Contributed by Mary Lou Fleming and Diane Ricordi, OntarioMD Practice Advisors
In early 2020, two of OntarioMD’s longest-serving Practice Advisors shifted into retirement. As key members of OntarioMD’s hands-on practice support team since 2009, Mary Lou Fleming and Diane Ricordi have had a first-hand view of the impact of digital health’s evolution on primary care practices, patients and the system as a whole. As OntarioMD celebrates its 15th anniversary, we asked Mary Lou and Diane to share some of the memories and insights they’ve gained through working at OntarioMD.
Our participation in OntarioMD’s work and evolution began in 2009 with electronic medical record (EMR) funding. The EMR Adoption Program launched by the provincial government and administered by OntarioMD provided the support for Ontario’s physicians to establish themselves in the developing digital health space. For us and our fellow OntarioMD Practice Advisors, the adoption program represented an opportunity to use our practice knowledge to help clinicians through this transition.
There were untold hours of face-to-face interaction – change management sessions, workflow reviews and countless signed documentation and agreements. Most of the physicians and practice staff in our region met with us in hotels in groups, coming together to learn about the value EMRs held for their practices and patients, and to sign up for funding to get an EMR in their practice. Our roles were complemented by our colleagues in the field and at OntarioMD’s head office. Together, we assisted the province-wide transformation of practices from paper-based to EMR-driven. And our efforts were wildly successful; In 2009 45% of community-based physicians in Ontario had an EMR, and by 2016 that percentage increased to 85%.
Over the past 10 years, OntarioMD’s Practice Advisors have spent countless hours in clinicians’ offices and clinics, helping them understand and connect to OntarioMD-developed products and those we deploy on behalf of our partners, and enabling clinicians’ growth in the effective use of digital health care. OntarioMD’s growing team of “boots on the ground” allowed us to provide the support needed to make the transition and adoption of these products and programs as seamless as possible for clinicians and their staff.
As health care workers throughout our careers, patient care
has always been our focus. Working for OntarioMD allowed us to continue with
that objective over the past 10 years. As we head into the next phase of our
lives, we will continue to closely follow the evolving challenges and
opportunities in health care and the ongoing important work of our OntarioMD
Contributed by Mavis Jones, OntarioMD Manager, Business Insight & Evaluation
Working in the health sector can be a source of pride.
Everything we do at OntarioMD helps over 17,000 clinicians across the province
effectively use the digital health tools in their practice, which in turn helps
patients access responsive care and live healthier lives.
In any job, however, there are days when the connection between the work and its meaning can seem tenuous at best. A great antidote for those days? Volunteering for an organization that helps build a stronger community, like Dixon Hall’s Meals on Wheels program. Dixon Hall has been OntarioMD’s charity of choice for more than year, and as we heard from CEO Mercedes Watson at our December 2019 Town Hall, our contributions to the organization are making a tremendous difference – and not just with Meals on Wheels, but with the wide range of Dixon Hall programs and services that impact housing, children and youth, employment and other key factors that are so important to full and equitable participation in a community.
A team of OntarioMD employees set out from our office in
Toronto one sunny Thursday afternoon this month to walk to Dixon Hall. We were
warmly welcomed by staff, given some ground rules and then provided with
insulated bags filled with hot meals to deliver to seniors across the downtown
Regent Park community.
As those who work in the health space know, seniors are
over-represented in complex chronic conditions, which for many means mobility
issues, dietary challenges, and vision or hearing limitations that may prevent
them from getting out to access healthy food (or even just preparing their own
meals). Meals delivery services like Dixon Hall’s Meals on Wheels not only provides
people with affordable, nutritious meals; for some, the volunteer delivering
the food may be the only face they’ll see all day, so it’s an opportunity to
connect, check in and make sure all is well.
Our driver went through our route list and gave us key
advice and insights like “if they’re not home, leave it in the building’s
office,” “this client appreciates the opportunity to chat,” and “don’t take the
stairwell because you won’t have a fob to get out.” Like a school orienteering
exercise, we paired up to navigate several highrise buildings until we had
delivered the 30 or so meals that had been loaded into the van. Anthony
delivered a meal to a gentleman who said very kind things in appreciation of
the service, to which Anthony responded that we’re lucky to work for an
employer who supports efforts to give back to the community.
This amazing experience was over for us almost too quickly,
and we dropped off the bags and headed into the sunshine to walk back to work.
