COVID-19 Says, “‘Bout Time” for Digital Transformation of Health
- sflevac
- Apr 2, 2021
- 6 min read
Before 2020, many jurisdictions attempted to embrace health transformation. EHealth, Ontario’s attempt at a single health record for its residents was poised to make the first electronic health record (EHR) available to all. In 2009, a financial scandal derailed and delayed the full implementation that was planned to be completed 2015 (CBC, 2009). Progress continues, and a patchwork of EHRs exist for hospitals, with expansion continuing through 2022.
Telemedicine has been around for a long time. Ontario Telemedicine Network (OTM), first starting in 1998 provides remote solutions for healthcare organizations and professionals an independent, not-for-profit organization funded by the Government of Ontario. Examples include, Patient Care via eConsult - with specialists, eVisit - real-time video visits with patients and other providers via room-based, desktop or mobile available, and eCare - apps and other devices to monitor and coach patients to manage their condition at home. OTM also provides Professional Development via eLearning with a library of resources, archived learning videos, peer-reviewed literature and other clinical information and ePodium - live learning events via video and webinars on how to use telemedicine services. For a time, I promoted, then worked for an eCare program called Telehomecare through Home and Community Care. Remote monitoring and education for patients living with chronic obstructive pulmonary disease (COPD), heart failure and/or diabetes continues and thrives during the current COVID-19 pandemic.
The pandemic has escalated the needs to keep all safe and to force the expansion of digital transformation. Health Sciences North became the first Northern Ontario hospital to adopt a virtual emergency room visit program in December. Funding was available from the Ontario government and additional sites in Southern Ontario were already set up. Forte (2020) wrote a blog before the pandemic started, suggesting just this program. While he wrote about severity and cost savings, lower rates of visits from patients perceiving the risks of attending the ED during the first wave did not force the transformation. As ED visits started to increase again, the transformation of waiting rooms due to physical distancing requirements was the main impetus.
Marr (2020) describes five trends in healthcare. Virtual care/remote care, genomics and gene editing, data and Artificial Intelligence (AI) drives shift to fairer healthcare insurance and coverage (noting this is an American author and perspective), AI, Internet of Things (IoT) and Smart Cities (improve our ability to detect and respond to future outbreaks). Bublitz et al (2018) also spoke to some of these concepts concluding that while AI, IoT and Blockchain, “have great potential to support initiatives integrating health and environmental data, including potential to be part of a pan-Canadian surveillance system, there are some limitations and challenges related to the use of these technologies in health surveillance that should be addressed”. Blockchain is defined by Chen et al (2019) as a “system for storing and sharing information that is secure because of its transparency. Each block in the chain is both its own independent unit containing its own information, and a dependent link in the collective chain, and this duality creates a network regulated by participants who store and share the information, rather than a third party”.
Smart hospitals (Guran, 2020) are now a reality. The Vaughn Hospital, part of Mackenzie Health opened in 2020. One of the remarkable aspects of this is a patient’s critically abnormal vital signs can send a signal to the critical care team, initiating a call for a “code blue” (cardiac or respiratory arrest) before noted by a staff member at the bedside. This can do many things to assist the team (and support the patient), including over-riding elevators to facilitate the teams arrival, stop medications which may be a cause or contributing factor in the code blue and even manipulate the bed to the appropriate level for intubation/chest compressions.
One area that would benefit from change is the pharmaceutical field. Marino (2019) writes that with transformation, “Pharma science has not only advanced the creation of specialty medications and biosimilars, but drugs formulated based on an individual’s genetics. Precision medications using genetics for treating certain cancers is already underway. The pharmaceutical industry will most likely evolve into true life sciences companies. Data again will be critical as the use of one’s biometrics will be used for ongoing pharmacological treatments.”
