primary care in ohts learning health system foundations · experience into the 21st century and...

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Primary Care in OHTs

Learning Health System Foundations

Information Management Strategy2020-2025

UpOnDigitalFebruary, 2020

Primary Care in Ontario

• Mix of primary care models in Ontario• Lack of equity in access to team-based care• ~70% do not have access to teams

• Team-based models include:• Aboriginal Health Access Centres• Community Health Centres• Family Health Teams• Nurse Practitioner Led Clinics

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Models of Health and Wellbeing

Health and Well-Being

https://www.health.org.uk/infographic/what-makes-us-healthy

Family doctors needed better access to alternatives to drug treatment. -Helen Stokes-Lampard, Chair, Royal College of GPs

TeamCare is Part of the Solution

• Facilitated-outreach approach to connecting non-team primary care providers and their clients to IP teams at CHCs and FHTs• Co-designs with clients and providers• Quadruple Aim Evaluation including:

• Client experience and outcomes• Costing analysis• Provider experience

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6STRONG PRIMARY CARE THROUGH SEAMLESS ACCESS TO TEAMS

Interprofessional Teams and Health Promotion

Home and Community Care/Nurse Navigation

Specialists (Internal Medicine, Radiology, Psychiatry)

Preliminary Results

• By the numbers; Dec/19• Over 22,000 people have access to teams

(and growing)• Close to 105,000 visits• 1625 physicians

• What people are saying• ‘I have benefited greatly and it has changed

my life’• ‘It felt very human – I am going to continue

to access services’ • ‘Improved quality of life for my patients’• ‘TeamCare is providing essential services’• ‘Cannot imagine my practice without

TeamCare’7

Social Prescribing

Key Components: The Role of Primary Care

“You look around at other hospitals -they don’t even ask you what you want. They tell you, you’ve got to do that, and this is it. They don’t give you any choice. Here,

they ask. They involve you in any decision that is happening.”

– Client from Centretown CHC

“It’s an invitation as opposed to just a resource that’s available to everyone so I’m grateful for the personalization, it made us feel like WOW!”

– Client from Rexdale CHC

"Depending on the week, anywhere from 25% to 50% of the time my appointments are not medical in nature.”

- Primary care provider, South Georgian Bay CHC

Collaboration and Co-Creation

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“After being laid off, I had lost my pride. By getting involved as a Health Champion, I was helping to fight my isolation while helping people in my

community fight their loneliness. I am now proud of myself, knowing that I offer others the chance to follow this good ‘prescription’... that of putting

life into our lives!“

– Health Champion, CSC du Témiskaming

Measuring What Matters

• Health Equity • Process measures & financial

accountability • Patient Reported Outcomes • Patient Reported Experience • Involvement in Care• Qualitative Data

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Information Management Strategy - Alignment

• The Information Management Strategy v2.0 was implemented in 2015 and was developed to align with the 2015-2020 Alliance Strategic Plan, the Ministry’s Patients First Action Plan, MoH ehealth strategy and LHIN priorities

• Changing environment, development of Ontario Health Teams

• Developing Learning Health System Foundations 2020-2025

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CIHICanada Health Infoway (PrescribeIT)Connecting Ontarioe-Consulte-Referrale-Notification

CI Resource & CIW

CHC Case CostingPanel Size% Admin

PS Suite EMR/Meaningful Use

Mental Health & Wellbeing Outcomes

Quality Improvement

BIRT, Data Miner

ACCESS CONNECT INFORM PROTECT

1. “Get Electronic”2. “Share your Data”3. “Promote Collaboration”4. “Improve Health and

Wellbeing”

Personal Health Records & Collaboration

Information Managemen

t Strategy

v2.0

Still relevant!

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HRIS, OCAN/RAI-CHA13

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External Environmental Trends

CIHI Chartbook. How Canada Compares: Results From the Commonwealth Fund’s (CMWF) 2019 International Health Policy Survey of Primary Care Physicians. January 2020.

Key Findings 2019 vs 2015:• More physicians in group practices 65% vs 60%• Physicians reporting job stress increased to 46% vs 27% (ON 55%)

1. Access to Care• More Canadian primary care physicians offer weeknight (57%) (ON=75%) and weekend appts (50%) (ON=57%) than CMWF• Only 49% of Canadian primary care physicians (ON=64%) have coverage for their patients when their practices are closed

CMWF average (75%)• Canadians can request appointments on-line doubled to 22% (ON=19%) over 5 yr period• Fewer Canadian primary care physicians (23%) (ON=30%) offer patients the option to ask medical questions over email or

secure website compared to CMWF average (65%)• Fewer Canadian primary care physicians (18%; same for ON) make home visits frequently compared to CMWF average (42%)

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External Environmental Trends (cont’d.)

