Provinces in Atlantic Canada are giving patients access to their own records

A wave of patient empowerment is sweeping Canada’s Atlantic provinces as patient records containing lists of dispensed medications, immunization histories, lab test results, diagnostic imaging reports, and information about hospital and primary care visits, are now or soon to be accessible in all four provinces on web-based portals and mobile phone apps.

Between 350,000 and 400,000 patients in Nova Scotia are using YourHealthNS, and close to 100,000 patients in Newfoundland and Labrador have downloaded MyHealthNL.

New Brunswick’s YourHealthNB stands out as the first portal in North America to include a patient-mediated Patient Summary, a health record extract of key health information that can be shared with healthcare providers in unplanned or emergency care situations locally, across provincial borders and even internationally. And across the Northumberland Strait, Prince Edward Island is just a few months away from launching its MyPEI portal.

“We know that when patients have access to their health records, they are more engaged in their healthcare, and when they are more engaged in their healthcare, they have better outcomes,” remarked Dr. Matthew Clarke, an ER doc and associate chief medical information officer at Nova Scotia Health.

Nova Scotia: Originally launched in November 2023, YourHealthNS provides patients with information about access to care, and a library of information about medical conditions and diseases. It also allows them to book blood tests, X-rays, flu shot and COVID-19 vaccine appointments.

In February of this year, personal health information was added on a pilot basis for some 14,000 patients registered at six primary care clinics, and as of July, all Nova Scotians 16 years of age and older with a Nova Scotia health card have access to their health records, reports Scott McKenna, chief information officer for the Nova Scotia Health Authority.

Information available includes a history of medications prescribed and dispensed, results of blood and urine tests, information about diagnostic imaging tests, immunizations records, and basic information about hospital and primary care visits. The portal provides up to 10 years of information about medications, immunizations and hospital visits, and a year’s worth of information about lab tests, diagnostic imaging and primary care visits with information from previous years to be added over time.

Most of the information is available to patients after approximately seven days except for diagnostic imaging information, which is available 14 days after the patient’s provider receives a report. This gives the provider an opportunity to contact the patient in advance to share any life-changing results. The portal includes X-ray and ultrasound reports, but only the date, time and body part imaged for CT and MRI scans as the intended audience for these reports are other providers and they include language that patients might not understand.

“It’s not a matter of transparency or not wanting the patient to have the information. It’s a matter of how the patient would interpret a report,” said Dr. Clarke.

While information about medications and immunizations is easily extracted from central databases, sourcing information from primary care and hospital information systems was much more challenging as there are no central repositories from which information from these systems can be ingested, noted McKenna.

“We’re investing with Oracle Health on a big project to roll out a clinical information system across our 40 plus hospitals, but we currently have multiple systems in our hospitals and two approved EMRs for primary care.”

In order to extract information from these systems, Nova Scotia is leveraging cloud technologies, the FHIR R4 standard and data pipelines to move data from disparate systems using automation, so “no clinicians are spending their valuable time running data reports for this initiative,” said McKenna. “All of this is only possible,” he added, “because of Nova Scotia legislation and regulations under the Personal Health Information Act that enable us to bring all of the health records together to create a comprehensive electronic health record for every Nova Scotian.

“This is what differentiates us from other jurisdictions in Canada, because we’re bringing together the health data for Nova Scotians from all parts of the healthcare system, including primary care,” said McKenna.

“As a practising physician in Nova Scotia,” said Dr. Clarke, “I would have said three years ago that it would be impossible to do what we have done. It was an incredible amount of effort to pull all of these pieces together.”

“None of this could have happened without the incredible partnerships we had,” added McKenna. “Everyone pushed really hard in the same direction.”

In addition to personal health information, YourHealthNS contains a wealth of other information, including emergency department and diagnostic imaging wait times by location, healthcare navigation resources, as well as physical activity, mental wellness and healthy eating information. Nova Scotians can also use the portal to book appointments for a variety of tests and vaccinations, and even locate the nearest automated external defibrillator.

New Brunswick: Like Nova Scotia’s portal, part of MyHealthNB consists of general health system information, including healthcare navigation resources, wait time data and information about social support programs that is accessible to everyone. Another section accessible only by login and patient authentication includes personal health information, including a list of dispensed medications, lab test results, diagnostic imaging reports and a history of immunizations.

However, what makes MyHealthNB unique is its Patient Summary, which conforms to the pan-Canadian Patient Summary specification developed by Canada Health Infoway, which is, in turn, based on the International Patient Summary specification and the HL7 Fast Healthcare Interoperability Resources Implementation Guide.

The Patient Summary contains a snapshot of essential healthcare information, including medications and immunizations that patients travelling across provincial or international borders can share in the event of unplanned or emergency situations.

