E-Health Ontario

 

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.

 

Show Credits:

Erin Anderson-Birmingham, Host and Producer
Ji Chen (Tony) Yin, Producer
Anna Millar, Producer
Dimitri Treheles & Nuri Kim, Executive Director and Technical Producer

Music Credits:
Last Two Standing by Dave Sampson
Comin’ Home by City and Colour

The Weekly: Carving Spaces for Diversity in Policy

This week, in collaboration with the Gender, Diversity and Public Policy Initiative, we discuss diversity in policy and what it entails. In particular, we talk about how spaces for diversity are carved at the Public Policy Program at the Munk School of Global Affairs and Public Policy.

Credits: 

Hiba Siddiqui, Senior GDPP Analyst
Sarah Khan, GDPP Analyst
Habiba Khaled, GDPP Analyst
Faiza Mehboob, GDPP Director
Antona Christus-Ranjan, MPP Equity Advisor
Nuri Kim, BTH Executive Director

The 411 on USMCA: What You Didn’t Think About

 

Since 1994 Canada, U.S. and Mexico have been economically tied through the North American Free Trade Agreement, harmonizing and liberalizing cross-border trade flows in a variety of exports and labour movements. That was until the election of Donald Trump, who called NAFTA the “worst trade agreement in history” and resolved to renegotiate the terms to be more in favour of the United States.

The United States has always had a problematic attitude towards NAFTA. The most immediate origins of the agreements was in the Canada-U.S. Free Trade Agreement, and it was a Canadian initiative that took a lot of lobbying in Washington and hard negotiations — Robert Wolfe

President Trump sent his detailed list of changes to Canada and Mexico in July of 2017. What followed were several rounds of talks in hope of finding a new agreement that all sides could agree on. On the deadline for Canada-US negotiations on September 30th of this year, a preliminary deal was finally reached, and the new United States-Mexico-Canada Agreement has been signed and awaiting ratification by each country’s parliament.

It’s about rules as opposed to power. In the power imbalance like the US-Canada, Canada needed assurance then and now that when there are disputes, they will be resolved on an equal basis and let the evidence talk as opposed to pure power politics — Drew Fagan

In this episode, we seek to learn the impact of this new agreement, the history that led to these massive negotiations, and how the everyday Canadian may or may be affected. Welcome to Beyond the Headlines.

Robert Wolfe is Professor Emeritius from the School of Policy Studies of Queen’s University, teaching in the faculty from 1995 to 2017. Before his work in academia Robert worked in the Canadian foreign service, serving placements in Bangladesh and in the Canadian delegation to the OECD. He is a fellow at Institute for Research on Public Policy, where he an author and co-editor of “Redesigning Canadian Trade Policies for New Global Realities”, which was published last year. (@BobWolfeSPS

Drew Fagan is a professor at the Munk School of Global Affairs and Public Policy at the University of Toronto. Mr. Fagan is a senior fellow at the Public Policy Forum, where he has overseen recent research reports, as well as the C.D. Howe Institute and a number of other university institutes. Mr. Fagan was previously a Deputy Minister at the Ministry of Infrastructure in Ontario Public Service and an Assistant Deputy Minister at the Department of Foreign Affairs and International Trade. Mr. Fagan is a sought after speaker and writer.

Credits:

  • Kevin Hempstead, Producer and Host
  • Nimmi Augustine, Host
  • Nuri Kim, Executive Director and Technical Producer

Music Credits: 

  • American Woman, by The Who

 

The Weekly: Canada’s Poverty Reduction Strategy

On November 6, 2018, Families, Children, and Social Development Minister Jean-Yves Duclos released Canada’s Poverty Reduction Act. The federal legislation defines Canada’s official poverty line for the first time and sets targets to reduce poverty.

Our weekly team discusses the implications of Canada’s Poverty Reduction Strategy with Joe Gunn from Citizens for Public Justice and Laura Neidhart from Canada Without Poverty.

Guests:

Joe Gunn, Executive Director of Citizens for Public Justice

Laura Neidhart, Development and Communications Coordinator for Canada Without Poverty 

Credits:
Alex Gold-Apel
Dimitri Trehels
Shalini Ramgoolam

 

The Weekly: Canada’s Carbon Tax

 

On October 23, 2018, Prime Minister Justin Trudeau announced Canada’s federal carbon tax.