But more of our colleagues at OntarioMD will have the opportunity to deliver
meals for Dixon Hall Meals on Wheels throughout January and February, and we
learned there may be more opportunities for us in future. Dixon Hall Donor
Stewardship Officer Cassie McIndoo told us that the organization hosts weekly community
dinners and breakfasts, where a classically trained chef provides healthy
meals. Corporate sponsors like OntarioMD can encourage employees to volunteer
with food preparation, service, and to just be there to share a friendly face
and a chat with clients as they enjoy their meal.
As my colleague Anthony pointed out, OntarioMD staff are
fortunate to work at a place that understands that employees are more than just
our jobs and finds ways to help us connect with our community in such an
important way. Thanks to Dixon Hall for the chance to volunteer – we look
forward to the next opportunity to give back!
Contributed by Simon Ling, Program Director, Insights4Care
In 2019, we launched the Insights4Care (i4C) program to help clinicians tap into the valuable data in their EMRs for improved patient health outcomes. By pairing analytical tools and coaching support, the i4C program offers an important step forward for clinicians and the health system in data quality improvement, population health management and optimizing the value of EMRs and integrated digital health services.
Our journey to this point began several years ago. While OntarioMD has helped more than 18,000 Ontario clinicians adopt and use EMRs, we saw an untapped opportunity to bring patient data in the EMR to life using widely adopted health indicators. With funding support from the Ministry of Health, OntarioMD began a proof of concept in 2015 to demonstrate the technical feasibility and clinical value of an EMR dashboard that gives clinicians real time, at-a-glance visual displays of their patient population’s health data. We partnered with organizations such as Health Quality Ontario, the Association of Family Health Teams of Ontario and the Canadian Institute for Health Information to identify 30 indicators to include in the proof of concept, and worked with EMR vendors TELUS Health and OSCAR EMR to implement the i4C Dashboard and indicators.
Fast forward to March 2019. After three years of trial use
and evaluation by 500 clinicians across Ontario, our proof of concept
successfully concluded with some exciting results:
The i4C Dashboard enabled quality improvement – 87% of indicators showed improvements after only 90 days of clinician use;
While physicians were the primary users of the Dashboard, feedback showed that other clinicians and staff took advantage of the Dashboard’s potential to drive quality improvement and more responsive patient care within the practice; and
Participants who took advantage of the opportunity to combine Dashboard use with OntarioMD-led change management support experienced greater data improvements than those who did not receive support.
The proof of concept confirmed the technical feasibility and
clinical value of OntarioMD’s i4C Dashboard in primary care, and clearly
demonstrated the impact hands-on support from OntarioMD staff can have on adoption
and use of the technology, and quality improvement in the practice.
As we start 2020, we’re excited by the impact the i4C Dashboard and i4C Advisory Service can have on the health care system. We’re focused on expanding the program across Ontario by giving more clinicians access to the Dashboard, advice and support. We’re engaging with more vendors with certified EMRs to incorporate the i4C Dashboard, and increasing the number of health indicators available in the Dashboard.
2020 promises to be another important year of health system
transformation in Ontario, as Ontario Health Teams (OHTs) continue to take
shape and digital health and data play a growing role in a model that places
the patient at the centre of their care and integrates patient information at
the point of care. OntarioMD’s i4C program is uniquely positioned to support this
change by helping to make EMRs and digital health tools more user-friendly, improving
the quality of patient data, translating health system priorities into
actionable i4C Dashboard indicators, and giving OHTs and other practitioners the
means to track and report on their performance improvements.
We’d love to talk to you more about how the i4C program will
benefit your patients, and how you can bring the i4C Dashboard and i4C Advisory
Service into your practice. Connect with us at email@example.com or 1-866-744-8668.
In last week’s blog, I shared some important reasons why clinicians should consider adding medical apps to their patient care toolbox, and some key questions to ask before deciding which ones are right for you. If you’re still reading, I can only assume I’ve caught your interest and you are ready to venture into the wonderful world of apps.
Or, perhaps you looked at the list of questions I provided
and are feeling overwhelmed, concluding that it is better to download the apps
I recommend with the hope that I have already done the work. If so, this post
is for you.
My app recommendations presented here are a mixed bag. I was
asked to limit the apps to the ones I felt were most relevant. But this proved
to be a difficult task – there are so many wonderful apps. For this post, I’ve
looked mainly at point-of-care and guideline apps. Should this blog become wildly
successful, I may be welcomed back and can recommend more apps geared to
The apps I have presented below are not listed in any particular order. To download, go to the Google Play Store or Apple’s App Store.
