December 2016

2016 Members' Forum Highlights

On Nov. 25, the OCFP Annual Members’ Forum took place in Toronto. Typically held during the OCFP Annual Scientific Assembly, this event provides the opportunity for family physicians to interact with today’s healthcare leaders; learning how government policy, best care practices and technology can help support their practice and produce better health outcomes.

This year’s Forum examined how digital health technologies are supporting primary care. Moderated by Dr. Darren Larsen, Chief Medical Officer, Ontario MD, this year's panel included:

  • Dr. Clare Liddy, Primary Care Lead for BASE e-Consult Service
  • Dr. Asim Masood, Chief Medical Officer for Canada Health Infoway
  • Dr. Rob Williams, Chief Medical Officer of Health, OTN
  • Dr. Abhishek Raut, OCFP Board Director 
  • Dr. Bob Bell, Deputy Minister of Health and Long-Term Care

While many audience questions were answered during the hour long discussion, we did not have time to get to all of them. Fortunately, our presenters were kind enough to provide responses to member questions that were submitted, but left unaddressed. Please see the questions and responses below:

Could I have explored a new relationship with OntarioMD, when my EMR provider was taken over by another provider, and I faced significant expense to change to the new provider?

"OntarioMD’s change management services are available to all EMR users and these are offered free of charge.  We offer some expertise, support and information to assist in the work of moving from one EMR to another, but unfortunately there is no funding from the province available to offset the cost of doing so.
- Dr. Darren Larsen, Chief Medical Officer, Ontario MD


With rising incidence of hacking and ransomware, is there a recommendation that family practice doctors or clinics look into some form of cyberinsurance? Are any medical organizations providing such products?

Cyberinsurance is a new offering from many insurance providers, including OMA InsuranceBesides learning about how to mitigate risk of being attacked (OntarioMD provides advice and tools to physicians on this topic:  Ransomware Threatens Health Care Industries), physicians are encouraged to examine these insurance offerings to decide if they would be valuable in their practice environments.”
- Dr. Darren Larsen, Chief Medical Officer, Ontario MD


Bandwidth required for high definition video is not available in all communities.  Who’s responsibility is it to ensure high speed internet is available at a reasonable cost? Are there alternatives that still support high quality video via OTN?

“The federal government has invested heavily over the last 20 years in ensuring reasonable bandwidth in all remote areas of Canada. I am not aware of anywhere in Ontario where bandwidth is an issue preventing the use of quality video for health interactions. One exception may be a few fly in communities in northern First Nations where they connect by satellite. That said, there are only a few communities in Ontario still on satellite.”
- Dr. Rob Williams, Chief Medical Officer of Health, OTN


In our sub-LHIN we are trying to vertically integrate as much of healthcare as we can, and foresee a common patient portal, as an important enabler of a successful outcome.  To what extent do you think we should pursue this, or do you think we should be confident that it will just happen?

“I am not expert in this area, but I know there are many organizations interested in promoting patient managed health records.  Internationally, countries like Denmark and Finland already have them and they are managed nationally.  I suspect that Ontario will soon develop one for everyone in the Province.”
- Dr. Rob Williams, Chief Medical Officer of Health, OTN


Pathways & Race in BC and MyChart in NS are all great.  When can we expect this to help facilitate consults in Ontario and reduce wait times?  

A provincial eConsult service in currently being implemented in Ontario. I have not heard any discussion from MOHLTC about supporting a RACE style of MD to MD collaboration.”
- Dr. Rob Williams, Chief Medical Officer of Health, OTN


The Centre for Clinical Interventions is a free web-based resource from Australia. With well-designed self-directed cognitive behavioural therapy packages on about a dozen topics.  Is there any work being done to provide Ontarians with quality, validated, web-based tools to help them to develop skills to self-manage their mental health? 

“There are a number of mental health organizations in Ontario offering digital services but they are not consolidated onto one website like in Western Australia. OTN has partnered with a number of mental health organizations to pilot an online self-help service called Big White Wall and we have reviewed several mental health conditions on our new app review service for family physicians . We are interested in learning about other digital health services (e.g. Break Free Group) and whether they may be appropriate digital services to offer in Ontario.”
- Dr. Rob Williams, Chief Medical Officer of Health, OTN


Is there a concern we are moving away from the direct interpersonal tangible meeting between physician and patient as we move to a more digital world?

"The objective of econsult is to improve timely access to specialist advice to improve care for the patient. eConsult is not intended to replace a face to face visit when required and/or requested by the patient.

We have surveyed patients about wait times and were told that wait times significantly exceeded what they considered acceptable. Many were worried about serious disease, spoke of having symptoms that affected their daily quality of life and caused them to miss work or school.[1]

In a recent telephone survey of patients treated using eConsult, 86% said eConsult was useful in their situation, and 93% would ask their PCP to use the service in the future.[2] Patients valued the service for its speed, deemed it an acceptable way to receive specialist care, and appreciated the stronger role it allowed their PCP to play in their care.

  • “She took photos of both my hands [and] sent them through the eConsult and within 24 hours I was back in the office [with a prescription].”
  • “I think my G.P. was happy to have somebody in the oncology section give her some information, and I think the suggestion for follow up was appropriate…eConsult is fabulous”
  • “I have the confidence in my family physician, you know, for him to go off and do the eConsult saved a number of months…rather than if he were just to refer me.”
In addition, in the Champlain BASE service, we have actually been surprised at how a ‘virtual community’ is being created through the eConsult service. By connecting the providers in such a timely fashion in a conversation about a patient, both the primary care providers and the specialists who use our service comment on how they have gotten to ‘know’ each other even though it is through a digital conversation."

- Dr. Clare Liddy, Primary Care Lead for BASE e-Consult Service


Can you choose a local specialist?
Yes, it is our recommendation, that local specialists be engaged and participate in the service if possible. However, not all regions will have access to all services and this is where specialists from other regions could be available for eConsult thus ensuring all Ontarians have equitable access.”
- Dr. Clare Liddy, Primary Care Lead for BASE e-Consult Service


How much and to whom does the specialist bill?
"In the Champlain BASE service, specialists are paid on a prorated hourly basis ( 200 $/hr in 5-10 minute time increments) which is based on self-reported time. The average cost per case is $45 with a majority taking the specialist less than 10 minutes to respond. At this time, payment is provided through the MOHLTC, and paid for on a quarterly basis through our local hospital as part of the Provincial eConsult pilot.." 
- Dr. Clare Liddy, Primary Care Lead for BASE e-Consult Service

[1] Keely E, Traczyk L, Liddy C. Patients’ perspectives on wait times and the referral-consultation process while attending a tertiary diabetes and endocrinology centre: Is eConsultation an acceptable option? Canadian Journal of Diabetes. 2015 Aug;39(4):325-9.

[2] Joschko J, Liddy C, Moroz I, Reiche M, Crowe L, Afkham A, Keely E. Patient perspectives on the Champlain BASETM eConsult service as an acceptable alternative to traditional referrals: a thematic analysis. [manuscript submitted]

Do you know of resources, events and opportunities of interest to family docs?

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