Ontario Health Transformation Needs Strong IT to Succeed

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.

ONE MORE PATIENT SEEN – ONE LESS PATIENT WAITING

Note:  This blog was originally published on the OMA website.  I’ve reproduced it here, for those who don’t normally go to the website.

I am proud to be the President of Ontario’s 31,500 practising physicians. I know that making sure every patient gets the care they need, when they need it is every physician’s top priority. We are on the frontlines of the health care system, caring for almost 340,000 patients every day.

Ontario is undergoing a much needed, and absolutely necessary health care transformation. Our population continues to grow and age and people’s health care needs are increasing in their complexity. All across the province, doctors are working hard to care for more patients and reduce wait times.

Under our health care system, doctors are independent contractors who own their own practices and operate as small businesses. Physician services depend entirely on patient need, and that varies from community to community, specialty to specialty, and physician to physician.

Doctors bill for patients they see, procedures they perform, and in some cases, the tests they interpret. It is important to note that the amount a doctor bills is neither their salary nor their take-home pay. Physicians must pay for the costs of operating their practices, from staff, to rent, to medical and office supplies. These expenses take up a significant proportion of billings, in some specialties up to 50%.

There are also many different models for practices. Some are small and have limited staff while some have a much larger team of several types of health professionals including: physician assistants, nurses, nurse practitioners, technicians and medical assistants. Expenses and volumes of patients seen would be very different depending on the operating model.

A physician’s annual gross billing amount reflects demand for treatment. The more patients need services, the more OHIP is billed for those services. This demand may be intensified in remote and rural locations where there are limited medical resources. In fact, many physicians in underserviced communities may work 7 days a week to provide the best care for their patients.

It is also important to note that Ontario continues to have a lower number of physicians than most other jurisdictions in the world. We currently have 2.6 physicians for every 1,000 patients, whereas Germany has about 4 physicians for every 1,000 patients. This means that our physicians have to see more patients (and thus bill more) to help keep the residents of Ontario healthy.

The OMA  (and I) support greater transparency of physician billings. But this should include appropriate context for the public and be governed by an Act of Legislature as it is in other provinces. The real value in greater transparency is to show how much patient demand there is for services. Looking at a select 0.3% of physicians will not do this.

Ontario’s doctors are working with the government to fix our health care system, solve critical issues like hallway medicine and deliver the high-quality care our patients deserve. Part of this work is to recognize the value of services patients need and how those services are provided. We will continue to do this work with the government going forward.

Each and every billing submitted by a doctor means that one more patient has been treated and one less patient is waiting.

Doctor’s Day Celebrated the Trust Patients Put in Us

“I love my Doctor and their team of colleagues. They are friendly and give me the best care I need. Thank you to Dr. Hameed and her team of Colleagues at St. Joeseph Family Medical in London Ontario.”
– Christine

“Dr. Gimbel is a super G.P. I have had issues from time to time, and Dr. Gimbel leaves no stone unturned until these issues are resolved. She has a good sense of humour, always listened to my issue and diagnoses them as speedily as possible. She is worthy of special mention on doctors day. “
– Roy

As President of the Ontario Medical Association, I am proud to lead an organization that represents so many remarkable people like Dr. Hameed and Gimbel. The public trusts us to protect their health and the health of their loved ones.

We repay that trust with a commitment to patients that often comes before everything else in our professional and personal lives. Ontario’s doctors keep the provinces 14 million people healthy, take care of them when they are sick and are vital members of our communities.

This commitment is the cornerstone of Ontario’s health care system.

For Doctors’ Day 2019, we asked Ontarians to share stories about their doctors and the difference they have made in their lives and communities.

Over the month of May, people across the province responded with moving personal stories like the two above.

Patients recounted how their doctor held their hand during their darkest hour, helping them to conquer illness or find the courage to keep fighting. They shared stories of doctors who went above and beyond and expressed admiration for the daily challenges that doctors overcome in the pursuit of excellent patient care.

This outpouring of support doesn’t surprise me. I know my colleagues well, and I’ve witnessed their daily dedication to their patients during my 27 years of rural medicine practice in Stayner.

I love practicing family medicine and value the trusting relationship between me and my patients. It is the same relationship Ontario’s 31,500 physicians have with more than 340,000 patients they see every day.

