A New Model for Better, Faster and Cheaper Healthcare 

Canadians have consistently listed access to quality healthcare as one of their top priorities. Unfortunately, our different levels of government have struggled to provide the timely and comprehensive healthcare that Canadians seek. Whether it is having a family doctor, receiving prompt service at an emergency room, timely access to a needed surgery, or access to long-term care, our various healthcare systems are simply not delivering as needed. To address these shortcomings, federal, provincial, and territorial governments are routinely adapting their healthcare systems. They have all consistently thrown more money at the problem. However, we find ourselves in a situation of ever-increasing costs while levels of service continue to decrease. Something has to change. We require a new way of thinking about the delivery of healthcare; we need a paradigm shift. 

Change in Needed in Canada’s Healthcare System

The Canadian healthcare system was conceived and designed around the medical model of the 1950s. Back then, the family doctor was the main provider of a patient’s healthcare needs. They were the central hub that would diagnose ailments, prescribe medications, or refer patients to various specialists as required. 

The family doctor was also the custodian of a patient’s healthcare records. Those records were kept in a manila file folder in the doctor’s office, and they captured the life story of a patient’s health. 

In addition to being the center of the system, the family doctor was also an independent businessperson, collecting fees for services provided and using those fees to pay for rent, equipment, and the salaries of support staff. Medical doctors were among the most trusted professionals, embodying the sentiment that “the doctor knows best.” This was an era long before computers entered everyday life and a time when the concept of artificial intelligence was barely understood. 

Today, while our healthcare systems have grown tremendously in size and scope, they remain fundamentally built around this original model. Governments addressing the many challenges our healthcare systems still operate within the confines of this 70-year-old paradigm. The consequence of staying with this approach is that we have healthcare systems that do not meet the needs of Canadians, taking up approximately 50% of provincial budgets, with no improvement in sight. 

A better, more efficient healthcare system at a lower cost is achievable by building a system based on a new model. This new model would take a different approach to healthcare delivery on three fronts: The government would become the custodian of a centralized electronic medical record for every citizen, nurse practitioners would play a key role in managing patient interactions with the healthcare system, and artificial intelligence would record appointments and assist in diagnosing patients. 

The Future of Canadian Healthcare

Step one starts with a government-run, central electronic medical records (EMRs) database. Manila file folders have largely been replaced by EMRs. However, there is no centralized repository for patient records. Each hospital, clinic, doctor’s office, and pharmacy runs its own EMR database, holding portions of a patient’s medical records. This scattered approach negatively impacts patient health and increases healthcare costs. Fortunately, it is now feasible to build interoperability into different EMR databases,  allowing data sharing in a single location. The Health Level 7 Fast Healthcare Interoperability Resources standard (HL7 FHIR) establishes a universal standard for medical record sharing. Governments should mandate that all EMR systems meet the HL7 FHIR standard. With that in place, they can then ensure that patient records are uploaded to a centralized database whenever updates occur in a patient’s file. 

Step two addresses the lack of proper access to healthcare systems. Currently, the primary entry into the healthcare system is through a family doctor’s office or, for those without a family doctor, the emergency room. With an estimated six million Canadians lacking access to a primary care physician, emergency rooms are chronically overrun. The solution is to create new, controlled, and inexpensive entry points. Nurse Practitioners (NPs) are trained to diagnose, prescribe, and treat patients. Government-run local community clinics staffed by nurse practitioners and supervised by a medical doctor could serve a new, inexpensive and controlled entry point into the system.  

If one nurse practitioner was assigned to look after 1,000 patients, then 6,000 NPs would be needed to cover the estimated six million Canadians who are presently without primary care access. With approximately 450,000 nurses currently working in Canada and around 1,000 NPs presently graduating annually, the federal government could fund the doubling of Nurse Practitioner training programs to produce 2,000 graduates per year. This initiative would significantly increase the number of NPs, addressing the primary care gap. Nurses already in the system could also be assisted in upgrading their education to become NPs if they want to do so. 

Step three will be accomplished through the implementation of artificial intelligence (AI) in a transformative way throughout the medical system. The use of AI is already being rapidly adopted in healthcare systems worldwide. Tasks like report writing, which used to take several hours per week of physicians’ time, can now be completed with a single click. AI programs that listen to medical appointments and automatically prepare comprehensive reports should be deployed in all clinics nationwide. This would free up doctors from administrative tasks, allowing them to spend more time with patients. The Canadian company Tali.ai provides such software. 

AI’s potential extends beyond report writing. It can significantly improve diagnostic outcomes by providing suggested diagnoses and treatments that can be reviewed by healthcare professionals. Eventually, AI’s second opinion could become the de facto first opinion, offering better diagnoses faster, efficiently and at lower cost. Once these systems are in place, AI can ultimately move the healthcare system from being reactive to proactive, identifying and addressing medical issues much sooner. 

Towards Better Healthcare

Three key steps—centralized government-controlled medical records, the introduction of 6,000 Nurse Practitioners, and the deployment of Artificial Intelligence for record-keeping and diagnosis —represent a fundamental paradigm shift in Canadian healthcare delivery.  The hub-and-spoke model, centred around independent family doctors, would be replaced by a new model. A centralized, government-run, electronic medical record database would be accessible to all caregivers. Access to the healthcare systems would expand beyond overworked family doctors and overcrowded emergency rooms.  Community-based NP clinics would become a new entry point. AI would enhance the efficiency of primary care providers, allowing them to spend more time treating patients. If implemented properly, this new approach would transform Canadian healthcare systems, providing excellent care to all Canadians at a reasonable cost.