Our weekly team breaks down how pollution pricing will affect Canadians with David McLaughlin from the International Institute for Sustainable Development (IISD) and Hadrian Mertins-Kirkwood from the Canadian Centre for Policy Alternatives (CCPA)

Guests:
David McLaughlin, Director of Climate Change Canada, International Institute for Sustainable Development (IISD)
Hadrian Mertins-Kirkwood, Researcher at the Canadian Centre for Policy Alternatives (CCPA)

Credits:
Alex Gold-Apel
Dimitri Trehels
Vienna Vendittelli

Music Credits:
Over Everything by Courtney Barnett & Kurt Vile

The Weekly: Cannabis Legalization

Beyond the Headlines is debuting its very first The Weekly episode! Tune in to our discussions of the societal implications of Cannabis Legalization in Canada.

Credits:
Aryeh Ansel
Jasper Paredes
Dimitri Trehels
Vienna Vendittelli

Music Credits:
Over Everything by Courtney Barnett & Kurt Vile

What Brings Us Together: A Discussion with the Young Diplomats of Canada Delegation to the OECD Forum 2018

 

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In May 2018, a group of six young Canadians came together from around the world to serve as Ambassadors of the Young Diplomats of Canada to the OECD Forum 2018 in Paris. The Youth Delegation met with high-level leaders and thinkers from around the globe, to discuss what the future will look like for youth and to reflect on what brings us together.

We are facing challenges that none of us can solve on their own. Our countries are connected, our destinies interwoven, our solutions entangled. In the words of Dostoyevsky – we are all responsible to all, for all. So welcome to the OECD 2018 Forum. Welcome to explore the DNA and the potential for collective action.” said José Ángel Gurría, Secretary General of the OECD, during his opening remarks at the OECD Forum 2018.

But it is also time to ask ourselves, why these pushbacks? Why these antibodies to our common cause are emerging? It is time to recognize that something is not working when the world’s richest 1% accumulate half of the world’s wealth. When more than 60% of the world’s employed work informally. When the richest 10% of the OECD population now earn 10 times more than the poorest 10%. It’s going in the wrong direction, fast.” Mr. Gurría continued.

While reflecting on the complexity of shaping policy in a post-truth world and identifying opportunities for civic engagement and co-creation with citizens, the 2018 Forum focused on addressing three key issues: International Co-operation, Inclusive Growth, Digitalisation.

Today, the Young Diplomats of Canada Delegation explore the conference themes and their implications for youth in Canada. In particular, the Delegates unpack rich Forum discussions on topics including trade, democracy and voting, housing inequality, digitization, and skills for the future of work.

Two representatives from the New Zealand Youth Delegation to the OECD Forum joined the Canadian Delegation in studio to discuss bilateral meetings had throughout the week with various high-level leaders, such as Helen Clark – the 37th Prime Minister of New Zealand, representatives from Etalab in the French Prime Minister’s Office, Rob Nail – CEO and Associate Founder of Singularity University, representatives from the Canadian Permanent Delegation to the OECD and more.

The Young Diplomats of Canada (YDC) is a federally incorporated non-profit, non-partisan, and youth-led organization. YDC develops the diplomatic leadership and international advocacy experience of young Canadians, through hands-on training programs and key partnerships that give delegates exclusive access to high-level geopolitical events and summits. YDC’s main focus is to create inclusive decision-making at the highest levels through carving space for young leaders to engage directly with global decision makers. You can visit YDC’s website youngdiplomats.ca for the latest information on recruitment, articles as well as reports on their activities.

[Interview begins at 2.45]

Credits

The Young Diplomats of Canada Delegation to the OECD Forum 2018, Hosts, Producers and Technical Producers

  • Tatheer Ali – Head Delegate
  • Celine Caira – Producer and Head Communications
  • Matthias Leuprecht – Ambassador
  • Adèle Bélanger-McMurdo – Ambassador
  • Sarah Bérubé – Ambassador
  • Garima Karia – Ambassador

Guests (in order of appearance):

  • Chhavi Breja – New Zealand Youth Delegation to the OECD Forum 2018
  • Bhavya Dhar – New Zealand Youth Delegation to the OECD Forum 2018
  • Helen Clark – 37th Prime Minister of New Zealand
  • Rob Nail – CEO and Associate Founder of Singularity University
  • Niels Braley – Etalab, Office of the French Prime Minister
  • Amélie Banzet – Etalab, Office of the French Prime Minister
  • Nicolas Vogtenberger – Etalab, Office of the French Prime Minister
  • Dr. Clement Dherbecourt, France Stratégie
  • Darren Rogers – Counsellor, Canadian Permanent Delegation to the OECD

Music Credits:

  • Change The Sheets by Kathleen Edwards
  • Entrepreneurs by Scott Holmes
  • Carry Me Home by Hey Rosetta!
  • Carried Away by Passion Pit
  • Breathe In Breathe Out by The Long War
  • Juice by Chromeo

Special Thanks:

Dimitri Treheles and Nuri Kim, Executive Producers

Ian Thomson – Executive Producer Emeritus

 

 

 

 

Addressing Intergenerational Mobility: A Discussion with Dr. Miles Corak

Addressing inequality is arguably one of the most challenging issues in public policy. How we choose to acknowledge past, present and future inequalities; how we measure and identify this issue; whether we address concerns on the basis of inequality of outcome or opportunity; and what policies we ultimately should implement to tackle inequality remain important political, philosophical and statistical questions for decision-makers around the world.

