OntarioMD’s Virtual Panel Discusses the Digital Health Transition

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 However, this transition to electronic information is being hampered by outdated privacy legislation that limits information exchange, clinicians who do not want patients to have unfettered access to their information, and patient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.

Digital health and rare diseases

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.

We enjoy open communication from clinicians like Dr. Gideon Hirshfield and Dr. Aliya Gulamhusein who are leading the charge to find a cure. Their perspectives are below.

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.”

Making population health measurement simpler for clinicians, in Ontario Health Teams and daily practice

Ontario Health Teams

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. 

Still using Windows 7? Keep patients’ information safe by upgrading before Windows 7 support ends.

Contributed by Ariane Siegel, General Counsel & Chief Privacy Officer, OntarioMD

In a busy primary care practice, it is critical that your computer hardware and software are up to date with the latest security updates. This task is essential to helping protect patients’ personal health information. Recently, Microsoft reminded users that Windows 7, one of its most-used operating systems, will no longer be supported as of January 14, 2020. This means that security updates for Windows 7 will no longer be issued, which may make an EMR vulnerable to being exploited.  If you’re one of the many clinicians who use Windows 7 in your practice, it’s critical that you act before Windows 7 support ends, to avoid putting your system and patient health information at risk of cyberattack. Under Ontario’s Personal Health Information Protection Act, physicians, as health information custodians (HICs), have a legal obligation to safeguard against unauthorized collection, use and disclosure of personal health information. Ensuring your practice technology is current can help physicians meet this obligation. Now may also be a good time to review your IT plan and ensure all applicable vendor-issued system and security patches are integrated.

If your practice currently uses Windows 7, you may also want to consider an upgrade to Windows 10, the latest Microsoft operating system. OntarioMD has recently published a Bulletin on how to check if your current technology is Windows 10-compatible, why it’s essential that you use the latest technology to protect patient information from cyberattacks and options for support. You may also wish to contact the Ontario Medical Association to learn about the work it’s doing to find practical solutions that support physicians and their practices from cyberthreats.

IT and EMR maintenance needs are best left to IT professionals. Obtaining assistance from an IT professional will help ensure your practice technology stays up-to-date and enables clinicians to focus primarily on patient care. OntarioMD is also here to support you. You can connect with an OntarioMD Practice Advisor for advice any time at support@ontariomd.com. If you’d like to learn more about privacy and security tips and best practices to protect your patients and your practice, take OntarioMD’s complimentary Privacy and Security Training Module. It’s comprehensive, available online and takes less than 60 minutes to complete. Physicians who complete the Module are eligible for 2 Mainpro+ credits.

I thought I knew what digital health was…

Humber River Hospital robot

Contributed by Kathy Tudor, Director, Communications and Marketing, OntarioMD

I have a passion for all things digital. I used to love sticky notes, now I use the notes and calendar tools on my smartphone for things like my shopping list and appointment reminders. I choose from an array of mobile apps to see and talk to my daughter in Ottawa. I track my steps using a mobile app. I don’t need paper maps and printed directions anymore. Google Maps gets me to where I want to go. Any digital tool that eliminates paper or stores PDFs of my documents, count me in. I received a Google Home for Mother’s Day. It’s still in the box, but I can’t wait to set it up and start asking it questions.

My family doctor records my visits and keeps track of everything affecting my health with an EMR. When I was treated for breast cancer, I jumped on the MyUHN Patient Portal to make sure my Princess Margaret Cancer Centre reports were getting to my family doctor through OntarioMD’s Health Report Manager (HRM). Full disclosure – I’ve been working in digital health for 16 years, helping to communicate its benefits. So I thought I knew what living in a digital world meant and thought all my digital tools were really cool – until I visited Humber River Hospital.

I attended the Breakfast with the Chiefs talk at Humber River Hospital on May 7 to listen to CEO Barb Collins talk about Healthcare’s Digital Future. I really wanted to know whether being a fully digital hospital meant providing impersonal patient care and promoting this type of care in the new world of Ontario Health Teams (OHTs). I also really wanted to go on a tour of the hospital to see if all the hype was justified. Before I even arrived at the session, I had to walk through the hospital past a life-like robot (the one pictured above). That was my first clue that this hospital was true to its digital moniker.

Collins outlined how Humber River solved the challenge of delivering enhanced care in a larger facility with more beds and increasing patient visits with the same operating budget, while creating staff engagement and high patient satisfaction. A tall order. More so when you think of how patients are more connected than ever before to knowledge and information.

