Leverage insights from your EMR data to enhance patient care

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:  

  1. The i4C Dashboard enabled quality improvement – 87% of indicators showed improvements after only 90 days of clinician use;
  2. 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
  3. 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 support@ontariomd.com or 1-866-744-8668.

Physician-Recommended Medical Apps

Contributed by Dr. Chandi Chandrasena

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 different specialties.

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.

RxTx mobile

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 content.

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.

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 more.

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 phone. 

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!

Digital Health Week: OntarioMD’s Cynthia MacWilliam on Supporting OHTs

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.

Medical Apps for Physicians

Contributed by Dr. Chandi Chandrasena

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.

Happy Digital Health Week!

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.

My Patient Experience in Denmark and Canada

Contributed by Patrick Kitchen

Throughout recent years, a recurrent health problem has required me to make frequent visits to my family physician, a specialist’s clinic and occasionally the ER. I became used to the routine of explaining what happened, describing previous events to various clinical staff, and providing context in lieu of a personal and up-to-date health record that the physicians or nurses could review. After each appointment or ER visit, I would request that the information be faxed to my GP or cardiologist, as well as take a personal printed copy in case the records were not sent, which turned out to be a common pattern.

In 2017, I was accepted to graduate school in Copenhagen, where I completed a Master’s degree in Business Administration and Innovation in Health Care this past June. Throughout the first semester of the program, discussions on digital health and how to improve outcomes, efficiency and the patient experience using digital health tools were fairly common. During classes we would hear from speakers who worked in the Danish health care sector, health care practitioners (HCPs) and professors who would proudly mention Denmark’s progress in achieving a largely digital health system. Numerous examples of these innovations included: MedCom, a non-profit agency developed in 1994 and responsible for the development of data standards and a national health data network; the national IT health portal launched in 2003 (Sundhed.dk); the extensive use, interoperability and portability of EMRs across primary and secondary care settings; ePrescription rates of nearly 100%; highly sophisticated public health registries, and many other examples. While impressive, these statistics and figures never fully resonated because I had not seen a doctor in Denmark, nor experienced these technologies or platforms as a patient or user.

When my health problem returned while I was studying in Copenhagen, I felt some uncertainty given that I was outside of Canada, and I had never visited my doctor before (I say ‘my doctor’ because I was automatically assigned one when registering with civil authorities based on my address). I arranged a visit with my GP the following day. She felt that we should do some diagnostic work, and as I left, I asked if there was any documentation I needed to bring. She looked at me with a curious face, and then stated it was all submitted digitally, and that she would receive the results digitally, which would also be available to me through my profile in the national patient portal. When I arrived at the lab, I simply swiped my personal ID card (all residents in Denmark have a unique personal identifier that is used in the public sector) in their scanner, and the lab tech knew what tests I needed to complete. While this process might feel insignificant and routine to Danes, it felt worlds ahead of the care process at home in Ontario. It was reassuring that the onus was not on me to ensure my doctor or the lab technician had the correct information, and that I could access it digitally and send the information back to my Canadian doctor if necessary.

When the problem presented itself again the following year, I called the acute nurse line as it was a Saturday. I was then referred to a nearby hospital, which had anticipated my arrival, and whereby I was immediately taken to an examination room, swiftly examined and discharged shortly after. On the Monday, my family doctor called and asked me to come in for an appointment, because she was notified that I had visited a hospital over the weekend. After discussing my results with me, she referred me to a specialist who’d conducted further testing by the following Wednesday. Again, the results and lab work were sent digitally, and I could access them online using the Sundhed.dk patient portal. Gone was the added stress associated with visiting the doctor or ER and needing to ask for documentation, retelling my medical history to various HCPs, or even being asked basic personal information over and over again. My experience both as a patient in the Danish health system and student in a Master’s program aimed at supporting innovation while sustaining publicly-funded health care allowed me to gain a real understanding of the importance of a digitally-connected health system, and provided me with further motivation in my studies. Knowing that my GP and other clinicians could easily access my records, easily communicate with each other and order tests and prescriptions if necessary, and that I had access to all this information in the patient portal, felt like another world – one that would be a luxury to have in Canada.