The Patient Summary has been widely adopted in Europe and was used for the first time by hundreds of thousands of pilgrims travelling to Saudi Arabia for the Hajj in June. It’s also being considered for use at future Olympic games, according to Abhi Kalra, executive vice-president for connected care at Canada Health Infoway.

In an unplanned or emergency, patients are able to share their personal health information through a QR code on their cellphones. Residents of New Brunswick, the first jurisdiction in North America to adopt a patient-mediated Patient Summary, can use it when travelling internationally, across Canada and even locally when engaging with a healthcare provider they’ve never seen and has no information about them.

“Only ten to 20 percent of the use cases for the Patient Summary in New Brunswick will be for out of province travel, but 20 percent of New Brunswickers don’t have a family doctor, so they’ll be able to use their Patient Summary when they go to a walk-in clinic and see a provider who doesn’t have a history of them,” said Kalra.

A patient portal like MyHealthNB provides “an ocean of information” that a healthcare provider in an emergency would have to spend time to digest, explained Kalra. The Patient Summary, in contrast, is a compressed view of essential information.

The healthcare sector “has been working on sharing healthcare information for decades, but it has always been between providers,” said Mark McAllister, CEO of VeroSource Solutions, a Fredericton-based company that worked with New Brunswick’s Department of Health to develop MyHealthNB.

“Until now, we’ve never empowered patients to share their information, so New Brunswick was very innovative and brave to be the first to move forward with this.”

The rest of Canada is not far behind, noted Kalra, with both Alberta and British Columbia planning to launch Patient Summaries in the very near future.

New Brunswick’s Patient Summary, McAllister notes, “is still missing information about allergies, intolerances and medical problems which are held in different systems that we don’t have access to at this time, but we’re looking at a road map to get there.”

Much of the information in MyHealthNB comes from central databases. The exception is information from primary care, which is housed in several different EMRs and not currently available for inclusion in the portal or the Patient Summary.

Newfoundland and Labrador: Newfoundland and Labrador started rolling out MyHealthNL as a web-based portal in February of this year to 5,000 people and opened the registration process to the entire province in April. Three months later, it launched as the MyHealthNL app for both Apple and Android phones.

MyHealthNL is a digital front door with information about navigating the health system and an extensive library of health information about everything from asthma and diabetes to parenting and sexual health.

Patients can also log into their personal health record containing a list of dispensed medications, lab results, X-ray reports and allergy information, said Russell Bungay, senior director, provincial clinical systems with NL Health Services. “Our roadmap is to include other information with ultrasound reports and some pathology results in our next release.”

Hospital information comes from a single, province-wide Meditech hospital information system which feeds into a provincial repository, but earlier this year, the province announced plans to transition to an Epic HIS. According to Bungay, there are no immediate or short-term plans to access information from EMRs.

Information is available after a delay of seven days for lab results and 14 days for X-ray results. “In the future,” said Bungay, “we’ll have another look at those delays because as patients become more empowered, they’ll probably want to see their results a little sooner.”

Having this information at their fingertips empowers patients to monitor their chronic conditions, have more informed discussions with their physicians, and save time and money on travel because in the traditional model, said Bungay, patients would often have to travel long distances to get their bloodwork results from their physicians. Now, they’ll be able to get them on their phone or computer and, if the results are normal, travel to a medical appointment won’t be necessary.

In addition, it’s now possible to easily and securely share personal health information with a family member or trusted caregiver to support patients through their health journey.

MyHealthNL, said Bungay, was developed in-house with assistance from Orion Health. “We are proud to support Newfoundland and Labrador with MyHealthNL, a platform that empowers patients to take control of their healthcare journey,” said Michael Craig, vice president of national solutions at Orion Health. “By providing access to vital health information, MyHealthNL is not only improving the patient experience but also helping the healthcare system become more efficient and connected. This is a significant step forward in delivering patient-centered care across the province.”

Prince Edward Island: Unlike most jurisdictions across Canada, Prince Edward Island has standardized on one EMR for the entire province. Until recently, community practices in Prince Edward Island used several different independently selected EMRs and paper in some cases. Today, more than 95 primary care clinics, more than 200 primary care providers and an additional 1,000 users, including clerical staff and allied healthcare providers, are using Telus Health’s Collaborative Health Record (CHR) software.

“When we considered implementing a CHR, we chose to go with a single instance so it would be consistent across all users to support training, reporting and integration, so standardization has been our guiding principle,” said Laurae Kloschinsky, assistant deputy minister of PEI’s Department of Health and Wellness.

“At the same time we were doing this,” she continued, “we were implementing medical homes, a team-based care model, so physicians, nurses, physiotherapists and social workers, are all charting on one system.”
With one EMR and one province-wide hospital information system from Cerner (now Oracle Health), pulling information into the soon to be launched MyPEI portal is a lot easier.