I could say a lot about what impressed me about Humber River, but I’ll break it down into four buckets:

Digital information

Humber River makes patient information readily available by many people simultaneously contributing to collaboration and sharing of knowledge. Information is actionable, contributing to workflow automation and better decision-making. All systems are IP-based: charting, biomed, diagnostics, robotics, building, etc.

Mobile and connected

The staff at Humber River can access and create relevant information anytime, anywhere! They communicate and collaborate with others instantly and conveniently to deliver care and keep patients safe. The systems used connect with people to drive performance, quality and safety. No fax machines to see here! Instead, what I saw was a Command Centre that reminded me of NASA, only smaller. All systems must be operational 100% of the time and work together to exchange information. At a glance, staff could see which beds were available, where staff were and much more.

Patient empowerment

Patients were just as connected as staff in the hospital. The rooms are amazing. They are all private to prevent the spread of infection. Patients can control the temperature, the tint of the windows and more, with a touch of a screen. Visitors are able to come at any time and always know where their loved one is. Collins said patient satisfaction is at 89%, higher than the national average.

System automation

I wished I could see all areas of the hospital, but there was only time to see a few things. My tour of the hospital took me to the pharmacy. Medications were dispensed by machine, almost completely eliminating the chance of error (it’s only 0.007%). There are bar codes on everything. I was hoping to see more robots in the meds area. Humans were placing and verifying orders. The robots were delivering the meds to decrease wait times.

At the end of the tour, I was humbled. The hospital has thought of everything – even the number of steps the staff take every day, with the hospital and flow of care designed to reduce what they called “sneaker time.” Bringing it all back to my world, I’m glad Humber River uses HRM to move information around part of our health care system. How could they not?

What’s all this wonderful digital connectedness going to mean for OHTs? Humber River could be a team by itself and has become the hub of a large, diverse community. The hospital has plans for community reach and reduced acute utilization that include supporting health and wellness, virtual visits, home monitoring, communication and collaboration.

HRM has become an indispensable tool that the OHTs may adopt. It has an important role to play in communication and collaboration. OntarioMD is planning to make HRM handle bi-directional communication – not only delivering information from the hospital to primary care EMRs, but from EMRs to the hospital. New groups outside the hospital who aren’t digitally savvy or don’t have much access to digital tools now will need to use HRM, and be trained on it, as they find themselves in OHTs. Patients also need and want to see more of their information, whether they’re in an OHT or not. That includes their hospital reports, and HRM will be able to do that too in the future. HRM, the “little engine that could”, is about to get a whole lot cooler in an increasingly digital world.

3 Reasons to Attend OntarioMD’s EMR: Every Step Conference in Ottawa

OntarioMD’s EMR: Every Step Conference returns to Ottawa on June 13, 2019. A lot has changed in the health care sector since our last Ottawa conference in 2017. The provincial government has announced a renewed focus on integrated, patient-centred care, driven by EMRs and digital health tools, and led by Ontario Health Teams. We’ve planned a day of learning and networking designed to help clinicians and other stakeholders make sense of it all.

Register by Friday, May 17 to save 15% with our early bird rate!

With a full day of learning that’s CME-accredited for physicians, access to vendors for EMR training, information on the latest practice technology, and opportunities to meet with OntarioMD Peer Leaders onsite, there are so many reasons to attend the EMR: Every Step Conference. Here are just three.

#1: Harness the Power of EMRs for Mental Health and Addiction Care

Mental health and addiction care are increasingly important focal points in primary care practice, and your EMR can play a vital role in helping you offer responsive, coordinated care to patients with mental health concerns. In a new session, titled Using An EMR to Communicate Between Psychiatry, Primary Care and Mental Health Patients and Improve Care, psychiatrist Dr. Hugues Richard will walk through how the EMR is a clinically valuable tool for communicating with staff, treatment teams and patients. The session will demonstrate how quality of care for patients with mental health and addiction issues is improved by using EMR features such as reminders and the CPP.

#2: Better Understand the Patient Perspective

Julie Drury, Chair of the Ontario Health Minister’s Patient and Family Advisory Council, returns to the EMR: Every Step Conference to deliver the morning keynote address. This year, she’ll lead a panel discussion with voices representing government, hospital, primary care physician and patient perspectives to discuss the challenges and opportunities of increasing patient access to their electronic medical information.