In the vast array of research on inequality lies the concept of intergenerational mobility. The Organization of Economic Co-operation and Development (OECD) defines intergenerational mobility as “the extent to which key characteristics and life experience of individuals differ from those of their parents” .  More generally referred to as “social mobility”, this is the inequality from generation to generation or how much inequality is passed on from parents to children.

Researchers of public policy examine how to measure and tackle intergenerational mobility and subsequently, address the larger questions of inequality. To help us unpack this multi-faceted topic today on Beyond the Headlines is one of the top economists leading the discussion, Dr. Miles Corak.

“What we’ve learned over the last 10 or 15 years is the idea that there is more intergenerational mobility in the United States is something that is not supported by the data.” – Miles Corak, Professor of Economics, Graduate Centre of the City University of New York

Miles Corak is a full professor of economics at The Graduate Center of the City University of New York, and senior scholar at the James M. and Cathleen D. Stone Center on Socio-Economic Inequality. He has previously taught at the University of Ottawa, Graduate School of Public and International Affairs and has been a visiting researcher and professor at Universities including Princeton, University of London, and Harvard University.  In addition, Professor Corak has been affiliated with a number of think tanks and research institutes as an advisor or research fellow including the Institute for the Study of Labour in Germany, the Stanford Center on Poverty and Inequality, The Centre for Research and Analysis of Migration at the University College London in the UK, and the C.D. Howe Institute and the Broadbent Institute in Canada to name a few.

We should pay attention not just to inequality but the nature of inequality. It’s not inequality in general that seems to matter for intergenerational mobility but rather its inequality in the bottom half of the income distribution.” –  Miles Corak, Professor of Economics, Graduate Centre of the City University of New York

Professor Corak’s research has focused on the topics of economic and social mobility, the effects of labour markets, unemployment, child poverty and social policy. This includes examining how social mobility affects Canada and other countries. Tied to this research is an examination of the meaning and measurement of equality of opportunity. Having written extensively on this topic, he has previously been published in Canadian Public Policy, Journal of Economic Perspective, Labour Economics and Child Development.  He has also been cited in outlets including the Wall Street Journal, the New York Times, the Economist and the Globe and Mail.

“While post-secondary education isn’t a guarantee for a successful outcome in life, it certainly is an important gateway.” – Miles Corak, Professor of Economics, Graduate Centre of the City University of New York

To learn more about Professor Corak’s work and research, visit his website milescorak.com

[Interview begins at 2.03]

Credits

Ian T. D. Thomson, Executive Producer, Technical Producer and Host

Music Credits
Not Dead by Fine Times
Street Hassle by Lou Reed
Honeybee by Unknown Mortal Orchestra

 

Net Neutrality Part Two: A Discussion with Martin Masse

This episode is part two of BTH’s examination of net neutrality in the Canadian context.  Listen to part one here.

On Thursday, December 14th 2017 the United States Federal Communications Commission voted to repeal Net Neutrality regulations originally implemented by the Obama administration. What is the importance of Net Neutrality in the Canadian context? What is the broader issue at play here? And how do we uphold the affordability and openness of the internet, while striving towards increased efficiency and competition.

Today we explore these questions and more with today’s esteemed guests

“You don’t know how the internet is going to evolve […] every year or two there is something new that revolutionizes the internet so why prevent these news business models that emerge […] because of a very rigid interpretation of net neutrality? You should not be doing this.” – Martin Masse, senior writer and editor, Montreal Economic Institute

Martin Masse is a senior writer and editor at the Montreal Economic Institute (MEI). He is a graduate of McGill University in Political Science and East Asian Studies. He is the author of a book on Quebec politics, and of several articles in various publications on economic, political, and philosophical issues. He was MEI’s Director of Research and Publications from 2000-2007. He also served as political advisor to Canadian Industry Minister Maxime Bernier, in particular on issues relating to the Canadian telecom industry. Since 2014, he’s been the author of an annual research paper titled ‘The State of Competition in Canada’s Telecommunications Industry‘ (2018 report). [First half of interview at 1.05/Second half at 15.35]

