Driving force for ehealth: centralized to decentralized care

The concentration of medical experts and state of the art medical instruments in hospitals make hospitals a great place not only to receive care for patients but also to provide diagnosis, administer treatment, and manage disease for care providers.

Unfortunately, operating hospitals come with an extremely high price tag for us all. It costs the Canadian health system over $6,000 on average for a hospital stay per patient – in 2018, this meant a whopping $68 billion spending of tax dollars in Canada.

The resulting financial pressure forces healthcare to move care away from resource-intensive central hub facilities such as hospitals to less costly community clinics or even home. In this new decentralized model, networks of providers work in separate teams spread across the community. The care providers can either see walk-in or referred patients in clinics, carry out home visits, or see patients virtually.

The decentralization of healthcare has created new demand on ehealth technologies in several areas: patient monitoring, provider-to-patient communication, and provider-to-provider communication.

The lack of hospital-grade bedside monitoring instruments in homes or community clinics creates challenges to providers who will need new ways to collect metrics from the patient. But they need not look further than their patient’s existing repertoire of digital tools as smartphones, tablets, and self-monitoring devices are already widespread. These devices can easily be adapted as ehealth tools to support sufficient, albeit crude, remote monitoring. With the increasing affordability and availability of ehealth, community-based care for certain diseases has become just as reliable as hospital care and can be delivered at a fraction of the cost.

Virtual health and telemedicine technologies are also an indispensable part of decentralized care model. They enable patients to speak remotely with care providers from home. While virtual visits are not a replacement to in-person visit, many consultations where in-person interactions are not necessary can benefit from virtual health technologies – commonly cited examples include chronic disease management and mental health support.

Decentralizing care to the community has also created adoption for care coordination tools. With providers spread across the community, novel methods are needed for providers efficiently communicate with each other. The coordination of care and sharing of patient history and care plans across teams is achieved with integrated electronic health records.

Lastly, it is important to mention that the adoption of ehealth, even in favorable environmental and policy shifts, is not unmet with challenges. Psychological resistance to change, varied technology acceptance, threat to privacy, ethical considerations, cost to ehealth system maintenance are some of the barriers to adoption that require the concerted effort of all stakeholders, including patients, to overcome.

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