Maintaining the healthcare system is hard work: My decision to the deep dive into Canada’s most complicated system

Contributed by Janet Song

OntarioMD is excited to partner with the Quality Improvement Practical Experience Program (QIPEP) at Queen’s University. Our two organizations share a passion for quality improvement in health care and a commitment to developing future health care leaders.

QIPEP aligns with OntarioMD’s EMR Practice Enhancement Program (EPEP) in seeking to enhance the quality improvement competencies of EMR users and students who will shape the future of health care increasingly enabled by digital health services.

In this blog post, Janet Song shares her perspective on how quality improvement will help practices, the impact of digital health, and more.


Why did you decide to join QIPEP?

My interest in Ontario’s healthcare system began with my frustration as a patient. It was a month of being ill in my second year of university where I was travelling from clinic to clinic, in a desperate search for a diagnosis. It was through hours in different waiting rooms, multiple retellings of the same medical history, and dealing with the inability to eat solid food, when a doctor finally decided to do a specific blood test for H.Pylori, when I finally discovered my illness.

Throughout this month-long journey, I became tired of complaining about everything wrong about my experience, and instead, I found the motivation find a way to improve the quality of our health care system.

It was through following the Queen’s Institute for Healthcare Improvement’s Facebook page where I found the opportunity to receive hands-on experience to do research in healthcare quality and improvement at a healthcare institution.

As a fourth-year commerce student who is interested in experience in healthcare management, I am extremely excited that experience will enable me to do work that can directly support the improvement of hospital operations to better improve the lives of patients. My project is in the cardiology unit at KHSC which involves working with hospital workers in assessing sources of delay for cardiac order entries for doctors to order care actions for nurses on their patients.

Why do you think Quality Improvement is important to your future practice?

Quality Improvement (QI) is important for my future practice because of my interest in utilizing my management degree to socially impacting the lives of those, and healthcare management is definitely a place where I can positively make a difference in someone else’s life.

I want to learn how to manage certain components of this complicated system, and it begins with starting in a small component of the healthcare sector and learning how to improve the quality of it. It is through the process of the Planning, Doing, Studying, and Acting (PDSA) model in my work. This process will sharpen my research, planning and implementation capacities to not only practice healthcare management in the future but also better manage a complicated system to positively impact the lives of others in other fields as well.

Additionally, as an Ontarian, I deeply care about the future of this fragile system, and I want to be part of improving the system.

In 2017, Ontario was recorded as having the shortest waiting times on average in the country at 15.4 weeks, which is under Canada’s average of 21.5 weeks.

However, digging deeper into this information, the Government of Ontario continues to balance $312 billion ($122,919 per Ontarian) where the cost of healthcare is almost 40%, pushing out resources for other social services to maintain this expense and also paying for interest— which half of the education expenses.

The major question lies, how sustainable is our healthcare system? How much longer can an insurmountable amount of debt be maintained in Ontario?

What do you think of digital health? Where do you think it’s going?

The greatest demand comes from the area of the greatest need; the increasing senior population.

Ontario has a senior population that is aged 65 and over is projected to almost double from 2.4 million, or 16.7 percent of the population, in 2017 to 4.6 million, or 24.8 percent, by 2041. This population is living longer lives, the model of the emphasis of healthcare services in hospitals, the highest healthcare expense, transformed into a home care model.

How can Canada prepare for this great demand?

It begins with redefining care to support these seniors through homecare and digitizing the experience to efficiently distribute resources, minimize costs, and still deliver quality care. Consumer digital health tools increasingly will focus on chronic disease management.

Incredible organizations are taking great steps towards improving this complicated system such as SE Futures, the innovation arm of the home care provider Saint Elizabeth. They focus on priorities such as new senior living communities, patient experiences in-home (home self-screening), homecare experience, caregiver experience (chatbot support), and more.

 

OntarioMD’s EMR Quality Dashboard and the Important Role of Data Quality

At OntarioMD, we talk frequently about how we add value to the health care system by helping physicians and stakeholder partners realize digital health’s tremendous potential to improve efficiency, reduce wait times, and improve population health management and patient outcomes. That’s a key focus of our 2017-2020 Strategic Plan, and is interwoven in everything we do.  

