Ontario Health Teams, which bring healthcare providers like hospitals, primary care and community health services together, are expected to resolve many of the concerns around how healthcare gets delivered in Ontario. OHTs will be able to address some of the major concerns currently dogging the healthcare system in Ontario, especially given the government’s plan to create a ‘low-rules environment’ with little governance.
The members of an OHT share a single funding envelope, co-ordinate care and provide 24/7 access to navigation services and take responsibility for outcomes. Here we look at some of the biggest challenges which OHTs might face, in meeting their vision and goals.
1. Hospital boards hold all the power
OHTs can plan and decide on service delivery, without the involvement of community or patient/family engagement in planning the service or allocation of resources. OHTs will also be, in most cases, led by the hospitals which have the largest budgets, however constrained, among the partners. On the positive side, given that most of the hospitals are well governed, this would help to improve the processes for other providers. But questions still remain. Who will ensure that the funding envelope is split up equally among these health care providers? Will the hospitals be able to resist the temptation to consolidate regional budgets to ensure better funding to hospitals first? How far will they be willing or able to meet the public demand for better community or mental health care? How transformative with their leadership prove
2. Collaboration and conflict resolution
The need to set a cleat locus for decision-making and to decide the degrees of freedom awarded to an OHT seems apparent at this time. There may arise a need for a conflict resolution mechanism to ensure the smooth and collaborative functioning of the OHTs with different opinions in the Ministry of Health as well other public sector unions like the Ontario Medical Association and Ontario Nurses Association.
3. Managing home care Services
Currently, 85% of home care visits are provided to patients directly by the community, without the involvement of any hospital or healthcare provider. Who will now manage the home care services worth over $4 billion, organized and standardized well at the provincial level? Will it now be decentralized and managed separately and independently by each OHT?
4. Consolidation of care provider compensations
The compensation paid to the providers in the care teams will be determined by the OHT’s budgets and governance process. However, physicians’ compensation would have to be negotiated with the Ontario Medical Association and may have to be kept out of the OHT, even though the physicians will be playing leadership roles in the OHT.
5. Meeting demands for accountability
The legislation behind the formation of OHTs has written in specific powers to coerce, to order, to direct mergers, amalgamations, service transfers and entire closures of health-service providers, at various points. Health care providers are just expected to step out of their silos and start working collaboratively in teams, and to ensure that a patient doesn’t get lost through the system. As a wide variety of different health-care organizations come together for patients within a geographic region for the first time in the province, issues of accountability are bound to crop up and could create legal snafus on an unprecedented scale.
6. Standardized health information systems
Nothing can be more important than establishing a comprehensive, standardized health information system, which can be securely accessed by both patients and health service providers. Adoption of technology is fundamental to such virtual access to health information, which is being collected as we speak by various care providers along with the information being collected by the innumerable wearable devices, which people are voluntarily adopting to track and record their own health. The information must be available for the assessment and analysis of the performance of the health services as well as the efficacy of the various population health measures being undertaken in the province.
The aim is to plan the health services of over 14 million people in Ontario and many aren’t sure if it may need more guidance than what is currently put in place. What would help to ensure that the participants who maybe hospitals, community care providers, public health units and even sophisticated referral hospitals will be able to work in harmony? We can’t afford to have the OHTs be thrown into a chaotic disarray after the existing order, however inefficient, gets dissolved. Which means, we will need to seek the answers to some of these questions, right now.
In efforts to build a connected and coordinated public health care system in Ontario, 14 LHINs (Local Health Integration Networks) have been restructured into 5 interim geographical regions for transition of certain LHIN functions and oversight responsibilities into Ontario Health. These five interim and transitional geographical regions are based on existing geographic boundaries as set out in the current LHIN’s governing legislation.
Under the operational realignment, Ontario has also reduced the LHIN CEO positions from 14 to five. To better reflect the changes, these positions will now be called Transitional Regional Leads. In accordance with the vision for a truly connected health care system, these transitional leads will report to the Ontario Health Board which will remain the Board for the realigned LHINs. All current functions of the LHINs including continued coordination of patient access to home and community care and long-term care placement will be managed by the reorganized LHINs.