As president of the Ontario Medical Association, I will be writing a lot about issues that affect both the profession and patients in my term over the next year. I will post them on this blog, and on my twitter feed.

Ontario’s doctors are on the front line of the health care system. We see what is not working within the system and how it can be fixed. We understand that changes to the health care system must work for patients in real-life situations. As we work with government to fix our health care system, solve critical issues like hallway medicine and deliver high-quality care, the health and well being of our patients will always come first.

For more stories underscoring the strong and valued relationship we have with our patients, click here. I beam with pride in my colleagues when I read these, and I hope you do to.

Note:  The original version of this blog appeared on the OMA newsroom and the OMA facebook page.

Ontario Health Teams A Good Start For System Transformation

The Ontario health care system is in distress.  Frontline health care workers like myself know this.  Many of the rules that we are forced to abide by are archaic and make no sense.  Outdated fax technology only flourishes in health care.  Hospitals are bursting at the seams.  Home care is proving woefully inadequate.  Sadly, patients are suffering from the consequences.  This is what 15 years of neglect and lack of foresight by the previous Ontario Liberal government has caused.

To fix the situation, the new Conservative government of Premier Doug Ford is proposing what has been called the most massive transformation of health care since Medicare. The first step is to form an agency– called Ontario Health – that will merge up to 20 different agencies into one.  Long-time fans of mine (all three of them) will know this is music to my ears.  It was step three in the seven-point plan I urged then-Premier Wynne to follow to fix health care back in 2017.  I can’t help but be pleased this is finally happening – and certainly expect a significant reduction in Ontario’s bloated bureaucracy as a result.

The second step is to form a number of “Ontario Health Teams”(OHTs).  The goal of these teams is to provide Integrated Care Delivery Systems (ICDS).  There’s a lot of bureaucratic verbiage in the documents released to date, but essentially the goal is to ensure that different health care providers (doctors/home care/hospitals, etc.) work seamlessly to deliver care to patients, as they move through the health care system.  I know, it sounds incredibly basic, and should be straightforward, but unfortunately, it just doesn’t happen as well as it should right now

Can OHTs work?  As always, the devil is in the details.  The first thing that is needed is the political will to transform the health care system.  This is clearly evident.  Health Minister Christine Elliott has been widely lauded as a very capable minister and truly has the ability to provide the political will necessary.  Dr. Reuben Devlin (the Chair of the Premier’s Council on Ending Hallway Medicine) is a strong leader as well.  Thankfully, the person who will have to do a lot of the bureaucratic heavy lifting is new Deputy Minister Helen Angus.  I’ve written about her before, and she certainly appears to be a very strong deputy minister.  I think she’ll do very well.

The next step is to ensure that similar models across the world are studied, and only the successful ones copied.  You see, the OHTs appear to be the Ontario version of something called Accountable Care Organizations (ACOs – I know, you have acronym overload by now).  The goal of ACOs is to provide an amount of funding to a geographic region, and to have all of the health care delivered to patients in that area paid for by that funding.  The OHTs however, appear to be taking a more cautious, pragmatic approach, and are only going to provide funding for outpatient services, and not include physicians’ services. They may evolve in the future, and it’s a smart move on the government’s part not to move too quickly.

Now, the reality is that only some ACOs worldwide actually meet the goals of simultaneously improving health care while reducing health care costs.  So it’s incumbent upon OHTs to reflect those effective models, and not the ones that have failed.  What do the successful models have in common?

First, it is essential to have strong physician leadershipin these models.  For too long, Ontario’s physicians have been blocked from providing advice to the government.  Physicians work on the front lines of health care delivery, and see the effects of bad policy every single day.  They have many ideas on how to transform health care for the better.  The previous Liberal government only viewed front line health care workers as eye candy for photo ops and nothing more. Thankfully, this seems to be changing, and it was refreshing to have Premier Ford’s Senior Advisor Greg Harrington come to visit us at the Ontario Medical Association head office last week (I can’t recall anyone from Kathleen Wynne’s office visiting us).  Governments co-operating with physicians can only help patient care.

Secondly, the mess that is Ontario’s IT infrastructure needs to get cleaned up quickly. You see in 2019, for seamless care to be provided to patients, hospitals need to talk quickly, securely and electronically with home care providers.  Doctors need to talk to pharmacies.  Nursing homes need to get doctors quickly.  In short, the relevant data has to follow the patient.  Projects like the one I was proud to spearhead in Georgian Bay have proven that we can save money and provide better health care at the same time.