But what does this mean in practice, exactly? It means that each offering under OntarioMD’s products and services umbrella – whether it’s something developed in-house like Health Report Manager, or a product like eConsult that our head office staff and field teams deploy on behalf of one of our partners – needs to meet these objectives. And it means that the primary care providers that look to OntarioMD as a trusted advisor are confident we’ve done the work needed to ensure the products and services we bring to their practice will help them with patient care and practice efficiency. 

Our ongoing work on the EMR Quality Dashboard initiative is a prime example of the rigorous testing and analysis we apply to ensure our offerings aren’t simply digital health tools, but innovations that integrate and add value to the system. We launched a proof of concept in 2015 to demonstrate how user-friendly dashboard tools use real-time EMR data for improved clinical outcomes and practice efficiency. In phase 1 of the proof of concept, we worked with vendor partners TELUS Health and OSCAR EMR, physician advisory board members and other health care sector stakeholders, to develop a framework that would allow clinicians to view their patients’ data measured against a range of widely-accepted health indicators, and to take immediate action by identifying patients in need of follow up.   

We’ve since expanded both the number of health indicators incorporated into the dashboard and the number of participating clinicians. Today, more than 400 clinicians from across the province are participating in the proof of concept. Their feedback and experiences will be reflected in a benefits evaluation after phase 2 ends in December. But we already know that by using the dashboard to view their patient population data across indicators for conditions including smoking status, cancer and diabetes, participating clinicians can see and quickly respond to preventive care trends among their population.  

They can also easily see where the data in the EMR appears to not match their patient care experience. For example, if the Dashboard shows that smoking status isn’t recorded for most patients, but the clinician knows it is, they can then take action to make sure the information is stored in the right place. An EMR’s potential can only be tapped into if data is being entered effectively. 

In recognition of the importance of change management and ongoing support in the adoption of new tools, this initiative has incorporated the expertise of OntarioMD’s EMR Practice Enhancement Program (EPEP) practice advisors. They are deploying the Dashboard to all participating clinicians and supporting them in getting the most out of the tool. The EPEP process involves first analyzing a practice’s workflow and EMR data and then working one-on-one with clinicians to improve their data quality so that the patient information in their EMR can be effectively used for better patient care. When paired with a digital health innovation like Dashboard, that’s a powerful combination that can lead to better patient care for all. 

We’re currently working on a business plan for the eventual province-wide availability of the Dashboard that will ensure that clinicians on all EMRs have access to both the tool and, crucially, the data quality support offered by OntarioMD’s EPEP team.  

For more information on OntarioMD’s EMR Quality Dashboard initiative, please visit https://www.ontariomd.ca/products-and-services/proof-of-concepts or email us at emrdashboard@ontariomd.com. To talk to an advisor about the quality of your EMR data or about any digital health tool, contact OntarioMD at support@ontariomd.com.  

 

What Digital Health Means to Primary Care

What do you think of when you hear the words digital health? Is it the latest medical health tracker app? Your electronic medical record? Robot doctors?  

Digital health includes all these tools, and many more. But the true essence of digital health – and the reason why it’s worth celebrating with its own Digital Health Week – is something much bigger than the technology itself.  

Digital health is a technology-led evolution aimed at empowering patients and clinicians. It allows us to better monitor, manage and improve our own health and well-being, while allowing clinicians to improve patient outcomes through more responsive technology and better use of patient data.  

In Canada and around the world, digital health is providing tremendous clinical value through improved  access to care for patients, reduced costs, cost avoidance, greater efficiencies, and better quality of care. 

The work we do at OntarioMD is guided by our aim to empower physician practices and enhance the care they and their teams provide patients using EMRs and digital health. We do this through focusing on innovation, and on forging strong relationships and collaborating with health care industry partners to offer products and services that deliver measurable value to the Ontario health care system.  By connecting clinicians with the right tools to meet their practice objectives and ensuring they understand how to effectively use those tools, we help them follow up faster with patients, ensure better coordination of care between all health care providers connected to a patient’s circle of care, reduce unnecessary hospital readmissions, lower wait times, and avoid administrative costs. 

Consider our award-winning Health Report Manager (HRM), for example.  Clinicians using an OntarioMD-certified EMR can use HRM to securely receive patient reports into their EMR from participating hospitals and specialty clinics. With HRM, primary care providers know when their patients get discharged from a hospital or specialty clinic, and all medical record and diagnostic imaging reports they need to ensure effective follow-up are transferred directly into the patient’s medical chart in their EMRs. This eliminates the need for mailed or faxed paper reports and time staff spend handling them.  Most importantly, it lets clinicians be more proactive and provide patients with the quality care they need, fast. 

