Commentary on the Supreme Court of Canada’s Decision in Cuthbertson and Rubenfeld v. Rasouli

Commentary on the Supreme Court of Canada’s Decision in Cuthbertson and Rubenfeld v. Rasouli
On Wednesday January 22, 2014, the Ontario Hospital Association (OHA), hosted the Health Links
Conference, bringing together stakeholders from across the healthcare spectrum: the Ministry of
Health and Long-Term Care (MOHLTC), hospitals, the Ontario Medical Association (OMA), local
health integration networks (LHINs), primary care providers, Health Quality Ontario (HQO),
community care access centres (CCACs) and community agencies among others. The conference
was an opportunity to share the implementation challenges and lessons learned from different
Health Links, and to provide attendees with advice, tools and tactics for success going forward.
Launched in December 2012, Health Links are a model of providing better-integrated services to
high-needs patients.  A Health Link is a voluntary partnership that may include a hospital as well as
community support agencies, primary care, home care, and long-term care providers – usually with
an identified lead organization. To date, 47 Health Links have been established across the province
with at least one Health Link in every LHIN. The goal is to have 98 Health Links in place by 2015.
Health Links focus on providing customized and coordinated care to the 1%-5% of the health system’s
so-called high-cost/high-needs users. According to Helen Angus, Deputy Minister of Health, these are
patients with complex conditions who rely heavily on the emergency room (instead of services available
in the community); are more frequently readmitted to hospital; and have trouble navigating the system.
From a system costs perspective, this small percentage of patients account for at least 74% of the
MOHLTC/LHIN operating budget.
Health Link implementation challenges
Privacy: One of the key themes at the conference was the issue of privacy and the sharing of patient
information with partners within the Health Links. In many cases, privacy was seen to be a real barrier
to implementing the coordinated care model. Ontario has very clear rules about when and to whom a
patient’s personal health information can be shared – limiting disclosure without consent to those
within the patient’s circle of care. We understand that the MOHLTC has reconvened its provincial-level
privacy forum to address privacy issues and provide guidance on best practices.
Access to Health Links programs in rural communities: The ability for patients, especially isolated seniors
in rural communities, to access services was another major challenge faced by many Health Links. These
Health Links were attempting to develop strategies to ensure that their resources and programs could be
utilized as intended.
Tool Templates: With coordinated care at the heart of the Health Link mandate, many participants were
eager to access tools that would allow them to capture information and provide real-time data to Health
Link partners. With respect to maximizing the value of patient case conferences and creating a repository
for patient information, we understand that a provincial coordinated care plan template is being developed
though there is no word on when it will be released.
The impact of Health Links
Health Links have been around for fewer than 2 years. Anecdotally, and primarily from the patient
experience perspective, the model has been a success. However, there is a recognized need for real
metrics to assess whether the model is working. A long-term evaluative framework and metrics are being
developed that will put numbers to the ultimate value that Health Links have brought to the system.
As a final point, Health Links, with its need for real time data on patients, may be one of the strongest
levers to date for the accelerated creation of the provincial electronic health record.
Click here for more information about Health Links.