Like many aspects of Danish society, consensus-building has been crucial in the continuing development of a strong, nationwide digital health strategy. Denmark may be a small country of approximately six million people. However, a country’s population should not dictate its ability to deliver high-quality and well-integrated health care assisted by the extensive use of digital health innovations. I decided to write this post since there is a lot of talk in Ontario about integration and digital health. Based on my experience as a patient in another country, and my Master’s studies in Copenhagen, I know what is possible and what we should strive for – a digitally-enabled health care system that benefits and empowers clinicians and patients to be true partners in care.

Patrick Kitchen recently graduated from Copenhagen Business School in Denmark, completing an MSc in Business Administration and Innovation in Health Care. Prior to that, he received a Bachelor’s degree from the University of Toronto in Political Science, with a specialization in Comparative Politics. Through his educational and professional experience, Patrick has developed a passion for digital health, health policy and strategy, and health system sustainability. Patrick recently returned to Canada and is looking to start a meaningful career in the digital health sector.

Virtual Visits: Hype or Hope?

Contributed by Dr. Anil Maheshwari

In this time of ongoing changes in our healthcare system, technology has emerged as one of the most promising ways to provide better care for our patients. One of the key areas of focus for the new Ontario Health Teams is digital health. The government clearly envisions technology tools such as virtual visits playing an important role in the province’s healthcare system.

You may be asking yourself, “What is a virtual visit?” My definition of a virtual visit is an interaction that occurs between a patient and healthcare provider without having to be in the same place at the same time.

In the Waterloo Wellington area, 67 clinicians have conducted over 10,000 virtual visits so far and the feedback has been overwhelmingly positive. Feedback indicates that 94% of patients thought that their virtual visit was the same or better than an in-person visit, and 94% of patients would recommend the solution to friends and family. In addition, 91% of providers indicated that the solution is easy to use, and 81% would recommend the solution to their colleagues.

We have rolled out three types of virtual visits at our 15-physician Family Health Team – secure messaging, phone calls and video visits.  We currently have over 2,800 patients signed up on our platform.

Our physicians have been predominantly using secure messaging, which provide a variety of benefits:

  • Patients and physicians are able to send and receive messages at their convenience;
  • Patients document their visit, which means less documentation to be done by the physician;
  • Everything that is documented is saved for the patient to come back and look at later, which leads to fewer communication mishaps;
  • Providers can send documents including handouts, prescriptions, laboratory and radiology requisitions;
  • Patients can send pictures of rashes, medicine bottles and other documents to their providers, who are able to save this information in the patients’ charts; and
  • The messaging takes less time than standard, telephone or video visits.

We are now looking to do more phone calls and video visits, which need to be scheduled. The biggest advantages to these are that the provider is able to hear and/or see the patient and is reimbursed at the same rate as an office visit for most standard visits. It can be more convenient for both the patient and the physician.

Virtual visits are clearly an important part of the future for the healthcare system. According to Kaiser Permanente CEO Bernard J. Tyson, out of 100 million patient-provider visits in 2016, 52% were done virtually. While Kaiser Permanente is a fully capitated model in the United States, virtual visits also work in our current system because the government understands the value of these types of visits and is reimbursing phone and video visits at the same rate as office visits. Physicians in a rostered model continue to shadow bill and fee-for-service physicians continue to receive the full fee-for-service rates. Messaging pays a slightly lower rate in both models but, as discussed above, has several advantages.

Overall, the most active virtual visit adopters in our group feel that using technology is a great way to provide care and avoid unnecessary face-to-face visits, saving both patients and clinicians a lot of time. We also understand that virtual visits will only improve with better integration into our electronic medical record.

Virtual visits should also allow us to prevent outside usage by patients. According to our data, high users of our platform were able to retain 8.5% more of their access bonuses while our control group’s access bonuses actually fell by an average of 5% during the same time period. A net difference of 13.5% provides some evidence that this technology does in fact prevent outside usage.

As we are better able to integrate these new types of visits into our office flow, we believe that many more physicians will see the benefits and embrace this technology.

Hear more insights from OntarioMD Peer Leader Dr. Maheshwari at his session, Virtual Care: Hype or Hope?, at OntarioMD’s EMR: Every Step Conference in Toronto. Register to join us on September 26. You can also get more information and support from OntarioMD anytime at support@ontariomd.com.