Moving through health-care transformation

Our health-care system is evolving to keep up with technological innovation and evolving patient needs. Behind this transformation, today’s physicians are adapting, balancing the rise in medical information, increased administrative demands, elevated patient expectations and increasingly complex care requirements. In this podcast, Dr. Veronica Legnini, a family physician in Kingston and chair of the Ontario Medical Association’s general assembly, discusses these trends, while outlining the priorities and challenges that need to be addressed in Ontario’s healthcare structure, including better resource management and fully integrated information systems. 

Transcript

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Georgia Balogiannis: In this podcast the Ontario Medical Association looks at current issues of interest in health care. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us. I'm Georgia Balogiannis for the Ontario Medical Association.  

Ontario's healthcare system is evolving to meet the changing needs of its patients. In this episode, Dr. Veronica Legnini, a family physician in Kingston and chair of the Ontario Medical Association's General Assembly, looks at the priorities and challenges of the province’s healthcare structure. 

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Dr. Veronica Legnini: From the physician perspective, you'll see that there's been an absolute explosion of medical knowledge. I'm fortunate enough, my mother was a family doc in Kingston and now I'm a family doc in Kingston — I actually have some of her patients. So, the complexity of the medical knowledge, I think, not just in primary care are expected to tackle, absolutely exploded over the last generation. We're expected to deal with a lot more information and there's also a ton more options for patients. So, you used to have a rather select menu of options for dealing with your hypertension, and the medication options as well as other types of interventions have really exploded. So, people have a lot more complicated problems, there's a lot more we know about it, there’s a lot more we can do about it; this all takes more resources.  

So, that would be, I think, the first thing of why we're seeing the system as we know it is not quite keeping up. 

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Dr. Legnini: I would say that the expectations of both physicians and patients have changed. We do have these digital silos that we all talk about. We don't actually have that easy information flow back and forth, and a lot of times there's legitimate privacy concerns. But all of these startups popped up all over the place. Everybody in different areas of Ontario are using different systems — it is very difficult to integrate. 

I do think the expectations of patients around what is medically possible, and how easy it is to achieve, has really also shifted. I'll get an emergency consultation from one hospital, and I'll only get imaging from another hospital or I'll only get lab work. And, sometimes the lab work will be pushed to me through my computer system, and other times, if I know it's there, I can go find it. But I think patients have skewed expectations of what I can actually access and how easily it comes to me and I can integrate it into their — our system here. 

Every single place requires a different requisition, different format, different information, and it is exhausting. I think the only thing that has outpaced medical information and medical treatment options over the last 20 years is probably the absolute explosion in administration for physicians. And I think that hurts patients, and I think it really is a major contributor to physician burnout. 

I've heard numbers anywhere from for every hour spent with direct patient care, you'll do either half an hour up to two hours administrative work, which is just mind boggling. 

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Dr. Legnini: The lack of information integration affects patients and physicians equally. What causes delays in patient flow? So, for instance, the wait times to get your knee or your hip replaced, wait times for hospitalized patients to be able to find a long-term care bed — what are the blockages? I know right now, patients who can't get their hip or knee replaced, there's like repeated, repeated visits to primary care providers. We're trying to fill the gap there. And it's no one's fault. Technology is ubiquitous and have to involve technology in any solution that actually addresses the problem. And I think there are some real challenges. 

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Dr. Legnini: We've already touched on the need for information integration. And really, you can't just take a pile of paper and throw it at somebody. Putting the information in my chart in the right spot will go a long ways to decreasing the administrative burden. 

The integration of physicians and allied health care providers, I also think, is absolutely critical. And we're seeing a real push for team-based health care, so physicians working side by side with nurses, nurse practitioners, physiotherapists, social workers, but the physician really taking on a leadership role in those teams I think is very important because, if you just throw more people at the problem, and they're not working together properly with the proper information flow, I think you're actually going to end up with duplication of efforts in a lot of areas and also some problems that you might otherwise have avoided. 

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Dr. Legnini: Now that we've seen the absolute explosion of virtual care, I think it's a double-edged sword. I think you'll see lots of physicians use it appropriately, and I think a lot of times, despite physicians’ best efforts, best intentions, sometimes you're not getting the quality of care that you should, of phone or video. 

I think patients now expect that things can be dealt with virtually. A lot of the messaging earlier in the pandemic was, you know, call first, don't expect to come in person, only come in if absolutely necessary. I think we're now seeing a bit of fallout from that, so things that were delayed that shouldn't have been. If you come into my office for your blood pressure check, I would have seen that spot growing on your skin, hopefully, or given you your test— tetanus booster that you missed. And it's really difficult to quantify those things. 

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Dr. Legnini: As far as system changes, with the exception of opening up virtual care, which was a real, real game changer, I don't feel like I've seen a ton in the way of system changes. I'm hopeful that— that there's some real fundamental change brought forward by the Ontario Health Teams; I haven't seen it yet. And I think physicians really need to show system-wide leadership with respect to healthcare transformation. 

So, it is incumbent upon physicians to educate themselves and others about what we need to see in a well-performing system. And really, what are the drivers for good health? 

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Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. To learn more about the Ontario Medical Association, please visit oma.org. 

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