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.

OntarioMD: Advancing digital health in Ontario

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Front-line health care providers, quality improvement organizations, digital health delivery leaders and government recognize that digital health delivery has become an indispensable support to keep up with increasing health system demands. It is no longer imaginable that health care could be delivered without digital information technology to manage the array of information processed and recorded for patients every minute in Ontario physician practices, hospitals, home care, long-term care homes, public health units and health care provider practices across the continuum of care. All have adopted digital health tools, in varying degrees, to manage and support patient care.

There is a lot of discussion about what digital health doesn’t do yet – the promise not yet fulfilled, and definitely the glass half empty analogy. What about the glass half full? It is truly important to understand what digital health is doing every day in the health care system.

I’m going to focus on digital health in primary care because that is the area in which we spend our time as an organization. OntarioMD has been at the forefront to rollout digital tools and services across the province to support and enable efficient and effective practice and underpinning the delivery of excellent care to patients. We are known for our success in getting electronic medical records (EMRs) into the hands of community-based family physicians and specialists. From a province with one of the lowest adoption rates when our work began, to now one of the highest. How valuable are EMRs to the health care system? They’re more valuable than people may realize. More than 15,000 physicians and more than 1,100 nurse practitioners are using them to care for about 11 million Ontarians.

EMRs in primary care enable clinicians to manage your personal health information in a secure manner. EMRs require login credentials to access information, and no charts will be misplaced or lost. Protecting personal health information is critical to all of us. EMRs are the secure virtual filing cabinet to protect your information and make it accessible only to those to whom you give consent. We take privacy and security obligations very seriously and we offer a comprehensive program to enable physicians to stay up-to-date on their obligations and how to protect your information in their EMR systems.

Let’s say you were in the hospital emergency department last week and experiencing severe abdominal pain. If your physician used an EMR, they would be getting your discharge summary about your visit from the hospital directly to the EMR through OntarioMD’s Health Report Manager (HRM). They see your discharge summary in their EMR inbox, with a summary of your visit and it is increasingly likely that they may have called you for a follow-up appointment before you call the office.

Whether you are a patient with a single lab test or you require regular laboratory tests to be performed. Physicians are sent your results electronically by the laboratory, and they can also query OLIS (Ontario Laboratory Information System) to see your results. EMRs enable the physician to display results graphically, and this makes a lot easier to review trends in your results, supporting discussions about what might be working well or where attention needs to be focused.

Prescriptions generated and managed in EMRs provide extraordinary value. With an EMR, your physician can alert about drug indications or potential conflicts with current medications. Thousands of Ontarians experience adverse events due to drug interactions every year. EMRs have helped to reduce adverse drug events. It is one of the most valuable things digital health delivers for patients and the health care system.

If your physician wants to ask a specialist about something, he or she can make a request through an online portal and get an answer often in hours. This means you don’t have to wait for months and then take time away from family or work to go to a specialist for something that could have been dealt with by your family physician. OntarioMD is working with our partners in the Ontario eConsult Program to make it even easier for physicians to request an eConsult through their EMRs. This is just one of the ways we’re connecting the health care system to benefit patients.  

Back to the glass half empty – can everyone in the health care system seamlessly exchange data electronically to care for patients? No, but we’re getting there. Ontario physicians understand that the way forward is digital. They see its value and potential by using their EMRs and connecting to OntarioMD products and services and those of our partners that augment the value of digital health to realize better patient outcomes and healthier Ontarians.  

What about the physicians who use digital health and their needs? It’s great that they’re using digital health in increasing numbers to care for patients. We care about their workflows and ensuring that they get the training and ongoing support they need.  We know that it is important to create capacity in a physician’s office to support their adoption and best use of digital health tools and services, all while they are getting on with their most important work – delivering excellent care to their patients.   

Let’s keep working together to fill that glass and realize even more value for our health care system!

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.

 

 

I hate paperwork!

Submitted by Dr. John Crosby 

I am a family physician in Cambridge with 1,400 patients serving 2 nursing homes in an 18-physician family health team with 30,000 patients in total. I have spent 26 years as a physician, with 20 years’ experience as an emergency physician.

A recent survey in the Medical Post listed paperwork as the biggest stressor for physicians. Luckily for me, paperwork is a thing of the past as we have eliminated paper coming from hospitals and specialty clinics and gone digital using Health Report Manager (HRM). It was easy to implement, and both my office manager and I have found that it saves us time to focus on delivering better patient care.

HRM is simple to implement as OntarioMD does all the work in helping to get your practice set up. OntarioMD came into my practice to sign subscription and user agreements and TELUS helped with the set-up of the system. Report types such as imaging, emergency, specialist and other hospital reports automatically downloaded into our EMR system. This eliminated the need to store paper reports. If I were to get an MRI report showing a brain tumour, I can quickly call the patient in and refer them to a specialist.