We’re also helping clinicians use digital health to take action to combat Canada’s growing opioid crisis. According to Health Canada in 2017, there were 4,000 opioid related deaths, up 25% from the year before.  

Digital health offers the tools needed to better combat crises such as this. By tapping into the power of their EMR, clinicians can analyze their patient data to learning more about trends and demographics. Armed with this information, clinicians can identify those patients who are most at risk of opioid abuse, and monitor them to prevent addiction and overdoses.  

OntarioMD’s Peer Leaders and EMR Practice Enhancement Program (EPEP) staff provide clinicians with important hands-on support to help them optimize how they input and use EMR data. Our Peer Leaders and staff have helped primary care providers learn how to use their EMRs to quickly identify their patients taking opioids, the number of different drugs prescribed, and the length of time they’ve been taking the drugs. Clinicians can then create alerts within the EMR to monitor patients on high doses and create a narcotics contract between clinician and patient that can help reduce the risk of addiction and further harm by opioids.  

Whether you need help managing a high opioid risk population, or have other practice challenges and goals, OntarioMD Peer Leaders and staff are like a Geek Squad for clinicians. These clinical practice and technology experts can: 

  • Help you better understand your EMR’s functions and tools; 
  • Analyze your data entry and practice workflows, to improve the quality of patient data in your EMR;  
  • Proactively use EMR patient reminders, reports, population health informatics and more to improve your population health practices; 
  • Implement best data quality practices to access the most relevant patient information at the point of care 

Digital health has the power to improve patient outcomes and help us live longer and healthier lives. But like any technology, the impact depends on the user’s understanding of how to tap into its full potential. By working with patients, clinicians, health care stakeholders and technology vendors, OntarioMD is working to advance digital health care, for the benefit of clinicians and patients across Ontario and all of Canada.  

Keep up to date on digital health advances and our work by following OntarioMD on FacebookTwitter, and LinkedIn. Also, subscribe to our blog at www.ontariomd.blog and visit us online at www.ontariomd.ca for more info on all our products and services. If you have any questions or want to get connected to digital health products and services, please call us at 1-866-744-8668 or e-mail support@ontariomd.com.

How EPEP Helps You Reach Your Practice Goals

OntarioMD’s EMR Practice Enhancement Program (EPEP) helps you realize even more value for your patients and your practice by tapping into more of the benefits of your EMR. EPEP staff will work with you and your staff to achieve your unique practice goals, at a time that’s convenient for you. We will analyze your EMR workflow and data quality, and identify quick wins that achieve tangible results or save your valuable time. EPEP emphasizes hands-on support as you move beyond basic data capture to use your EMR for enhanced patient care and improved practice efficiency. 

Watch the latest EPEP Success Story to find out how EPEP helped one practice focus on population health through better prevention and screening management. For more information on EPEP, visit https://www.ontariomd.ca/products-and-services/emr-practice-enhancement-program

Digital health helped me breathe again!

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Contributed by Surya Qarin, OntarioMD Practice Management Assistant 

Anyone that has known me long enough knows I have spent much of my life in and out of hospitals – and that’s not because the doctors are cute. As a matter of fact, Etobicoke General’s nurses and I are on a first name basis now, and they know exactly which vein works best when drawing blood, and which ones “hide.”

As a child, I was hospitalized every other week for severe asthma. It seemed to subside after I turned 12… at least I thought it did. I didn’t even think asthma was a real issue for adults. I’d always been told people outgrow it. But this is not the case: According to the Centers for Disease Control and Prevention, 9.7% of women aged 18 or older have asthma and are more likely to die of asthma than men. Adults are also four times more likely to die of asthma than children. Asthma Canada stats show that up to 250,000 Canadians are living with severe asthma.

Asthma returned to my life a few years ago, as a moderate condition. I had become more active, believing it would help with my other health issues (which it did). As long as I took my puffers before and after working out, I would not have any issues with breathing.

Then flu season hit, and I got sick a few times between December 2016 and February 2017. Those who know me understand my strong belief that I am super woman and do not like to complain about being sick or having “a little cold.” Unfortunately, this was not just a small cold: it had turned from a cold, to bronchitis, to full blown pneumonia by April 2017. Even then, I still refused to see a doctor. One day, on my drive home from work, I felt a sharp chest pain, and something didn’t seem right. I was not just having a little difficulty while breathing as I had been the last few months. I actually could not breathe.