UpToDate by Wolters Kluwer
This app needs no introduction, as most physicians have
heard of or used UpToDate at some point in their career. But not all have used
the app version. It’s a great point-of-care app, which requires a subscription
to use. It uses Lexicomp as the drug database.
A subscription is about $519 US per year, and discounts are available for CMA, OMA, and CCFP members, as well as for residents and medical students.
Dynamed by EBSCO
This point-of-care app was founded by a family physician and is now owned by EBSCO. It uses Micromedex as its drug database. Similar to UpToDate, use of the app requires a paid subscription, which is about $395; if you have a CMA membership, it is free.
This app is developed by the Canadian Pharmacists
Association and is literally the old blue CPS we used to have in our offices in
days of yore. I remember it fondly, with its paper-thin pages and miniscule
font. I am unsure why we ever left that format, as it was a great doorstop for
the ever-closing exam door.
The new and improved RxTx includes the same information as the old book, plus regular updates, Health Canada advisories and a limited medical calculator. It unfortunately cannot do multidrug interactions and doesn’t provide LU codes. It also will not hold the exam door open. Cost varies on the functionality. The basic drug database is $239, and this increases if you wish to have guidelines and such added. It is free with the cost of CMA membership.
By now, you may be sensing a pattern involving the CMA. I
can categorically state that I do not have any affiliation with the CMA, other
than buying a membership so I can have access to these apps and other clinical
The Joule app is easy to use, has a searchable database for
InfoPoems, InfoPratique and CMAJ. It offers access to Dynamed, RxTx and
Clinical Key gives access to 1,000+ texts, 600 journals, handouts, practice guidelines, podcasts and videos. Journals include AFP, Lancet, BMJ, NEJM and many others. It also provides access to a librarian who will answer your research questions. All this for the $195 cost of a CMA membership.
Thrombosis Canada (Free)
This guideline app provides clinical guidelines and algorithms for the use of antiplatelet agents and oral anticoagulants. It is easy to use and allows you to enter anonymous patient data and achieve individualized recommendations. It was developed by Thrombosis Canada and was last updated in November 2019. The app is bilingual.
INESSS Guides (Free)
This guideline app was developed by the
Institut national d’excellence en santé et en services sociaux (INESS) and
supported by the Quebec government. Their website, available in French and
English, outlines their methodology and answers all pertinent questions.
This free app was originally developed in
French and is now available in English as well. It is a great app that gives
you antibiotic prescribing information and guidelines for various chronic
diseases including dementia, type 2 diabetes, STI, indications for testing and
CDN STI Guidelines (Free)
This very useful guideline and treatment app was developed
by the Public Health Agency of Canada. It examines the Canadian Guidelines for
Sexually Transmitted infections and provides treatment recommendations and advice
on diagnosis. I particularly like this one, as antibiotic resistance is
constantly changing and it offers up-to-date options.
Anti-Infective Guidelines (MUMS)
This is an app version of the infamous “Orange Book” anti-infective guidelines that was first released 20 years ago. This was a game-changer app for me, as I used to carry that orange book with me everywhere. I would write across the front page with a black Sharpie daring anyone to take it from me. I would glare at anyone who would even look at it. Now that it is on my iPhone, I am quite happy to lend my tattered paper copy! The app is also updated – there was a free update released about a month ago. This wonderful book/app is developed by MUMS Health/PAACT CME. This app is $24.99.
Visual Anatomy Lite (Free)
I would be remiss if I didn’t recommend an anatomy app of
some sort, and decided on this free, simple option.
This basic anatomy app allows physicians to refresh their memory about the human anatomy. It is also a good app to use for educating patients. There are a large number of paid apps that are more comprehensive and potentially much better, but this is a good starting point.
GRC-RCMP Drugs Awareness (Free)
This simple app was developed by the RCMP to educate about
drugs and illegal activities. It was recently updated to remove cannabis from
the illegal list.
Where else can you learn the many names used to refer to
certain drugs? The app discusses the drug, its effects, visible signs and
symptoms of usage, myths and truths, information for parents, legal status and
more. It also provides numbers to call for help and outlines ways to prevent
drug abuse. It is a necessary app for the medical toolbox, but also a good one
to recommend to patients.
Aspirin Guide (Free)
This has made it to my list of
recommended apps, as the big question in my clinic lately seems to be, “Do I
stop ASA, or do I start?” I was not able to find a great algorithm online to
help me with my clinical decision until now.
