Publications

Digital health has massive potential in health care but has been slow to evolve in comparison to other information-intensive industries, which have more readily taken advantage of new technology. One of the key barriers has been the complex relationship between the perceived return on investment for the investor and the resulting value to patients and caregivers. Those actors who pay for technologies do not always see an appreciable return for themselves, while those actors who must apply the technology to generate value are not always incentivized to do so. This misalignment across health system payers and administrators, clinicians and patients must be better understood and addressed to help accelerate digital health. This paper will examine this challenge through the clinician experience, using empirical case examples from Canada to illustrate opportunities for change. While many factors may influence digital health adoption, this paper specifically aims to explore the shifts in the balance of the perceived value of implementing digital health tools, vs. the efforts required to adopt them. It will explore two contrasting case examples: clinical adoption of EMRs in Canada from 2009 to 2015, and clinical adoption of virtual care technologies during the COVID-19 pandemic from 2020 to 2021. ..

This study emphasizes the critical importance of nursing designation, geographic location, and type of patient record–keeping system in predicting virtual care integration in nursing practice. The findings related to geographic location can be used by decision-makers for better allocation of digital health resources among care settings in rural and urban areas. Similarly, the disparities observed across nursing designations have some implications for the digital training of nurses at all levels of practice. Finally, the association between electronic medical record use and uptake of virtual care could accelerate the implementation of more modernized record-keeping systems in care settings. Hence, this could advance interoperability and improve health care delivery.

This study found that compared to video visits and secure messaging, the demand for and use of telephone visits were more prevalent among older adults during the pandemic. The gaps between the demand for and use of video and secure messaging services remain substantial. Our results highlight socioeconomic disparities among older adults that could potentially explain this trend. Lower income and a lower education level may act as barriers for older adults in acquiring the skills and technologies necessary to use more complex solutions, such as video and secure messaging. In addition, higher eHealth literacy was found to be critical for older adults to successfully navigate all types of virtual visit technologies.

Our study provides empirical evidence on the impact of individual health utilization factors on the use of eMH among Canadians during the COVID-19 pandemic. Given the opportunities and promise of eMH services in increasing access to care, future digital interventions should both tailor themselves toward users of these services and consider awareness campaigns to reach nonusers. Future research should also focus on understanding the reasons behind the use and nonuse of eMH services.

Proponents of virtual care have long touted its potential to improve access to and quality of care, and to produce cost and time savings for patients. More recently, the potential environmental benefits of virtual care have also garnered attention. These benefits derive most demonstrably from the reduction in patient travel (for primary care and specialist care) and its associated reduction in carbon emissions (and resultant harms1), though in the longer term they may also arise in relation to virtual care’s potential to reduce facility size and improve health outcomes. While the latter benefits are difficult to quantify at present, there is a growing number of studies that seek to measure the reduction in emissions due to avoided travel from the use of virtual care. This focus is warranted given that transportation of people and goods contributes significantly to overall health sector carbon (CO2) emissions. The National Health Service (NHS) in the United Kingdom attributes approximately 9% of its total carbon footprint to “personal travel,” which includes trips made by employees (4%), patients (5%), and visitors (1%) to care facilities2. Reducing unnecessary journeys represents an important pathway to reducing personal travel emissions, and virtual care clearly has a key role ..

Canadian physicians’ perceptions on their use of and experience with virtual care offer important insights into finding the right balance in virtual care. Using data from the 2021 National Survey of Canadian Physicians conducted by Canada Health Infoway and the Canadian Medical Association (Canada Health Infoway and CMA 2021), we explored the mix of virtual care use by physicians, satisfaction with and challenges of virtual care and other perspectives around its continued use. We discuss how these data inform and enrich some of the key recommendations put forward by Falk (2022) in this issue.

This JMIR article examines the use, utility and impact on engagement in care of a client/family health portal. Clients at Holland Bloorview Kids Rehabilitation Hospital were provided access to their electronic health records (EHRs) and secure, two-way e-messaging with care providers. The findings demonstrate the portal’s potential value and outlines the need for ongoing evaluation to show the portal’s ultimate potential in enhancing engagement in care and communication with care providers.

