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.

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.

Ontario Health Teams – Update on Timelines

The Ministry of Health and Long-Term Care has announced updated timelines for the process by which it will identify the first cohort of Ontario Health Teams. The Ministry has extended the time period for its review of submitted self-assessments. Rather than issuing invitations to submit full applications in early June, as previously expected, the Ministry now anticipates beginning to issue such invitations in early July. The deadline for submitting full applications is correspondingly extended until September of this year.

The Ministry update describing the revised timelines for Ontario Health Teams can be found at the following website: https://mailchi.mp/ontario/june-06-update?e=ca30a798b1.

Ontario Health Teams – Collaborative Models

The Ontario Ministry of Health and Long-Term Care is seeking applications from health care organizations to form Ontario Health Teams (OHTs). Successful applicants that meet the readiness requirements will be designated by the Minister as “integrated care delivery systems” under Section 29 of the Connecting Care Act (Bill 74). Designated OHTs will be prioritized for future investments and be eligible for performance-based financial incentives.

The vision is for every patient in Ontario to be served by an OHT that provides a continuum of coordinated care.

Every OHT needs to establish its own leadership, accountability and governance model. There is no prescribed right or wrong way to set up an OHT. The model you choose needs to work for your organizations. It needs to ensure that there is a mechanism to make collaborative decisions that will support the continuum of care envisioned by the MOHLTC. The model will likely evolve over time – in initial stages the participating organizations will likely want to maintain their autonomy while coordinating service delivery and decision-making. This model may evolve, as the organizations work together and better understand each other’s operations and services, to more integrated management and/or governance models.

We can help.

We have worked for years with health care organizations on many different types of collaborative models that span the spectrum from complete integration to complete autonomy with coordinated decision-making. These models include variations on the following:

  • collaborative governance models that facilitate shared boards or shared committees that implement joint decision-making and allow for coordinated financial and clinical oversight
  • alliance arrangements that allow separate boards or separate committees to work together to make joint decisions
  • arrangements that facilitate efficiency through sharing of scarce resources – those resources may include management resources, back-office services or IT services (including sharing of an electronic medical record)
  • complete integrations through merger or amalgamation.

We would be happy to work with you to review the options that are available, how they may evolve, and what solution would best suit your potential OHT. We can also help to ensure that whatever model you establish reflects best governance and oversight practices to manage the financial and quality risks (and opportunities) associated with collaborative service delivery.

We can also document your model in a formal legal agreement that will demonstrate your readiness to move forward as a designed OHT.

Please contact either Kathy O’Brien (kobrien@ddohealthlaw.com) or Michael Gleeson (mgleeson@ddohealthlaw.com) for a discussion about next steps.

Important Developments on Police Record Checks

Initially enacted by the Ontario government in 2015, the Police Record Checks Reform Act, 2015 (the “Act”) has finally been proclaimed by the Lieutenant Governor to come into force on November 1, 2018.  In addition to standardizing requests for police record checks, the Act extends privacy protections to the individuals who are the subjects of police record checks (“subject individuals”) by (i) implementing a consent regime, and (ii) prescribing what can and cannot be disclosed in respect of each type of police record check requested.

Impact on your Organization

If your organization requests police record checks as part of its recruitment efforts, whether in respect of employees, volunteers, or volunteer Board members, you will want to refresh your policies and procedures to ensure that they align with the requirements of the Act.  Contravention of the Act is an offence liable to a fine of up to $5000.

Application of the Act

The Act applies to a “police record check”, which is a search of the records maintained within a police database in Canada (e.g., Canadian Police Information Centre database) and required to be conducted by persons (including organizations) in respect of a subject individual for the purposes of:

  • Hiring the subject individual for employment.
  • Engaging the subject individual for volunteer work.
  • Admitting the subject individual to an educational institution, a program, or a membership body.
  • Receiving goods and services from the subject individual or providing them to the subject individual.

