In today’s Digital Health Week video, OntarioMD General Counsel and Chief Privacy Officer Ariane Siegel speaks about the importance of keeping patient data safe and secure – and OntarioMD’s commitment to helping clinicians ensure they’re able to do this.
As Digital Health Week 2019 continues, we bring you a video message from OntarioMD Chief Medical Officer Dr. Darren Larsen. Watch for Dr. Larsen’s insights on how the work of OntarioMD and our sector partners are helping advance practice efficiency and patient care.
OntarioMD has spent 15 years helping physician practices adopt and implement digital health technology. All week, we’ll be sharing messages from OntarioMD leadership team members focused on how digital health is helping transform the system. To kick things off, here’s a message from our CEO, Sarah Hutchison.
Contributed by Patrick Kitchen
Throughout recent years, a recurrent health problem has required me to make frequent visits to my family physician, a specialist’s clinic and occasionally the ER. I became used to the routine of explaining what happened, describing previous events to various clinical staff, and providing context in lieu of a personal and up-to-date health record that the physicians or nurses could review. After each appointment or ER visit, I would request that the information be faxed to my GP or cardiologist, as well as take a personal printed copy in case the records were not sent, which turned out to be a common pattern.
In 2017, I was accepted to graduate school in Copenhagen, where I completed a Master’s degree in Business Administration and Innovation in Health Care this past June. Throughout the first semester of the program, discussions on digital health and how to improve outcomes, efficiency and the patient experience using digital health tools were fairly common. During classes we would hear from speakers who worked in the Danish health care sector, health care practitioners (HCPs) and professors who would proudly mention Denmark’s progress in achieving a largely digital health system. Numerous examples of these innovations included: MedCom, a non-profit agency developed in 1994 and responsible for the development of data standards and a national health data network; the national IT health portal launched in 2003 (Sundhed.dk); the extensive use, interoperability and portability of EMRs across primary and secondary care settings; ePrescription rates of nearly 100%; highly sophisticated public health registries, and many other examples. While impressive, these statistics and figures never fully resonated because I had not seen a doctor in Denmark, nor experienced these technologies or platforms as a patient or user.
When my health problem returned while I was studying in Copenhagen, I felt some uncertainty given that I was outside of Canada, and I had never visited my doctor before (I say ‘my doctor’ because I was automatically assigned one when registering with civil authorities based on my address). I arranged a visit with my GP the following day. She felt that we should do some diagnostic work, and as I left, I asked if there was any documentation I needed to bring. She looked at me with a curious face, and then stated it was all submitted digitally, and that she would receive the results digitally, which would also be available to me through my profile in the national patient portal. When I arrived at the lab, I simply swiped my personal ID card (all residents in Denmark have a unique personal identifier that is used in the public sector) in their scanner, and the lab tech knew what tests I needed to complete. While this process might feel insignificant and routine to Danes, it felt worlds ahead of the care process at home in Ontario. It was reassuring that the onus was not on me to ensure my doctor or the lab technician had the correct information, and that I could access it digitally and send the information back to my Canadian doctor if necessary.
When the problem presented itself again the following year, I called the acute nurse line as it was a Saturday. I was then referred to a nearby hospital, which had anticipated my arrival, and whereby I was immediately taken to an examination room, swiftly examined and discharged shortly after. On the Monday, my family doctor called and asked me to come in for an appointment, because she was notified that I had visited a hospital over the weekend. After discussing my results with me, she referred me to a specialist who’d conducted further testing by the following Wednesday. Again, the results and lab work were sent digitally, and I could access them online using the Sundhed.dk patient portal. Gone was the added stress associated with visiting the doctor or ER and needing to ask for documentation, retelling my medical history to various HCPs, or even being asked basic personal information over and over again. My experience both as a patient in the Danish health system and student in a Master’s program aimed at supporting innovation while sustaining publicly-funded health care allowed me to gain a real understanding of the importance of a digitally-connected health system, and provided me with further motivation in my studies. Knowing that my GP and other clinicians could easily access my records, easily communicate with each other and order tests and prescriptions if necessary, and that I had access to all this information in the patient portal, felt like another world – one that would be a luxury to have in Canada.