The interim regional clustering of LHINs are as follows:
||Transitional Regional Leads
||Clustering of LHIN Corporations
||Erie-St. Clair, South West, Hamilton Niagara Haldimand Brant, Waterloo Wellington
||Mississauga Halton, Central West, Central, North Simcoe Muskoka
||Central East, South East, Champlain
||Rhonda Crocker Ellacott
||North West, North East
According to the Ministry of Health, this reorganization of LHINs is operationally necessary to establish regional oversight between existing LHINs. As per the transition plan, certain functions of the LHINs will eventually move to Ontario Health, however, other functions such as delivering home and community care and long-term care placement services will remain under current LHINs jurisdiction.
The main purpose behind establishing an OHT (Ontario Health Team) is to encourage collaboration with the formation of specific groups of healthcare providers and organizations which are clinically and fiscally accountable for delivering a full and coordinated continuum of care to a defined geographic population within Ontario. The OHT assessment makes sure that the teams are fully equipped to function collaboratively and those in development are to be supported by the Ministry of Health until full provincial coverage of OHTs is achieved.
The OHTs will be prioritized for future investments and receive incentives based on performance. They are set to redesign relationships, accountabilities, and incentives which put patients at the centre of how seamless care and services are delivered and funded. There are 8 building blocks of OHTs which act as guiding principles for establishing a truly connected healthcare system. Let’s look at what they are and why they matter:
- Defined Patient Population: OHTs should be responsible for the health outcomes of patients, through access to sustained care and meeting service delivery targets, within the
- In-scope Services: OHTs should leverage existing capacity to deliver coordinated services across at least three sectors of care (especially hospital, home care, community care, and primary care) while putting a plan in place to include or expand primary care services to a significant portion of the population. When mature, an OHT shall provide a full and coordinated continuum of care for all but the most, highly specialized, conditions.
- Patient Partnership & Community Engagement: Be committed to an integrated patient engagement framework and demonstrate a history of meaningful patient, family and caregiver engagement. Commit to a plan which encourages patient leadership and include patients, families and caregivers in the governance structure.
- Patient Care & Experience: Implement programs to ensure improved digital access to health information, transitions and coordination, key measures of integration, patient self-management and health literacy. Offer 24/7 coordination and navigation services with zero cold handoffs as well as virtual care to improve patient experience. Be committed to measure care and redesign care by offering digital access to health information, as and when needed and from anywhere.
- Digital Health: Develop the ability to digitally record and share information across partners by addressing any existing gaps in digital health activities. Increase the adoption of digital health tools to harness data. Adopt or provide digital options to streamline and integrate point-of-service systems and use data to support patient care for decision support, operational insights, population health management, and for tracking/reporting key indicators. Mature OHTs should be able to adopt digital health solutions to support effective healthcare delivery, ongoing quality and performance improvement, and better patient experience.
- Leadership, Accountability, & Governance: OHTs need to develop a central brand, demonstrate a history of working together to provide integrated care through physician and clinical engagement and inclusion in leadership and/or governance structure(s) through formal agreements, where necessary. The aim is to have every OHT operate through a single clinical and fiscal accountability framework, with appropriate financial management and controls.
- Performance Measurement, Quality Improvement & Continuous Learning: OHTs need to demonstrate a track record of responsible financial management and understanding of population costs, cost data and cost drivers. They should work towards an integrated funding envelope, based on the care needs of their attributed patient. Teams shall identify a single fundholder and reinvest savings to improve patient care.
- Funding and Incentive Structure: OHTs should be able to collect data and pursue joint quality-improvement activities, engage in continuous learning and champion integrated care. They shall also demonstrate an understanding of baseline performance on key integration measures and a history of quality and performance improvement. They need to reduce inappropriate variations and implement clinical standards and best evidence and provide complete and accurate performance reporting on the required indicators. The aim is to ensure that integrated care is offered based on the best available evidence and clinical standards, with an ongoing focus on quality improvement.
When they reach a mature state, each Ontario Health Team will be ready to demonstrate the ability to:
- Provide a full and coordinated continuum of care for a defined population within a geographic region,
- Offer 24/7 access to coordination of care and system navigation services to patients while working to ensure that their patients’ care journey is a seamless transition through the various stages of care,
- Improve performance to ensure the quadruple aims of better patient and population health outcomes; better patient, family and caregiver experience; better provider experience; and better value,
- Follow a standardized performance framework and be measured and reported against it,
- Operate within a single, clear accountability framework,
- Receive funding through an integrated funding envelope,
- Reinvest the funds into front line care; and
- Adopt a digital first approach and be aligned with provincial digital health policies and standards, including the provision of digital choices for patients to access care and health information and the use of digital tools to communicate and share information among providers.