2. Patient-Centred Care• Fewer Canadian primary care physicians feel prepared to care for patients with specialized needs such as dementia

(40%), palliative care (36%), and substance use (19%) (ON=similar for all 3 measures) • 13% of Canadian primary care physicians feel well prepared to care for MAID patients (ON=similar)

3. Care Coordination across Healthcare System and with Social Services• Fewer Canadian primary care physicians communicate with home care providers about their patients’ needs (24%)

(ON=20%) compared with CMWF (31%)• Similar to CMWF, only 36% of physicians receive updates about their patients (ON=26%)• Fewer Canadian primary care physicians coordinate care with social services (43%) (ON=47%) due to inadequate

staffing to make referrals and coordinate services (43%) (ON=similar)• 65% of Canadian Primary Care physicians (ON=similar) think that better integration of primary care with hospitals,

mental health services, and community-based Social Services is the top priority in improving quality of care and patient access.

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4. Coordination using Information Technology• EMR use by Canadian primary care physicians increased to 86% (ON=similar) still lower than CMWF average (93%)• Fewer Canadian primary care practices offered patients the option to electronically view their patient visit summaries

online (Canada: 5%; ON: 6%; CMWF: 26%), request prescription renewals online (Canada: 10%; ON: 15%; CMWF: 52%), exchange patient summaries with doctors outside their practices including patient clinical summaries (Canada: 25%; ON=30%; CMWF: 63%), lab and DI test results (Canada: 36%; ON: 35%; CMWF: 65%) and medication lists (Canada: 33%; ON=29%; CMWF: 62%)

• Fewer Canadian primary care physicians review their performance on clinical outcomes (Canada: 34%; ON=40%; CMWF: 60%), patients’ hospital admissions (Canada: 25%; ON: 30%; CMWF: 32%), prescribing practices (Canada: 26%; ON=29%; CMWF: 58%), survey of patient satisfaction and experiences with care (Canada: 17%; ON: 22%; CMWF: 38%), and surveys of patient-reported outcome measures (Canada: 8%; ON: 8%; CMWF: 22%)

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2020-2025 USA Federal Health IT Strategic Plan

Health IT Intent:- Transparency, Competition and Consumer Choice- Protect privacy and security of PHI- Application Program Interfaces (APIs) for data sharing- Outcomes-Driven Plan

Federal Health IT VisionA health system that uses information to engage individuals, lower costs, deliver high quality care and improve individual and population health

Federal Health IT MissionImprove the health and well-being of individuals and communities using technology and health information that is accessible where and when it matters most

The USA Office of the National Coordinator for Health Information Technology


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Federal Health Principles• Focus on value• Put individuals first• Build a culture of secure access to health information• Put research into action• Encourage innovation and competition• Be a responsible steward

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Canada Health Infoway

Building the pan-Canadian EHR Infostructure

Investing in standards-based provincial/territorial EHR infostructure

Digital Health Canada-Aug/19 & HQO-Dec/19

Strategies to Support Effective Care Coordination & Patient Transitions1. Integration of care delivery, processes and data2. Single point of access for clinicians to patient information

3. Collaborative culture4. Patient/care-giver engagement

5. Spread/scale of well-defined guidelines and processes

6. Performance measurement/quality and economic outcomes7. Governance (shared accountability)

8. Aligned financial incentives9. Population health management

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Ontario’s Digital First for Health Strategy: Nov/19

Ontario's Digital First for Health strategy will bring the patient experience into the 21st century and help end hallway health care by offering more choices and making health care simpler, easier and more convenient for patients. At the same time, this new strategy will harness the imagination and capabilities of Ontario's digital health innovators to improve care for all Ontarians.

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Digital First for Health Strategy - The Five Pillars

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Once the new strategy is fully implemented, patients can expect:1. More virtual care options: Expanding availability of video visits and enabling other virtual care tools such as

secure messaging. Additionally, providers will be able to leverage a variety of virtual care technologies that best meet the needs of their patients.

2. Expanded access to online appointment booking: Patients will be able to book appointments that best meet their needs.

3. Greater data access for patients: More patients will be able to review their secure health record online and make informed choices about their care.

4. Better, more connected tools for frontline providers: More providers will be able to access patient records stored across multiple health service providers to provide better, faster care.

5. Data integration and predictive analytics: Providers will face fewer barriers to integrating and using secure health information to manage health resources and improve patient care. This could lead to improvements such as earlier intervention and better management of chronic disease.