Gasping for air, I pulled over, sent a quick text to my sister and drove to Humber River Hospital. There, I realized how difficult it would be for me to get my medical records: My family doctor was not affiliated with the hospital, nor was Etobicoke General. They were, however, able to pull my past drug history from my pharmacy and go based off that information. I was stabilized and discharged.

A few days later, my breathing difficulties returned. I went into Etobicoke General, and they were able to pull my history right away and admit me to hospital within the hour. Turns out my lungs had started shutting down due to the pneumonia and asthma, and as it was high-humidity and high-allergy season, being outside did not help me. During my stay in the hospital, my family doctor received hospital reports via Health Report Manager (HRM) and he was kept updated on my condition, as were my respirologist and cardiologist.

After a few weeks of recovery, I thought all was well. However, I caught a “cold” again in October, and this time things deteriorated fast! I ended up in hospital yet again. My respirologist was made aware of my condition in real time via the hospital’s EMR and was able to work with the other respirologist on duty and doctors working on my case to provide the best course of treatment given my history. My current spirometry test results were easily available for the clinicians, and the instant connectivity between those on my medical team helped improve my care and recovery process.

Once again, my family doctor’s ability to receive hospital reports to his EMR through HRM enabled him to follow-up accordingly, ensure I had the contacts I needed for my health, schedule regular testing, and most importantly, help ensure that I didn’t end up in the hospital again. I’m happy to say that I have not been hospitalized overnight since November of 2017.

As a member of the team at OntarioMD, I help clinicians across the province understand the value that EMRs and digital health tools such as HRM can bring to their practice and the quality of patient care they’re able to provide. But being a patient in the health care system has really demonstrated the importance of these tools to me first-hand. If you’re a clinician who has questions about optimizing your EMR use, or you want to connect to HRM or the wide range of other digital health tools in Ontario, contact OntarioMD at support@ontariomd.com.

 

 

Digital Health helped save my baby and kept me sane twice!

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Submitted by Amanda Story, OntarioMD Practice Advisor 

On April 11, 2017, at the Muskoka Algonquin Health Centre in Huntsville, my third child was born. Clark was a perfect 19 inches long and 7.7 pounds, with a full head of hair.  But things quickly got scary, when his blood sugar and body temperature began dropping and his breathing became irregular. He was stabilized, and we were transferred to Toronto’s Sick Kids Hospital. 

Little did we know our journey with Kabuki Syndrome was about to begin. Kabuki syndrome is a rare, multisystem disorder characterized by multiple abnormalities including facial features, growth delays, varying degrees of intellectual disability, skeletal abnormalities, and short stature. There’s also the potential for a wide variety of additional symptoms affecting different organ systems. Kabuki syndrome affects males and females in equal numbers, and specific symptoms can vary greatly from one person to another. The incidence of Kabuki syndrome has been estimated to be somewhere between 1 in 32,000 to 1 in 86,000 individuals in the general population.  

Sick Kids Hospital was up and running on a computerized charting system, and was able to get all the test results from our local hospital quickly. It was amazing how hospital information flowed – physicians of all specialties sharing one chart, no test duplication, everyone knowing and seeing what had been ordered, what was pending and what the plan was.  I was a stressed out, tired and scared mom, and I appreciated not having to repeat Clark’s history over and over again.  When Clark would decide to throw a wrench in the plan, it was easy for the nurse and I to note it and a message was sent to the physician to get new orders and/or a new plan. The digital health system made it easy for the changes to be communicated to his entire team of cardiologists, respirologists, and endocrinologists.  

Eventually Clark rallied, and we were transferred closer to home, to The North Bay Regional Health Centre. It was a big adjustment. We were surprised that communication between Sick Kids and North Bay Regional Health Centre was by paper and mail. When Clark regressed a bit, it was hard to compare results, causing duplicate tests and delayed treatment while phone calls were made to discuss results. We had experienced the power of digital health at Sick Kids, and appreciated how all the health care providers were connected. At the time, North Bay didn’t offer this – though it has since implemented a computerized system. It did offer video conference calls through the Ontario Telemedicine Network’s system, which allowed Clark’s entire team to connect and get his treatment back on track. 

