Benefits:Reminders, alerts and reports will allow both patients and care providers to better manage diabetes in accordance with best practices, reducing complications and avoiding hospitalizations, thereby reducing costs and emergency room wait times.Where are we at right now:- In 2010, a vendor was selected in a competitive bid to produce the Registry and Diabetes Portal. eHealth Ontario is currently working with the vendor and MOHLTC to fine-tune the product as to meet the needs of Ontario’s primary care providers.
What would you have done differently?
Week 9 - eHealth in Ontario
Policy Issues:eHealth in Ontario HLTH 405 / Canadian Health Policy Winter 2012 School of Kinesiology and Health Studies Course Instructor: Alex Mayer, MPA
Briefing NotesMost Common Mistakes: • Did not substantiate the problem with statistical evidence! • Lack of specific information provided • Saying that there is an ‚increase in rates of drug abuse‛ is not sufficient • Using Fallacious Logic to say that there is a problem worth addressing • Suggesting that ‚Obesity is on the rise, therefore physical activity must be decreasing‛ • Suggesting that ‚U.S. rates are increasing, therefore there must be a similar problem in Canada‛
Briefing NotesMost Common Mistakes: • Did not make evidence-based recommendations! • Locked in on the ‘common-sense’ option too quickly • Made a guess as to what would work best, based on intuition rather than evidence • Did not try to compare the effectiveness and cost of different approaches • Did not present statistical evidence to prove an option’s effectiveness
Briefing NotesMost Common Mistakes: • Did not understand the purpose of a Communications section! • This section is used to highlight a messaging strategy • To allay potential concerns in specific segments of the population • To promote a policy’s benefits • Should include specific talking points E.g. ‚The Liberal government’s introduction of full-day kindergarten is a hard-won victory for young families in Ontario! It will save parents money, improve educational outcomes, and prime our province for continued economic growth in a competitive future.‛
Last Week…Government intervention in the marketplace isjustified when there is• Market Failure: The market for a good or service is not resulting in an optimal gain in societal welfare due to unequal power and/or information between buyers and sellers, or due to the nature of the good.• Equity Concerns: Socially unacceptable outcome where some segment of the population is going without an essential good or service, due to a lack of resources.
Last Week…5 Instances of Market Failureo Informational Asymmetryo Non-Competitive Marketso Principal-Agent Problemo Negative Externalitieso Public Goods
Last Week…Net Present Value and DiscountingIf you are trying to assess the costs or benefits of your policyrecommendation, be sure that your analysis is making an ‘applesto apples’ comparison. A $50 savings in 1980 is not worth the sameas a $50 savings in 2012.The inflation rate (CPI % change) measures the rise in the price ofa basket of goods. If the price of goods rises by 3.3% over 2011-2012, then the relative value of money has declined by thisamount.E.g. My grandmother likes to tip people with a couple of quarters($0.50). This may seem rude, but in 1950, two quarters were worththe equivalent of $5 in today’s market! So you see, mygrandmother is actually an excellent tipper… Kind of.
Last Week…Net Present Value and DiscountingE.g. My grandmother likes to tip people with a couple ofquarters ($0.50). This may seem rude, but in 1950, twoquarters were worth the equivalent of $5 in today’s market!So you see, my grandmother is actually an excellent tipper…Kind of.
