Health care trends to watch for in 2018
The continuously evolving dynamics of health care means practitioners must constantly keep abreast of issues that can affect delivery of care, clinic management and day-to-day operations. As 2017 draws to a close, Canadian Chiropractor explores emerging trends, issues and opportunities in the health care sector.
Several factors and events happening in 2018 can have direct or indirect impact on chiropractic practices, and industry observers say practitioners need to take stock.
The previous year has been marked by continued push toward patient-centred care, which has spurred growth and focus on interprofessional, collaborative health-care environments. With more patients demanding more from their health-care providers, practitioners are increasingly looking at ways to deliver better, more efficient care to their patients that moves away from siloed, redundant care and toward more open collaboration with other allied health practitioners.
According to David Turcotte, global industry director with Microsoft, greater mobility and access to data are changing the face of health-care and patients' perspectives. Today, patients are able to compare and review their doctors online the same way they would evaluate a restaurant or a product. Innovations in digital health are also transforming the way patients are receiving care.
"New health system technology, such as moving beyond basic EMR (electronic medical record) infrastructure to full patient-focused CRM (customer relationship management) solutions, has enabled providers to integrate extended care teams, enhance patient satisfaction and improve the efficacy and efficiency of care," Turcotte wrote in a recent blog post. "Organizations are aggregating tremendous amounts of data - they just need to figure out how to use it to drive innovation, boost the quality of care outcomes, and cut costs."
Over the last decade, there has been a steady increase in adoption of technologies among health-care organizations across Canada - from hospitals and community health centres to doctors' clinics - that enabled the digitization of patient health records. Expect a continuation of this trend, however, true integration of these electronic health records across multiple organizations leaves much to be desired.
"The majority of health-care technologies that we see today are used within health care provider organization," explains Catherine Hunter, partner and national health care consulting leader at PricewaterhouseCoopers in Toronto. "What we are still lacking is that connectivity between those various solutions. It's growing but we have a lot of opportunity still existing in that area."
There are some contributing factors to this relatively slower pace of progress for integration, Hunter says. Concerns about patient privacy have generally inhibited most organizations and health-care providers to take the leap toward full interconnectivity. In an ideal, interconnected health-care world, a patient would have full control over which provider would have access to what patient data. That may be coming soon, but such capabilities do not exist at the moment.
"Providing the patient or consumers themselves with their own access to care, that still remains a challenge for us. All of that information remains largely in the hands of singular providers without having enough connectivity to those in the full circle of care," Hunter explains. She added, however, that there is great interest in this kind of patient-driven access to care.
Expect this trend of technologies that put health care in the hands of the patients to gradually grow and take mainstream adoption.
"Patients are demanding and we deserve it," Hunter points out. "By having greater involvement in their own health care, they feel more connected, they feel more accountable and responsible.
"There is a better dialogue that tends to happen between care providers and patients and as a result of that, quality tends to trend upwards."
The growth of wearable technologies in recent years, which allow consumers to take charge of their own health and wellbeing, is an indication that consumers are welcoming these types of technologies. While its current application is largely for self-care, wearable techs provide a snapshot of a patient's overall health and can potentially be a useful tool for health-care providers in their health assessments and care recommendations.
There are also signs in the market place that people are increasingly taking the reins in their own health care. Increasingly, patients are taking to the worldwide web and acting as "consumers" when searching for health-care services. The internet has become their information portal and gateway to access services and professionals.
Health-care providers, including chiropractors, are expected to ramp up their online presence and offer potential patients the conveniences of a digital interaction.
The chiropractor's website is typically the first place a potential patient would look to find a provider that's right for them, says Dr. Stephane Laverdiere, president and co-owner of Atlas Chiropractic Systems, and a chiropractor in Tillsonburg, Ont.
"A trend with the internet is that people want to be more immersed in it, they want to streamline things, and patients are so used to filling out things online for everything and they expect chiropractors to rise to that standard as well," Laverdiere says.
As health-care practices and organizations increasingly become digital, the collective accumulation of all health care data provides opportunities for practitioners to gain more insights into their patient population's health.
However, that opportunity seems to generally remain as such for the majority of health practices, says PwC's Hunter, who has been involved in a few studies on data analytics in health care.
"Interestingly, a lot of physicians are using their EMRs (electronic medical records) only for 'exotic care' rather than using it to manage the health of their patient population," she says.
However, in certain more progressive clinics, EMR data is used to determine potential clinic service offerings, for example. "Using their EMR data to look at all of their patients with diabetes, for example. They would say, 'Ok, if we have x number of patients with diabetes, and a lot of them require foot care, let's hold a foot care clinic.'
"The other thing, and again this is relatively nascent stages, is the use of EMR data for preventative care for things like screening. How can you use your EMR to trigger you to remind a patient that they need to be screened for whatever condition?"
Data is also important in providing critical information to support financial and operational decisions in practice, Laverdiere says. Collecting data for things like the number of patients completing their recommended care, patient wait times, appointment cancellations, and team meetings can all provide clinic owners insights into their day-to-day clinic operations.
"These are all different things that can be collected depending on the type of system you have and help you make decisions on how to run your practice," he says.