These are challenging times in health care, but there is also a great opportunity.  By properly instituting OHTs, Ontario has a chance to finally start reversing its poor record of the past 15 years.  Done properly, this reform of health care could also be a lasting legacy for Premier Ford.

Let’s get it done right.

A Personal Journey Through Public and Private Health Care

Disclaimer:  The following blog was written by Dr. Darren Cargill (pictured below).  He asked that I put it up for him.  Dr. Cargill is a palliative care physician from Windsor, Ontario.  Opinions are his and his alone, and do not necessarily reflect my opinions, or those of the Ontario Medical Association.

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Recently, a series of articles in the Toronto Star claim that Ontario Premier Doug Ford is looking at “private” options to end hallway medicine.  This was, of course, immediately denied by Health Minister Christine Elliot who stated her government’s ongoing support for public health care.

To support this narrative, the Ontario NDP brought forward a leaked piece of draft legislation called the “Health Systems Efficiency Act”. This draft suggests that all 14 Local Health Integration Networks (LHINs) and many other agencies (Health Quality Ontario, eHealth, etc.) are to be rolled into one big Agency.  NDP Leader Andrea Horwath claims that this draft legislation is a signal that private health care is the real agenda for the Ford government.  Interesting times for health care in Ontario.

In Andre Picard’s book “Matters of Life and Death,” he eloquently outlines the history of Medicare in Canada, warts and all.  I think we can all agree with his comment “Canadians want care that is appropriate, timely, accessible, safe and affordable, from birth to death.”

So here is our story. In 2007, my wife was diagnosed with cancer. She received excellent care here in Windsor as well as at Western in London as part of her journey.  I can honestly say, that she would not be here today if not for that excellent care. I am indebted to our system for saving her.

Getting cancer at 29 is frightening.  When we wanted a second opinion to confirm the diagnosis and ensure that we were receiving the best possible care, we booked an appointment at Karmanos Cancer Centre in Detroit.  A second opinion in Ontario would have taken months. We got our appointment within days across the border. They confirmed that Windsor was giving us fantastic care.

At one point during her treatment, she needed an MRI.  The wait was many months in Ontario.  At first, she was ok to wait but as the days passed, the wait took its toll.  Eventually, we decided to go to Detroit and have the MRI done, with only a few days wait and near instantaneous access to the results.

When we needed help conceiving following chemotherapy, this too was not covered by our public system and we paid out of pocket for that.  We required help from physicians in both Windsor and Detroit. Today we have a son.  And he has a mother.

Neither system alone gave us what we needed. It was both.

We already have private health care in Canada.  Doctors’ offices are privately run businesses that rely on single-payer public funding to operate. We also have private care when we pay out of pocket for drugs, physiotherapy, psychotherapy, fertility treatments, and dental care.  Canadians already spend money out of pocket for health care so the fears around a “two-tiered” system are odd, to say the least. Two-tiered refers to the argument about equity, not public/private, in my humble opinion.

Many will claim I am a physician and had “the means” to avail myself of private care.  But for the record, I was less than 2 years into my career and still had over two hundred thousand dollars in debt from tuition gathering interest every day.  We had to ask family for loans to support us.

For me, the price was worth it.  I would have preferred to have all of our care provided in Canada, but the public system simply could not give us everything we needed.  I believe it was providence that we ended up in Windsor, a short drive away from a world class cancer centre and fertility experts in Detroit.  Ontario gave us most of what we needed and prevented catastrophic financial consequences but privately delivered care in Detroit helped to fill in the gaps.

Why couldn’t I have those options in Canada?

To be clear, I am not suggesting we adopt a US style for-profit system and I am not suggesting we abandon our public system. What I am suggesting is that we have a mature conversation about our system, it’s limitations and whether there is a way to supplement or augment our “good not great” publicly funded, single payer system with private options that could enhance the care we deliver. Can we make our system better through private innovation and efficiencies while preserving all the best parts of public Medicare?

I am asking for a conversation.

As a palliative care physician, I won’t benefit from privatization.  End of life care and symptom management for patients with life-limiting illness will remain publicly funded.  But end of life care does give us a great example of what a good conversation could look like.

