This bulletin, the seventh in our series on Bill 74: The People's Health Care Act, 2019, provides an overview of technology, information sharing and privacy aspects of Ontario's new health care legislation and describes the province's vision for an integrated and connected health care system.
Applications are now being accepted from health service providers who would like to be designated as an Ontario Health Team. The first call for self-assessments closes on May 15, 2019. Certain groups will be selected to submit a full application based on the self-assessments. As reported in our bulletins published on April 18 and April 25, providers that would like to become an Ontario Health Team must successfully complete an application and in-person visit, and begin implementation of the Ontario Health Team model (at which time they will be referred to as an "Ontario Health Team Candidate"), before they will be designated as an Ontario Health Team (a stage referred to as "maturity"). Digital health capabilities are expected in applicants, Ontario Health Team Candidates and Ontario Health Teams.
The Ontario Ministry of Health and Long-Term Care (the "Ministry") has released a guidance document for applicants, Ontario Health Teams: Guidance for Health Care Providers and Organizations (the "Guidance Document"). Among the Ministry's expectations are compliance with a number of digital and privacy-related standards. The proposed "digital first approach" will require Ontario Health Teams to provide digital choices for patients to access care and health information, and use digital tools to communicate and share information among providers. Applicants will be expected to expand their digital tools during implementation. The Ministry has committed to minimizing barriers for the first Ontario Health Team Candidates.
This bulletin describes the role of technology and information sharing in the Ontario Health Team model, sets out the expectations at each phase of becoming an Ontario Health Team and describes the tools, services and steps that the Ministry has proposed to advance the model. It also includes privacy considerations that each member of a proposed Ontario Health Team must consider when implementing the model.
Technology is Central to the Ontario Health Team Model
One of the main goals of the Ontario Health Team model is to integrate and coordinate providers and services. The vision is that patients will move seamlessly between different providers and settings in their Ontario Health Team. Another goal of the Ontario Health Team model is to meet needs across rural, urban and northern communities. It is likely that access to technology will be even more important in areas where travel time to see a care provider in person is longer.
The Guidance Document describes the rationale for the new model, including that, currently, patients experience fragmented care, long wait times, and are required to provide the same information to each provider they see. Lack of communication or miscommunication is considered to be one of the most common patient complaints about the current system. The Ontario Health Team model, as envisioned, will be interconnected so that patients do not have to repeat their health history or take a test multiple times for different providers.
Readiness and Implementation
Self-Assessment and Application
The Guidance Document indicates that groups who have already partnered and can collectively demonstrate key capabilities will be identified for early implementation. The Guidance Document sets out readiness criteria for applicants (for both the self-assessment and formal application stage) which include:
- demonstrating that most partners in the proposed Ontario Health Team have the ability to digitally record and share information with one another (e.g. point-of-service systems are in place and provincial clinical viewers are used by most providers);
- demonstrating that at least some partners have the ability to adopt and provide digital options for decision support, operational insights, population health management and tracking/reporting key indicators;
- identifying a senior-level, single point of contact for digital health activities;
- identifying existing digital health gaps and confirming a commitment to develop a plan (with provincial support, if desired) to address them; and
- confirming a plan to share information across partners for the purposes of integrated care delivery, planning and quality improvement.
The Guidance Document also explains that the readiness criteria include a commitment to offer one or more virtual care services to patients such as email, secure messaging, phone and video visits and digital self-care supports. Applicants will also be expected to propose a plan to provide patients with some digital access to their health information. Providers who are invited to complete a full application will be provided with details on provincial policies and standards that an applicant's plans will be expected to meet.
Year One of Implementation
After the first year of implementation, Ontario Health Team Candidates are expected to meet the following criteria:
- have a harmonized information management plan in place;
- increase adoption of relevant digital health tools; and
- have plans in place to streamline and integrate point of service systems and use data to support patient care and population health management.
Implementation is expected to be consistent with provincial frameworks that will be shared prior to the beginning of the implementation process. The first year targets also include that 10-15% of patients who receive care will digitally access their health information.
Designated Ontario Health Teams
At maturity, Ontario Health Teams will use digital health solutions to support effective health care delivery, ongoing quality and performance improvements, and better patient experience.
The Guidance Document sets out expectations for what the digital health goals will look like when fully implemented. Ontario Health Teams at maturity will be expected to have the following capabilities:
- to adopt provincial tools and services and adhere to provincial standards;
- to efficiently and effectively communicate, and digitally and securely share information, among all providers in a system or network;
- to drive performance improvements through clinical and data standardization, advanced analytics and strong information management practices to enable population health management, quality improvement and outcomes measurement; and
- to provide patients with digital choices such as virtual care and full and timely digital access to patient health records that empower patients to manage their health.
The Ontario Health Team model is also intended to address bureaucratic and administrative hurdles that prevent providers from delivering coordinated care to their patients. A secure means to share necessary information among Ontario Health Team members is a priority.
Ontario Health Team Candidates and teams who are identified as "In Development" (meaning not yet in a position to become an Ontario Health Team Candidate) will receive priority access to provincial digital health services and tools, and change management support. Examples of these services and tools listed in the Guidance Document include provincial clinical viewers, ONE ID and provincial client and provider registries (each currently hosted by eHealth Ontario) and eConsult (currently hosted by the Ontario Telemedicine Network).
Policies and standards will be provided to Ontario Health Team Candidates and those "In Development" to guide their redesign of their digital health and information management practices, if required.
In order to deploy new electronic medical record and virtual care solutions as part of an Ontario Health Team, providers must consider a range of privacy issues arising out of the Personal Health Information Protection Act, 2004 ("PHIPA") as well health professional record-keeping requirements.
In particular, privacy law requirements (such as limitations on collection of, access to and disclosure of personal health information, security requirements, and breach notification) will apply to each member of the Ontario Health Team. This will require team members to develop policies and procedures to ensure both individual and collective compliance. In particular, for Ontario Health Teams that consist of multiple providers (i.e., separate health information custodians acting as a team), steps must be taken to ensure that the personal health information of patients is only disclosed among team members to the extent that they are involved in the patient's "circle of care" – i.e., the implied consent regime under PHIPA which permits certain health information custodians to assume an individual's implied consent to collect, use or disclose personal health information for the purpose of providing health care. This may require technological measures to segregate patient information in a shared electronic medical record system, and/or seeking the consent of patients to the retention of their information in such a system. It will also require such a system to be capable of responding to consent directives under PHIPA's lockbox regime, in which a patient can notify a health information custodian about access, use or disclosure limitations on his or her personal health information (which can include barring other providers from accessing or using that information).
The Guidance Document notes that proposed teams that consist of multiple providers may seek to be designated as a single health information custodian under PHIPA. This may mitigate some of the potential privacy law risks arising out of a shared electronic medical record platform. However, it does not obviate the need for common, integrated privacy and security policies and practices across all team members.
To the extent that existing legislation impedes providers from participating in the Ontario Health Team Model, the Guidance Document indicates that the Ministry will identify and consider the need for any reforms. Given this, and the above PHIPA considerations, we may see changes to Ontario's health privacy regime in the near future.
Finally, of note, the Guidance Document notes that research shows that successful models for integrated care contain an "integrated digital health ecosystem to manage patient health information and financial data". There is no further discussion of what financial data will be shared among members of Ontario Health Teams, but applicants will likely need to consider privacy laws more broadly if they are to become fully integrated.
Integration is the focus of the new Ontario Health Team model and has been addressed from various perspectives in our series of bulletins on Bill 74, from governance to employment to funding. The backbone of integration will be the ability to share information. Privacy law will apply, and should be a key focus, in all stages of implementation.