My 100-year-old, complex patient is forgetful, has a hard time seeing and has paper-thin skin. She bumped her shin, tore her skin and got a wound infection. I scheduled a house call and put her on antibiotics, but I also wanted home care to provide services to care for her wound because she herself could not. I filled out the forms, faxed them in and assumed home care would step in as usual. I found out from the patient two weeks later that nobody came. By then, the patient, a stoic and lovely woman, had recovered with the help of family and friends.
This is what lack of integration looks like — lack of coordination and communication between the different parts of the health-care system become cracks in the system. And patients fall through those cracks. Don't get me wrong; this does not happen all the time, but it does happen more than it used to.
On January 31, the Premier's Council on Improving Health Care and Ending Hallway Medicine released its first report. It painted a picture of a health-care system that was in pieces.
One where patients wait for days for home care after they go home from the hospital, or months for a nursing home when they're no longer independent. One where patients serve as messengers between doctors, hospitals and pharmacies. One where the system itself is so siloed that information sharing is difficult and services don't coordinate.
I want to work in a health-care system that provides the right care for the right person, right when they need it.
There's more to the report, but what struck me was the emphasis on integration.
With a properly integrated system, when someone falls ill, all the necessary pieces come together in a continuum of care to help the patient and their family. It is seamless. Effortless.
What we have now is a series of one-offs with different frontline providers and long waits in between.
It's not that we aren't all working hard. I see doctors, nurses and allied health working so hard they're buckling under the workload. A recent study by the Canadian Medical Association showed that nearly one in three physicians is, frankly, burned out. And it's no wonder — we work in a system where, no matter the individual expertise, patients suffer unacceptable waits, delays and shortages.
So many pieces of the health-care system are missing or deficient that it makes it harder to provide the kind of care we want to provide. And that creates burnout in providers, caregivers and patients.
It's not just a matter of more funding and more services.
What we also need is a system that works smarter. At the end of the day, I want to work in a health-care system that provides the right care for the right person, right when they need it — not six days or six months down the line.
We must get this right. For that, we need doctors helping to make the decisions that matter at each turn. We know from health system reform efforts from around the world that the ones that succeed involve physician leadership from street-level to CEO — whether it's in primary care or in integrated care delivery systems.
The Premier's Council is charged with finding answers. This report is the first step of many.
It all starts with communication.
The report committed to expanding and integrating digital health networks. Doctors like me invest a lot of time and money in digital medical records to manage patient information. Some doctors are even able to hold virtual visits to improve access for people who live in rural, northern or under-serviced communities. But we're not yet at the point where everyone can do that. We're not even at the point where computer systems in one office, hospital or care setting can talk to another. So patients serve as messengers between providers in different care settings.
In an integrated care system, my office computer could communicate with the specialist's computer in a hospital, the nurse's computer in home care or the pharmacist's computer in a pharmacy. There would even be a portal where my patient and I could talk in a virtual visit. In an integrated care system, all of the services my patients need would be coordinated so that they work together.
Primary care, hospital, home care, nursing homes and outpatient care — all of it would fit like pieces of a puzzle without any holes in between. My patient would not fall through the cracks, because the necessary services would be there when needed. And it all starts with communication.
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There are pilot projects like this one in Ontario. The problem is that they're needed everywhere.
That's why the health system reform ideas drawn up in Queen's Park should be flexible enough to adapt to the local needs of any community — whether it's in Toronto's east end or in Kirkland Lake. That's why the input of frontline physicians through the Ontario Medical Association will be critical.
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