This scoping review published in Journal of Medical Internet Research (JMIR), explores the concept of patient empowerment within the context of citizen access to their health information through an online personal health record.  The review furthers the measurement methodology of this concept in the context of tethered citizen portal use. An important advance in the field of digital health research.

This article published in Health Affairs broadly examines the potential health and financial benefits of health information technology (HIT). It compares health care with the use of IT in other industries and estimates potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits.  This article is available in English only.   

This BMC Medical Informatics and Decision Making journal article examines the adoption of interoperable electronic health records (EHRs) across Canada through March 2015. Nearly 250,000 clinician and administrative users, approximately half of Canada’s potential clinical population, indicate that they electronically accessed data in 2015. Based on current trending, further growth is expected as maturity of use increases. See also: The value of connected health information: perceptions of electronic health record users in Canada

This BMC Medical Informatics and Decision Making journal article summarizes the results of six provincial and territorial surveys, conducted between 2006 and 2014, about interoperable electronic health records (iEHRs): system, information and service quality; iEHR use and user satisfaction; and net quality and productivity benefits. Overall, users view iEHRs and their effect on productivity and quality of care positively. See also: Measuring Interoperable EHR adoption and maturity: a Canadian example

The COVID-19 pandemic changed Canadian health care almost overnight. The need to contain the virus’ spread — while maintaining access to health services — prompted the swift deployment of virtual care tools and services. Immediately after the COVID-19 pandemic was declared in March 2020, Canada Health Infoway (Infoway), Health Canada and the provinces and territories began working together to help provide urgently needed programs and services that could have immediate impact as well as continued value post-pandemic. Infoway established a Rapid Response to COVID-19 fund by reallocating $35 million of its existing funds. The program resulted in 17 projects being launched across all jurisdictions, in four focus areas: virtual visits, e-mental health, remote patient monitoring and access to COVID-19 test results.  The Rapid Response to COVID-19 initiative demonstrates how aligned priorities and strong collaboration acted as drivers for the rapid identification and deployment of virtual services. As of March 31, 2021, 3.5 million Canadians and more than 91,000 health care providers had logged more than five million uses of virtual care solutions as a result of these investment projects. This paper will examine the factors that impacted the Rapid Response program’s success, key learnings and next steps.  

Research was conducted on the adoption, use and impact of e-booking in private medical practices over a two year period. Canada Health Infoway invested in this project. The article is available in English only as originally published in JMIR Medical Informatics.

This study examined the availability of patient information to specialists during patient visits in ambulatory settings. Findings were that information gaps are common in ambulatory care encounters, and do have consequences, but that physicians with connectivity to information resources face significantly fewer gaps and consequences. The article is available in English only.

The Mental Health Engagement Network (MHEN) project developed, delivered, and evaluated an interactive Web-based personal health record, the Lawson SMART Record (LSR), to assist mental health clients in managing their care and connecting with their care providers. This paper presents a secondary analysis of data collected in the MHEN project regarding clients' perceptions of technology and the use of these technologies in their care.

Practice-based population health (PBPH) management is the proactive management of patients by their primary care clinical team. The ability of clinics to engage in PBPH and the means by which they incorporate it in a clinical setting remain unknown.

Using data from the 2023 Digital Health Equity Analysis conducted by Canada Health Infoway, we examine the current landscape of access to electronic personal health information across several population groups in Canada. We explore the concept of digital health equity and discuss its importance in facilitating improved health outcomes and experiences through increased access to electronic personal health information across the health system. Furthermore, we present examples of current initiatives and work taking place to support equitable access to personal health information online.

This review offers the first consolidated evidence base to inform the responsible adoption of AI scribes in healthcare systems. It highlights clear gains in clinician well-being and documentation efficiency, while identifying critical areas for further research, such as ethical safeguards, patient acceptability, and long-term outcomes, requiring strategic oversight. These findings equip decision-makers with timely guidance to support effective, and equitable AI integration through investments in EHR integration, clinician training, human-in-the-loop safeguards, and real-world pilot testing.