Last Week…Net Present Value and DiscountingTry the inflation calculator below to figure out the netpresent value of a $50 savings generated in 1980.Bank of Canada Inflation Calculator:http://www.bankofcanada.ca/rates/related/inflation-calculator/
Last Week…Net Present Value and DiscountingInflation, however, is only one part of the equation. The other is‘opportunity cost’.Say I want to buy a TV; I have the option of paying in a lump sumor paying the same amount but spread out over 12 monthlypayments.In order to figure out the true cost of each proposition, I have tocalculate the ‘opportunity cost’: The value of the next bestopportunity foregone, say by investing the money and earninginterest. O.C. = $P * (1 + r%)t
Last Week…Net Present Value and DiscountingE.g. Buying a $1000 TV.Opportunity cost of TV (lump sum): Had I not bought the TV, I couldhave invested that money and earned 5% interest instead! $P (1 + r%)t = O.C. $1000 (1 + 0.05)1 = $1050Opportunity Cost = $1050Opportunity cost of TV (monthly payments): If I buy the TV by makingmonthly payments of $83, the opportunity cost is the foregone interest. Month 1: $83 + $83* IR (5%/12 * 12 months) = $83 + $4.15 Diminishing Month 2: $83 + $83* IR (5%/12 * 11 months) = $83 + $3.80 O.C. in foregone interest Month 3: $83 + $83* IR (5%/12 * 10 months) = $83 + $3.46Opportunity Cost = $1023
Last Week…Net Present Value and DiscountingCombining these two concepts: the time value of money andopportunity cost… We can come up with there followingequation.$FV = $PV * (1 + r%)tWhere real rate of return, r: r% = interest% - inflation%
Last Week…Net Present Value and Discounting$FV = $PV * (1 + r%)t or $PV = $FV / (1 + r%)tWhere ‘real rate of return’ or ‘discount rate’, r: r% = interest% - inflation% and t = yearsThe Government of Ontario plans to spend $5M per year over 5 years tobuild new bike lanes once Toronto finalizes its new transit investmentstrategy. The Bank of Canada website says that the 3-year movingaverage for inflation is 3% and the government’s next best alternative isnot to incur debt, thereby eliminating interest on long-term bonds of 6%per annum?What is the net present value of this investment?
Last Week…Net Present Value and Discounting$PV [Year 4] = $5M/ (1 + 3%)4 = $4.44M$PV [Year 3] = $5M/ (1 + 3%)3 = $4.58M$PV [Year 2] = $5M/ (1 + 3%)2 = $4.71M$PV [Year 1] = $5M/ (1 + 3%)1 = $4.85M$PV [Year 0] = $5M/ (1 + 3%)0 = $5.00M $PV of Project Outlays $23.58MSo in comparing the cost of the bike lane project to the costof, say, building a dedicated street for cyclists for $25M this year, the bikelane project is actually $1.42M less expensive in an apples-to-applescomparison.If they provided equivalent benefits, the bike lane project would bethe more cost-effective option!
DefinitioneHealth: (n) ‚A consumer-centered model of health care where stakeholders collaborate utilizing information and communications technologies (ICTs), including Internet technologies, to manage health; arrange, deliver and account for care; and manage the health care system.
Canada Health InfowayCanada’s eHealth Story• In 2000, the First Minister’s agreement on health sees the forging of a federal-provincial-territorial agreement to build up ‚infostructure‛ in Canada’s health care system.• ‚Canada E-Health 2000‛ conference sees 400 stakeholders meet to discuss progress on a national action plan for eHealth.• In 2001, Canada’s Health Infoway is operational.
Canada Health Infoway• Introduction to eHealth in Canadahttp://www.youtube.com/watch?feature=player_embedded&v=3SYtv5jh4tQ#!
eHealth ConsultationsObstacles to better health care in Ontario o Paper-based information management o Limited integration of local applications and data o Limited information-sharing across providers o Varying technological capacity across the health system o Fragmented and incomparable data o Lack of common data and technical standards o Underinvestment in technology o No provincially coordinated strategy for eHealth funding and planning!
eHealth in Ontario• 2002: Creation of the Smart Systems for Health Agency (SSH)• 2003: SSH begins its operations with 6 key priorities • Develop a common unique patient identifier in Ontario • Establish privacy and security requirements for eHealth • Design an Ontario EHR starting with Hospital-to-Primacy Care Physician information exchange • Initiate an ePharmacy Initiative for Ontario • Expand on Telehealth’s success and capabilities • Evolve a Wait List Management Initiative for key health services
eHealth in Ontario• 2006: Deloitte is hired to conduct an operational review of SSH’s activities.• The final report finds that SSH has not delivered sufficient value-for-money for the $650M invested thus far. It recommends an aggressive agency-turnaround plan.• Smart Systems for Health (SSH) is reborn as eHealth Ontario in 2008, with heavy-hitting CEO Sarah Kramer at its helm.
eHealth in Ontario• In 2008, Ontario’s new eHealth Strategy is developed.