Like many aspects of Danish society, consensus-building has been crucial in the continuing development of a strong, nationwide digital health strategy. Denmark may be a small country of approximately six million people. However, a country’s population should not dictate its ability to deliver high-quality and well-integrated health care assisted by the extensive use of digital health innovations. I decided to write this post since there is a lot of talk in Ontario about integration and digital health. Based on my experience as a patient in another country, and my Master’s studies in Copenhagen, I know what is possible and what we should strive for – a digitally-enabled health care system that benefits and empowers clinicians and patients to be true partners in care.
Patrick Kitchen recently graduated from Copenhagen Business School in Denmark, completing an MSc in Business Administration and Innovation in Health Care. Prior to that, he received a Bachelor’s degree from the University of Toronto in Political Science, with a specialization in Comparative Politics. Through his educational and professional experience, Patrick has developed a passion for digital health, health policy and strategy, and health system sustainability. Patrick recently returned to Canada and is looking to start a meaningful career in the digital health sector.
Contributed by Dr. Anil Maheshwari
In this time of ongoing changes in our healthcare system, technology has emerged as one of the most promising ways to provide better care for our patients. One of the key areas of focus for the new Ontario Health Teams is digital health. The government clearly envisions technology tools such as virtual visits playing an important role in the province’s healthcare system.
You may be asking yourself, “What is a virtual visit?” My definition of a virtual visit is an interaction that occurs between a patient and healthcare provider without having to be in the same place at the same time.
In the Waterloo Wellington area, 67 clinicians have conducted over 10,000 virtual visits so far and the feedback has been overwhelmingly positive. Feedback indicates that 94% of patients thought that their virtual visit was the same or better than an in-person visit, and 94% of patients would recommend the solution to friends and family. In addition, 91% of providers indicated that the solution is easy to use, and 81% would recommend the solution to their colleagues.
We have rolled out three types of virtual visits at our 15-physician Family Health Team – secure messaging, phone calls and video visits. We currently have over 2,800 patients signed up on our platform.
Our physicians have been predominantly using secure messaging, which provide a variety of benefits:
- Patients and physicians are able to send and receive messages at their convenience;
- Patients document their visit, which means less documentation to be done by the physician;
- Everything that is documented is saved for the patient to come back and look at later, which leads to fewer communication mishaps;
- Providers can send documents including handouts, prescriptions, laboratory and radiology requisitions;
- Patients can send pictures of rashes, medicine bottles and other documents to their providers, who are able to save this information in the patients’ charts; and
- The messaging takes less time than standard, telephone or video visits.
We are now looking to do more phone calls and video visits, which need to be scheduled. The biggest advantages to these are that the provider is able to hear and/or see the patient and is reimbursed at the same rate as an office visit for most standard visits. It can be more convenient for both the patient and the physician.
Virtual visits are clearly an important part of the future for the healthcare system. According to Kaiser Permanente CEO Bernard J. Tyson, out of 100 million patient-provider visits in 2016, 52% were done virtually. While Kaiser Permanente is a fully capitated model in the United States, virtual visits also work in our current system because the government understands the value of these types of visits and is reimbursing phone and video visits at the same rate as office visits. Physicians in a rostered model continue to shadow bill and fee-for-service physicians continue to receive the full fee-for-service rates. Messaging pays a slightly lower rate in both models but, as discussed above, has several advantages.
Overall, the most active virtual visit adopters in our group feel that using technology is a great way to provide care and avoid unnecessary face-to-face visits, saving both patients and clinicians a lot of time. We also understand that virtual visits will only improve with better integration into our electronic medical record.
Virtual visits should also allow us to prevent outside usage by patients. According to our data, high users of our platform were able to retain 8.5% more of their access bonuses while our control group’s access bonuses actually fell by an average of 5% during the same time period. A net difference of 13.5% provides some evidence that this technology does in fact prevent outside usage.
