The annual Canadian E-Health Conference was held in Vancouver, BC last week. I had the opportunity to speak about the work we’re doing at Wellpepper in applying machine learning to patient-generated data, and in particular the insights we’ve found from analyzing patient messages, and then applying a machine-learned classifier to alert clinicians when a patient message might indicate an adverse event. Our goal with the application of machine-learning to patient generated data is to help to scale care. Clinicians don’t need to be alerted every time a patient sends a message; however, we don’t want them to miss out if something is really important. If you’d like to learn more about our approach, get in touch.
My session was part of a broader session focused on ‘newer’ technologies like machine-learning and blockchain, and some of the other presenters and topics definitely highlighted key differences between the US and Canadian systems.
Aside from the obvious difference of Canada having universal healthcare, there were subtle differences at this conference as well. While the same words were used, for the most part: interoperability, usability, big data, and of course blockchain and AI, the applications were different and often the approach.
Interoperability: Universal doesn’t mean one
Each province has their own system, and they are not able to share data across provinces. Unlike the UK which has a universal patient identifier, your health records in Canada are specific to the province you live in. As well, apparently data location for health records is sometimes not just required to be in Canada, but in the actual province where you reside and receive care. As for interoperability, last we heard, British Columbia was doing a broad roll out of Cerner while large systems in Alberta were heading towards EPIC, so Canada may see the same interoperability challenges we see here if people move between provinces.
Privacy: The government is okay, the US is not
What’s interesting is as a US company, is that whenever we talk to health systems in Canada they bring up this requirement, but as soon as you mention that the PIPEDA requirements enable patients and consumers to give an okay for out of Canada data location they agree that it’s possible. Regardless, everyone would rather see the data in Canada.
What was possibly the most striking example of a difference in privacy was from one of my co-presenters in the future technologies session, who presented on a study of homeless people’s acceptance of iris scanning for identification. 190 out of 200 people asked were willing to have their irises scanned as a means of identification. This identification would help them access social services, and healthcare in particular. The presenter, Cheryl Forchuk from the Lawson Health Research Institute said that the people who participated didn’t like to carry wallets as it was a theft target, that they associated fingerprinting with the criminal justice system, and that facial identification was often inaccurate due to changes that diet and other street conditions can make. When I tweeted the 95% acceptance rate stat there were a few incredulous responses, but at the same time, when you understand some of the justifications, it makes sense. Plus, in general Canadians have a favorable view of the government. The presenter did note that a few people thought the iris scan would also be a free eye exam, so there may have been some confusion about the purpose. Regardless, I’m not sure this type of identification would play out the same way in the US.
Reimbursement: It happens, just don’t talk about it
The word you didn’t hear very much was reimbursement or when you did, from a US speaker the audience looked a bit uncomfortable. The funny thing is though, that physicians have billing codes in Canada as well. It’s just that they are less concerned about maximizing billing versus being paid for the treatment provided and sometimes even dissuading people from over-using the system. Budgets were discussed though, and the sad truth that money is not always smartly applied in the system, and in a budget-based system, saving money may decrease someone’s future budget.
Blockchain: It’s not about currency
Probably the biggest difference with respect to Blockchain was the application, and that it was being touted by an academic researcher not a vendor. Edward Brown, PhD from Memorial University suggested that Blockchain (but not ethereum based as it’s too expensive) would be a good way to determine consent to a patient’s record. In many US conferences this is also a topic, but the most common application is on sharing payer coverage information. Not surprisingly this example didn’t come up at all. If you consider that even though it is a distributed ledger, a wide scale rollout of Blockchain capabilities for either identification or access might be more likely to come from a system with a single payer. (That said, remember that Canada does not have a single payer, each province has its own system, even if there is federal funding for healthcare.)
— Anne Weiler (@annewellpepper) May 30, 2018
For many of the session the “E” in e-health stood for EHR, which while also true in the US, the rollout of wide scale EHRs is still not as advanced. Cerner and EPIC in particular have only just started to make inroads in Canada, where the a telecommunications company is actually the largest EHR vendor. In one session I attended, the presenter had done analysis of physician usage of a portal that provided access to patient labs and records, but they had not rolled out, what he was calling a “transactional” EHR system. Physicians mostly accessed patient history and labs, and felt that if the portal had prescribing information it would be perfect. Interesting to see this level of access and usage, but the claim that they didn’t have an EHR. What was also interesting about this study is that it was conducted by a physician within a health system rather than an academic researcher. It seemed like there was more appetite and funding for this type of work within systems themselves.
Other Voices: Patients!
During the interlude between the presentations and judging for the well-attended Hacking Health finals, and on the main stage, presenters interviewed two advocate patients. While they said this was the first time they’d done it, both patients had been at the conference for years. So while the mainstage was new, patient presence was not, and patient advocate and blogger Annette McKinnon pushed attendees to go further when seeking out engaged patients. Noting that retirees are more likely to have the time to participate in events she asked that they make sure to seek out opinions for more than 60 year old white women.
There was also an entire track dedicated to First Nations Healthcare. Think of the First Nations Health authority as a VA for the indigenous people of Canada, which incorporates cultural differences and traditional practices of the First Nations people. The track started and concluded with an Elder song and prayer.
Speaking of diversity, I didn’t witness any manels.
— Anne Weiler (@annewellpepper) May 30, 2018