#3: Discover How to Work Even More Efficiently with Your EMR

The increasing number of EMR-integrated digital health tools available hold tremendous promise for improving the patient experience and health outcomes. But they’re only right for your practice if they can help you meet your unique clinical goals. An EMR Progress Assessment (EPA) is a quick and easy way to understand your current EMR use, what else you want to do with health care technology, and which tools can help you do that. The EPA is an OntarioMD-designed online self-assessment tool that asks you a series of questions about how you’re using EMRs and technology in your practice, and helps you understand what else is available. Want to improve appointment scheduling? Document management? How about Chronic Disease Management? Sign up to complete an EPA at the conference when you register for the event and OntarioMD staff can help steer you in the right direction.

We look forward to having you join us on June 13 at the Brookstreet Hotel in Ottawa for OntarioMD’s EMR: Every Step Conference. Visit the conference website to register today!

Track Your EMR Improvements with an OntarioMD EMR Progress Assessment

If you’re using an OntarioMD-certified electronic medical record (EMR) in your practice, you’re one of approximately 17,000 primary care clinicians in Ontario who’ve integrated this valuable patient management tool into your workflow. You’ve seen how your EMR makes your work better, more efficient – and has a direct impact on your patients’ health.

You’re entering patient data into your EMR. You may be capitalizing on the power of that data to run preventive care reports for more proactive care. And speaking of proactive care, perhaps you’re one of almost 10,000 clinicians getting hospital discharge summaries and other reports to your EMR through Health Report Manager (HRM). That’s the power of your EMR – and we know most Ontario primary care clinicians are discovering that power.

But are you really using your EMR to its fullest potential? Do you understand what else you could be doing with it to reach your practice goals? If you’re not sure, OntarioMD can help you. Our EMR Progress Assessment (EPA) is an online self-assessment tool designed to help you measure your current EMR use, help you prioritize what else you want to do with your EMR, and track improvements in your EMR use over time. With EPA results at your disposal, you can easily determine what you’re doing well with your EMR, and how else you could be using the technology for better practice management and improved patient care.

Your EPA results can also help us help you – which is what we’re here to do. With your EPA results as a guide, OntarioMD practice advisors can customize a hands-on support plan that works for your practice. We know not all health care technology is right for all clinicians. The more insight we have on what you want to do, the more we can do to help you get there.

The EPA and EPEP in action

Want to better understand the EPA in action? A research paper from JMIR Human Factors uses real-life case studies to illustrate how OntarioMD’s EMR Practice Enhancement Program (EPEP) helps clinicians make better use of the patient data in their EMR, improve practice workflows and meet practice clinical goals. In most cases, EPEP engagements start and end with an EPA as an essential component of the EPEP team’s analysis and work. EPA results help reveal how a clinician’s EMR knowledge, data quality and practice efficiency improve as a result of taking advantage of OntarioMD’s complimentary EPEP support.

Consider the case of Dr. F, who the EPEP team first met within 2016. At the time, an EPA and initial analysis revealed that the practice wasn’t entering data consistently into the EMR – which meant they couldn’t properly measure the quality of care they provided. Over several months, the practice and EPEP team focused on ways Dr. F’s practice could use their EMR to better capture important preventive care and diabetes data – and act on it for more responsive patient care.

An EPA and data analysis conducted six months after the engagement began showed improvement in EMR use and data quality. Another check-in more than a year later showed even more dramatic – and sustained – improvements.

Data Quality review – Dr. F

Contact us. We’re here to help!

You’ve invested a lot of time and money into adopting an EMR and building workflows around it. And we know that you probably want to do more with it. But you can’t improve what you can’t measure and track. That’s where an EPA comes in. Complete an EPA today to get a clearer picture of what you’re doing right with your EMR – and what else you could be doing with it. Find out more at https://www.ontariomd.ca/products-and-services/emr-practice-enhancement-program/emr-progress-assessment or contact us at support@ontariomd.com.

Ontario Health Teams are Coming!

Contributed by Dr. Darren Larsen, Chief Medical Officer, OntarioMD

Change is happening now in Ontario healthcare. It has been needed for some time, but a new provincial government with a demand to deliver high value for public dollars is making the change imminent. OntarioMD is front and centre of assisting with this change as it relates to digital demand for care.

So what, exactly, is “value”?

Value is best defined as quality (in all of its domains) divided by cost. It can be measured from different perspectives (patient, provider, health system, funder) but ultimately the same principle applies. If we increase safety, efficiency, effectiveness, access, patient-centered care, and equity, and can offer it up for a lower provincial spend, we have created value.

How do we do this in our current fractured, silo-based system? It won’t be easy. It will involve letting go of certain tightly held concepts. It will include changing structures we have known for a long time. It will take real leadership. OntarioMD is showing such leadership.