As we are better able to integrate these new types of visits into our office flow, we believe that many more physicians will see the benefits and embrace this technology.
Hear more insights from OntarioMD Peer Leader Dr. Maheshwari at his session, Virtual Care: Hype or Hope?, at OntarioMD’s EMR: Every Step Conference in Toronto. Register to join us on September 26. You can also get more information and support from OntarioMD anytime at email@example.com.
Contributed by Dr. Sunny Vikrum Malhotra
The application of artificial intelligence (AI) in the medical field holds great potential for improving patient health. AI has already made an impact around the world, assisting in the process of diagnosing, treating and preventing many health problems. A major priority in the healthcare industry is finding new ways to improve efficiency and reduce costs, and automating manual tasks is one way to achieve this. Robotic process automation (RPA), for example, can streamline many office procedures by decreasing paperwork and shortening the time it takes to process files. This form of technology can reach even further heights by decreasing costs, increasing efficiency and enhancing patient care.
As technology continues to expand, the number of ways that information can be exchanged is increasing. However, it’s important to recognize that no one solution can be the answer to all our challenges. A combination of approaches, including operational AI, can connect patient data from the Internet of Things/wearable devices and allow organizations to use it effectively. A multifaceted problem requires a multifaceted solution.
Ontario Health Teams (OHT) represent a new model of integrated care delivery that will allow patients, communities, providers and leaders to each play a role in a value-based health care system. OHTs will give healthcare providers the ability to work together in teams to deliver coordinated and standardized care for patients.
However, as the number of OHTs expands and the population continues to grow, healthcare providers will see increasingly higher volumes of work and are seeking solutions for this workload. It is already becoming evident that providers are overwhelmed with patient care responsibilities, leading to clinician burnout.
However, in order to see successful and sustainable change in the healthcare sector, large-scale adoption of digital health programs will need to be part of the solution. These programs have the ability to decrease the time it takes to complete administrative tasks, thus reducing staff turnover and decreasing burnout. They can also effectively allocate staff to more meaningful frontline care, leading to a much more fulfilling and rewarding experience for workers, as well as increasing engagement and retention. The Ontario government recently introduced its Ontario Health Teams: Digital Health Playbook to help OHTs build a digital health plan that will help meet their clinical and practice objectives.
As the use of digital health applications continues to expand in the healthcare system and government encourages the use of this technology to improve patient care, we believe that government-led reimbursement policies will aid in increasing the use of digital health tools such as operational AI, telehealth and remote monitoring
Clinicians are at an important juncture in the digital health transformation. Hear more insights from Dr. Malhotra at his session, Using AI Automation to Improve Health Costs, Revenue and Outcomes, at OntarioMD’s EMR: Every Step Conference in Toronto. Register to join us on September 26. You can also get more information and support from OntarioMD anytime at firstname.lastname@example.org.
This is the second part of our OntarioMD virtual panel discussion, in which we ask the patient advocates and clinicians who spoke at our Ottawa EMR: Every Step Conference keynote panel in June for their insights on the question “What will a successful digital health transition look like to you?” If you missed Part 1 of our virtual panel, you can read it here.
Also, don’t miss your chance to join us at our Toronto EMR: Every Step Conference on September 26 for more great education and networking around how to build an effective patient-centred health care system driven by digital health technology.
Claire Dawe-McCord, Former Member, Minister’s Patient and Family Advisory Council
We have reached a tipping point in Ontario where if the digital health transition is not properly executed soon, we will be left stagnant in an ever-developing electronic world. As a Health Sciences student and a patient with many complex, life-threatening disorders, I believe digital health is crucial not only to the functioning of our health system, but also to the safety of patients. At age nine, I began experiencing what seemed to be vague, unconnected symptoms that landed me in the emergency department and specialist offices countless times. Every test came back inconclusive, until I became extremely ill in grade 11 and spent ten days in a medically induced coma and months as a hospital in-patient. During that time, I luckily received the diagnoses I had long awaited, Ehlers-Danlos Syndrome and a sodium channel malformation resulting in a rare neuromuscular disorder which often induces massive potassium abnormalities.
