Who should be the bearer of bad news in health care?

Imagine finding out your diagnosis for cancer on a Saturday night - without a trusted oncologist to go over your charts.

The real-time feature of Hamilton Health Science's (HHS) new patient record system, MyChart by Epic, has made patients the bearers of bad news" instead of doctors.

I've had patients break me the bad news rather than me breaking them (the news)," said Dr. Richard Tozer, head of medical oncology at Hamilton Health Sciences.

Although some patients are fine with it, others get really, really upset" - finding themselves emailing Tozer at 8:30 p.m. on a Saturday evening, for instance, he said.

The problem is that MyChart (has) no filters," Tozer said.

The shift in how the charts are being disclosed to patients began with the launch of Epic in June of this year, replacing the hospital's existing system, Meditech. Epic's program is a $175-million standardized patient portal meant to simplify patient access to medical reports, appointments and prescriptions - all in one place.

Tozer said the issue he takes with the system has been brought up with the administration, but there isn't an easy solution."

While finding sensitive information without notice could be unnerving for many patients - or could give them severe anxiety - Tozer said, the results belong to the patient. They have all the rights."

Tozer gives his patients a warning, just like a Netflix disclaimer before a TV show starts, he said. But again, it's within a patient's rights."

This means patients get to decide whether they want to access the results by themselves or wait for the doctor to delve into the charts with them.

Doctors have medical training" and they know how to interpret these things. And expecting patients to be able to interpret these things ... the way we do is unrealistic."

HHS spokesperson Wendy Stewart told The Spectator that the decision to make test results available in real time was based on best practice, as well as the input of both physicians and patient advisers at HHS and other health-care organizations that have implemented Epic.

But, she said, real-time access to test results may not be appropriate for every patient.

For those that do not wish to view their test results, a notification can be disabled in MyChart, Stewart said.

Tozer knew for a decade that this day would come - with the necessity for tech advancements in the health-care system. In his opinion, it isn't all that bad and it depends on how the patients would decide to take the news.

At HHS, there are over 26,000 MyChart accounts created by patients and, in some cases, are assigned a proxy to help them navigate the app.

Stewart said the app is optional for patients at HHS and signing up with the app doesn't influence regular services, including printouts of visit information, medication instructions, procedural or surgical instructions, and phone calls to book and confirm appointments.

Still, the app could be hard to navigate for many users - young and old.

The new patient portal was particularly hard to use for Roy Miller, a 76-year-old Hamilton man, who spent much of his life working in tech.

When Miller turned 75, his doctor suggested it would be a good time to get an MRI scan done.

The average wait time for lower-priority patients could vary from 74 days to 253 days at Hamilton locations - Hamilton General Hospital, Juravinski Hospital and St. Joseph's Health Care System's West 5th Campus.

Miller agreed and signed up for the appointment.

On the scheduled day, Miller said, the staff at West 5th made an error and he was given a choice to wait another six months for the next appointment or stay overnight at the hospital and get an opening for his MRI right away.

It sounded like a good idea, but in retrospect, it wasn't a good idea because once I was there" the hospital suggested additional tests - part of the regular checkup to sense the impacts of aging on his body.

After the tests were done at the hospital, Miller was prompted to sign up with MyChart to access his reports easily - but he ran into usability issues with the app. MyChart requires patients to sign up through an email address with which they receive communications routinely.

Patients' familiarity with navigating and accessing web pages helps them use the application better. Even with this capability and my years of online experience, I have been greatly annoyed by the system," Miller said.

In a letter to the editor published on Aug. 30, Miller said that he has spent many hours updating and correcting (his) health record."

If Americans can put a man on the moon, why can't Hamiltonians have a medical system they can easily access and use with or without a computer?"

Dr. Pamela Baxter, a nursing professor at McMaster University, said that when it comes to technology use among older adults, principles of equity and inclusivity seem to be lost."

It goes back to software developers, who have to recognize that they are responsible to ensure equity when they're developing the tech," she said.

Baxter emphasized the need for education with advancing technologies, not just for patients but also for their families and caregivers to help the patients navigate confusing waters.

She suggested a good start would be taking the issue back to the aging population - not isolating them from the tech advances" - and learning how to make accessibility better for them.

But Tozer doesn't think usability has to do with age." Cautioning about ageism, he said the usability of MyChart depends on the degree of comfort for individuals ... equally prevalent among younger people too."

Pointing to his 90-year-old father who chooses MyChart regularly," Tozer said, the app could be very helpful."

Stewart said that of 155 million unique MyChart patients around the world, 25 per cent of them are over the age of 61.

For Tozer, who works closely with patients at HHS, the benefits of the upgraded health record system outweigh the risks," saving the emergency physicians from making some bad decisions" in the absence of (a patient's) trajectory of the disease."

Ritika Dubey is a reporter at The Spectator. rdubey@thespec.com