We finally made it home after a couple more weeks. Unfortunately, our stay at home was short. Within a couple of months, Clark caught a cold and a bad cough. We quickly took him back to North Bay Regional Health Centre, where he was admitted and put under observation. After the first 24 hours, Clark got worse. The following day, he went from needing a little bit of oxygen support to needing to be intubated and rushed to The Children’s Hospital of Eastern Ontario (CHEO), which had been consulted during his rapid decline. During transportation, his heart got tired and arrested from working so hard to make up for the decreased lung function. The amazing transfer team from Ornge was able to revive him quickly en route to CHEO. The Pediatric Intensive Care unit was ready and had pulled together a team to assess him and move him to extracorporeal membrane oxygenation (ECMO), which is a heart and lung bypass to allow him to heal.  

CHEO had just implemented a computerized charting system called EPIC. It allowed the hospital to flow information around his care, similar to what we’d seen at Sick Kids. Everyone could see and use the same information in real time to assist with coordinating Clark’s care. His entire team at CHEO – Pediatric Intensive Care Unit (PICU), cardiology, vascular surgery, perfusionists, respirology, genetics immunology, infection control, physiotherapy and pain and symptom management, along with imaging and pharmacy, were all working in one chart around a single patient. This was digital health at its best – facilitating communications and transitions in care.  

Our family physician was also kept informed through her office EMR, using Health Report Manager (HRM) to get Clark’s hospital reports quickly and keep up to date on his progress. I received many phone calls for support and counselling without having to give updates or go into details. It very much kept me sane during a very scary time.  

When Clark was able to be transferred to recovery, the same chart, same information and same teams followed him.  Even after discharge, the amazing efficiency of digital health still helps us to this day with his scheduled follow-ups. Each team can communicate and coordinate his appointments into clusters that help us save travel time, and tests and procedures can be grouped together to help minimize Clark’s discomfort. 

I am very thankful for the adoption of digital health by Ontario hospitals and health care providers. I’ve seen the high level of accuracy and understanding it offered to everyone involved in Clark’s care. It made me feel comfortable and confident that the physicians had access to everything they needed all in one shareable electronic record. Clark’s medical information followed him wherever he was treated. Digital health has helped connect all the hospitals we visited with Clark, so they could share information and make the best decisions for his care. The digital health change in our health care system is also providing more information quickly and easily to family physicians everywhere in the province. Keeping physicians up to date to provide supportive care to caregivers and other family members is easier and faster. I am convinced that digital health is removing many barriers to efficient and effective health care in Ontario, and I honestly believe it helped save my baby’s life!  

Clark is growing stronger daily. We have celebrated many “inchstones” such as regaining head and neck control and re-learning how to roll over, along with a few milestones such as pulling his socks off.  He is a very happy baby that brings so much light into our lives.

Digital Health Shift – EMR Quality Dashboard and Quality Improvement

This Digital Health Shift vlog is the second in a video series of OntarioMD Chief Medical Officer, Dr. Darren Larsen discussing the EMR Quality Dashboard. This segment focuses on how the EMR Quality Dashboard delivers Quality Improvement to patient care.

Darren Larsen on the State of Digital Health in Canada

This post was originally published April 29th, 2018 on RDP Associates

Dr. Darren Larsen is Chief Medical Information Officer (CMIO) at OntarioMD. As CMIO, Darren provides clinical advice to many provincial and national steering committees and clinician advisory groups and has been instrumental in forging system-level partnerships in many sectors. Darren is a tireless champion of optimization of EMRs and health informatics in empowering Ontario’s physicians, with a focus on quality patient care and practice efficiency. He provides a clinician perspective and guides all aspects of OntarioMD’s work to evolve and advance EMRs and digital health for primary care and community specialist clinics. This includes clinical practice change, quality improvement, data quality and analytics, and EMR maturity measurement. He recently shared his insights with RDP Associates on the state of innovation in Canada’s digital health sector.

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Canada’s biotech and health-tech industries are among the most dynamic and innovative sub-sectors of the tech industry. But despite its dynamism, scaling up and go-to-market remain pressing challenges. Why is that?