In 2015 the Supreme Court of Canada’s Carter decision came down and we were required, as a nation, to address the issue of Medical Assistance In Dying (MAID). Previously, MAID was taboo and “verboten.”  We could not raise it with our patients or even discuss it. But a funny thing happened. Once this prohibition was raised, it got easier to discuss death and dying. Whether or not you support MAID or not, one thing is indisputable.  The conversation has been elevated.

In his book, Picard states “we talk endlessly about sustainability of Medicare but have no idea what we want to sustain.  Our Medicare model is a relic, frozen in time. Tommy Douglas’s role in shaping publicly funded health care is celebrated, mythologized even.  But we conveniently ignore that Medicare was designed to meet the needs of 1950s Canada.”

All on the first page of his chapter on Medicare.I couldn’t agree more.  And while we are at it, let’s stop tilting at wind mills.

I do not pretend to have all the answers.  I just know we need a mature conversation about public AND private health care.  Let’s not shut down the conversation out of fear-mongering and ignorance. To paraphrase former CPSO president David Rouselle: “let’s not repeat the same sterile conservations again.”

How to “Axe the Fax” in Health Care

Recently, Globe and Mail Health Columnist Andre Picard wondered why fax machines are still the norm in health care.  Electronic communication is faster and more efficient than faxing.  In the past, it was thought that faxing was at least more secure.  However, with the emergence of “faxploit”, and reports showing how missed results are worse, it’s clear that secure electronic communication is safer.  Britain has moved to “axe the fax”in health care, acknowledging that using fax machines is farcical.

So why are faxes used so often in health care?  I can’t speak for other provinces (although the answer is likely similar) but in Ontario, it’s because the IT infrastructure for health care was so poorly thought out by the previous Liberal government that there really is no choice.  There is a mis-mash of different software for different health care providers, none of which interacts with each other.

Physicians in Ontario currently are able to purchase one of twelve Electronic Medical Record (EMR) services. NONE of these services is actually able to communicate with each other electronically.  Going from one doctor to another, means that your records are not interchangeable.

Hospitals in Ontario have the choice of even more products, though generally pick one of the three most physician unfriendly versions.  The Home Care system uses a Province wide system, but can’t interface with hospitals and physicians.  Then there’s Public Health, multiple allied health care agencies, nursing homes and so on.

The result is a byzantine system with no easy co-ordination and absolutely no interchangeability.  Hence, I fax referrals to Home Care, specialists fax me with their consult notes, and nursing homes fax me three month drug reviews.

The most commonly suggested solution for this problem is to develop something called a Provincial Electronic Health Record (EHR).  The idea is to have every health care provider get rid of whatever software they are using now, and use one Province wide system only.  The system would be cloud based, and allow you only to access the information that you have privileges for.  For example, family doctors could see the whole chart, but a pharmacist could only access the medication record (and some relevant lab work), a personal support worker would only be able to access notes they had written and so on.

In an ideal world, this makes the most sense of course. However, proponents of this solution fail to recognize that this will be exceptionally costly.  There are the initial costs of development of such software. But there will be additional hidden costs to such a solution.  EVERY health care provider in the province will have to get re-trained on this new software.  We’re talking all 30,000 doctors, 100,000 nurses, goodness knows how many PSWs, Pharmacists, Pharmacy Technicians, radiology technicians, clerical staff etc.

Unfortunately, the reality is also that when people go from one system to another, mistakes are going to be made and there will be a number of errors.  These errors will also have a cost to them.

But what can be done then?  Clearly the current system of archaic faxing is unacceptable. Turns out there is a solution that is relatively easy, relatively in-expensive and has already been piloted with great success in my neck of the woods (Georgian Bay, Ontario).  The government should mandate that all health care software providers must have an Application Programming Interface (API) that meets a rigid province wide standard, by the end of this year.

As I’ve written about before, when I was Chair of the Georgian Bay Family Health Team, my colleague Dr. James Lane piloted a project that allowed pharmacies limited access to our Electronic Records and allowed secure communication between pharmacists and physicians. There were numerous efficiencies and safety benefits, including an unexpected 90% reduction in drug diversion (selling/stealing of opiod prescriptions).