Like Hunter, Laverdiere believes data analytics in health-care practices leaves so much to be desired and hasn't really reached full potential - and it's an educational process as much as it's a technology issue.
"Some chiropractors might not even think to collect that data or even look at that data. So I guess coaching comes into play there," Laverdiere notes.
The internet provides a vehicle for health providers to reach existing and potential patients in a whole different level. It enables engagement without necessarily having them at the clinic physically. In recent years, many chiropractors have started to embrace social media, mainly, Instagram, LinkedIn, Twitter and Facebook, in the hopes of establishing a social media network that they can then leverage to push out their content and build up their reputation as health experts.
Blogs and videos are gaining traction as the content delivery of choice for digital marketing. In the 2016 Canadian Chiropractor Trends and Practice Survey, 71 per cent of respondents maintain at least one social media account, with the majority using Facebook, LinkedIn, Google Plus and Twitter.
"We are definitely seeing that the chiropractor who is going to get the most new patients is going to be the one that's going to show up number one in Google search," Laverdiere says.
Practices need to compete for higher Google ranking, especially in larger communities where competition is higher, because when patients search online, the higher the doctor's or clinic's name is on that search result, the better the likelihood that patient is going to connect with that practice. Original content like videos and blogs are always going to get high index ratings by Google, and therefore have a higher chance of showing up on top of search results.
"Videos are huge," Laverdiere points out. "We're seeing a lot of chiropractors doing this... they're putting out little tips and that's what patients want to see. They want to see a health tip - something that's 20 to 30 seconds long - and they're very, very powerful when they're in video format."
Websites are also becoming a vehicle for health practices to deliver unique content to their audience/patients. The more dynamic and content-rich websites are the ones that will gain more eyeballs online, which can turn into new patients. Websites are no longer just static web pages that provide information about a clinic or health professional's background, services and location. It is increasingly becoming a communication tool to provide its visitors useful content that is always fresh.
This is a trend in the marketing world that is increasingly picking up in the health-care space. Tips, how-tos and short articles about specific health conditions or treatment techniques are only some of the content that doctors are putting up on their websites, and they are using their social media accounts to draw people to their content.
"Chiropractors are using tools like Facebook to get their name out there," Laverdiere says. However, the trend seems to be moving away from Facebook and toward Instagram and Twitter, he adds. The brevity and almost instantaneous response that these social media tools offer are what attracts people to them.
"I think chiropractors that are relying on their Facebook business page are going to have to make some shifts and start using things that are a little bit quicker. People like quick visuals like in Instagram," Laverdiere says.
This year saw the rapid rise of the opioid epidemic as a national health crisis. In the last several months, federal and provincial governments, professional organizations and advocacy groups have started to come together in the hopes of finding solutions to the opioid crisis and put a stop to the avoidable overdose deaths that occur.
Medical associations in Canada and the U.S. have both come out with low-back pain management guidelines that tout non-drug conservative approach as the first line of treatment.
The Canadian Chiropractic Association (CCA) has been active this past year in engaging with stakeholders in government and other sectors to help develop sustainable solutions to the opioid crisis. The CCA did not respond to this writer's request for interview.
"One thing that I would love to see more is better access to chiropractic services, especially those group who typically can't access us for various reasons," says Dr. Peter Emary, chiropractor at Parkway Back Clinic in Cambridge, Ont.
Emary points out some community health centres have already started providing chiropractic services, particularly to the members of the community who otherwise could not afford it, but tend to suffer from chronic pain and drug addiction the most.
He says increasing access to chiropractic services and other non-opioid alternatives for patients may not necessarily be the one solution to the opioid crisis but can significantly lessen its impact.
In 2018, the Canadian government is moving forward with the legalization of recreational marijuana. Some cannabis and liberal drug policy advocates believe marijuana could play a role in solving the opioid crisis by helping reduce people's opioid dependency. They cite a 2014 study published in the Journal of the American Medical Association which found that U.S. states that have medical cannabis laws had a 24.8 per cent lower mean annual opioid overdose mortality rate, compared with states without these laws.
Emary points out, however, there are still many things unknown when it comes to marijuana and its benefits. Anecdotally, he notes, patients have told him that marijuana helps with their back pain and other health issues. However, the evidence paints a less definitive picture.
"When you look at the scientific literature, it's pretty inconclusive at this point in the studies that have been done," Emary says. "Systematic reviews, for example, concludes that there is basically insufficient evidence to suggest that it's beneficial or not."
While stressing that chiropractors will not be able to give patients advice or recommendations about marijuana, still, Emary believes all health-care practitioners need to brush up on available knowledge about medicinal cannabis, anticipating more patients will likely more openly be talking to their health-care providers about marijuana when it is legalized by summertime in 2018.
The Cambridge chiropractor also thinks the issue around opioids and marijuana presents a deeper question about today's society as a whole.
"My biggest thought or concern is to the question of why so many people in our society seems to be suffering from chronic pain, anxiety, depression, and these types of disorders," Emary asks. "I often think that it's maybe more of a reflection of society in general... but that's probably a long and complicated answer - and maybe nobody has the answer to that question."
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