The definition of E-Health has many variations, but what it generally refers to is electronic communications and processes supporting health practices. Since 2008, the Ontario government has been focused on implementing a province-wide medical records database. This would create a single forum for physicians, pharmacies, testing centres, and patients to access. Theoretically this would electronically keep a patient’s entire medical history in the province.
The standardization of the data for sure in another barrier we’ve sort of encountered as we have started to put our data in. (29:35) – Gail Wilson
Ontario’s E-Health initiative was a big topic of discussion in 2009 when the Auditor General reported that the successive government had wasted 1 billion in taxpayer dollars. Contract awarding was said to have shown favouritism, and money was recklessly spend on this limousines and coffee runs. But since this story broke, discussions about E-health have quieted on the public front. That is why we are speaking today. In the policy field, you hear that one of the biggest areas of interest right now is in healthcare. Focusing on a health records database, we will be looking at some of the existing policy and discussing some of the areas of interest going into the future.
With all this rich data there, can we expose this data to the individual patient. There’s a lot of opportunity there for patients to be able to see their data across their continuum of care. But, there’d have to be a lot of policy work with how you grant access, what you can see, how you interpret that information.” (30:45) – Giuseppe Cammisa
According to Statistics Canada, the baby boom generation is defined as Canadians born between 1946 and 1965. In 2011, this demographic accounted for roughly 29% of the Canadian population, or roughly 3 in every 10 persons. Within Ontario, seniors aged 65 and older are the fastest-growing age group. In 2016, there were 2.3 million seniors living in Ontario, this accounts for 16.4% of total provincial population. By 2041, that number is projected to increase to 25%, amounting for a total of 4.6 million seniors. There are a number of other age-related considerations to take into account when examining Ontario’s healthcare system. First, Ontario’s senior population is becoming increasingly diverse. The number of visible minority seniors in Ontario increased by 44% between 2011 and 2016, compared to only a 16% increase among non-visible minority seniors. Second, aging in place has become more common as 93% of seniors live in private households, among which 63% live with a partner or spouse, and 23.5% live alone. Third, seniors in Ontario face an increased prevalence of numerous chronic health conditions, such as high blood pressure (48.7%), arthritis (46.8%), diabetes (18.4%), and chronic obstructive pulmonary disease (7.3%). It is estimated that between 17 to 30 percent of Ontario seniors are impacted by aging-related mental health conditions, including depression and dementia. Collectively, these factors signal the importance and unique nature of addressing the healthcare needs of Ontario’s baby boomers.
These demographic considerations are projected to put fiscal pressure on Ontario’s healthcare system. With the cost for hospital care being three times higher than the average person ($842 per day for one senior, compared to $280 per day for one adult aged 18-64), the Government of Ontario faces increasing hospital expenses as baby boomers age. If these age-specific costs today are left as is and applied to the 2030 population, Ontario’s health costs could increase by $24 billion – this is equal to an increase of 50% more on healthcare spending today solely from the aging of the baby boomers. The healthcare sector also represents the largest sectoral expenditure in the OPS with health spending amounting to 42% of total government operating expenditure. The cost of hospital care, compared to long-term care and home care, is also fiscally burdensome on Ontario’s health care system. For example, the cost per day for one hospital bed for one senior is $842/day in comparison to one long-term bed equaling $126/day and home care equating to $42/day.
Structurally, Ontario’s healthcare system operates within the domains of Local Health Integration Networks (LHINs), with care being provided primarily through hospitals. Ontario’s health system is the outcome of a hospital-based insurance system, which has yet to be fully integrated and coordinated with primary care and Community Care Access Centres. The set-up of Ontario’s healthcare system has been noted as not aptly meeting the needs of an aging population that is facing higher incidence of multiple chronic conditions and has an expressed desire to age in place.
In light of the diverse needs of the aging population and today’s fiscal reality. It is prudent for the government to consider reforming the current healthcare system to ensure that is addresses the multitude and diversity of care needs facing seniors. With health sectoral costs continually increasing due to related increases in hospital-based care, it is important for the Government of Ontario to explore more efficient and responsive approaches to delivering health care for Ontario’s seniors. One way to achieve this goal is through the ehealth system.
In 2008, eHealth Ontario was created out of a merger between the Ontario Ministry of Health’s electronic health program and the Smart Systems for Health Agency (SSHA), with a mandate to create electronic health records for all patients in the province by 2015. However, eHealth Ontario has been plagued by delays and its CEO was fired over a multimillion-dollar contracts scandal in 2009. Particularly, in late 2009, the Auditor General of Ontario published a highly critical report that documented problems with procurement rules and hiring practices. Private sector leadership unfamiliar with government practices, coupled with a sense of urgency, had resulted in a culture that did not comply with the exacting standards of the Ontario Public Service (OPS). In the years that followed the 2009 Auditor General’s report, the agency received further criticism and negative headlines when work ceased on two of the projects that were part of its original mandate. The Diabetes Registry was not completed because of project delays and, as technology rapidly evolved, the information that was to be captured in the database could now be accessed through patients’ electronic medical records. Management made the decision not to sink further investments into the project. The Medication Management database was cancelled because after a lengthy procurement process, the first of its kind, no vendor would undertake the work within the funding envelope proposed by government.
The agency today bears little resemblance to the organization that existed six years ago. Under new leadership and management, eHealth continues to operate of creating a Electronic Health Record, EHR, system that includes four fundamental components of 1. a secure network on which patient data can travel; 2. applications that enable users to record, store, and retrieve that patient data; 3. patient data, such as treatment history, test results, diagnostic images, and prescribed medications, in digital form; and 4. terminals or access points from which users can input and retrieve patient data. Moving into the future, hopefully eHealth Ontario could continue improve its EHR system and deliver high quality healthcare services to Ontario’s continue aging population.
[Interview begins at 12:20]
Giuseppe Cammisa possesses a wide-range of healthcare experience in both the public and the private sector. He has previous hospital experience around the Toronto area, having previously held positions at St. Joseph’s Health Centre and the University Health Network. He currently works as the Director of the Project Management Office at St. Michael’s Hospital where he manages a team in the delivery of clinical and business IT implementations for the organization.
Gail Wilson is the Director of Nursing Practice and Clinical System Adoption in the Professional Practice department of St. Michael’s Hospital. Gail possesses a great deal of clinical experience and has practiced in a variety of clinical settings. Currently, Gail is accountable for the clinical workflows and clinical staff education as it applies to all IT clinical applications within the organization.
Dr. Alykhan Abdulla is the Medical Director at the Kingsway healthcare centre in the outskirts of Ottawa. There, he practices family medicine and teaches medical students, internationally trained doctors, residents, and nurses regarding the concepts of primary care. Dr. Abdulla is very involved with the implementation of Electronic Medical Records (EMR) in Ontario. He is a peer leader for the OntarioMD, meaning he is an expert user of Ontario Certified EMR programs and can provide support to other physicians in regard to efficient uses of EMR in their clinics.
Erin Anderson-Birmingham, Host and Producer
Ji Chen (Tony) Yin, Producer
Anna Millar, Producer
Dimitri Treheles & Nuri Kim, Executive Director and Technical Producer
Last Two Standing by Dave Sampson
Comin’ Home by City and Colour