As the needs and preferences of patients are known ahead of time and communicated at the right time to the right people, providing safe, appropriate, and effective care to the patients in Ontario will become seamless and efficient.
Microsoft finally released Azure API for FHIR in general availability to azure customers, thereby becoming the first cloud with a first-party service to ingest, persist and manage healthcare data in FHIR format.
Azure API for FHIR helps manage and exchange health data in HL7 FHIR format in the cloud. Through this service healthcare providers and payers (including developers, researchers, device makers, or anyone working with health data) can easily connect existing data sources such as electronic health record systems and research databases.
With FHIR becoming the standard of choice for exchanging and managing healthcare information in electronic format, this turnkey platform from Microsoft is capable to spin a new cloud-based FHIR service within minutes and begin securely managing PHI data in Azure. To that extent, FHIR has truly revolutionized healthcare interoperability.
Also, because of normalized data in FHIR format it is now easy to merge and understand differently configured data sets for accelerated machine learning development. And as providers test, develop and research optimal models for their health systems, the normalized data output can be securely and easily exchanged with any application interface that works with FHIR API.
Therefore, some of the benefits that Azure API for FHIR brings to healthcare teams include– pay what you use, optimized latency and performance, and providing on-demand, scalable machine learning tools with built in controls for security and intelligence.
Some key features of the Azure API for FHIR are:
- Enable and start running an enterprise-grade, managed FHIR service in just a few minutes without considerable development team effort
- Support for R3 and R4 of the FHIR Standard
- Track audit logs for access, creation, modification, and reads within each data store
- Secure compliance in the cloud: ISO 27001:2013 certified, supports HIPAA and GDPR, and built on the HITRUST-certified Azure platform
- Role Based Access Control (RBAC) – allowing you to manage access to your data at scale
- Global Availability and Protection of your data with multi-region failover
- SMART on FHIR functionality
Whether it’s improving operational efficiency or a need for secure data exchange and interoperability platform, the Azure API for FHIR available for all Azure customers is a game changer. This is why Azure on FHIR is now fueling the potential of machine learning and life sciences in healthcare to deliver better health outcomes.
To learn more about Azure API for FHIR, read here.
Integrated care refers to the coordinated continuum of care provided to patients even if they are not in the same physical location as the care provider. Integrated care delivery enables providers and health systems to improve health outcomes through real-time collaboration, access to system navigation services, and seamless transition throughout the patient-care journey.
Ontario Health Teams, therefore, are a new model of integrated care set up to innovate care delivery within a geographic region. The eventual goal of the OHTs is to provide integrated services to patients, families, and communities to improve health care in Ontario.
Integrated care across the OHTs is possible by following these tenets of health care delivery:
- Timely access to patient health information for decision making at point-of-care;
- Smoother patient transitions between health care providers and geographies;
- Better coordination of care between multiple practitioners, and within health care teams;
- More efficient workflow and reduced dependency on paper-based systems;
- Lower cost, better-quality patient experience by eliminating duplicate tests;
- Improved monitoring over time to support chronic disease management;
- Fewer gaps in patient information as patients move between hospital, practitioner’s office, home care and long-term settings; and
- Continuous improvement in the delivery of care with data to support a population health approach and research activities
Each serving up to 300,000 people, Ontario Health Teams will share funding as well accountability as they bring providers together. Funding will now incentivize care for patients who are in most need, instead of the earlier preference given to a patient’s age and sex, which made healthcare providers prefer admitting healthier patients.
Some Pre-requisites for Delivering Integrated Care
- Ontario maintains a series of provincial data repositories containing important patient records and digital health information. These repositories include historic as well as current data gathered from care and diagnostic settings across the province. Such repositories can help support Ontario’s transformation toward integrated care delivery and health sector efficiency.
- The direction set by four general digital health policies will support the implementation and/or use of all the digital health systems:
- Digital Health Information Exchange Policy
- Digital Health Investment and Value for Money Policy
- Digital Health Access, Privacy and Security Policy
- Digital Health Reporting and Performance Policy
- A robust in-house digital strategy or with home-grown health IT companies to deliver disruptive solutions such as real time care team collaboration, secure messaging, and secure EHR data access.
