The Ontario government announced recently that it is consolidating local and provincial health organizations to create a central super agency, designed to end silos and fix a disconnected system. The system is fragmented for many reasons. A lack of data and information sharing between healthcare providers is a persistent problem that has been resistant to change.
The government's goal is to improve the patient’s journey through the health system, so it is more efficient and better serves patients’ needs. Providers readily admit the system’s different elements don't communicate well. As a consequence, patients may be discharged after surgery without follow-up home care being arranged. Additionally, hospitals may be unaware of a patient's medical care that has already been provided by a family doctor.
The Orion Health Chronic Care Index, a poll of 1,551 Canadians, found that healthcare delivery is fragmented into silos that do not communicate well together. People with chronic conditions such as arthritis, diabetes and mental illness/addiction are the biggest users of healthcare. Nearly one-in-five Ontarians with chronic conditions have experienced medication errors or duplications and more than one-in-10 often undergo unnecessary repeat procedures. Additionally, nearly half of Ontarians living with chronic conditions describe repeatedly outlining the same information about their condition every time they visit a care provider.
Among Ontarians with chronic conditions, one-in-four said their specialist didn’t have their primary care physician’s information about them available. The same amount said nobody at the hospital let their primary care doctor know when they were discharged. Three-in-10 say their complete healthcare record is not available every time they see a clinician.
Experience in Canada and internationally has shown that integration of care delivery is best achieved by means of a single, complete, electronic patient health record that is made easily accessible wherever the patient is seen. This improves the accuracy of diagnoses and treatment, facilitates healthcare coordination, and enables seamless transitions of patients across healthcare settings and providers.
Fragmentation of care is not unique to Ontario – it is the case to greater or lesser extent in all regions of the world. Care fragmentation reveals itself in many ways; a lack of communication between specialists and primary care physicians is one of the most frequent and obvious in its impact on patients. A sizeable proportion of Ontarians believe their care providers need better means to share health information. Patients have explained in focus groups that they were asked the same question so many times by multiple care providers that they thought they must be providing the wrong answers. Some even changed their story to try and please their clinicians.
Care coordination should be targeted at those who are most at risk of falling through the cracks, as they are being cared for by many providers for several different reasons. Integration of information across the community can help significantly. However, there is more to care coordination than simply having access to a single, complete record. Care coordination involves the creation and use of a single, patient-centric care plan that synchronizes all providers involved in the care of each patient. There also needs to be regular analysis and reporting of care gaps and overall health system performance.
There is a massive increase in the amount of data available to patients and providers, including from wearable devices, social and environmental determinants of health, and genetic data. Finding ways to best use this data and make it appropriately available is challenging. Nevertheless, digital health technology provides an opportunity to improve the existing disconnected system and significantly advance patient care.
When healthcare providers and patients have access to complete information, including an integrated care plan, then we can realize the full potential of a streamlined, coordinated healthcare system. But first, Ontario must tackle interoperability of health information head on.
Dr. Chris Hobson is a former family physician with 15 years of experience and the Chief Medical Officer at Orion Health, a global provider of health information technology. He is a recent nominee to Digital Health Canada’s Board of Directors.
Republished with permission from The Hill Times. Originally published on March 18, 2019.