Top External Trends in Healthcare

1. Client Expectations• Value-Based Healthcare• PREMs/PROMs• Convenience/power shift• Smooth transitions• 24/7 access ‘where/when I am’

2. Disruptive Innovations• Digital ‘Twins’• Digital FTEs (chatbots)• Cloud-/Mobile-/Voice- (thought-) First

3. Regulatory Environment• Value-Based Healthcare• Consumerism• Privacy/Security

4. Population Health• At-risk bundled payments• Complexity measurement

5. Value Creation• Increased organizational loyalty• Increased scalability/agility/speed• Increased engagement• Talent optimization and creativity

6. Challenges• Funding• PM/IM/IT HR• Capacity building• Governance – ‘last mile’ compliance• Power shift between providers & clients

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Engaged Clients, Family, Carers

Aligned governance, financial and

delivery arrangements

Digital capture, linkage &

timely sharing

Timely production of

research & evidence

Appropriate decision supports

Culture of learning and improvement

Competencies for learning and improvement Assemble

relevant data

Analyze

data

Interpret

results

Deliver tailored

feedback

Take

act

ion

to im

prov

e

Better Outcomes

Care Team Well-being

Lower Costs

Improved Client

Experience

Learning Health System

Draft Framework

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Learning Health System Design to support Health Equity through Comprehensive Primary Health Care

Information Management Foundation

Comparative Health System

Research & Performance

DecisionSupport

AlwaysBetter

Clients, Caregivers & Community Engagement

Research, Measurement &

Evidence-informed practice

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Information Management Foundation

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1. Client Experience: Consumer Health-‘e’ Strategy• Identity Management, Access, Authorization• Client Relationship Management platform• Internet of Things (IoT) & Mobility• Community Capacity Building • Sensor integration (Home/Self Care)

2. Staff Experience: Meaningful Use• EMR, BIRT, CIRT, OHRS/MIS/HRIS, etc.• Data integration, Data Quality & tools• Artificial Intelligence/Machine Learning• OHT support

3. Privacy & Security: Promoting Trust• Capacity building• Two-factor authentication & password blacklist• SIEM/Managed Detection & Response• Audit Logging and Reporting

4. Integration with provincial/regional Digital Landscape• 5G access and mobility• Affordable broadband Internet• Single Sign-On/Context Sharing• Robotic Process Automation• e-Visit/e-Consult/e-Referral

5. IMS Governance Maturity• Data Governance & Compliance Program• Business Continuity/Disaster Recovery/Risk Mgmt• PREMs/PROMs• Value-Based Healthcare• Policy and Procedure Harmonization

Our Focus: Health and Wellbeing through Technology

1. Person-driven healthcare: harm reduction approach

2. Enabling Primary Care to be the foundation of the healthcare system

3. Integration of physical, social, cultural, emotional, mental, spiritual needs

4. Digital Twinning

5. Learning Health System

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1. “Get Electronic”2. “Share your Data”3. “Promote Collaboration”4. “Improve Health and Wellbeing”

Questions/Comments?

Thankyou/Merci/Miigwetch

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Please send your feedback to [email protected]

http://allianceon.org




Challenges• Increasing costs may impact IT investments potentially

exacerbates health inequities• Poor health outcomes: US life expectancy decreased

between 2016-2017 for the first time in decades• Increasing rates of mental illness and substance use disorders

are major contributors to decreased life expectancy• Access to care and uninsured• Access to technology – broadband internet at home for

minorities, low income, indigenous and rural/remote populations

• Health literacy to promote engagement and self-care

The Office of the National Coordinator for Health Information Technology



Opportunities in a Digital Health System• Person-centred care – person/family/carer engagement• Patient access to PHI – penalties for information blocking• Achieving Interoperability – FHIR APIs for data sharing• Value Based Care – payments linked to performance and

patient outcomes• New Technologies – Artificial Intelligence, Machine Learning

and Robotic Process Automation, 5G, remote monitoring, wearables, IoT devices, big data, prescriptive analytics

• Reducing Regulatory & Administrative Burden via interoperability and automation

• Privacy & Security of PHI – managed detection & response




Goal 1:1. Promote Health and Wellness

a) Improve individual access to PHIi. Improve access to smartphones and other technologies for at-risk, minority, rural, disabled and indigenous populations

b) Advance healthy and safe practicesi. Promote healthy behaviours and self-managementii. Leverage all levels of date (e.g. person to community)iii. Advance use of evidence-based digital therapeutics (e.g. VR)

c) Integrate health and human servicesi. Strengthen communities’ health IT infrastructureii. Foster greater understanding of how to use health ITiii. Capture and integrate social determinants of health data into EHRs




Goal 2:2. Enhance the Delivery and Experience of Care

a) Ensure safe and high-quality care through the use of health ITi. Improve Optimize care delivery by applying advanced capabilities