I can also access lab results through my EMR via the Ontario Laboratories Information System (OLIS). I simply login into my computer and click on lab reports to view any abnormal patient results. If a patient’s potassium level comes back low, I can simply tell my office manager to tell they will need to change their diet or take certain medications.
One of the newer digital health tools I’ve connected to is eConsult. I can send a message and documentation to a specialist anywhere in Ontario without having to send my patient for an in-person visit. This means faster advice, usually within a couple of days, I can use for my patient who doesn’t have to wait months to benefit from a specialist’s advice.
These tasks are all done without paper. Prior to using an EMR, HRM, OLIS and eConsult, receiving, sending and viewing patient health information was tedious and time consuming. In the past, all my reports were mailed or faxed. We would have to physically travel to the hospital and pick up the paper reports daily. Then the paper report was scanned, the patient’s file had to be opened and the report dragged there. Then my office manager would mark it as seen by me.
With HRM, I see a patient’s report as soon as it downloads. With a couple of clicks, the information is posted into the patient’s chart. I no longer need to go to the hospital and wait for mail and faxes. Now I can receive specialist reports the same day of the patient’s visit all thanks to HRM. HRM also sends me eNotifications so I know when my patients were in the hospital and know that I can expect hospital reports to follow.
My practice is more efficient all thanks to my EMR and other digital health tools like HRM. They have benefitted my practice by:

  • Enabling me to find patient information quickly
  • Allowing me to spot trends and abnormalities
  • Providing faster patient follow-ups
  • Accessing specialist advice and getting responses sooner
  • Enabling more time spent on patient care
  • Creating workflow efficiencies
  • Less time spent on administrative and operational tasks

Physicians and other clinicians need digital health tools to practice medicine today. They really need the services of OntarioMD to advise them on how to go digital. You can start with one digital service and OntarioMD will help you integrate it into your workflow. Or, you can start with multiple digital health tools. OntarioMD can connect you to all of them and help you understand how to use them effectively to care for patients and to manage your practice. If you hate paperwork like I do, contact OntarioMD to get HRM, eNotifications, OLIS, eConsult or any other available provincial digital health tools (e.g., ONE® ID, ONE Mail, ConnectingOntario Clinical Viewer and more). Call 1-866-744-8668 or e-mail 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.

A Summer as an Intern at OntarioMD

This blog post was contributed by Summer Intern, IT Deployment and Integration Graeme Larsen. 

“Digital Health” is a complicated idea. To the uninitiated, the phrase could mean all manner of things, from robots performing surgery, to artificial intelligence solving diagnostic problems, to information networks connecting doctors to their patients hundreds of kilometers away. Nevertheless, regardless of how the words are interpreted, I am sure everyone agrees that “Digital Health” is important.

Flung head-first into this crazy new world – wow – did I ever feel out of my depth! 

Four months ago, I began my journey as an intern at OntarioMD, a provincial leader in Digital Health, where I quickly learned that it’s not at all about robots.

The most important aspects of digital health concern information management. For instance, OntarioMD has developed a service called Health Report Manager (HRM), which connects Ontario’s primary care providers to surrounding hospitals to facilitate the sending and receiving of patient information. It is responsible for many things I used to take for granted. Think about the impact of electronic sending and receiving of an x-ray report immediately after it is issued – it is colossal. Doctors are now able to receive patient information in real time, and are immediately notified when a patient is discharged from hospital. They can then follow up right away, thus improving quality of care when the patient needs it the most. Digital upgrades like this have substantially improved patient outcomes in Ontario, and have contributed to a greater standard of care across the province.

As an intern, I was lucky to be directly involved with HRM as a part of the OntarioMD Deployment Team. This was a big opportunity for someone my age. I was responsible for the early stages of the on boarding process, connecting medical clinics to the HRM system. I can hardly begin to think of how many patients may be positively affected by my work.

I also had the opportunity to be involved in the development of the company’s new Client Relationship Management system. I was invited to take part in discussions and to offer possible improvements and strategies to be used in the process. It was a privilege. Only a few months ago, I was a naïve 18-year-old with not a clue that this complex, corporate world existed. That has all changed.

The trust that OntarioMD placed in me early on left a positive, lasting impression in my mind. This company trusts and hires the right people. Sarah Hutchison and her team of executives have worked tirelessly to push change and innovation in the healthcare sector, and working with them has inspired me to want to do the same. From the executives, all the way down to the other interns, everyone is extremely welcoming, encouraging, and they are all working towards the same goal: to improve Ontario’s healthcare system.

As an intern, I was not grabbing coffee. I was contributing to important projects, systems, and conversations in a significant way. I am extremely grateful to OntarioMD for trusting me as one of their own. My time here is guaranteed to benefit my future career – and I know that I leave with lasting friendships, and a wealth of knowledge that could not have come from anywhere else.