At the recent OntarioMD Every Step Conference in Canada (#OMDESC19), two topics dominated the agenda and the hallway talk – the new Ontario Health Teams and integration with provincial health data repositories. Only one of those two generated excitement.
OntarioMD, is a subsidiary of the Ontario Medical Association and is funded by the Ontario Ministry of Health and Long-Term Care. OntarioMD’s mission is to support physician practices in the selection, implementation and adoption of electronic medical records (EMRs) and other digital health tools. Amongst other things, they certify EMRs for use by Ontario physicians and provide access to provincial repositories of health information.
Attending their OMDESC19 conference was a fascinating window into the technology concerns of Ontario primary-care physicians.
The Ontario government’s new Ontario Health Teams (OHTs) initiative was the most talked about topic at the conference and sessions dealing with OHTs were standing-room only.
What is an OHT?
An OHT is a team of providers who work together to deliver care to a population of patients. OHTs must have the ability to deliver at least three types of healthcare services including: primary care, home care, acute care, mental health + addiction services, and more. OHTs must include at least one primary care provider, hospital and home/community care organization.
OHTs in Canada are analogous to Accountable Care Organizations (ACOs) in the US.
Many Questions Around OHTs
OMDESC19 attendees had many questions for session leaders about OHTs, but two dominated the discussion:
- At maturity, how will OHTs be evaluated? What will the metrics be?
- What are the financial incentives and funding model for OHTs? In particular, will funding be available to help the members of an OHT integrate their systems and processes?
Unfortunately for attendees, neither question could be answered.
The Ontario government is still working with public stakeholders to develop the metrics and measurement criteria for OHTs. There is a promise of more information in the months ahead.
As for funding, the only details available are in the government’s OHT Guidance Document: “At mature state, budgets will be set according to a blended funding model, which will feature risk-adjusted population-based funding, as well as elements of activity-based funding (ie: bundled care) for specific episodic conditions”. The Document also mentions a “shared savings incentive structure…to reward OHTs that realize efficiencies and exceed performance targets”.
Despite the many unanswered questions, many attendees expressed support for the OHT model. One of the biggest complaints physicians have of the current system is the lack of coordination between healthcare organizations. OHTs brings different parts of the healthcare continuum together to serve patients better.
We are still very early in the creation of OHTs and the entire journey is expected to take years. Hopefully we will look back at 2019 and laugh at our collective nervousness.
Expanded Integration with Provincial Data Repositories
In stark contrast to the discussion around OHTs, there was genuine excitement for OntarioMD’s pilot project to make data available from two provincial sources:
- Digital Health Drug Repository (DHDR)
- Digital Health Immunization Repository (DHIR)
Integration with the DHDR, will provide authorized clinicians with the ability to:
- View all dispensed, monitored drugs (narcotics and controlled substances), including opioids;
- View publicly-funded drugs dispensed in Ontario, including those paid for by the Ontario Drug Benefit (ODB) program;
- View publicly-funded pharmacy services, such as the MedsCheck Program medication reviews and pharmacist-administered influenza vaccines;
Through the DHIR, clinicians will be able to:
- Submit data related to patients’ immunizations they have administered;
- Retrieve data related to patients’ immunizations administered from other institutions such as schools, public health units and hospitals; and
- Forecast upcoming required immunizations according to the provincial immunization schedule.
Both the DHDR and DHIR information will be made available directly to clinicians through their EMR. There will not be a separate app or website that they will need to visit. It will all be seamless in the system they currently use.
With the current opioid crisis showing little signs of abating, access to the drug repository was seen by OMDESC19 attendees as a critical piece to monitoring and curbing the unnecessary prescribing of opioids. Attendees were also excited about being able to access the dispensed drug information to help monitor medication adherence.
It was clear to me that the Ontario EMR market mirrors the broader EHR market in North America. The focus has shifted from implementations and switching to integration and optimization.
There was very little talk of changing EMRs at OMDESC19, something that had been a topic of much discussion at prior events. Instead, most of the conversations were on how to best leverage the existing technology to deliver better (read: more coordinated) care.
I came away from the event very encouraged.