In 2014 we used an API to allow us to communicate securely with our nursing homes.  The result was an over 50% reduction in admissions to our local hospital from nursing homes.  The cost of the API was about $35,000 a year. The funding ended in 2018 and for whatever reason our LHIN has chosen not to continue funding it – and of course hospitalization rates are going up again.

Having a provincial standard for an API can be done easily (there are multiple existing standards out there).  Forcing the software providers to add this to their software will take a little intestinal fortitude, but I suspect the current government has that.  By doing so, it means that a physician, can continue to use whatever EMR he has, but transfer relevant data electronically to home care, public health, hospitals and so on.  It will mean that the agencies can communicate directly and quickly with each other on the patient’s chart, without the mess that was caused by faxing. Our system was actually compatible with smart phones, so home care nurses could message a physician’s office right from the patient’s home.  And, it will be far less expensive than developing a brand new system.

The time to mandate a Provincial API Standard probably came 8 years ago.  Hopefully 2019 will be the year it happens.

Premier Ford Is Taking Promising Steps

Editorial Note:  This article was submitted for publication to the Huffington Post.  They published it yesterday (my thanks to the editorial team their for feeling it was worthy).  I’m republishing it here for those of you who don’t read Huff Po.

Ontario Premier Doug Ford sent a New Year’s letter to all members of the Ontario Public Service recently, announcing his three main priorities for the next year.  Happily, for those of us who provide front line health care, fixing Ontario’s troubled health care system continues to be one of those priorities.  Ford also specifically emphasized “embracing change and innovation, deploying technology more effectively, and committing to new models of collaboration and patient care.” But what exactly does that mean?

There’s been much written about the rather unique, even disruptive, style of the Ford government to date.  However, from a health care perspective, while Ford has moved quickly, he also, to date, seems to have moved pretty fairly – the hiccup around arbitration with the Ontario Medical Association aside.

First, he appointed Christine Elliottas Minister of Health (MOH). She’s clearly one of, if not the most experienced Minister in his cabinet.  Immediately after, deputy Health Minister Bob Bell retired, and was replaced by Helen Angus.  Helen Angus herself is a consummate professional and very highly regarded amongst the health care community.  There was clearly a feeling that steady hands were going to be on the tiller when these appointments were announced.

The first thing that Elliott and Angus did was streamline the MOH bureaucracy, reducing the number of Assistant Deputy Ministers from what looks like 21 to 11.  What’s that you say?  Didn’t former Liberal Health Minister Helena Jaczek state that that it was a myth that the MOH had a bloated bureaucracy?  Come to think of it, didn’t the former deputy Health Minister, the aforementioned Bob Bell, write that this was a myth too? Oops.

The next step was to hire Dr. Rueben Devlin to be the Chair of the Premier’s Council on Improving Health Care and Ending Hallway Medicine. I’ve had the opportunity to meet Dr. Devlin a couple of times. He’s smart, down to earth and has a strong background himself in providing front line patient care.  More importantly, he has a proven track record in embracing change, and deploying technology effectively.  He created the first fully digital hospital in the continent.  He showed me how some things work at his hospital, and I confess, I was drooling over how advanced they were.

It was just leaked to the media that the Government is looking at dissolving the dreadful Local Health Integration Networks (LHINs).  I’ve written about just incompetent LHINs were in 2016, so I personally am very glad to see them go.  The money saved from these wasteful behemoths of bureaucracy can be divested directly into front line care.

So, what’s next?  Having read through a bunch of information, I think we can expect the Premier’s Council to do the following:

  • Implement an IT plan of some sort, that has teeth to it. Ontario’s health care IT infrastructure was left in a complete mess by the previous Liberal government.  It is ridiculous that a patient in the Georgian Bay region has their health care team securely emailing each other about their case, but that nobody else in the Province can have this.  The fact that we still use fax machines (!) leaves us squarely in the dark ages.  The IT infrastructure already exists to modernize and streamline things.  We just need somebody in charge to say “make it so.”

 

 

  • Hopefully there will be an outreach to front line health care providers in their communities. Many of them know how the system is failing and have insight and ideas on how to fix things.  Giving them a true voice is important.

 

Premier Ford has a big challenge ahead of him with health care.  Our population is aging.  Health care technology is improving at a rapid pace.  Cost of care continues to rise.  But to these old eyes at least, it seems he has taken some reasonable first steps into getting a handle on the problem.  For the sake of all Ontarians, let’s hope he succeeds.