International Exchange of Medical Information

Accidents happen. While travelling, tourists can become sick or injured. People might need medical treatment in a foreign country. And with an increasing number of people travelling abroad for medical procedures, we are beginning to see a change in the way medical information is stored and exchanged.

In the past, the onus of medical record keeping often fell to the patient. When consulting a specialist, or changing doctors, the patient needed to obtain and bring along copies of their medical records. In many areas, or when travelling abroad for a medical procedures, patients are still required to provide and manage their own medical records to ensure their healthcare professionals are all up-to-date. Or in the event of illness, accident or injury when travelling, the patient may not have access to their medical records – or can only obtain them through lengthy procedures requiring authorizations that the patient may not be physically able to provide due to the nature of their injury.

With the advances in technology and digital record-keeping, more and more doctors have migrated to a Health Information Exchange (HIE) which allows the electronic movement of patient information between different organizations.

Records can be accessed by health professionals community-wide, within a specific hospital network or even – as in the province of Ontario – across an entire region. This allows for more timely access to clinical information, and leads to more efficient and effective patient-care. Organizations, sometimes supported directly by government offices, are emerging that focus on creating HIEs nationwide and even worldwide.

Once HIEs are implemented on a planetary scale, medical tourists will no longer need to provide their specialist with a paper copy of their medical records; any medical professional with the necessary credentials could potentially access the relevant information. Further, they would not need to bring back records of the procedures and medications received abroad.

Organizations like Health Level Seven (HL7) International are dedicated to building a framework that will standardize and regulate the exchange, integration, sharing and retrieval of electronic health information; they aim to support clinical practices and better the management, delivery and evaluation of health services.

Over time, we will be able to establish a super-directory of medical records so that information can be shared across international border in a timely manner. This will also prevent important details from being lost in translation as any follow-ups or verifications can be handled at a moment’s notice. The future of medical record keeping will be patient-friendly and ensure that their medical professionals can offer the best care with the most precision and the shortest delays.

What is Medical Tourism?

Canadians travel to every corner of the planet – we are avid tourists, explorers and connoisseurs of the delights of foreign travel. And sometimes, we may access medical care while travelling; this might be due to a medical emergency such as illness or injury, but there is an increasing trend toward medical tourism, also known as medical travel or health tourism.

A medical tourist visits another country in order to receive medical care that is either unavailable or for which there may be an extended wait in their region. The Canadian government suggests steps to take for anyone contemplating a trip abroad for medical reasons: first, discuss your medical care plans with your Canadian healthcare provider before leaving and follow up when you return; ensure that your health insurance covers medical procedures in other countries; verify the risks, if any, of airline travel after your chosen procedure, and bring back copies of any medical records, including the procedure you underwent, medications you received, and the results of any medical tests. It is vitally important that you be informed about the source of any tissues or organs if you undergo a transplant abroad. Also, you should consult a health care provider upon your return to Canada if you suffer from chronic illness, were treated for malaria while travelling, or experience any other illness such as fever, jaundice, skin disorders, urinary or genital infections, vomiting, or persistent diarrhea.

Many people are travelling between Canada and Japan as medical tourists; both countries offer excellent medical care with particular areas of expertise. While the Japanese are known for innovative medical technology and rigorous study, Canadian schools of medicine offer training in some of the most advanced forms of medical care available worldwide. Specialized travel insurance policies allow foreign patients to travel to Tokyo or any other large Japanese city with major medical facilities to undergo specialty testing, procedures and medical treatments such as surgeries, biopsies and transplants.

While the wealthy and powerful have, for years, travelled the globe for the best and most innovative medical care, increasing globalization and reduced-cost travel options have made medical tourism a possibility for the average Canadian. And it is a very lucrative industry; in some countries the medical industry is the largest source of income, and opening it to foreign patients allow them to multiply their revenue.

Promoting foreign exchange, the global economy, and good diplomatic relations in addition to providing quality healthcare, for many, medical tourism is truly the way of the future.

Comparing the Japaneses and Canadian Healthcare Systems

A recent study by the Fraser Institute compared the Canadian healthcare system to 27 other universal healthcare programs worldwide; its co-author, Bacchus Barua, stated that though Canadians spend a lot for the universal healthcare system, it compares poorly to that of other countries as it “generally has fewer resources, a mixed record on the quality of care patients receive, and remarkably long wait times.”

Ontario’s Health Minister, Dr. Eric Hoskins, considers their system among the best in the world, and a 2015 Conference Board of Canada report ranks it 7th best in the world – placing it ahead of Japan, Germany, the UK and the US. Canada’s system is the 3rd most expensive on the planet, and yet ranked only 24th for the availability of physicians and 15th for that of nurses. We had the least amount of acute care beds of all 28 countries examined, and our quantity of psychiatric care beds falls far below Japan (ranking 25th and 1st, respectively). Japan also had the most MRIs and CT units, while Canada ranked below the average in 18th place.

The Legatum Institute, based in London, prepares an annual global Prosperity Index every November; one of the nine sub-indices ranks the health of each country’s population. They use 3 key components: the country’s basic mental and physical health, the health infrastructure, and the availability of preventative care. From the 5th spot in 2016, Canada dropped to 24th in 2017 while Japan rose from 22nd in 2016 to 4th in 2017.

