OHTs must address governance, privacy laws and funding

TORONTO – What are the main stumbling blocks as healthcare providers align themselves into Ontario Health Teams? A panel of CIOs commented on this question at the recent HIMSS Ontario conference, and they agreed the biggest hurdle isn’t the technology.

“We’re going to need a room full of lawyers,” asserted Mark Farrow, CIO at Hamilton Health Sciences. “That’s who I’m spending my time with now – lawyers and privacy specialists.”

Indeed, the technology needed to connect the various levels of healthcare providers – acute, complex, long-term, and home care – is all available, he said.

What’s more difficult is working out the governance agreements between the partner organizations, along with navigating the privacy regulations that may prevent the sharing of information.

As Rod Burns, CIO of the Alliance for Healthier Communities put it, “These are the elephants in the room. Governance, policy and privacy.”

Shafique Shamji, CIO of the Ottawa Hospital, had some insights on this score. His hospital has already partnered with five other organizations in the eastern Ontario region, to share an Epic health information system. The other medical centres are all much smaller, and include places in Barry’s Bay, Hawkesbury and Renfrew, Ontario.

“What do you do when someone wants something, and the others don’t want it,” asked Shamji. “Does the biggest partner get to dictate? Unless you have thought about this beforehand, it won’t work out.”

He observed, as well, that Ontario’s current privacy laws are an obstacle to the efficient sharing of patient data. “The legislation needs to change,” he said. “The current legislation is not conducive to the sharing of information.”

For his part, Burns added that the Alliance for Healthier Communities has some 80 agreements in place, holding members to service guarantees.

He said that alliances often start with enthusiasm, but then encounter rough patches – and that’s when the agreements are really needed.

“When the honeymoon is over, you better have that pre-nup in place,” he cautioned.

Dr. Sarah Muttitt, CIO at the Hospital for Sick Children, in Toronto, observed that her medical centre, too, faces some trials and tribulations in forging alliances.

It recently implemented an Epic information system, and partnered with the Children’s Hospital of Eastern Ontario, which has similar aims.

However, not all organizations are on the same wavelength, nor do they share a similar culture.

For one thing, SickKids is a very large organization, with world-leading research and clinical practices.

“As we bring partners together, there is often disparity. There may be some challenges, as different organizations’ financing models vary according to their size and scope.

“They often have a different culture, values and business models,” Dr. Muttitt asserted.

Another issue for SickKids: as an internationally renowned pediatric centre, 80 percent of its patients come from outside the Greater Toronto Area. For that reason, working only within a “local” health team doesn’t make sense. “We could be in every OHT that provides pediatric care,” she said.

Tara Coxon, CIO at St. Joseph’s Healthcare, Hamilton, mentioned that funding will also be a challenge, as Ontario Health Teams are expected to build ties and resources without any additional financing.

She added that the current privacy laws are also out of whack with reality. As an example, she pointed to the virtual visit system that St. Joseph’s recently rolled out, connecting surgeons with post-op patients at home.

In the project’s early days, when a surgeon wanted to Skype a patient at home, to check on him, he was reprimanded by colleagues who complained about the privacy implications and who worried that the flow of patient data might not be secure.

“But the patient said, you saved me a 45-minute trip to the hospital,” commented Coxon. St. Joseph’s has since implemented a secure video platform as part of the solution, but this initial experience shows the difference between the needs of patients and current regulatory practices.