Developed by researchers at the
Brigham and Women’s Hospital (Harvard Medical School), this app helps
clinicians decide who is a candidate for low dose ASA in primary prevention of
atherosclerotic cardiovascular disease (ASCVD). It walks you through a
screen-by-screen algorithm that allows you input anonymous patient specific
data, and it gives you a clinical summary with NNT and NNH for ASA. Brilliant!
TELUS EMR App (Free to TELUS EMR users)
I’m biased in that I use PS TELUS EMR, but I do recommend this
app to fellow users. This is a rather easy-to-use app that adheres to all
privacy regulations. It allows you to manage your schedule and your patients,
giving you access to their charts anytime of the day. Who wouldn’t want to work
24 hours a day!
The real advantage of this app is the camera. I often use it
in the office, as it allows me to take pictures of rashes or medical anomalies
and download them directly into the EMR. It does not store the photos on your
Another unique feature is the ability to dictate directly into the EMR using the microphone function. At times it is faster to dictate into my app while I am sitting at my desk than type in my notes.
What are your favourite apps? Do you recommend any that you
think are truly amazing? I welcome any comments and hope that you find these
apps useful. Perhaps I will see you at one of my talks someday!
The landscape around digital health is shifting rapidly, with patients increasingly aware of the potential and seeking access to their data, and emerging Ontario Health Teams (OHTs) focused on integrating care through technology. In our final video for Digital Health Week, OntarioMD Executive Director, Client Services & Engagement Cynthia MacWilliam talks about how OntarioMD is working to support primary care providers realize the potential for their practice and patients.
According to a 2014 Canada Health Infoway study, 67% of
Canadian family physicians own a smartphone. Of those who own a phone, 82% said
they use it to look up drug references
and 50% use it for clinical decision support.
The number of smartphone owners has continued to grow over
the past five years and, with it, the number of physicians who consult their
phone for clinical information.
There are many reasons why physicians with smartphones use – and should use – medical apps. Apps can improve practice efficiency by saving time, speeding up diagnoses and limiting unnecessary visits. Some offer easier access to electronic health records or to colleagues for medical advice and insight. Many apps give clinicians quick access to accurate information.
I personally want to use my “over 40” memory for other things, and offload what I can. I’ve been giving talks and workshops focused on medical apps for almost two years. When I initially reviewed the literature, I found a handful of articles with sporadic mention of apps, and the options for download were limited. Today, the number of medical apps has exploded and the ease of finding and downloading these to your phone has grown.
Before considering an app for your own use, you should review it like anything else. As physicians, we are taught to use clinical judgment and evaluate anything before incorporating it into practice. If we are looking at a journal article or study, we have a standard way to assess the results and conclude if the information is accurate and useful. Medical apps should be assessed in a similar fashion.
Always ask yourself the following questions before adding a particular app to your toolbox of patient care.
Who produced it?: Who developed the app? Is it a private company or a drug company? A university or association? What do they have to gain from you using it?
Is it regularly updated?: This info can be found at the download point of the app. If you are using it to make clinic decisions then it is important to know that it is using the latest medical knowledge; apps that are regularly updated are more likely to incorporate new info.
Is it properly referenced?: If the app uses an algorithm, does it tell you what the clinical judgment is based on? Does the app actually do what it is supposed to do? How is the developer getting their conclusions?
Is it possible to give feedback?: Can you contact the developer to provide input regarding the app’s accuracy and its use?
Is it peer reviewed?: Is it widely used, and does it come recommended?
Is the app’s primary purpose to inform health professions or patients?
Any issues with privacy?: Does the app collect data? What is the data used for? Does it adhere to local privacy regulation?
You can find answers to most of these questions in the App
Store or in Google Play prior to downloading the app. A quick online will also
yield useful info and reviews.
In the second part of this post, I’ll share with you my recommendations for what I consider the most relevant point-of-care and guideline apps.
Dr. Chandi Chandrasena is a family doctor practicing cradle to grave medicine in Ottawa. She is co-owner of a seven-doctor FHO and is currently the IT Lead. She is an OntarioMD Peer Leader and has no conflicts to declare.
Dr. Chandrasena has an iPhone 11 but not the Pro (as she couldn’t afford the extra $800 for another lens) and she uses TELUS PS EMR. She does not receive any financial compensation from any of the apps mentioned here (much to her chagrin). She gives talks on Medical Apps for Physicians at various conferences and also talks about Medical Apps for Patients.
In today’s Digital Health Week video, OntarioMD’s VP, Business Development and Stakeholder Relations Elizabeth Keller reflects on the amazing growth of Health Report Manager, the Insights4Care Dashboard, eConsult and more.
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.