A Digital Health Perspective

Before I dive into my experience with YourHealthNS (YHNS), allow me to set the stage. Everyone’s story will be different based on their prior experience with the health care system, and their own health status.

I am a first generation immigrant to Canada who has lived and worked in 4 different provinces since 29 years ago when I landed. Of those 29 years, I have been without a primary care provider since 2006. This was the year I moved to Quebec, eventually moving to Nova Scotia, where I currently reside.

In my mid-50’s, I am fortunate to be in good health. In my country of origin, health care and education (including university) were free of charge, and accessible to all, during my 21 years of life there. Having been born to physician parents to boot, I was in healthcare heaven for the first 21 years of my life.

Not only was access to primary care (including dental care), guaranteed to all, but pharmacists in my country of origin, received exceptional education that allowed them to consult and prescribe both natural products (herbs, vitamins, homeopathy), AND actual prescription medication (with the exception of some opiates and anti-psychotic meds). These are the standards I had gotten used to.

Since 2006, I had to take myself to a few walk-in clinics, and into emergency departments. A total of 4 or 5 of those visits over the course of 19 years. Not bad. I consider myself really lucky.

When in the summer of 2024, I received a postcard/notification from Premier Tim Houston about Nova Scotians now having access to their medical and imaging records,  as well as the appointment scheduling functionality in YHNS app, I thought:”how nice”, and the notification reminded me how low the bar had been in this province.

I cannot name a single service from banking to hair salons, even some car dealerships, not to mention wellness centers with massage and chiropractic services, that have not had online scheduling for over a decade. We are starting this with health care appointments in 2024 in NS. Of course, we have to start somewhere, but development of YHNS is more a necessary growing pain, rather than something to shout about from the rooftops. 

Now let us look at what YHNS is showing for yours truly …..To sum it up: the information is disjointed and partially inaccurate, so if one of the purposes of the app is to allow my future primary care provider, or god forbid, a paramedic or ER doc, to make sense of my medical history in NS; it is NOT going to happen with YHNS.

So my question is: what is the actual PURPOSE of this app for the citizens, and those (including our government officials), who have access to it?

Storyline 1- The Carpal Tunnel Syndrome: For a part of 2023, I  was working as a chef at a resort where large volumes of cooking and baking were taking place. I am also an avid gardener. Heavy pots and pans, massive weed pulling, raking, and other garden activities, and I developed Carpal Tunnel. For this, I went into a walk-in clinic (pain and numbness being major complaints), and a kind physician there told me I stand no chance of seeing a neurologist for nerve function testing (too long of a wait list), so he suggested that I see an orthopedic surgeon instead, and get a prescription for neuropathic pain (Gabapentin). The orthopedic surgeon’s office was to perform an X-ray of my shoulder and thoracic spine area to rule out calcification or another type of obstruction of the nerve (thoracic outlet syndrome), which could be causing Carpal Tunnel symptoms. Far fetched, right? So, I filled the Gabapentin prescription but haven’t taken a single pill having learned about the side effects. I never saw the orthopedic surgeon, rather only an X-ray tech. YHNS however, is showing I have seen an orthopedic surgeon and that I have a prescription for Gabapentin. Ha! Even with a detective nose, you would never guess that my medical complaint was Carpal Tunnel. Noone sees orthopedic surgeons for that condition. What you will NOT see in YHNS is the actual diagnosis, or reason for my walk-in clinic visit. It is not apparent that I had never taken Gabapentin, since I have filled the prescription. Lastly, nowhere is it noted that I pursued treatment through physiotherapy and acupuncture, which led to improvement..  

