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COVID, growing costs, and clinician burnout require the improved use of data


Author: Sonia Pagliaroli


Over the last decade, the need for a clinical voice at the heart of digital health has become increasingly recognized. This is a marked shift; whereas previously, using technology was viewed as the goal, the reality is that technology and data are enablers to achieving the goal. Digital health solutions deliver process transformation, service integration, and the implementation of evidence-based care pathways. Nurses, however—particularly Chief Nursing Information Officers (CNIOs)—play a critical role in care delivery as they’re tasked with leveraging digital platforms and tools in primary, community, and acute care settings.

The COVID-19 pandemic was a pivotal moment during which the importance of healthcare data was realised. The pandemic amplified the need to identify, manage, and mitigate the impacts of unprecedented healthcare demand and required the rapid reconfiguration of services; however, it acted as a catalyst and did not reveal a brand-new realisation. Worldwide, organisations that had already implemented multidisciplinary teams around digital innovation were better prepared for the speed of change necessitated by pandemic.

With underlying problems highlighted by the pandemic, the realities of Canadian healthcare today demand change. According to the Canadian Institute for Health Information (CIHI), Healthcare costs represent 12.7% of GDP and growing, alongside the need of the healthcare system to recover from a $1B financial hangover and a massive surgery backlog. Alongside the financial cost, the workforce has come under increasing strain, with a recent study by the Canadian Medical Association finding that 53% of clinicians are now experiencing burnout. While the Canadian Healthcare system has largely coped, the repercussions from delays to treatment and reduced access to care will be felt for years—and require transformative action. 

Meaningful action will rely on smarter—and the better use of—data. Canada’s use of digital platforms is far from uniform, and the use of unified data to effectively inform practice across health systems is sporadic at best. As we learn from the best, domestically and internationally, the need for data and rapid technology adoption is necessary to identify variance and inefficiencies. Subject to appropriate rigour around data protection, digital platforms allow data to monitor a patient through treatment and identify those at high risk of chronic conditions within the broader population.

Canada has already shown the potential for data mobility to allow for care delivery outside hospitals, providing a better experience for patients and those close to them. Island Health in BC has been highly successful in the provision of hospital at home, providing hospital-level care by a mobile team of nurses and physicians within the person’s own home. Therapies and tests are also provided at home, freeing acute staff and beds for the highest acuity conditions and reducing the pressure on caregivers and facilities.

In Ontario, the implementation of a health information exchange (HIE) will see data mobilised between primary care physicians, specialist units, acute hospitals, and long term and community facilities. Commonly adopted by the National Health Service (NHS) in England—for example, connecting healthcare data for London’s population of nine million under the OneLondon project—HIEs have overhauled the way that providers can contribute to care. Visibility into data across the health and social care system has provided more equitable access to care and has reduced the incidence of duplicative and unnecessary activities by overstretched caregivers.

Registered nurses in the Canadian health system outnumber physicians by nearly five to one, according to 2019 OECD data. To effect real change and recover from the pandemic-induced backlog, it’s critical to maximise the productivity of nursing staff, minimise burnout in the workforce, and truly consider the role of the nurse in system design.

Within Canada there are existing innovations in nursing that tackle the challenges described above. By increasing nurses’ access to digital platforms —a 2020 survey by Canada Health Infoway found that 27% of nurses now work entirely in digital platforms—the opportunity to maximise the value of data and efficiencies in data collection are more easily realised. 
However, poorly implemented digital platforms do not save time. Many experience challenges with multiple logins, substandard infrastructure, and forms that demand excess or duplicate information. Healthcare facilities worldwide are streamlining data input using Oracle Cerner solutions.

For example, the implementation of the Essential Clinical Dataset (ECD) in Island Health, BC in 2019 redirected 96.5 hours per month of nursing time from charting to patient care. The process of evaluating all previously gathered datapoints in the admission history forms was thorough; determining the value of each data element across the full care pathway requires end-to-end review. The outcomes, however, reduced nurses’ time in the patient record, lessened workload, and improved data quality—eliciting an overwhelmingly positive response amongst providers across the organisation.

System redesign and transformation is a multidisciplinary exercise impacting all care providers and therefore requiring a voice from all stakeholders. It’s necessary to reflect on the specific need for nursing, and in doing so to officially recognise the role of the CNIO within an organisation. The CNIO is crucial in distilling diverse feedback and nursing practices across settings to ensure system design is conducted in partnership with those delivering care, rather than imposed from above.

As health systems worldwide enter a new wave of demand-led system transformation, the role of the CNIO is one that all organisations should consider critical to maximising the value of digital investment—and one that is increasingly critical to future success.