Rare diseases are difficult for patients and caregivers to navigate; In the years following my diagnoses I have had to repeatedly explain my disorders to health care providers, often in critical situations. This is where digital health can play an important role. For many people, digital health is about efficiency and cost cutting, but for patients like me, having quick digital access to my records can mean the difference between life and death.
For me, a successful digital health transition would involve a single sign-in system where all of my records dating back to when they were first digitized from all of my providers – including my primary care team both at home and at university – can be accessed in real time both by me and by any providers who may require the information. Ideally, this system would also incorporate ways for patients to make the “small things” easier: that means, being able to email my care team, book appointments online, and see where I stand on wait lists for specialist referrals.
Dr. Daniel Pepe, Family Physician, London Lambeth Family Medicine Clinic
Navigating a successful digital health transition is not an easy feat. The current digital landscape is a partially developed polaroid at best. I first was exposed to “digital healthcare” during my first night on call as a surgical resident. As a medical student, I had learned to be efficient by opening each chart to the correct page, filling out as much information as I could for my senior so that with a swipe of a pen we could move onto the next room. However, overnight, our hospital went “online” with electronic ordering and our workflow was immediately thrown into chaos.
As a family physician, I have learned that digital health transitions provide us with an opportunity to not just digitize our processes, but to, more importantly, evaluate and improve our underlying culture. Thus, I believe a successful digital health transition must be able to transform the underlying culture. Digital health solutions today provide us with a rudimentary quilt of various partially integrated solutions that allow us to do some, but not all, of the functionality we require to be effective digital healthcare providers. I would contend that the most effective digital solutions are those that enhance, rather that detract, from the patient-doctor relationship.
Most importantly, we must look to digital solutions to allow us to solve problems dynamically. A few days ago, I was reflecting on how the problems I see are sometimes due to medical illnesses, sometimes due to social determinants of health, and other times due to access to, or awareness of, community services. Imagine an e-referral network where we could simultaneously search for an endocrinologist, Meals on Wheels or assisted living. That to me is a holistic solution to upstream care that doesn’t involve huge investment, but just requires making the current solutions more readily available to providers.
One thing is clear to me – this transition will not happen successfully without the intentional inclusion and empowerment of patients, caregivers and families. Google would never design a new product without considering the user experience, and we, as healthcare providers and leaders, need to focus on the patient journey from diagnosis until end of life. We don’t need many tools, but they need to be employed in a thoughtful way. Technology has the ability to help us deliver the best care, at the right time, by the right provider, through the right means.
If you attended OntarioMD’s Ottawa EMR: Every Step Conference this past June, you know about the amazing discussion and insights shared by our keynote panel on the challenges and opportunities of patient access to electronic medical information. We’ve invited our Ottawa panelists to continue the conversation over the coming weeks here on OntarioMD’s blog, to discuss the question “What will a successful digital health transition look like to you?”
Join us at our Toronto EMR: Every Step Conference on September 26 for more great education and networking around how to build an effective patient-centred health care system driven by digital health technology.
Julie Drury, Former Chair, Ontario Minister’s Patient and Family Advisory Council
In our current health care landscape, patients are their own care
coordinators, information gatherers and information disseminators. That is a
reality that is unlikely to change as patients become increasingly supported to
be partners in their care, are encouraged toward self-care and self-management,
and are engaged in shared decision making.
These are all good things.
However, we are no longer a ‘paper-based’ society, and there are high levels of inefficiency, poor communication and issues of patient safety in the absence of digital solutions. Patients must submit applications for requests to access their health information (and pay for it). They create binders of their own personal health information, and they are forced to use technology such as CD images to access and share information.