Whether we are patient, clinician, or Ministry planner, many feel the same systemic pain. We see a lack of integration, from the services being delivered to the data generated from them. Transitions in care present substantial risk. There are rarely warm handoffs between care settings. They are loaded with processes that remove personal accountability and ownership for outcomes (good and bad). We measure, but not necessarily the right things. We default to quantitative metrics when the tough job of looking at behaviours and action drivers (qualitative measures) are ignored or downplayed. The opportunity for change is here.

If transitions in care are the primary points of error and loss in healthcare, what is being proposed to change things?

Integrated care delivery systems are a potential solution. In Ontario, the government hopes the new Ontario Health Teams will accomplish this. They will take many forms, as they should, to reflect the diversity in local healthcare needs. Some will be led by communities and primary care. Others will have a hospital at the core. All are meant to blend and offer seamless care for individuals, whether in the home, doctor’s office, nursing home, or hospital. They will succeed in some fundamental principles, common to all.

  • People moving between different parts of the system will have care coordinated as they move between them.
  • Navigators will assist to ease the burden for those who have no energy or experience in health maneuvering.
  • Care follows the person, and eventually, so will the funding to pay for that care (bundled payments)
  • There are financial rewards for doing better than a benchmark (gainsharing) and disincentives for doing worse (risk-sharing).
  • Silos of care delivery will be brought down. Acute care hospitals, home care in the community, primary care and long-term care form a fluid continuum for patients who move between them. There will be a focus on difficult care areas: mental health, palliative, frail elderly, indigenous patients, those disproportionately impacted by the social determinants of health.
  • Information will flow between system partners to ensure that accountabilities and decisions made are factual and data-driven
  • The patient will experience nothing about them without them. They will have full transparency into where they are in their journey. As an extension, they deserve full access to their health records.
  • Digital care tools will be front and centre. Use of existing digital products created by system partners will be recommended or mandatory. New tools that meet current needs will be designed and allowed. Options for patients will include virtual visits, e-consultations, data viewing portals, online booking, and more.
  • Records systems will not be one size fits all but important core data will be exchanged between all of them for transparency and appropriate care.
  • Privacy and security rules will be modernized to reflect patient needs and expectations for sharing, while still ensuring that only the data which must move for care moves. Personal health information is held sacred.
  • Antiquated procurement rules built to reduce the risk of failure will be modernized to allow new technology to move forward quickly. Legacy products that no longer, or perhaps never did, meet our needs should not be protected
  • Changes that succeed will be promoted and celebrated along with failures as learning points for others. Lessons will be shared between OHT’s.

The pace of change we are seeing now in Ontario is unprecedented. In a few short months, we have witnessed the introduction of Bill 74, creation of the Ontario Health super-agency, and movement toward integrating acute, primary, community and long-term care. Doctors welcome this change because the current path is unsustainable. Patients cannot wait for change because they never want to be trapped in a transition. They demand transparency along their healthcare journey. Moreover, as a digital health system partner, OntarioMD is incredibly enthused as we watch duplication and waste disappear, silos break down, honesty and transparency increase, and higher quality care produced at a lower cost. All of this motion should lead to a healthier, more sustainable, coordinated system. We will, when we get this right, have reduced the burden of care for all, and will be well on the path to real improvement!

It’s Amazing What I Can Do with My EMR!

Dr. David Weinstein

Contributed by Dr. David Weinstein – Nephrologist, Belleville, ON

I wanted to share my experiences with other physicians and offices about some tools for my Electronic Medical Record in Ontario. I have been a physician in Ontario since 2015 and have been in practice since 2002. I work in both my local hospital and my private practice. My EMR and associated tools are so important for making my practice and life more efficient. It is really amazing some of the things I can do. 

  • In the office, I seamlessly pull labs from OLIS (eHealth Ontario’s Ontario Laboratories Information System) into my EMR. I no longer need my office to call around for blood work. I have access to the data quicker and can work more efficiently. My referring doctors know not to send me blood work. This speeds up the flow through my office and saves me on monthly faxing costs.
  • In the office I no longer call pharmacies looking for medication lists. I can just pull recent prescriptions electronically and now I know I have accurate medication lists. 
  • I can access records from other hospitals including blood work, radiology reports and images and dictated reports using the ConnectingOntario ClinicalViewer. It makes it so much easier to reconcile patients from other sites back into the office and make sure I have a complete picture of what is going on with my patients. 
  • I can access hospital reports in my EMR as soon as they are finalized because my EMR is connected to HRM (OntarioMD’s Health Report Manager). I do not have to wait for anyone to mail or fax them to me anymore. In fact, I have asked my local hospital to stop sending me paper copies of EVERYTHING. 
  • From my smartphone, or form any hospital computer, I can easily access my EMR and review patient history, medication, prior labs and notes to streamline hospital care. 
  • As a e-Consult consultant, I can help out other physicians through the Ontario eConsult Program, but I also can challenge myself based on the difficult questions I am being asked.   

