What is Virtual Care?

Virtual care, or telemedicine, is the use of communications technology to provide clinical patient care, or to assist in the provision of such care, at a distance. It includes communications technologies such as telephones (land lines and mobile devices), electronic mail, text messaging, video-conferencing, audio-conferencing, remote monitoring, internet-based tools and telerobotics. The June 2019 Devlin Report on Ending Hallway Medicine referred to several of the Ontario Telemedicine Network programs as innovative successes that could be built upon in the pending digitization and realignment of Ontario’s health care system.[1]

 

The Ontario Telemedicine Network website[2] provides or links to many different types of virtual care, which can be broken down into 3 basic types:

  1. eCare: applications or devices used to monitor patients, or to allow patients to self-monitor; such applications or devices may be sourced via innovative procurement together with the MOHLTC and the LHINs
  2. eVisit: real time video visits with patients, usually initiated by the health care provider
  3. eConsult: secure electronic consultations between health care providers about a specific patient

 

Virtual care services require registration by the physician to use OTN infrastructure.  Other infrastructure may be used if approved by OTN. The following chart identifies different types of virtual care solutions, most of which are provided by OTN or available through the OTN website.

[1] Premier’s Council on Improving Healthcare and Ending Hallway Medicine, A Healthy Ontario: Building a Sustainable Health Care System, June 2019, available at https://files.ontario.ca/moh-healthy-ontario-building-sustainable-health-care-en-2019-06-25.pdf, pages 20-21.

[2][2] https://otn.ca/


How DDO Can Assist Your Ontario Health Team

In the Second Report from the Premier’s Council on Improving Healthcare and Ending Hallway Medicine, the Premier’s Council offered 10 recommendations on how Ontario might achieve a healthcare system that is modern, sustainable, integrated and centred on the patient. It will be incumbent on Ontario Health Teams (“OHTs”), as the primary providers of front line health care services, to be examples of how the Council’s recommendations can be put into practice.

Our Experience & Expertise

DDO Health Law has the experience and expertise to help OHTs implement many of these recommendations in practical, effective and cost efficient ways.The

The Premier’s Council Recommendations

1. Integration

Recommendations 1-3 are focused on creating a healthcare system that is integrated around patients and across providers. The system should provide (i) more accessible and effective information to patients, families and caregivers and (ii) health services providers that can guide patients through a full continuum of health care services.

DDO can assist OHTs with:

Accessible and Effective Information

  • Obtaining patient consent
  • Disclosure of information to family and caregivers
  • Sharing of information across health care providers
  • How patient information may be made available for research purposes
  • Policies and procedures related to consent and handling of personal health information
  • Template documents for obtaining consent and for protecting and sharing information
  • Training staff on consent and privacy requirements 

Integration of Health Service Providers

  • Collaborative governance mechanisms, e.g. multi-organization steering committees
  • Moving towards long-term integration, e.g., shared committees, boards or full-on merger/amalgamation
  • Contractual arrangements for shared services and collaborative initiatives
  • Sharing of electronic health records between health services providers

2. Innovation

Recommendations 4 and 5 are attempts to modernize the healthcare system to better use current technology and to expand on the pathways by which healthcare has traditionally been provided.

DDO can assist OHTs with:

  • Providing virtual health care in accordance with applicable laws
  • Creating inter-professional care teams
  • Seeking required approvals for the provision of home and community care services
  • Providing home and community care services in accordance with applicable laws (including privacy and consent requirements)
  • Purchase and use of innovative software and equipment for patient care

3. Efficiency and Alignment

Recommendations 6-8 propose means of creating a healthcare system that: (i) strategically collects and uses data in a manner that will improve health outcomes and (ii) coordinates services to allow for increased value for taxpayer dollars.

DDO can assist OHTs with:

  • Sharing data and electronic health records
  • Using data for research and quality improvement purposes
  • Methods of collaborative governance
  • Co-location options
  • Sharing of management and front-line staff
  • Integration of administrative and procurement services
  • Integrating health services through services agreements and inter-professional care teams
  • Electronic referral processes

4. Capacity

Recommendations 9 and 10 consider how short- and long-term capacity issues might be better addressed by maximizing assets and skills that are currently available. The recommendations propose that collaborative leadership and integrated care are keys to maximizing the benefits of available assets.

DDO can assist OHTs with:

  • Shared governance models
  • Inter-professional care models
  • Data sharing
  • The procurement and use of innovative tools that allow for integrated care

For more information, please contact mgleeson@ddohealthlaw.com.

DDO Health Law Update

July 19, 2019: A weekly scan of new legislation and regulations important to the Ontario health sector, as well as articles of interest.

 

Bills

 

The Ontario Legislature has adjourned until October 28, 2019.

 

Proposed and Approved Regulations

 

No new and approved regulations of interest.

 

Ontario Newsroom

Ontario Investing in New Program to Support Seniors’ Mental Health

Ontario opening more transitional care beds in the GTA

 

Articles of Interest

 

Ontario Health Teams

Orillia group chosen to establish new Ontario Health Team

Hamilton and Burlington health providers apply to be first in Ontario to reinvent care

 

Cannabis

Retail cannabis company wants to see store open in Kitchener

Cannabis sales jumped $11M in May as more stores open

Who’s really behind Toronto’s chain of illegal pot shops that won’t quit?