We are increasingly a digital society. We bank, pay bills, make appointments (other than medical), update our health cards, licenses and pet registration, all online. Digital health is slowly evolving through the application of EMRs in clinicians’ offices, EHRs in hospitals, and the establishment of patient portals. We are discussing electronic referrals and electronic consultations. Virtual care via secure email and video-medical technology is slowly emerging. However, this transition to electronic information is being hampered by outdated privacy legislation that limits information exchange, clinicians who do not want patients to have unfettered access to their information, and patient portals/EHRs that are not interoperable.
In some instances, solutions to these issues are on the horizon. But from the patient perspective, these solutions seem to be focused around organizational and provider needs, while the needs and expectations of patients is secondary.
For a digital health care system transition to be effective for all system participants, patients must be part of the conversation.
Selina Brudnicki, Program Lead, Digital Patient Experience, University Health Network
As Ontario Health Teams move toward a connected health care system centred on patients and their families and caregivers, a successful digital health transition must enable seamless flow of information for patients, authorized care providers and family/caregivers that make up their circle of care. Flow of information includes electronic access to data and analytics; virtual, real-time or asynchronous communication; and the ability to facilitate other types of interactions. This supports safe transitions and activates patients to gain the skills and confidence they need to participate in their own care. Patient activation leads to better health outcomes and care experiences.
One of the basic digital needs of patients is online access to their complete health record information, including test results, reports and clinic/doctor notes, so they can communicate effectively with their care team to make safe, timely and informed decisions. Transparency helps patients feel more engaged, and engaged patients are “more likely to adhere to treatment plans and medications, follow through on screening and prevention protocols, detect and prevent errors, and adopt more effective management strategies for chronic illnesses.”
Unfortunately, barriers to patient access exist such as health professionals’ fear of increased workload, telephone calls and duration of appointments. Despite these concerns, that fear has been unfounded. There is a perception that patients and society may expect more of physicians and care teams in the future. EMR vendors could help reduce fears and potential burnout caused by excessive time, effort and frustration associated with electronic documentation. Observing and understanding the needs and challenges of providers, patients and family/caregivers could improve their EMR products and result in efficiencies and better experiences.
Seamless flow of information requires health data to flow privately and securely between information systems or applications when authorized to do so. Interoperability standards already exist and we must advocate that these services be readily available for the purpose of health information exchange, integration and retrieval of data. With recent advances in technology and innovation, it will be important for patients to gain visibility and transparency into all their health data, wherever it lives, and be able to control, authorize and monitor secondary use by third-party companies or organizations.
Ontario Health Teams (OHTs) hold the promise of organizing and delivering care that is more connected to patients in their local communities. Health systems and health data have lived in fragmented silos for far too long, and we must be careful that we do not create new types of silos. We must find better ways to collaborate, share knowledge and expertise across OHTs and disciplines, and think beyond ‘health care’ toward larger goals of ‘health.’ Bringing together patients, family/caregivers, care providers (including solo primary and community care practitioners), privacy/policymakers, government, technical and innovator subject matter experts would help leverage and scale investments and find sustainable solutions toward a connected health system.
Contributed by Virve Aljas, Manager, Employee Communications & Engagement, Ontario Medical Association
I have a vested interest in improving digital health systems. The information housed across a number of systems within different institutions can be applied directly to research that could save my life. Full disclosure, I work for the Ontario Medical Association, of which OntarioMD is an affiliate. I’m writing this blog through the lens of a patient with a rare disease, navigating a complex health care system. You’ll also read the perspectives of two physicians who are deeply involved in transforming digital health to inform their research.
I have a rare liver disease called Primary Sclerosing Cholangitis (PSC), which affects roughly 21 in 100,000 men, and 6 in 100,000 women. It progressively inflames and scars bile ducts to the point that the liver ceases to function. No one knows what causes PSC, and there is no cure. If the disease progresses to a certain point, liver transplantation is currently the only solution.
You might not expect me to follow that up by saying that I feel incredibly lucky. I’m fortunate to live in a city where I have access to multiple centres of excellence in gastroenterology, hepatology and therapeutic endoscopy. I can access care by boarding the subway, while some patients I know have to board a flight to see their specialists.
