Ontario has recently embarked on what has been described as the biggest transformation in health care since Medicare. Central to this transformation are the development of two new organizations.
The first is Ontario Health. Ontario Health amalgamates numerous separate agencies (all 14 LHINs, Cancer Care Ontario, eHealth, etc.) into one large corporation. The goal is clearly to reduce the duplicate back end administrative costs (separate payrolls, HR departments, workplace policy and procedures and so on) and create an integrated agency with seamless and consistent policies. As someone who was a fierce critic of the previous LHINs, I can’t help but be pleased at this move. (It was also recommendation 3 I made to then Premier Kathleen Wynne on how to fix health care).
The second move is to create Ontario Health Teams (OHTs). In broad terms the goal of the OHTs is to ensure that doctors, hospitals, home and community providers work together as one co-ordinated team to help patients. The OHTs stated goal is to integrate care around the patient.
The concept of OHTs is certainly a good one. There is plenty of evidence that suggests integrated care is good for patients. Jenny Grant (from McKinsey and Company) wrote about the benefits of integrated care (particularly for patients with chronic disease) and pointed out:
- Sweden reduced the need for hospital beds after introducing this model
- Sweden also reduced the number of “delayed discharges”
- A reduction in hospital admissions AND lowered patient costs for patients in Geisinger’s Medical Home Program
- A 79% reduction in wait times for social care assessments after Tobray Care Trust introduced the model
Given numbers like that, it’s no wonder that the government is exploring this model for Ontario. Physicians also support the concept of integrated care because at the end of the day, we want what’s best for our patients. We will always support policies that provide good health care (and we will always criticize polices that disadvantage patients).
What’s needed however is to turn that concept into a truly functioning entity. These models be voluntary, physician led and primary care based. In order to do that, there are two absolute musts that the OHTs require to be successful.
First, the OHTs must have strong physician leadership, particularly at the governance level. Greg Scrine from Lumeris said it best regarding the American version of integrated care (the Accountable Care Organization):
“Physician engagement is the key to the success of an ACO, and consequently the efforts of setting up an ACO need to be physician driven to achieve the desired results.”
In Ontario, this does not seem to be a problem. The Ontario Medical Association (OMA) has held several town halls on what OHTs are, and over 800 physicians participated. There is keen interest in this model from leading family physician organizations like the Section of General and Family Practice of the OMA as well. So long as the government wants physician leaders, it appears they will have them.
The second essential component of a successful OHT is a robust health IT system that integrates seamlessly with the various organizations that support patients.
“In order to achieve benchmarks, ACOs rely on a strong population health technology infrastructure (and rely on EMRs to bridge this)” – Healthpayerintelligence.com
To put it charitably, Ontario’s current IT health infrastructure is a mess. In the past 15 years, the government seemed to have absolutely no vision for an overarching health IT system that would put patients at the centre of the system. We currently have three main hospital IT systems, about 7 physician-based EMRs (electronic medical records), multiple pharmacy systems, a home care system and a nursing home system, and none of them co-ordinate with each other. Add in a multitude of radiology systems, and a separate system for all sorts of allied health care providers (Red Cross, St. Elizabeth, etc) and you essentially have a potpourri of systems, that unfortunately when put together emit an odour reminiscent of Pepe LePew.
Thankfully all is not lost. The current government is taking a measured, thoughtful approach to the formation of the OHTs. The first thing they are doing is introducing a Provincial standard for interoperability. Essentially this would be a secure format that allows, say, hospital IT systems to talk to Physicians EMRs and then to home care and nursing homes. I suspect some legislation will be needed to force IT companies to adopt this standard, but it is long overdue and I’m glad the current government is finally implementing this.
The next step is where some challenges lie. One of the goals of the current health care transformation is to allow patients to have more access to their records. Several hospitals already allow this. The issue is that different hospitals use different portals to allow access. I’ve also seen some physician EMRs allow this, of course, all using their own portals. The last time I counted there were something like 70 Apps right now that purport to allow patients the ability to access their charts. Clearly, there needs to be just on Province wide patient portal that allows patients to access their information.
To do this the government should simply partner with an organization that develops the patient portal. Obviously, the organization could not be a for-profitentity (more to ensure privacy of data as opposed to any anti-capitalist sentiment on my part). This would ensure that everyone in Ontario could use the same software to access all their records, and allow the seamless integration necessary for OHTs tosucceed.
There have been big changes in health care the past few months, with much more to come. Thankfully the Premier’s Council on Ending Hallway Medicine is led by Dr. Reuben Devlin, who has a strong history of supporting IT to enable better health care. Hopefully, the government will see the benefits of using a single Provincial Portal as a means of enabling the success of the OHTs. This would be a benefit for all Ontarians.