“Net neutrality if you at look at it from a very orthodox perspective, it says [a] cat video data packet gets the same treatment as data packet[s] that are used to help a self-driving car not crash.” – Martin Masse, senior writer and editor, Montreal Economic Institute

Credits

Jasper Parades, Junior Producer, Host
Mary Shin, Junior Producer, Technical Producer
Tom Piezkarski, Junior Producer, Technical Producer
Ian T. D. Thomson
Executive Producer

Music Credits
Not Dead 
by Fine Times
Black Mirror by Arcade Fire
Thirty
by The Weather Station

Clearing the Air: Examining Global Air Pollution

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More than 80% of people living in urban areas are exposed to poor air quality levels that exceed the safe World Health Organization (WHO) Standards.  A declining air quality is associated with a host of health problems, including risk of stroke, cardiovascular and respiratory diseases, allergies and asthma. It is also linked to approximately 6.5 million deaths annually across the world. While some countries follow the WHO standards for air quality, there are also countries like India that have developed their own, more ambitious national ambient air quality standards for various air pollutants. Unfortunately, India does not meet its own country’s safe standards. 

The majority of the world population is exposed to air pollution and major global cities are significantly affected by its presence; the cities of Zabol, Iran, New Delhi and Gwalior, India, and Beijing, China have all been listed as having some of the worst air qualities in the world. Particles like black carbon also are significantly responsible for the warming experienced in the world. Therefore, air pollution is increasingly seen as a dual threat to the environment and public health across the world.

In Canada, according to the November 2017 Health Canada report(“Health Impacts of Air Pollution in Canada”), approximately 14,000 premature deaths can be linked to air pollution. It has costed Canada $36 billion due to illnesses and premature deaths. The Government has stated that even though Canada currently has relatively lower levels of air pollution compared to levels in other countries, addressing air pollution remains a priority for the government.

Experts around the world are calling on their respective governments to do more to reduce air pollution through stricter policy interventions. Conversely, there are critics who argue that policies around air quality are arbitrary in targeting specific health benefits; not enough considerations are given to the various hidden costs associated with air pollution.

To help us tackle these issues and take the policy discussion forward, we are joined by Dr. Chung Wai Chow, a lung transplant physician and  Professor at University of Toronto,  and Dr. Ross McKitrick, Economics Professor at University of Guelph and a senior fellow of the Fraser Institute.

“Although, we live in a country with […] very good air quality, we are very much impacted by air pollution” – Dr. Chung-Wai Chow, lung transplant physician at University Health Network, and Professor at Dalla Lana School of Public Health

Dr. Chung-Wai Chow is a lung transplant physician at University Health Network. She is a researcher at the Toronto General Research Institute, a professor at the Dalla Lana School of Public Health, and a clinician-scientist at the Department of Medicine at University of Toronto. She is a Director of Biotox Laboratory at Canada Aerosol Research Network. Dr. Chow’s research interests include Cardiovascular, Respiratory, Musculoskeletal areas. Additionally, she is also a Science Ambassador at Alexander von Humboldt Foundation in Germany. [Interview at 3.21]

“There is clearly an association between exposure to air pollution and worsening of lung function and worsening of lung disease” – Dr. Chung Wai-Chow, lung transplant physician at University Health Network, and Professor at Dalla Lana School of Public Health

Ross McKitrick is a professor of economics and a CBE Fellow in Sustainable Commerce at the University of Guelph. He is a Senior Fellow of the Fraser Institute and is widely published and cited on the economics of pollution, climate change and public policy. He has also worked collaboratively across a wide range of topics in the physical sciences. He is a sought-after guest speaker around the world, and makes appearances on various news outlets discussing issues in environment, energy and climate policy. His research has been featured in many prominent outlets including the The New York Times, The Economist, and The Wall Street Journal. [Interview at 29.21]

“On a typical day in a Canadian city, you won’t really experience the kind of bad air that you would have experienced in say the 1960’s…We don’t have the same nuisance of air quality and we don’t have the same issues around the air just being toxic and dangerous. ” – Ross McKitrick, Professor at the University of Guelph and Senior Fellow at the Fraser Institute

Credits

Shirin Bithal, Junior Producer, Host
Nuri Kim, Junior Producer, Technical Producer
Mary Shin, Technical Producer
Ian T. D. Thomson
Executive Producer

Music Credits
Not Dead 
by Fine Times
Can’t Leave the Night by Badbadnotgood
We Find Love
 by Daniel Caesar