These hospitals have some of the most advanced medical technology available. However, like many patients in Toronto, I’ve made the familiar trek across University Avenue from one specialist to another with an armful of my medical records on paper, because their EHR systems can’t communicate with each other.
Digital Health Information and Research
Another way I’m lucky as a patient is that I’m based in the same city as doctors who are researching ways to cure my specific disease. If they based their work on data from solely their local patient pool, their sampling would be relatively small. You can imagine that patients would want them to have access to as much data as possible to find common trends.
Another layer of complexity is added in this case, when you consider that over 75 percent of PSC patients also have ulcerative colitis. PSC researchers and their peers in gastroenterology are keen to collaborate in order to find out more about this relationship. Unfortunately, good intentions only take us so far.
Like many rare disease groups, the PSC patient community has self-organized to create resources like a voluntary patient registry, online forums, annual patient conferences and fundraising to support research. I’m privileged to use my voice through a forum like this blog, but patients would love to find other ways to help move digital health and research forward.
Dr. Gideon Hirschfield
MB BChir PhD FRCP (Lon), Director, Autoimmune Liver Disease Programme, Toronto Centre for Liver Disease, Lily and Terry Horner Chair in Autoimmune Liver Disease Research
“Electronic health in Ontario has a long history and some recent positive advances. We now have, albeit a slow and not easy to use, system of getting results about our patients through the ConnectingOntario ClinicalViewer. However, as academic clinicians, we often find ourselves with a focus on diseases that frequently don’t have very good treatments at present. It is therefore quite discouraging to see barriers to using existing electronic resources for simple observational research.
As an example, PSC is a rare disease, very impactful, and has no present therapy. Our patients live all over Ontario and we use tools like ConnectingOntario for their clinical care to reduce the burden to them, every day. We can see blood results, radiology investigations, etc. However, if we want to cohort and learn more about our patients, we cannot use ConnectingOntario data in that way, as that is classified as using the data for research. To be honest, it is hard for us to explain this to patients who live with an impactful disease with no therapy.
No one is asking for unrestricted academic privileges that discard privacy concerns. But if you had a rare disease, and you knew that simple research to learn more about the nature of the disease is hampered by poor access electronically to existing data already used in your clinical care, you might question whether it was a small win for all to proactively solve the problem. Certainly, as academic clinicians develop solutions to working together clinically and for research, collaboration across institutions is one priority we really want addressed as e-health expands.”
Dr. Aliya Gulamhusein
MD, MPH, Assistant Professor of Medicine, University of Toronto, Clinician Investigator, University Health Network
“Chronic diseases are increasingly complex and patients with rare, multi-system diseases often ultimately seek care in highly specialized centres. Rare diseases like PSC affect multiple organ systems including the bowels, liver and biliary tree, and are often managed by distinct clinicians who specialize in management of these individual systems, with each clinician contributing an important element to patient care. Clearly, however, learning about patients in silos of organ systems without considering the broader picture is misleading and close collaboration to optimize outcomes of patients with PSC is essential.
For academic clinicians who manage rare disease like PSC, which itself has no effective treatment option and progresses to important outcomes, it is our responsibility to work towards discoveries that optimize patient outcomes — but this relies on collaboration. Barriers to collaboration amongst engaged and willing academics are immense and, particularly for junior faculty, can be obstructive and discouraging and can easily lead one to simply lose the drive to persist. Creating a network between gastroenterologists within the same specialty, division, and university who simply work at different hospitals managing the same patient can require approval from up to four ethics boards (SickKids, University Health Network, Mount Sinai Hospital, St. Mike’s) and development of individual data sharing agreements — each of which takes months to process. For rare diseases requiring international collaboration, you can just imagine the administrative burden.
Patient privacy is a priority and must be protected — this is not at question. But for observational minimal risk data, collaboration between engaged academics must be fostered, not obstructed. This is ultimately most important for our patients who we want to learn from, with, and for.”
