The pandemic has laid bare a weakness in the health system that limits how information is shared, says a Stayner family doctor and past-president of the Ontario Medical Association (OMA).
Although the organization working with doctors on integration says a great deal of progress has been made and the evolution continues.
Dr. Sohail Gandhi says while some efforts are being made, disparate software systems causes gaps that prevent the proper flow of information.
“This whole pandemic has really brought home to me really just how poorly linked and integrated our system is,” he said. “If I’ve got a patient who gets really sick with COVID and goes to Toronto General, they kind of get lost and I don’t get any information. Nothing sort of comes back to me even though I’m the family doctor until they come back and then I only get reports by fax later on.”
Gandhi added that the failure is not of any organization or individual, but rather Ontario’s system itself. He said the various pieces of software used does not integrate the different parts of the health care community.
As a doctor in Stayner, Gandhi said he sees patients from both the Grey-Bruce and Simcoe-Muskoka areas, which he says use separate systems, preventing an integration and sharing of information.
“There’s no way of tracking who’s ill and no way of sharing information electronically from say Collingwood hospital to Toronto General and there’s no way of sharing information from the hospital to public health if someone’s really sick with COVID so they can start the contact tracing process. It’s all done by paper and fax and that sort of thing," he said.
The lack of integration, he said, means the apps that have been created since the start of the pandemic don’t work as well as they could because the different pieces of software don’t communicate with each other.
He points to South Korea and Japan during the pandemic. South Korea, he said, has a seamless integration of the health-care system for the whole country — which he said sets a solid foundation for efforts such as contact tracing.
He believes political will is required to effect change.
“I hope that coming out of this pandemic that someone does a review of what went wrong,” he said.
The result, he said, is it becomes challenging for a doctor like him with patients in two different jurisdictions to report reportable diseases because of the different systems in place that have no means of seamless communication.
There is an ongoing evolution and development of a more cohesive system for the movement of information, enhanced in the face of the current pandemic, says the head of OntarioMD, a subsidiary of the Ontario Medical Association meant to assist clinicians in their adoption of technology on the digital health front.
OntarioMD works with physicians, Ontario Health and vendors in the delivery of technology in primary care, explained CEO Sarah Hutchison.
“I think COVID has certainly has us focused on very different things as we’re needing to exchange information in different ways and we’ve been very focused on virtual care and care delivery and information in ways that have changed our focus,” she said. “Across all of the sectors, everyone’s really done a really good job in their vertical.”
Hospitals have new hospital information systems, physicians have electronic medical records systems and new technology for virtual care delivery — all reflecting a maturation of the use of technology.
Hutchison sees the challenge now as being the integration of all those verticals and the movement of the information about the patient which requires a focus on standards and exchange and a more patient-centric focus.
“It’s impractical to think in 2021 we’re just going to find one room to rule them all. It is, however, entirely achievable that we can advance an integration agenda, and that we can move information across the system between systems,” she said.
“Now we’re really just focused on what does integration look like? What information needs to move between points?”
One of the tools developed by OntarioMD during the pandemic aims to loop in the province’s doctors. Its Health Report Manager digital health tool allows the flow of patient information in reports from COVID-19 assessment centres to 21,000-plus family doctors and nurse practitioners.
It also alerts them, for example, of positive COVID-19 tests as soon as the results are available in the Ontario Laboratories Information System.
While the evolution of technology and how it is used continues, Hutchison believes there is a decent alignment in the sector about the need for integration of information, the movement of information about the patient as well as the patient’s access to the information.
“Technology is going to continue to advance and support how care is delivered so we’re going to be constantly striving for better,” she said. “The reflection is, though, we have to be thoughtful of the burden of change on everybody.”