eHealth in Ontario – A ShiftNo dedicated provincial Funded, Cabinet approved StrategyeHealth Strategy Government as stewards; eHealthGovernment responsible for Ontario responsible forStrategy eHealth eHealth StrategyDiffuse/competing/confusing Single point of accountability at accountability eHealth Ontario Provincial strategy deliveredDuplication, fragmentation and through local, regional andProliferation of eHealth efforts province-wide solutions Health SystemTechnology plan Transformation Strategy 26
3 Clinical PrioritiesDiabetes Management Medication Management Wait Times Enable online prescriptions and Enable public reporting and Monitor patientcompliance with medication History performance management evidence-based interventions Provide decision support for Expedite patient referrals out Alert physicianswhen best practices physicians of acute care where appropriate not being followed ordering drugs Divert ER visits to more appropriate Report on care gaps Alert of potential adverse drug events community care settings ER length of stay To Reduce Wait times Blindness Adverse drug events Focus of ERs on Heart attacks urgent patientsTo Reduce To Reduce Physician office visits Amputations To Increase Hospitalizations Access to community Renal failure services Deaths Deaths % prescriptions ordered % patients receiving ER length of stayMeasure Measure online Measure best practice care Wait for post acute % reduction in adverse drug events care
Ontario eHealth SolutionsDiabetes Management Medication Management Wait Times• Baseline Dataset ePrescribing Demonstration Project • eReferral and Resource Matching• Diabetes Registry • Drug Information System (DIS) • Emergency Department Reporting• EMR interoperability with Diabetes • Drug Profile Viewer (DPV) System (EDRS) Registry • Systemic Treatment Computerized • Wait Time Information System• OLIS interoperability with Diabetes Physician Order Entry (CPOE) (WTIS) Registry 28
eHealth Scandal• 2009: The ‚eHealth Scandal‛ A loosening of managerial policies around hiring private-sector consultants, meant to make eHealth Ontario more efficient, actually leads to more problems after the AG’s report finds that $1B had been spent with little to show for it.Oct 7, 2009. News Report (Global TV)http://www.youtube.com/watch?v=txkoB8s5qZ8&feature=results_video&playnext=1&list=PL9EFAFB182DCE4C29
Doctors Use Electronic Patient Medical Records 99 97 97 96 95 100 94 94 72 75 68 50 46 37 25 0 NET NZ NOR UK AUS ITA SWE GER FR US CAN* Not including billing systems. 31Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Third Time’s A Charm?eHealth Reboot (Feb 24, 2012)http://www.youtube.com/watch?v=F7kYDCtuTnQ 32
Diabetes Management•Baseline Dataset • Provides primary care MDs with a Diabetes Patient List • Testing reports inform MDs of most recent dates for 3 key tests for diabetes patients (blood glucose, cholesterol, retinal eye exam) • Reports give MDs %patients whose tests were within recommended guidelines so they can identify care gaps•Diabetes Registry • Fancier version of the baseline dataset • Will connect to OLIS give to notify MDs when patients are due for tests or when lab results are higher than normal • Will connect to EMRs so that a new diagnosis instantaneously gets added to a patient’s medical record and generates a care plan • Will eventually provide patients with self- management tools
Medication Management ePrescribing MDs can electronically ‘push’ prescription Demonstration directly to a local pharmacist Project Prescriptions can be printed in order to avoid deciphering MD’s handwriting•Drug Information •Will allow multiple health practitioners to System (DIS) ePrescribe •Will produce comprehensive medication profiles and tools for predicting allergic reactions, drug-to-drug interactions and accurate dosages•Drug Profile Viewer •Will give health providers connected to (DPV) eHealth Ontario access to ODB claims records so that all pharmaceuticals consumed by elderly and welfare patients will be visible at the point-of-care
Wait Times•eReferral and Resource •Hospitals to plan post-discharge care for Matching patients at the time of intervention •RM&R Solution will communicate with community care providers to flag a patient’s discharge date to ensure that someone is tasked with, and accountable for, providing follow-up care•Emergency Department Reporting System •Will record and publicly report ED wait (EDRS) times online, for both high and low acuity patients•Wait Time Information System (WTIS) •Will record and publicly report wait times for many types of surgeries and diagnostic imaging, and for both adult and children.