Marr (2020) also speaks to genetics and genomics. Gene manipulation to help with diseases is on the horizon. While the development of the Maderna and Phizer COVID-19 vaccines utilizes mRNA manipulation. “Functional synthetic mRNA may be obtained by in vitro transcription of a cDNA template, typically plasmid DNA (pDNA), using a bacteriophage RNA polymerase.11 Hence, the preparation of pDNA is the first step in the production of mRNA. Manufacture of mRNA might thus appear to require more effort than manufacture of pDNA. However, unpolished pDNA contains traces of bacterial genomic DNA and three forms of pDNA (supercoiled, relaxed circle or linear) in variable proportions. Hence, the reproducible preparation of pure and invariant pDNA, as required for a vaccine, is demanding. Remains of bacterial DNA and the heterogeneity of pDNA are not a concern, on the other hand, if linearized pDNA is transcribed using bacteriophage RNA polymerase,5 because all DNA is removed during further processing steps” (Schlake et al, 2012).
Genomics is an interdisciplinary field of biology focusing on the structure, function, evolution, mapping, and editing of genomes. A genome is an organism's complete set of DNA, including all of its genes. The human genome was sequenced in thirteen years. Since then, the potential for designer drugs to either very specific diseases or to individuals could have far-reaching implications, including denying health insurance for diseases that do not have a cure yet, to certain treatments being so expensive that only the well-to-do could afford them, setting up again limitations to those who are economically disadvantaged. The ethics of this research (and who has access to this information) is the subject of The Postgenomic Condition: Ethics, Justice, and Knowledge After the Genome (Reardon, 2017).
A final consideration of a future transformation that has already started is drone deliveries. Scott and Scott (2020) report:
Drone delivery is a valuable innovation that can save lives in medical emergencies. Urgently required blood, medications, vaccines, and small medical equipment can be delivered by drones. Drones, with rapidly improving technology, have the advantage of speed and efficiency compared to traditional forms of transportation, which are dependent on adequate infrastructure… Implications include the potential to lower healthcare costs while saving lives.
In Canada, regulations for drones and our vast geography with limited internet may prevent this newer technology from being an effective delivery system until the governments implement a plan to ensure full internet coverage for all. At the current time, the Canadian Radio-television and Telecommunications Commission (CRTC) is still accepting requests for funding to ensure all Canadians have access to broadband speeds of at least 50 Mbps download and 10 Mbps upload and access to unlimited data.
There has been much appetite for digital transformation of health, not only in Canada but around the world. The COVID-19 pandemic has expedited some of this transformation, as well as highlighting some of the limitations and ethical considerations that are involved with the decision-making processes by those in power, whether by politicians and their political parties, bureaucrats, or businesses.
References
Bublitz, F., Oetomo, A., Sahu, K., Kuang, A., Fadrique, L., Velmovitsky, P., Nobrega, R., and Morit, P. (2019). Distruptive Technologies for Environment and Health Research: An overview of Artificial Intelligence, Blockchain, and Internet of Things. Int. J. Environ. Res. Public Health, 16(20). Retrieved from https://doi.org/10.3390/ijerph16203847
Chen, H. S., Jarrell, J. T., Carpenter, K. A., Cohen, D. S., & Huang, X. (2019). Blockchain in Heathcare: A Patient-Centered Model. Biomedical journal of scientific & technical research, 20(3), 15017-15022.
Guran, C. (2020). Canada’s first smart hospital is becoming a reality. Hospital News, retrieved April 2, 2021 from https://hospitalnews.com/canada-first-smart-hospital-becoming-reality/
Marino, B., (2019). The Future of Healthcare: An Outlook and Perspective. Blogpost retrieved April 2, 2021 from
Marr, B. (2020). The 5 biggest healthcare trends in 2021 everyone should be ready for today.
Forbes Magazine.
Reardon, J. (2017). The Postgenomic Condition: Ethics, Justice, and Knowledge After the Genome. The University of Chicago Press.
Schlake, T., Thess, A., Fotin-Mleczek, M., & Kallen, K. J. (2012). Developing mRNA-vaccine technologies. RNA biology, 9(11), 1319–1330. https://doi.org/10.4161/rna.22269
Scott J.E., Scott C.H. (2020). Drone Delivery Models for Medical Emergencies. In: Wickramasinghe N., Bodendorf F. (eds) Delivering Superior Health and Wellness Management with IoT and Analytics. Healthcare Delivery in the Information Age. Springer Nature, Switzerland.
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