Canada’s health-care system is undergoing a digital revolution. The technology is new, but it must be used by the existing health workforce.
A recent report by the British National Health Service found that a lack of training for health-care providers created barriers to access digital health care. Here in Canada, we face the same challenge.
Digital health is about connections. Services that were designed to electronically connect health-care providers are now giving patients a way to access their health data. Although for many Canadians, this promise of digital health is not yet realized.
Since 2001, Canada Health Infoway — a government-funded not-for-profit organization — has led the development of a Canada-wide electronic health record. These electronic records contain patient information, medication history, lab and diagnostic reports, hospital discharge summaries and immunization records.
Many clinicians can access patients’ records, but access for patients themselves varies by region. Only 22 per cent of Canadians can log onto their health information. The 73 per cent who cannot would like to have this access.
Canadians are also interested in virtual visits with health-care providers, online prescription renewal and appointment booking, including managing specialist referrals. Infoway’s Access 2022 plan is designed to provide the digital transformation required to increase access to digital health care.
The Canadian digital health lag
But is access enough? Establishing these services is a key first step, one that will help Canada improve its digital health stats in comparison with other countries. However, in taking this step, now may also be the time to learn from those others, and to honour the spirit of Canadian health care by reflecting on the difference between access and accessibility.
In the 1970s, the World Health Organization adopted primary health care (PHC). One of the five components of PHC was accessibility: an organized supply of essential health services available to all people with no unreasonable geographic or financial barriers.
Once Canada is able to deliver on the promise of digital health access, supports will still be needed to promote accessibility to this technology. And Canadian nurses will be essential in this evolution.
Nurses’ digital duties
Nurses and midwives are the largest group in the global health-care workforce. In many countries, they account for more than 50 per cent of all health professionals. Nurses are also a constant at the point of care, providing around-the-clock assessment and care for patients in many different settings.
As digital health expands in Canada, there is also a risk of increasing what has been called the “digital divide.” Initially based on differences in broadband or internet access, this divide has come to include many other socio-economic, literacy and ability factors. In addition to these, in Canada, the large size of the country creates other “divide” challenges related to the reach of reliable internet service.
Nursing is based on a strong foundation of ethics, and nurses learn about social justice and the determinants of health so they can support all people needing care. That care is then given by taking a holistic, or whole-person, view.
In this way, nurses can support the health of individuals, families and communities, by helping to address many different factors that can impact wellness and quality of life. Canadian nurses are a part of urban, rural and remote communities across the country. They will be the professionals most accessible to patients with questions or needs related to the use of digital health services.
But are nurses equipped to provide these supports?
Adding informatics to nursing curricula
While nurses are well-situated to assess and address many issues of accessibility, the current capacity of the profession to meet digital needs is less certain. Although nursing informatics has been present in the literature since the 1980s, it has yet to be recognized as a Canadian nursing specialty, and there is a persistent lack of targeted informatics content in nursing education programs across the country.
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The Canadian Nurses Association (CNA) has highlighted the importance of nursing informatics competencies, noting they are “essential for nurses in all roles to function in complex, contemporary health environments.” The Canadian Association of Schools of Nursing (CASN) published an informatics competency document and teaching toolkit in 2013. Yet there is still a lag in content, and/or in complete courses on digital health, particularly in undergraduate programs.
It’s time to examine nursing curriculum and rethink how best to support nursing students in the development of in-depth information and communication technology (ICT) skill sets.
This learning should deliver foundational knowledge of relevant devices, software/applications, data standards, regulations, principles of digital design and evaluation and the vital importance of digital literacy in supporting patient care.
Partnerships with patients
Students and practising nurses need to prepare to partner with patients who want to access their electronic records in their self-care management. Patient issues may include initial access, interpreting data, record navigation, user-interface challenges, privacy concerns and proxy access for caregivers.
Left without answers or support, each of these could influence choices about the ongoing use of the service.
Advocacy will be another area where nurses can support both access and accessibility in digital health services. Technology can deliver on the promise of patient-centred care, but only when it is used to meet diverse patient needs and abilities.
Nurses must be able to speak out when new digital health solutions are needed to reach underserved or disadvantaged populations, support improved care transitions or better inform those managing multiple chronic conditions. The importance of user-centred design in these cases, involving both nurses and patients, cannot be overstated.
Access to personal health data can be a catalyst for positive change in health outcomes across the lifespan. CASN and the Canadian Nursing Informatics Association promotes the importance of digital health skills in nursing classrooms and practice settings.
Schools of nursing, provincial regulators and other nursing organizations must also recognize the urgent need to better position the profession as experts in the age of informatics.