 

Health Care

Ontario hospital visits related to sexual assault much higher than previously thought: study

4 in 10 deaths avoidable in northern Ontario First Nation communities: report

 How one Ontario town is luring young doctors – and keeping them there

 

Privacy

Is privacy dead?

‘Just walk away from it’: The scary things companies like FaceApp can do with your data

 

Physicians

Nearly 53, 000 sexual assault cases treated by Ontario doctors over 15 years: study

 

AI

Former Vector Institute VP Darin Graham to lead LG’s Toronto AI Lab

 

Things to do this Weekend

35 things to do in Toronto this weekend

Update on Ontario Health Teams: The Self-Assessment Process is Complete

On July 18, 2019, Ontario’s Minister of Health and Long-Term Care hosted an audio webinar to announce that the Ministry has completed its review of the first phase of self-assessments to become Ontario Health Teams. Before the end of July, the Ministry expects to make public the list of applicants that have been identified as ready to proceed to the Full Application portion of the approval process.

During the webinar, the Ministry announced that 31 applicants will be invited to submit Full Applications. Full Applications are to be submitted for review in October of this year. The Ministry will soon make available online materials that will describe the processes and requirements for completion of a Full Application.

The Ministry hopes to provide final approval for the first wave of Ontario Health Teams before the end of the calendar year.

Ontario Health Teams and Governance

Where are we in the OHT application process?

With the deadline to submit self-assessments now passed, the next phase in the Ontario Health Team (OHT) process is the selection by the Ministry of Health (Ministry) of groups of healthcare providers and organizations to submit full OHT applications.

Per the Ministry’s website, invitations to submit full OHT applications are expected to occur early July (extended from early June), with a subsequent deadline to submit the full application in September 2019.  The Ministry has said in its Guidance Materials that the full OHT application form will be provided to those groups selected for this next stage of the OHT process.

If invited to move forward to the full application stage, the organizations and providers (who will form the OHT) will be expected to demonstrate their ability to meet the readiness criteria identified by the Ministry in the Guidance Materials. One criterion is a commitment amongst the group of organizations and providers to formalize relationships for the proposed OHT’s structure and governance model. The Ministry has indicated in the Guidance Materials that:

providers that form Ontario Health Teams will be free to determine the governance model that works best for them, their patients, and their communities. Regardless of what governance model an Ontario Health Team adopts, it must be conducive to coordinated care delivery for patients, support achievement of performance targets, and enable the achievement of accountability objectives.

Governance is critical

The Ministry has also indicated that, at maturity, OHTs will receive an integrated funding envelope, and OHTs will be expected, as part of their governance structure, to demonstrate their ability to manage and oversee the integrated funding envelope. It will therefore be a critical exercise for the organizations and providers forming the OHT to determine how the OHT will be governed, as this governance model will have an impact on the distribution of the funding envelope amongst the members of the OHT.

FHT Boards need to consider …

For smaller organizations such as FHTs, it will be imperative that their Boards of Directors fully understand the implications of joining an OHT from a governance perspective. For example, FHT Boards should consider the following questions:

  • Will one member of the OHT become a leader or designated paymaster for the integrated funding envelope? If so, how will this leader/paymaster be determined (e.g., will the choice be dictated by size and influence of the member organization?)
  • How will a unified governance structure for the OHT impact the FHT’s ability to self-govern? For example, certain structures such as amalgamations and shared boards would remove the ability of the FHT to self-govern entirely.
  • How will FHTs ensure that they are adequately represented in the governance structure selected for the OHT? The healthcare organizations and providers expected to form the OHTs will likely differ in size, the type of care provided, and patients cared for. It will be important for these organizations and providers to maintain their voice within the greater OHT structure.

Setting priorities

Before FHTs go down the path of submitting a full OHT application package and deciding (along with other members of the OHT) on a structure and governance model for the OHT, it is a worthwhile exercise for FHT Boards of Directors to:

  • identify priorities for the FHT
  • come to the OHT table with a plan to ensure that these priorities will not be lost or overshadowed in the greater OHT structure.

How we can help

DDO has provided advice to many FHT Boards of Directors on governance and can assist Boards in understanding how different structures and governance models will impact their ability to lead and govern the FHT once it is a part of the OHT.

For more information, please contact mdeiana@ddohealthlaw.com.

DDO Health Law Update

July 12, 2019: A weekly scan of new legislation and regulations important to the Ontario health sector, as well as articles of interest.

 

Bills

 

The Ontario Legislature has adjourned until October 28, 2019.

 

Proposed and Approved Regulations

 

No new and approved regulations of interest.

 

Ontario Newsroom

Ontario Expanding Midwifery Services

Electronic Press Kit Now Available: Ontario Expanding Midwifery Services

 

Articles of Interest

 

Cannabis

Ontario’s slow rollout of weed stores could help the black market thrive for longer

 

Health Care

About 150 Baycrest hospital workers let go after audit finds misuse in employment benefits

Ontario government wants to expand midwives’ ability to prescribe medications

 

Physicians

Search the Star’s database of Ontario’s top-billing doctors

Alliston doctors no longer practicing after probe into opioid prescribing

 

Things to do this Weekend

Meet the new Raptors trying to fill the Kawhi-shaped hole in Toronto’s heart

25 things to do in Toronto this weekend

Summerlicious – July 5 – 21