Nadeem Esmail, a Senior Fellow at the Fraser Institute wrote in 2013 that Japan outperformed Canada on five of eight measures of healthcare performance, while Canada led Japan on only one of the eight measures. He suggests that Canadians could learn much from the Japanese health care system – though emulating their approach would require substantial reform of our own, including a shift away from tax-funded government insurance.

The Japanese Health care model includes cost sharing for all forms of medical services as well as activity-based funding for hospital care and a system of statutory independent insurers that provide universal services to their clientele on a primarily premium-funded basis, which is commonly known as a social insurance system. Japan permits privately funded parallel health care and the provision of acute care hospital and surgical clinic services is largely private. As per Barua’s report, there may currently be an imbalance between the high cost of the Canadian healthcare system and the value received by its users and their access to resources. Clearly, it may be time to update the decades-old Canadian Universal Healthcare system.

Health Trends in Canada

In one of the world’s largest developed countries, free healthcare has been readily available to the entire population for 50 years – and for those with private supplemental health insurance, or who are willing to pay private practitioners, services can be obtained quickly and easily. However, as the cost of healthcare increases, we will begin to see a shift in private health insurance – which covers all “non-essential” treatments such as dental, vision and chiropractic care as well as prescription drug costs.

The Canadian healthcare industry is currently booming, as substantial investments are being made privately and in the public sector. Additionally, as in other parts of the world, more people are turning to alternative medicines and health supplements, which can be quite costly if not included in a private health insurance plan – plans which are, themselves, sometimes cost prohibitive for the average Canadian who doesn’t have health benefits through an employer, leading people to forego some health services altogether.

Also, the population is shifting: while the percentage of people over age 65 is growing quickly, that of people under 14 is decreasing as Canadians choose to have fewer children. Therefore, though most seniors are in good health with a life expectancy of 79 for men and 85 years for women, we are seeing an increased need for senior healthcare services. Further, as more and more medical professionals are retiring, and fewer young people are stepping into their positions, we will soon see a shortage in available healthcare personnel.

And while there will always be users of the traditional healthcare system, there is a rise in “self-diagnoses” using online tools, and “self-prescriptions” of alternative care, or fad diets to improve overall health. Some, like the rise in veganism and the juicing trend, can – if not followed properly – actually cause gaps in nutrition or excesses in sugar intake.

Canadians’ schedules are fuller than they have ever been, and we’re increasingly looking for the quick fix – and with today’s online solutions, a rise in the numbers and visibility of diet and exercises gurus are making that possible. Why spend 45-60 minutes getting exercise when a 7-minute Crossfit circuit can target the whole body more quickly and efficiently? Why prepare a meal when you can drink a green smoothie or protein shake? While natural healthcare is an admirable choice, we haven’t had enough exposure to study the long-term effects it may have on an individual’s overall health even when done right, let alone followed sporadically by internet enthusiasts.

Health Trends in Japan

Japan prides itself on being at the forefront of technology and innovation. They have streamlined homes with integrated storage and automated systems, computerized public toilets, and their health trends are no less advanced. As Japan is an ageing society, with a declining birth rates, the ageing population has led to a strong nationwide drive toward overall health and wellness. For the past 3 decades, Japan has hosted an annual Health Industry Show where more than 500 exhibitors will be divided into 5 zones: Health Food & Supplements, Health Equipment & Health Care, Beauty & Aging Care, Sports Conditioning, and Organic & Natural Products.

Though food safety is a concern due to nuclear radiation and a proliferation of tainted food warnings worldwide, there is a growing need for ready-to-eat products and more convenient meals. In single-person and elderly households, there is a need for individual food products that allow personalization. As such, the Japanese diet has greatly diversified and the population seem increasingly willing to try new products.

Japanese companies are focussing more now on the business of Inner Beauty – selling ever-increasing amounts of natural health products and supplements such as healthy drinks; as a result, the average Japanese life expectancy has increased to 72.14 years for men and 74.79 for women. Changes in food regulations over the past year and the more relaxed Food with Functions Claims have increased the potential to market foods with health benefits – and not just allergen-friendly or organic foods – one cooking oil is advertised as contributing to lower cholesterol levels.

A recent trend toward warming the body from the inside has developed as more than 80% of Japanese women are concerned about their sensitivity to cold. Many forms of thermotherapy have come to light, such as Onkatsu (using food and drink to warm the body from the inside out), Onnetsu (using physical stimulation from far infrared to warm up the body and helps blood circulation), and Onyoku (hot baths); the physiological benefits of Heat Shock Protein (HSP) are drawing the attention of Japanese health experts. HSP is believed to increase the level of protein in the body, help repair injured cells, and even control the production of lactic acid.

As pollution and smog levels continue to rise, health accessories such as air and water purifiers remain trendy, as do state-of-the-art sports conditioning equipment like specialized athletic wear, training equipment, and sports nutrition. It will be exciting to see what the future holds for healthcare in Japan.