Indeed, Canadian minds are anteing up some amazing ideas in the digital health space. We have such a strong well to draw upon for creativity and innovation. There is an endless need for new products, services and thinking in health care, for patients, providers and the health system, yet despite the demand, it is incredibly hard to bring innovation to market. I frequently say that real change requires resolution not revolution, and it is hard to maintain excitement and enthusiasm when the system falls short of the needs of innovators beyond the ideation phase. The reasons for this are complex, but some key issues that we could collectively work on to try to improve the situation quickly bubble up.

a) There is very low tolerance for failure in health care. Some of this is predictable, based on clinicians’ training in evidence. Some fall at the health system level, where even small failures lead to blame rather than learning, and it often becomes a story on the front pages of a newspaper. Some of this is even cultural. As Canadians, we do not trust our own innovators until they have been proven in another market or immediately hit the news.

b) Our classic public-sector procurement rules are complicated and hard to navigate. This leads to a bias toward established companies which have greater capability to persist and respond.

c) There is a basic distrust of business in our socialized health care system. The private sector is viewed with suspicion, and the introduction of profit motives makes those of us who believe and have invested in socialized medicine, somewhat wary. We must find a middle ground.

d) Regulatory issues abound in health-tech, from Health Canada medical device status rules, to technical standards often being vague, to privacy legislation being used as an excuse to stop innovation even when it is designed to permit it.

e) The investment/venture capital landscape is different and less permissive in Canada than it is in the US. It is frankly easier to find investors and backers south of the border than it is within our own country.

f) The desire to take a chance on promoting and partnering with new companies is low in Canada. We are guilty of “death by a thousand pilot projects” and accept this as the norm. Most pilots are created to test a very narrow product or service window of safety rather than facilitate scale and spread of the same. Unlike in the start-up space, in healthcare, we lack the “fail fast and fail forward mentality”, which is essential to the innovative process.

Many government grants are generic, but some are industry-specific such as those for clean-tech and agri-tech. Do we need specific grants that target biotech and health-tech sectors to ease some of the challenges they’re facing?

This might well be an option to try. The use of grant money could be tied to co-design or creative procurement that does not predict the final end-point for a product, but rather allows it to evolve organically until it reaches a desired state or value. Design thinking methodology could, and likely should be placed into the grant awarding process. Technology engineers, designers, and providers must align to ensure that they have created a product or service that is actually needed. Then, a shift to value-based funding and support might ensure ongoing success. Currently, many innovation grants do not consider scale and spread of an idea or product. There are incubators that provide in-kind expertise rather than cash. And there are investors who want to see successful companies move forward. The sweet spot is combining these in partnerships.

How would you describe the relationship between the government and Canada’s tech sector including its startup community? Where do health-tech and health care fit into their dynamics?

I possess a cautious optimism in this space. There is certainly an increase in the promotion of start-ups and a growing community of innovators who network and learn from each other. Also, we are seeing some fantastic government-supported or -partnered innovation hubs like MaRS, McMaster Innovation Park, the BMZ and DMZ at Ryerson University, and Velocity at the University of Waterloo, which are great as examples in Ontario alone (and more nationally: Ontario even has a Chief Health Innovation Strategist in the Ministry of Health and Long-Term Care, William Charnetski. These are great starts, but these are early days and this is still nascent work. It will take a long time to change a culture.

Are there sub-sectors of Canadian healthcare that conduct a significant amount of R&D?

I see a lot of progress in Canada now with the creation of health care “living labs“. These are unique spaces where partnerships are used to test products in working environments like hospital units (Mackenzie Health, Southlake Hospital) or human-centred design spaces (UHN Centre for Global eHealth Innovation, JLabs by Johnson and Johnson, Bridgepoint Active Healthcare) or digital health evaluation spaces (MEDIC at Mohawk College, WIHV at Women`s College Hospital). These serve as platforms for integrated thinking about solving clinical problems using integrated technology, not as siloed projects that are procured individually. I believe these may be our future.

What is your definition of a ‘value-based healthcare system’ and what are its key defining parameters?

Value takes many forms and changes according to who is looking for it and what their goal is. Certainly, from the government’s perspective, the value can be calculated in the ratio of quality (or outcomes) over cost. This is very important when setting budgets and ensuring that they are getting what they pay for. This is often the default value proposition in a publicly-funded health system, and it is indeed important.

Value, as measured by a patient, is a whole other proposition. They may value being listened to, having a concern demystified, or simply being told they will be fine.

The clinician perspective exists in the intersection of the health system and patient lived experience. We face the multifaceted challenges of unprecedented demographic change, medical system evolution, and continual demands to innovate every day. But on the positive side, this can challenge physicians in creating solutions.

