The mission of the Research Chair in Digital Health is to evaluate the benefits of deploying new information technologies in health care facilities and identify the main hurdles and conditions for success when adopting and implementing these technological innovations.
The health care sector, in Québec as in the rest of Canada, is evolving constantly, undergoing major transformations both structurally and in the provision of care. Numerous medical innovations, such as the miniaturization of surgical techniques, introduce treatment modalities that favour ambulatory care rather than hospitalization.
What we commonly call the ambulatory shift therefore leads to a major reform and modernization of our traditional health care organizational models. The episodes of care are now shorter and can be segmented into sub-episodes provided at different times and at several service points, including emergency rooms, ambulatory clinics, private medical clinics, rehabilitation centres and CLSCs. Patients are therefore seen several times and fall under the responsibility of different health care teams. These teams are part of different organizations selected for their intervention and cost structures that are better adapted to the severity and nature of each case. Delocalizing health care in this way is taken to extremes when health care is provided in the patient’s own home. Under certain circumstances, patients are empowered and must notify one or several health care professionals of the status of their health on a regular basis.
The trend over the last few years has been in fact to organize health care around technological developments. These new forms of organization imply intensive, and often shared, management of clinical information as, for instance, patients need to be seen at one or several points of service at different times. Several initiatives are indeed leveraging the potential of information technologies (IT) in order to improve access to, and sharing of, clinical information, which is essential to the coordination and continuity of health care between facilities.
For example, telehealth enables remote medical teams to exchange clinical information about a patient and thus coordinate their interventions. This type of mechanism can also improve medical coverage in remote areas and increase access to secondary and tertiary care while reducing costs, thanks to fewer patient transfers. In Québec and Canada, where populations are spread out and the distribution of health care professionals is uneven, telehealth is, in theory, an interesting solution to several problems currently burdening the reconfiguration of the health care system. At the same time, telehealth marks a drastic change in the way physicians have been interacting in the past. It implies, among other things, the transformation of traditional coordination mechanisms within medical practice.
In addition to telehealth, numerous innovative experiments for the integration of health care have been carried out and others are currently taking place all over Québec. The development of a shareable electronic patient file (such as the Québec Health Record) is at the core of these projects. This solution aims to overcome the limitations of paper records and take advantage of the potential of electronic data to manage and communicate information. Therefore, thanks to powerful telecommunications networks, such as the Québec government’s integrated multimedia telecommunications network (Réseau intégré de télécommunication multimédia or RITM), it is now possible to exchange data without the constraints of distance.
The new IT-supported methods for organizing health care provide major levers to transform and improve our health care system. However, they also present considerable challenges because of the extent and complexity of the organizational restructuring involved, especially as these transformations deal with the core of health care facilities: the provision of care. This complexity stems mainly from the fact that information technologies are not limited to simple technical devices: the ones mentioned above also concern the knowledge, standards, values and methods shaping clinical practice. Their implementation leads to organizational changes that extend far beyond simply improving existing information systems. These technologies also play a part in communication and coordination and therefore come within medical practices to form complex socio-technical systems whose technical and human components are mutually dependent.