(e.g. machine learning, evidenced-based clinical decision support, alerts)ii. Expand care beyond traditional clinical settings (e.g. telehealth, mobile, remote monitoring)iii. Identity solutions - improve patient matching across data systemsiv. Expand use of health IT for safer clinical practices – medication reconciliationv. Use electronic clinical quality measure data to assess quality and outcomesvi. Promote interoperability and data sharing through widely-accepted standardsvii. Precision medicine




Goal 2 (cont’d.):2. Enhance the Delivery and Experience of Care (cont’d.)

b) Foster competition, transparency, affordability in healthcarei. Encourage pro-competitive business practices – give patients choice of appsii. Merge admin and clinical data for enable rea-time financial data at point of careiii. Publish care quality and cost in easily understandable format for the publiciv. Educate consumers on how to use this for care based on value

c) Reduce regulatory and administrative burden on providersi. Simplify and streamline documentation and ensure quality standards are upheldii. Promote the use of evidence-based automated toolsiii. Monitor the impact of health IT on provider workflowsiv. Harmonize provider data collection and reporting requirements




Goal 2 (cont’d.):2. Enhance the Delivery and Experience of Care (cont’d.)

d) Enable efficient management of resources and a workforce confidently using health ITi. Streamline processes to reduce clinician data burdenii. Implement education and training programs – interprofessional teams and ruraliii. Continue to invest in health IT workforce




Goal 3:3. Build a Secure, Data-Driven Ecosystem to Accelerate Research and Innovation

a) Advance individual- and population-level transfer of health datai. Improve harmonization of data elements and standards – data quality & use of APIsii. Strengthen secure access to large datasets – quality improvement & outcome measurementiii. Enable individuals to securely provide data – via apps; consent for researchiv. Support appropriate use of health and human services data across federal and province/territory levels

for population health planning, quality and patient outcomes across programs and clinical researchv. Foster data governance that supports a secure, unified platform for researchers, innovators, providers,

individuals, payers




Goal 3 (cont’d.):3. Build a Secure, Data-Driven Ecosystem to Accelerate Research and Innovation

b) Support Research and analysis using health IT and data at the individual and population levelsi. Increase use of new technologies and analytic approaches – machine learning and predictive modellingii. Build evidence base on use of health IT for improving quality – research that assesses safety and outcomesiii. Increase research into targeted therapies – real-time data, machine learning intelligence, informed

through public health principles, data and researchiv. Identify and implement health IT opportunities – support rapid sharing of disease surveillance data




Goal 4:4. Connect Healthcare and Health Data through an Interoperable Health IT infrastructure

a) Advance the development and use of health IT capabilitiesi. Promote a digital economy – leverage research and development and protect privacy rightsii. Reduce financial and regulatory barriers – lower barriers to vendor innovation and procurement rulesiii. Promote trustworthiness of health IT – rigorous enforcement of information blocking, privacy and security lawsiv. Develop frameworks to assess patient and care team use of new technologiesv. Support provider adoption and use of health IT – meaningful usevi. Enable competition by reducing switching costsvii. Adopt and advance nationally endorsed standardsviii. Follow health IT safety and user-centered design principles




Goal 4 (cont’d.):4. Connect Healthcare and Health Data through an Interoperable Health IT infrastructure

b) Establish transparent expectations for data sharingi. Address information blockingii. Develop resources and communication plansiii. Support a common agreement for nationwide exchange of health informationiv. Promote data liquidity – reduce unnecessary restrictive data sharing practices through standards

c) Enhance technology and communications infrastructurei. Assess current and expected broadband needs and gapsii. Improve and expand affordable broadband access and wireless infrastructure – 5Giii. Deploy cloud-based servicesiv. Promote adoption of infrastructure needed for telehealth




Goal 4 (cont’d.):4. Connect Healthcare and Health Data through an Interoperable Health IT infrastructure

d) Promote secure health information that protects privacyi. Integrate privacy and security considerations into the design and use of health ITii. Implement privacy and security mechanisms appropriate to the sensitivity of the data

– multi-factor authenticationiii. Increase patient understanding and control over their dataiv. Provide guidance and technical assistance on policies and regulations – secure

exchange of PHI and rule enforcement

The Digital Health Playbook was published on August 23rd as part of the ministry’s centralprogram of support for Ontario Health Teams.

The Playbook is made of 3 components:

The Digital Health Playbook explains how the adoption and use ofdigital health can help OHTs meet their clinical and performance objectives.

The Digital Health Service Catalogue provides a number of digital tools and services that will assist OHTs in meeting their objectives.

The Digital Health Policy Guidance Document lays out draft policy directions, including draft standards for interoperability to inform how OHTs (and the broader sector) should approachnew digital health assets and services.

Ontario’s Digital Health Playbook: 2019

The Playbook sets the stage for further improvements through the Digital First for Health strategy.

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primary care in ohts learning health system foundations · experience into the 21st century and...

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