Ultimately, the value can be only generated in trusted relationships. All three players in healthcare (funder, provider, patient) must work on mutual trust to achieve common goals. This is more than value; it is being valuable.

Do you think the newly revamped tax laws in the U.S could be incentivizing Canadian health-tech companies to move south?

Certainly, permissive tax rules may have an influence, but I believe that tech companies venture south before developing a strong presence in Canada for some far more basic reasons. The US market is much larger. An entrepreneurial spirit is deeply ingrained in American culture. There is greater degree of tolerance for failure. There is much more capital to draw upon from investors who are willing to take a chance on health-tech, knowing that they will win some and they will lose some. Still, there are challenges in the US too. It is a dog-eat-dog world in health care south of our border. Sometimes the stories of speed in success or failure are a distraction from a business purpose that enables longevity. Real change requires resolution rather than revolution.

This interview was conducted by Reza Akhlaghi, a digital content and social media strategist at RDP Associates.

Physicians Own the Value of the Data Within Their EMRs

Submitted by OntarioMD Dr. Adam Stewart 

This blog post was originally published on April 22, 2018, on Dr. Adam Stewart’s website at www.stewartmedicine.com.    

Information and data have value in every industry. The value of data in health care is only beginning to bloom. Who owns it, though?

Patients undoubtedly have rights with respect to their medical records. It goes unrecognized by most, however, that physicians own the value of data with their electronic charts.

Patients have rights to the content of the data within their medical records. The charts contain their personal information. This is unquestionable. However, the value of data comes from its structure and the organization, which is fully dependent on the physician who generates and maintains the medical record.

The organization of a patient’s chart may vary from being a barely legible handwritten paper chart to the other end of the spectrum of being a complex Electronic Medical Record (EMR) with the advanced data structure. Across the spectrum, the exact same patient information (content), can have widely different functionality and analyzability (value). This quality differential is entirely dependent on the physician and there can be extreme differences when comparing the charts, and thus data quality, of one physician to another.

Governments covet the value of the aggregate, even anonymized, data within EMRs for planning and policy purposes. Pharmaceutical companies share a similar craving for the data for marketing and development purposes. Innumerable interest groups and organizations equally desire data that relates to their agendas. (The legalities and ethics of sharing or selling data are beyond the scope of this article. Rather, the intent of this article is to identify and raise awareness of the value of EMR data that physicians possess).

As per College of Physicians and Surgeons of Ontario (CPSO), “patients have a right of access to their personal health information that is in the custody or under the control of” a physician.1  Patients can request copies of their charts. Even if the original chart was in EMR format, though, what the patient is entitled to and receives is either a printed paper copy of the records, or an electronic PDF document saved on a CD or memory stick, for example. In these formats, the data has relatively nil to minimal value because it is not structured in a way that is easily navigated and analyzed.

Physicians, and staff hired by physicians are the ones who input the notes and structure the data within their charts. Many physicians further build and customize tools within their EMRs to aid in the documentation. Physicians are the ones who pay for the EMR software, training, and vendor support. Physicians are the ones who are responsible for funding all of the computer hardware, technical support, and the physical space in which to house the infrastructure. Accordingly, in every sense, physicians own their EMRs.

One might try to argue that part of the payment to physicians from Ontario Health Insurance Plan (OHIP) for their services includes the generation and maintenance of the medical record.2  However, OHIP simply mandates and includes payment for physicians to “keep and maintain appropriate medical records”.3  It specifies nothing with respect to a standard of quality. The CPSO has more specific requirements.1  However, even a legible and complete paper chart meets those standards of care. Anything above and beyond the minimum baseline of those requirements has value, and that value is derived from, and therefore owned by, the physician who generates and maintains that chart.

There is obvious variability with respect to the quality of data within physicians’ EMRs. The difference from one extreme to another highlights the differences in the value of EMR data. Physicians own that value.

Patients have rights to the content of their individual data. Physicians own the organization, structure, functionality, and analyzability of the data. Physicians own their EMRs. It follows that physicians own the value of the aggregate data within their EMRs. These are careful and important distinctions.

References:

  1. http://www.cpso.on.ca/Policies-Publications/Policy/Medical-Records
  2. https://www.ontario.ca/page/what-ohip-covers
  3. http://www.health.gov.on.ca/en/pro/programs/ohip/sob/optometry/sob_optometrist_services_20090401.pdf