Contributed by Darren Larsen, MD, Chief Medical Officer, OntarioMD
With fairly radical transformation happening in health care in Ontario as we speak, a question looms large: how do we measure success?
How do we know that the change we get is what we need? Which lens do we look through as success will appear differently for patients, physicians and the health system itself? Is there a benchmark we can compare to that goes beyond “at least it’s better than it used to be”?
We have experience with measurement. Understanding that not all that can be measured matters, and not all that matters can be measured, we still need to ante up useful performance indicators that will allow course correction or celebrations of success.
OntarioMD has been measuring practice change for nearly a decade already. We have been measuring maturity of EMR use by over 5,000 doctors for 7 years. The Insights4Care Dashboard is installed in 500 offices now, with at least another 500 more to come this year. We implemented indicators that matter (valid, meaningful, measurable, open for improvement), although this was no easy task. The dashboard uses real world data from practices with the robust data set found in primary care EMRs. It pulls results in real time. It visualizes the data to be easily consumed. And it allows for direct action from the dashboard itself.
The first batch of indicators was strong in four major domains: roster management, chronic disease, screening and prevention and opioid management. Opioid indicators were added as a direct response to a partnership with over a dozen provincial organizations who want to bend the curve on opioid prescribing in the Ontario. They are pithy and impactful, taking into account current guidelines on risk levels. Clinicians can now quickly see all patients using over 50 and 90 morphine mg equivalents per day, those on dangerous opioid / benzodiazepine combinations, and those who have been on the drugs for a prolonged period of time signaling risk of addiction. This information can help clinics and their staff develop a plan of action to handle complex and complicated patient problems, and proactively move to change behaviours and reduce risk.
Advanced measures will be required for showing the progress of OHTs, and for the comparators needed for accountable care. The same principles apply.
- Indicators chosen must matter not just to policy makers, but also to patients and providers, taking Quadruple Aim concepts into full consideration. We must ask ourselves “do we know what those we care for really need?” Do we know? Have we asked?
- Evidence, standards and guidelines do not always translate into actionable measures of the practice or data source level. For example, when looking at Quality Standards, some of these are aspirational. There are often few that can be boiled down to indicators at the coal face.
- Basic principles of indicators being measurable, valid, subject to improvement and actionable apply. If an indicator does not lead to change, then it should stop. As much attention should be paid to removing indicators that are not adding to improvement as to adding new ones that might.
- Too many indicators are a bad thing. Where possible, and where insights are not lost in doing so, similar indicators should be combined for a larger world view.
- Balancing measures are important to ensure that focusing on one specific area does not have an unintended consequence in another.
- Real-time access to data is important. Insights should derive from the data at its source, wherever possible, with little delay.
- Accountabilities for any recommended action need to be shared, especially in integrated care delivery systems. Outcomes are not solely controlled by clinicians. The health system must support their work. Citizens need to be included and empowered to make changes in their health. This will likely require exposing them to their own data and even the higher lever metrics. We will have to grapple with the daunting issue of public reporting sooner rather than later.
- Wherever possible, measurement should be automated. Manual extraction and reporting must not be accepted as the norm as this net-new work distracts from the main task of delivering excellent care.
Success takes many forms when it comes to measurement and reporting for Ontario Health Teams. We have created a framework for success with the OntarioMD Insights4Care Dashboard. A series of metrics have been carefully chosen from provincial and national measurement frameworks. They have been analyzed tested and vetted. They are automatic and in real time. They can be acted upon in a meaningful way. Combined with effective change processes and practice advice and coaching, OHTs being built with primary care at the core have a tool that showcases their great work, and which will ultimately produce better population outcomes. When this primary care data is combined with administrative data from government sources, utilization information, statistical data on social determinants of health, prevention, and health promotion, and knowledge, even data from patients’ own devices, we have generated wisdom and clarity.
We have seventy more clinical indicators in development for the dashboard. Let’s scale up this important tool. Doing so will help create a culture of knowing and lead to lasting, sticky change in the health of the communities we care for.