The Act will not apply to certain types of searches, such as those in connection with an application for a change of name, an application for custody of a child by a non-parent, certain searches requested by a children’s aid society, and certain others that are listed in the Act and one of its accompanying regulations (“Exempted Searches”).

For some Exempted Searches, the application of the Act is simply delayed for a year and will apply to those searches on November 1, 2019.  Examples of Exempted Searches for which the application of the Act is delayed is a search requested by the Crown in Right of Ontario for appointing certain public servants under Part III of the Public Service of Ontario Act, 2006, or for screening a provider of goods or services to be awarded a contract to provide goods or services to a ministry or government agency.

Types of Police Record Checks

The Act creates three types of police record checks, each disclosing only the information permitted to be disclosed in the Schedule to the Act.  The types of police record checks are set out below in order of the amount of information disclosed (greatest to least):

  1. Vulnerable Sector Check
  2. Criminal Record and Judicial Matters Check
  3. Criminal Record Check

While there is variation amongst the types of police record checks and the information that is permitted to be disclosed, the following is a list of information that is not permitted to be disclosed for any type of check:

  • Summary convictions, if the request is made more than 5 years after the date of the conviction.
  • Court orders made under the Mental Health Act, Part XX.1 of the Criminal Code (Canada), or those related to withdrawn charges.
  • Certain restraining orders made against the subject individual.
  • Convictions for which a pardon has been granted (subject to exceptions).

The Act also specifies when “non-conviction information” can be disclosed. Subject to certain exceptions under the Act, this is information related to the subject individual being charged with a criminal offence which was subsequently dismissed, stayed, withdrawn, or resulted in a stay of proceedings or acquittal.  Non-conviction information may only be disclosed pursuant to a Vulnerable Sector Check if certain criteria listed in the Act are met (e.g., the criminal charge is one listed in the regulations under the Act, the alleged victim was a child or a vulnerable person, and there is a pattern of behaviour or incidents indicating a risk of harm to a child or a vulnerable person). The subject individual has an opportunity to request a reconsideration of any disclosure of non-conviction information.

Procedure for Police Record Checks

In order to standardize the request for and conducting of police record checks, the Act establishes the following procedures:

  • A written request for a police record check may be made by the subject individual or by a person or organization in respect of the subject individual.
  • The written request for a police record check must:
    • Specify the type of police record check being requested.
    • Include the written consent of the subject individual (such consent must be in respect of the particular check being requested).
    • Include any applicable fee.
  • The results of the police record check must first be disclosed to the subject individual, and to no other person.
  • If, after receiving the results, the subject individual provides written consent, the results may be provided to the person or organization that requested the police record check or other person or organization specified by the subject individual.
  • The individual or person that receives the results of a police record check on the consent of the subject individual shall not use or disclose the results except for the purposes for which it was requested or as authorized by law.

If you need assistance in updating your policies and procedures, contact me @ mdeiana@ddohealthlaw.com.

ONCA Update

The Ontario Legislature passed Bill 154, the Cutting Unnecessary Red Tape Act, 2017, on November 14th. Bill 154 effected changes to non-profit corporate legislation in Ontario.

The Government has announced that it is working to bring Ontario’s Not-for-profit Corporations Act, 2010 (ONCA) into force and effect by early 2020. This aligns with the long-promised 2 years’ notice that the Government would give to the non-profit sector to allow the sector to prepare for ONCA’s arrival. Even once ONCA is proclaimed, non-profit corporations (now governed by the Corporations Act) will have 3 years to transition under the long-anticipated ONCA regime.

Bill 154 also made changes to the Corporations Act – some of which are beneficial to non-profits in Ontario and can be taken advantage of now, particularly related to relaxing the rules around the conduct of members’ meetings.

Bill 154’s changes to ONCA have no immediate impact. Boards are encouraged to keep ONCA on their radar – but no immediate steps are required. Keep posted.