Minister Eric Hoskins’ Bill 41 continues to be confounding for many physicians, but possibly the most consistent question I am hearing is: Why do we need another layer of bureaucracy? How will sub-LHINs improve the system? One very intriguing twitter answer that I received suggested that this extra bureaucratic layer will serve as “administrative infrastructure” for primary care. That is something worth considering since I agree that Family Doctors need much more support than they are currently receiving.
Before I move directly into the discussion, I want to stress that I am not including those primary care providers who are not physicians in this consideration. The reason is that I want to focus on the infrastructure resources needed to deliver primary care and the Nurse Practitioner- led clinics are tremendously well-resourced, with all expenses already covered by the government, a luxury that physicians cannot access to the same degree which is the point here. https://www.aohc.org/nurse-practitioner-led-clinics
Remembering that the point of Bill 41 is better integration within the health care system, one of the tools that can best assist with this is the Electronic Medical Record (EMR). At its best, the EMR can facilitate a patient’s health information being updated quickly, accurately and efficiently, hopefully from every care provider and facility generating information. This, unfortunately, is not at all the case with most EMRs in Ontario. For example, wouldn’t it make sense that anytime a patient has lab tests completed anywhere in the province that the results of these tests would be immediately sent to the records in each of their doctors’ offices? Wouldn’t you expect that discharge summaries, consultation reports, and other documents related to a patient’s hospitalization would automatically be sent to their family physician? Wouldn’t it be great if, no matter where you were, a doctor looking after you could access your health record with your permission from anywhere? Well, that is certainly the vision but it is not at all the reality for most patients in Ontario. As a practicing physician with the best Electronic Medical Record that my underfunded hospital can afford, my patients do not have access to any of the above elements of an EMR. The electronic medical record is administrative infrastructure that can facilitate improved integration for patients in Ontario today and the funding for this important tool has been cut by the Government. Doctors are now expected to fund all improvements to the functionality of the EMRs in their offices.
How will another layer of bureaucracy solve the problem of insufficient funding for electronic medical records?
Let’s think of other administrative resources that could improve integration of primary care in Ontario. Many patients may suddenly need housing and financial supports after falling ill and become unable to work. Social workers might be able to assist them in navigating Ontario’s complicated social welfare system, or Canada’s employment insurance supports. But no social workers are being funded for patients.
The Community Care Access Centres are being transferred to the Local Health Integration Networks (LHINs) in Bill 41. The CCACs provided services while the LHINs provide administration. It is not yet clear how the services are to be developed. What is even more worrying is that the Registered Nurses Association of Ontario (RNAO) is concerned that nursing jobs will be lost with the transition. I would like to be assured that nursing is not being replaced with administration – what Family Health Group, or Family Health Organization or Family Health Team would not benefit from more nursing support?
These are just three examples of support services that would help primary care physicians better integrate patients’ care within the larger system of health care in Ontario. The last support, nursing care, cannot be seen as “administrative infrastructure” in the same way as EMRs and Social Work are, but they are a resource that would be a great benefit to patient care.
These are the kind of practical resources that would help family physicians in Ontario feel confident that the Government of Ontario understood their day to day struggles integrating their patients’ care. If the Government of Ontario had asked doctors what would help, these are the kind of answers they would have gotten, I believe. I still have not heard any doctor say that more administration was the answer.