Ontario's eHealth Strategy and Implications in Primary Care: Does the Strategy Have the Necessary Components to Succeed?( file size: 1182k )
Murphy, F. A.
Teresa Rose, PhD
Ontario is spending 46% of its budget on health, a number that is expected to increase over the next two years (Ontario Ministry of Finance, 2010). Data shows that more Ontarians wait too long for cancer surgery, diagnostic scans, specialists, or for space in a long term care facility (Ontario Health Quality Council, 2009). Over 7% of adults in the province don’t have a family doctor; the average Emergency Room visit is 7.3 hours; Ontarians experience 217,000 adverse drug events annually; and $300,000 million in preventable hospital costs can be saved and reinvested in the health system by providing better preventative care for patients with diabetes (eHealth Ontario, 2009). One method of addressing these fiscal and health system pressures is to advance health information technology to support efficiency gains and improve the health of the citizens of Ontario.
In 2009 Ontario developed the eHealth strategy for the province, focusing on clinical and foundational priorities developed through engaging with Ontario’s stakeholders and learning from the efforts of other jurisdictions. One of the foundational priority projects identified is Physician eHealth, a program that provides primary care physician offices in Ontario with electronic medical record systems (EMRs), an element the strategy suggests is an absolute requirement for eHealth to have clinical impact. Ontario’s eHealth Strategy is very aligned with two other initiatives, OntarioMD’s EMR Adopter Program, established by Ministry of Health and Long Term Care through collaboration with Ontario Medical Association, and the province’s health strategy, which has a focus on primary care reform and chronic disease prevention and management.
Healthcare is a complex industry. Other industries such as banking and the airline industry have been able to use information technology to drive transformation, resulting in more efficient use of resources, cost-savings and increased revenues, often demonstrating increasing client satisfaction with products and services. Use of health information technology has been cited frequently as a way of improving health outcomes and generating efficiencies in health spending. And yet Canada and Ontario’s ability to harness information technology in support of health system improvements is lagging behind other countries. In a 2009 Commonwealth Fund Survey of primary care physicians in eleven countries, Canada came in last in the use of EMRs in primary care practice. Only 37% of Canadian physicians use an EMR (Schoen, Osborne, Doty, Squires, Peugh & Applebaum, 2009).
The author of this research paper asserts that implementing information technology in the Ontario healthcare environment is more likely to be successful if Ontario’s eHealth Strategy identifies and addresses the barriers and success factors encountered by others, and follows change management principles and practices found to be useful in previous transformation initiatives. This research is an in-depth literature review for evidence of success and failure in the implementation of health information technology, in healthcare generally and in primary care specifically. The review consists of a search of over 400 peer-reviewed journals, issue briefs, government documents, technical and research reports, and media reports, to determine what success factors and barriers to adoption are relevant to physicians and to primary care in the Ontario healthcare environment. The author compares common change success factors across a number of change management models, and determines which success factors, change management and adoption practices are evident in Ontario’s eHealth Strategy 2009-2012, using their presence as a predictor of success to the implementation of the strategy.
The results of the literature review and subsequent analysis of the strategy, in the context of Ontario’s primary care reform, suggest a number of steps have been taken to mitigate or eliminate barriers documented in comparable initiatives in other jurisdictions. Given the state of Ontario’s economy and the imminent provincial election, the strategy will be implemented in a highly complex and unstable environment. The author identifies some areas for improvement in the strategy, and suggests significant effort will be required to mitigate risks associated with the uncertainty in the environment. Evaluation of the key components of the strategy suggest that critical success factors have been incorporated and key principles of change management employed to engage the primary stakeholders. The eHealth strategy’s clinical priorities weave a compelling story that aligns with the province’s health strategies, and the sector’s most influential stakeholders have been engaged and will participate in a collaborative guiding coalition to drive the agenda. The author concludes that with a renewed focus on the deployment of Ontario’s eHealth Strategy, and with leadership in place, it is well positioned for success.