This article originally appeared in the Fall 2022 issue of the Ontario Medical Review magazine.
Dr. Veronica Legnini is a family physician in Kingston. So was her mother before her. In fact, Dr. Legnini treats some of her mother’s former patients and still has some of her mother’s old handwritten patient notes. When she looks through them, she’s amazed at how simple they are.
“You’ll see the note – hypertension, HCTZ, and a blood pressure scrawled hastily on the file,” she said.
It’s a far cry from the world of detailed electronic medical records, sophisticated tests, expanded treatment options, cutting-edge technologies and increased expectations that today’s physicians face.
“There’s been an absolute explosion of medical knowledge,” said Dr. Legnini, who also chairs the Ontario Medical Association’s General Assembly. “So, people have a lot more complicated problems, there’s a lot more we know about them, and more we can do about them. This all takes more cognitive resources for both physicians and patients. The system is not keeping up.”
Dr. Veronica Legnini, Kington family physician and chair of the Ontario Medical Association’s General Assembly Steering Committee, says physicians really need to show system-wide leadership with respect to health-care transformation.
To deal with the problem, the OMA and the doctors it represents are pushing for fundamental changes to how health care works in the province. They are calling for a system that organizes teams of health-care providers around the patient, supported by a well-designed digital infrastructure that links them. System transformation and modernization would result in better patient outcomes and help fix problems such as the family doctor shortage and wait times for surgeries and tests that are beyond provincial guidelines.
The recommendations are laid out in the OMA’s Prescription for Ontario: Doctors’ 5-Point Plan for Better Health Care, released last year. The OMA also has other initiatives, such as leadership training for doctors and sophisticated analysis of Ontario’s health-care needs, including health human resources.
The OMA is calling for a system that organizes teams of health-care providers around the patient, supported by a well-designed digital infrastructure that links them.
“Our health-care system is too fragmented to be successful,” said OMA CEO Allan O’Dette. “Today’s patients want a seamless experience, where health care follows them, not a system where they are sent from their doctor’s office to specialists and other health-care settings.”
Doctors want to enable an environment where every patient has a team of health-care providers and linking them digitally. To really transform health care so that it is efficient and is meeting the expectations of our consumer-minded population, we need to integrate all of our skills and all of our systems,” O’Dette said.
Even before the COVID-19 pandemic, the cracks were showing. People waited hours for treatment in hospital emergency departments and, if admitted, were sometimes treated in hallways because of a lack of beds. The pandemic only made things worse, creating a backlog of more than 20 million patient services. One million people in Ontario are without a family doctor.
The system is taking a toll on doctors as well: just before the pandemic, 29 per cent of Ontario physicians reported they were experiencing high levels of burnout but by March 2021, that number had risen to 34 per cent. Three-quarters of physicians reported some degree of burnout in March 2021.
In a 2021 report on physician burnout, the OMA found that the biggest stress on physicians was increased patient expectations. That’s a trend that will continue, said futurist Zayna Khayat, vice-president of client success and growth at Teladoc Health, a virtual health-care company.
“Patients and their families are going through a revolution,” Khayat said. “They’ve woken up, they have access to all the tools, all the information. They’ve come to expect a certain level of experience in any service, including government services, and they’re just not going to accept a 19th-century experience from health care.”
But the system isn’t keeping up with those expectations. Dr. Legnini gives a rueful smile when she talks about a television commercial showing a patient being wheeled into the emergency department and before you know it, their complete patient health history appears on a monitor.
"Our health-care system is too fragmented to be successful. Today’s patients want a seamless experience, where health care follows them, not a system where they are sent from their doctor’s office to specialists and other health-care settings." — Allan O'Dette, OMA CEO
In fact, digital patient information is poorly integrated across systems and hard to access, with different vendors selling different tools that don’t always work well together. Even when digital records are available, it takes time and effort to access them and include them in the patient’s record, she said.
In the meantime, the administrative burden on doctors is increasing as they are required to input more data into more systems.
When the OMA surveyed its members about burnout for its 2021 report, respondents reported that administrative burden was the second-highest cause of physician burnout. The problems surrounding administrative burden are not confined to Ontario. The OMA burnout report noted that a 2020 Nova Scotia study found physicians there spent 10.6 hours a week on administrative tasks, 38 per cent of which they considered unnecessary.
A major recommendation of Prescription for Ontario is to give every patient a team of health-care providers and link them digitally. When patients have co-ordinated teams made up of family doctors, specialists, nurses and other health-care professionals, they get faster access to care and end up in the hospital less often, according to the Prescription for Ontario.
But right now, many doctors aren’t able to provide this kind of care. Progress was made under the Physician Services Agreement ratified in March 2022, when the province agreed to start taking applications again for doctors who want to join Family Health Organizations and to increase the provincial FHO numbers by 480 physicians a year. FHOs are a model that makes it easier to form the kinds of health-care teams envisioned by Prescription for Ontario.
The OMA is also working with the health ministry on a new model of care called Ontario Health Teams. Introduced by the province in 2019, the teams bring together physicians and other health-care providers, along with hospitals and other institutions in a region, with the goal of integrating and co-ordinating care. That includes making decisions about what resources an area needs and sharing information throughout the team.
The province has already selected all of the 51 teams. The OMA has said that if they are implemented effectively, this could improve care and increase efficiencies. A key to their success, the OMA says, is that the teams remain voluntary, that they are focused on primary care and that doctors have a role in designing and leading the teams.
To solve the problem with the lack of integration of digital records, systems need to be linked and made compatible with one another. In a survey by the OMA, Ontario doctors estimated this change alone could save them anywhere from one to 10 hours a week.
The OMA’s subsidiary, OntarioMD, is supporting this change, developing technologies and programs that integrate medical data and create a co-ordinated approach to delivering digital health. OntarioMD’s mission is to help family physicians, specialists and nurse practitioners use digital health technologies efficiently. This includes providing software and training and advocating for better systems.
For instance, OntarioMD certifies the EMR systems used by physicians to keep track of patient records. To gain certification, an EMR has to integrate with other health record systems that physicians want to access, such as the Digital Health Drug Repository, which offers access to dispensed medications to help physicians track which medications their patients are on. Requests to access these EMR systems can be directed to OntarioMD.
The OMA also plans to use new technology to help it predict what parts of the province will demand which services. It is developing plans for a Physician Resources Integrated Model (PRIME), which would use detailed clinical information and artificial intelligence to predict future health-care needs, such as how many family physicians and specialists will be required to meet patient needs in a specific geographic area.
As it works on recommendations to change the system, the OMA is relying on the knowledge of its physician members for solutions. Under its new governance structure, OMA members are suggesting changes through the General Assembly, which prioritizes the system improvements Ontario doctors say they need most. The board has already approved a number of General Assembly priorities, including advocating to reduce delays in patient care, the need for a comprehensive human resources strategy and national licensing system, and standardizing requisition forms for lab work.
"Physicians really need to show system-wide leadership with respect to health-care transformation. It is incumbent upon physicians to educate themselves and others about what we need to see in a well-performing system." — Dr. Veronica Legnini
The OMA will also start offering a new Physician Leadership Program, in partnership with the University of Toronto’s Rotman School of Management, designed to coach physicians who can drive transformational change. Every year for three years beginning in 2023, 30 physicians will be chosen to take the 10-month program.
“I think physicians really need to show system-wide leadership with respect to health-care transformation,” Dr. Legnini said. “It is incumbent upon physicians to educate themselves and others about what we need to see in a well-performing system.”
Kurt Kleiner is a Toronto-based writer.