best’. Adoption requires both engagement and empowerment of health consumers and willingness by providers to embrace active patient involvement for joint decision-making and shared responsibility.
Physicians’ self-view has historically been the all-knowing guardian of information, placing them safely on a pedestal. This phenomenon is not unlike the clerics of the Dark Ages who recognized knowledge is power and went to great lengths to reduce the threat to their powerbase by followers who wanted direct access to this information.
Forward thinking physicians today recognize that the world’s medical literature is already available to their patients and some find relief in no longer having to appear to know it all – as this is just no longer possible. The amount of medical information doubles every 3 to 5 years (Dr. Daniel Sands, Beth Israel Deaconess Medical Centre). Some physicians are now – perhaps grudgingly – accepting the new paradigm while others openly welcome the active engagement and participation of their patients and the joint decision-making it enables.
My experience in the work I do, is that patients and their health care providers, families and caregivers often do not have access to a complete record or all the relevant information necessary to make decisions in line with desired outcomes. This compromises quality, puts lives at risk, and prevents the engaged and shared decision making that are the cornerstone of a sustainable model.
The most effective way to improve health care is to make it more collaborative. It is our greatest hope for restoring the lustre of our national pride – our universal health care system. Moving toward a ‘health’ system supported by participatory medicine and less of an acute health ‘care’ system will make our public system more sustainable and ensure its viability for generations to come.
Fundamental changes in society and economy have happened during periods of upheaval that caused people to think and behave differently. I believe we are in just such a period of emerging upheaval; it may be the impetus we need. A demanding, technology-savvy baby boomer cohort reaching old-age in historic numbers and suffering multiple chronic conditions will combine, not least of all, with the advent and adoption by patients of Web 2.0 and mobile technologies to form the basis for collaborative participatory medicine. This electronic collection and dissemination of information has the ability for mass collaboration – transcending silos, old paradigms and geographic borders and allowing for partnerships.
If we don’t take action, if we don’t urgently move to participatory medicine we risk turning our national dream of world-leading, universally accessible health care into a nightmare of even longer wait times, scarcer resources, crammed, crumbling hospitals and vulnerable to the inevitable human tsunami that threatens our cherished system.
We will end up with a system no one wants. One that is unworthy of this great country.