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

Contributed by Janet Song

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

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

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


Why did you decide to join QIPEP?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How can Canada prepare for this great demand?

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

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

 

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

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

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

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

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

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

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

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

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

 

Digital Health Shift – EMR Quality Dashboard

In this Digital Health Shift vlog, OntarioMD Chief Medical Information Officer Dr. Darren Larsen discusses the need to help physicians move beyond simply focusing on patient care for individuals, toward being able to more easily analyze their entire patient population and proactively those at risk. OntarioMD is focused on improving population-based care through the development of EMR-integrated tools such as our EMR Quality Dashboard proof of concept, which translate EMR data through user-friendly visualization. And, through the ongoing development of our Quality Support Program, we’re providing the support and education physicians need to improve EMR data quality for efficient population-based care.