Storyline 2- ER admission for severe abdominal pain. Late in December 2023, I was admitted to a  County hospital ER with severe abdominal pain. Over the course of two hours, the pain became so severe that I started vomiting. In the ER, the staff and the physician on duty were incredibly caring and with outstanding bedside manners. Within a few hours, every imaginable test was done from blood work to abdominal ultrasound and CT scan. I was placed on high doses of IV antibiotics, and released the next day with an order to come for outpatient administration of said antibiotics for the next several days. The diagnosis was tubo-ovarian abscess (severe gynecological infection which can spread to other abdominal organs). I was told that the ER doc consulted a gynecologist who ordered very high doses of antibiotics for me. I dutifully took 2 out of 3 prescribed antibiotics because they were making me very sick. I lost a lot of weight that holiday season as I had diarrhea, no appetite, and I was ecstatic when the treatment was over. Now comes the cherry on the icing. Three months after the episode, I was called in to see the gynecologist who was consulted about my ER treatment. Another highly positive human-to-human experience. However, he told me I never had the tubo-ovarian-abscess. My body temperature was never elevated, at no point did the fever kick in, and all the blood results that would point towards inflammation or infection were clear, including those repeated 15h after admission to the ER. So why did you prescribe such massive doses of antibiotics, I asked him? Because it is standard of care. My mouth dropped, but I had to ask my second question: what was in fact going on with me that night? Turned out it was most likely a cyst on one of my tubes, which may have gotten twisted, squeezed, or otherwise irritated. I had done a lot of heavy physical work before the episode and the trans-vaginal ultrasound did show a cyst on admission, one that had disappeared on the 3-month followup ultrasound. YHNS is showing ER admission but no actual diagnosis (only states “abdominal pain”), and then lists the 3 antibiotics prescribed. From this, you would naturally jump to a conclusion there was something GI related or in fact the appendicitis. There is NOTHING in the online YHNS records to lead the viewer towards either the wrong diagnosis of tubo-ovarian abscess OR the correct diagnosis of tubal cyst.

My conclusion: The displayed records are disjointed and have very limited utility for an overarching health provider such as a primary care physician, unless they are interacting directly with a very knowledgeable patient who can guide them and explain the records, which may not always be the case (eg if one is admitted into an ER after an accident or in critical condition). The medical visits and appointments info is only useful if associated with the diagnosis, opinion, or notes.

YHNS is missing life-saving information such as severe allergies and equally importantly- blood type. 

I applaud the initiative of including “wellness” modules into the app (healthy eating, alcohol, active living/exercise). I note information about nutritional supplementation is missing. It is a critical aspect of chronic disease prevention and by now, plenty of data and peer-reviewed articles have been published about antioxidants like vitamin C and D, as well as herbal remedies like ginger, curcumin, and others. Within the healthcare system that is so fragile, our best bet is prevention. Healthy food and a balanced diet will NOT supply enough of vitamins, minerals and antioxidants that are required to maintain a healthy immune system and ease us into better and more active aging. I am both saddened this aspect is missing in the YHNS app, and also wonder why this is the case.

All this makes me wonder, yet again, about the purpose of the app and the information fed into it. I will never, however, question or criticize the utility and practicality of online scheduling of tests and appointments.

Last but not least: the app, or database, is only as good as the information fed into it, which, as we have seen, is highly questionable. The other side of the success equation is the app  uptake.

A word on uptake: It took me, a medical researcher with an advanced science degree, some time to figure out the app. It can be done, however, I have my doubts that an average resident of rural NS, or an elderly person without access to technology, will ever come on board with the technology. Perhaps the designers of the app thought it good enough to cover and serve current and future users, leaving the rural residents, the immigrants, the elderly, the Indigenous people, to rely on the younger members within their families or communities. If the purpose of YHNS is to make health records and appointment scheduling available to all Nova Scotians, I am certain it is not serving that purpose as half of Nova Scotians are in various rural areas, and many are elderly and not necessarily tech-savvy.

Having seen that my personal health information is not entirely accurate and definitely does not allow connecting the dots into a meaningful picture of my health journey and diagnoses, I decided to revoke my consent to my information being displayed. To achieve this goal, I had to  contact the Department of Health and Wellness, and get instructions on how to do it. Revoking the consent is not an intuitive or obvious set of steps. If you are the YHNS app user, the link taking you to revoking the consent will flash before your eyes. In my case, I was not able to find it on subsequent log-in, so I contacted the Department of Health and Wellness.

I will continue to follow further improvements and developments within the app, as spaces for improvement are considerable! Meanwhile, wishing everyone a Healthy New Year, as well as courage and curiosity to dig deep and ask questions!

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