Benefits of Integrated Care in OHTs
Eventually the care delivered through OHTs would be connected and fully shared across the Ontario Health Teams network including hospitals, home care providers, acute care providers, primary care providers, doctors’ offices and mental health providers. This approach is expected to reduce duplication of efforts through effective coordination, which would ultimately benefit the patients and their caregivers. Among other things, OHTs will help:
- Connected care teams in the OHT (including in social service agencies) address social factors which are the root cause of illness, like unemployment, housing and poverty.
- Reduce gaps in providing home care services and mental health services.
- Meet expectations at a lower cost than a pre-established benchmark, and thus help keep a portion of the savings to invest in improving direct patient care.
- Enable digital solutions like patient, portals, secure messaging, virtual provider visits and virtual consultations.
Finally, Integrated Care is quintessential for the OHTs to succeed and achieve common goals related to patient experience, provider collaboration, improved health outcomes, and value based care. And while different OHTs will have different approaches to reach this common goal of providing integrated care, it will help create a coordinated continuum of care which would improve healthcare in Ontario by leaps and bounds.
The Ontario Health Teams are being introduced as an innovative model of care, set to transform the healthcare landscape in Ontario with new ways to organize and deliver services to patients and achieve better health outcomes. This connected health care system will be centered around patients, families, and caregivers, enabling patients to navigate the system and transition between providers. With its high-performing, integrated care delivery system, an OHT will offer seamless, coordinated care for patients, improving population health in the province.
Why the need for Ontario Health Teams?
No one can deny the fact that healthcare delivery in Ontario today needs to be revamped and re-imagined to stay sustainable and to deliver on its promise of improving care outcomes. In order to understand why there’s a need to overhaul the current system with Ontario Health Teams, it is important to understand the lacunas in the current system at play.
Some of the results of a disconnected, siloed healthcare system in Ontario are:
- Patients are kept waiting for very long periods, on all levels of care needed. The wait periods are growing everywhere.
- Hospitals are resorting to hallway care, jeopardizing the health and well-being of both patients and their caregivers alike, as hospital beds are underutilized and funding for new beds is not meeting the growth in demand.
- Leveraging technology to treat patients when and where they need it most and to get patients involved in their own care is an absolute need of the hour.
- At the end of a clinical interaction, clinicians may refer patients to other providers, prescribe drugs, order lab tests or imaging, or apply for supports such as assistive device coverage. Conventionally, these activities are fax-and-paper-based, resulting in significant administrative burden and provider burnout.
- The digital tools developed to address these problems have been developed in siloes, and there is significant fragmentation and that leads to too many solutions that are not interoperable.
- EMR integration is also not consistently available for all eService solutions, or all EMR users.
Therefore, to help create a more integrated ecosystem for patients and providers alike, the concept of Ontario Health Teams took seed. Here are some of the important questions that OHTs will answer once fully operational.
What does OHT mean for providers?
With Ontario Health Teams, knowledge and experience of healthcare providers will now be leveraged to provide integrated care to Ontarians with:
- Timely access to updated information
- Improved communication and collaboration with other HCPs
- Avoidance of duplication and unnecessary costs
- Increased productivity and efficiency
- Access to learning resources
- Improved information management
- Improved clinical decision-making and quality of care
- Reduced administrative burden
What does OHT mean for patients?
With fully operational Ontario Health Teams, patients will be able to experience connected care – one where their primary care teams and specialists collaborate over a single platform to improve care outcomes.
- Patients can expect to be closely monitored and experience seamless healthcare journey across various points-of-care.
- The ER doctor will be able to access provincial data, with the patient’s consent, and check medication records.
- The patients need not repeat their medical history multiple number of times nor will they have to repeat tests which have been already issued.
- At the time of discharge, the patient will receive a care plan and may be eReferred to a different specialist. They may also go through an eConsultation if the specialist is not available.
- Their family physician will receive eNotifications informing them of the hospital admission and treatment received by the patient.
- The patient’s recovery may be monitored by a specialist through a virtual video visit with the findings recorded in their integrated health record.
Eventually the care delivered through Ontario Health Teams would be connected and fully shared across the Ontario Health Teams network including hospitals, home care providers, acute care providers, primary care providers, doctors’ offices and mental health providers.
To learn more about enabling integrated care solutions in an Ontario Health Team, visit here.