I encourage all Ontario physicians to incorporate the various digital health tools into your office practice. You will work more efficiently and your patients will be happier. Contact OntarioMD at support@ontariomd.com to connect your EMR to the services I mention above as well as additional services to help you use your EMR more effectively.  

Screening tool addressing poverty in patient populations

Submitted by Jerry Zeidenberg 

This article references a session that was presented at the EMR: Every Step Conference. Make sure to register for the EMR: Every Step Conference Ottawa at https://www.ontariomd.ca/about-us/events/emr-every-step-conference/emr-every-step-conference-ottawa-2019 for engaging content on OntarioMD digital health products and services.

It’s well known that poverty is a major determinant of health, and that one’s social and economic environments play a large role in whether a person becomes physically or mentally ill. However, little has been done in a practical way to identify and assist at-risk members of society at the primary care level.  

Now, however, a project has been launched to turn things around. Initially, a two-month pilot project was conducted in 2018 that gave primary care providers a computerized tool to identify patients who are at risk of living in poverty, and who could use the support of community resources.  

The project was conducted at primary care clinics in four Ontario cities – London, Sudbury, Cambridge and Toronto – under the leadership of the Toronto-based Centre for Effective practice (CEP), a not-for-profit organization which started at the University of Toronto’s Department of Family and Community Medicine to create and disseminate evidence-based improvements in primary care. 

“My office screened 700 patients for poverty, and 100 were identified,” said Dr. Mario Elia, a London-based family physician and one of the pilot site leads.  

Overall, 4,517 patients were screened at the four sites, and 12 percent were found to be at risk of poverty.  

Of these, 30 percent were provided with customized resources and referrals to community supports at the same visit.  

Dr. Elia and Claire Stapon, a manager at the CEP, spoke about the poverty screening project at a session for physicians at OntarioMD’s EMR Every Step Conference, held in Toronto in September.  

Stapon said that 20 percent of Ontario families live in poverty – about 1.57 million persons. At the same time, she noted that 50 percent of a population’s health is determined by social and economic environment, according to recent studies. 

Indeed, all of the following have been strongly correlated with a person’s environment: diabetes, asthma, arthritis, cancer, COPD and mental illness. 

“Often, doctors don’t have the resources, and we struggle with how to help patients living in poverty,” said Dr. Elia.  

The computerized intervention devised through the Centre for Effective Practice has been identified as a step in the right direction.  

The tool was developed in partnership with CognisantMD, which produces Ocean software, a system that helps automate information gathering as patients arrive at a clinic. Also involved is 211Ontario, a free helpline and online database of Ontario’s community and social services.  

The Centre for Effective Practice has been producing other tools used in clinics; the one created for this project has been optimized to screen for patients struggling financially.  

In the pilot, staff and clinicians at the four clinics were first given education about the topic and training on use of the tool. Dr. Elia said it wasn’t difficult to implement at his clinic, as the office had already been using Ocean questionnaires to gather patient information.  

All patients over the age of 18 were given tablet computers, on which the form to screen for poverty would pop-up. Questions included such examples as, “Do you ever have difficulty making ends meet at the end of the month?” and “Have you filed your taxes?”  

Not only does the tool effectively identify at-risk populations, importantly, it also provides physicians with sets of local supports and resources for patients.  

Low income patients who haven’t filed their taxes – because they fear they might have to pay – are often entitled to tax refunds. The tool shows doctors how to connect their patients with the right resources in order to file their returns and receive these refunds.  

Other social supports are also available, making it much easier for physicians and their staff to help patients in need.  

The Ocean tool integrates with EMRs and can automatically create reminders on follow-up visits to inquire about different issues.  

After the pilot project ended, each of the sites had the option to stop using the tool. However, they all wanted to continue using it, Stapon said.  

Now the Centre for Effective Practice wants to spread the resources to other primary care practices in Ontario. They have created a modified version of the tool for TELUS PS suite physician systems, to start. Eventually they’d like to make the tool available for all EMRs in Canada. Those who are interested in more information can visit http://cep.health/poverty.