Tag Archives: Breakfast with the Chiefs

The end of efficiency – will appropriate care become the new system of rationing hospital services?

Former OHA President Tom Closson speaking at Longwood's Breakfast With The Chiefs June 10.

Former OHA President Tom Closson speaking at Longwood’s Breakfast With The Chiefs June 10.

The relentless pursuit of efficiency may be coming to an end for Ontario hospitals.

Thank goodness.

As former OHA chief Tom Closson said today at Longwood’s Breakfast With The Chiefs forum, year after year it gets more difficult for hospital CEOs to balance their budgets — “you can’t cut the same thing as you cut last year.”

This hardly means that hospitals are about to enter a new era of sustainable funding, especially in Ontario where public health care spending is already the lowest per capita of any Canadian province. Closson says Ontario hospitals also have the lowest worked hours per weighted case, the shortest length of stay in acute care, and the fewest beds per capita.

Have we found bottom yet?

Closson says we still have to reduce costs “because we have to.” Instead of seeking more efficiency, a new approach is needed.

Closson was joined by the Hay Group’s Mark Hundert and Chris Helyar to preach the new orthodoxy of appropriateness and to suggest that the HBAM (Hospital Based Allocation Model) of funding needs fixing.

Continue reading

Tommy Douglas never said health care would be free — advisor to Premier

Roger Martin at Breakfast With The Chiefs

Roger Martin advocates government treat worker health plans as a taxable benefit.

Is Roger Martin having us on?

This morning the publicly funded Institute for Competitiveness & Prosperity released a working paper on policy opportunities for Ontario’s health care system during Longwood’s Breakfast With The Chiefs speaker series.

Roger Martin, the former Dean of the University of Toronto’s Rotman School of Management, was breezy in his presentation of the paper’s eight big ideas.

Some of it is the predictable low-hanging fruit, such as the need to get on with electronic medical records, reforming primary care delivery and focusing on end-of-life care (which accounts for one-third to one-half of a person’s lifetime health expenditures).

More alarming, three of the recommendations are essentially a manifesto for shifting the cost of health care away from the collective to the individual, and especially to low-income Ontarians.

In the brief question period after Martin’s presentation, his argument for co-payment on health care costs failed to get much attention despite being the most radical. Perhaps the audience felt it so far-fetched it was unlikely to get any traction from government despite coming from an advisor to the Premier.

Continue reading

More than a third of Canadian physicians still without EMRs

Dr. Jennifer Zelmer, Executive VP at Canada Health Infoway, speaking January 22 in Toronto.

Dr. Jennifer Zelmer, Executive VP at Canada Health Infoway, speaking January 23 in Toronto.

When a drug recall takes place, does your family doctor have the ability to identify which patients are on that drug and notify them in a timely manner?

For more than a third of Canadian doctors that may be very difficult.

Canadian doctors have been slow to adopt electronic medical records (EMRs) and even slower to interact with patients in a virtual environment. Very few Canadians can simply e-mail their doctor or book an appointment on-line.

Speaking at Longwood’s Breakfast with the Chiefs forum this morning, Dr. Jennifer Zelmer, executive vice-president with Canada Health Infoway, points out that if patients were able to renew their prescriptions on-line, view their own test results, and consult virtually with physicians when they wanted, it would lead to 47 million fewer in-person visits and require us to take 18.8 million hours less off work to show up in the doctor’s office.

At present only 64 per cent of Canadian physicians are reporting EMR use – albeit that is up from 16 per cent in 2004. That means it’s taken nearly a decade to persuade an additional 48 per cent of physicians to get on board. Do we really have the patience to wait another decade for the rest to follow?

Continue reading

Guidelines for media reporting of suicide need reconsideration – Picard, Goldbloom

David Goldbloom and Andre Picard speak about media guidelines for suicide coverage.

Dr. David Goldbloom and Andre Picard speak about media guidelines for suicide coverage as part of a December 12th Longwood’s Forum.

If the audience was expecting a debate, they may have left disappointed.

Globe and Mail reporter Andre Picard and Dr. David Goldbloom, Chair of the Mental Health Commission of Canada, spoke about the media’s portrayal of mental health during a Longwood’s Breakfast with the Chiefs forum December 12.

While billed as being about mental health, much of the discussion centered around whether media reporting of suicide prompts copycat actions.

The issue is particularly timely given the Vancouver School Board has challenged the media in its reporting on the death of Amanda Todd, the teen who took her life after experiencing on-line bullying. The Board has suggested the media follow guidelines established by the Canadian Psychiatric Association for reporting on suicide.

Picard challenged the science used by the CPA to establish the guidelines and suggested that the “hush hush” attitude towards suicide actually created more stigma.

Continue reading

Privacy breaches can cost $214 per record — Cavoukian

The audience laughed when Ontario Information and Privacy Commissioner Ann Cavoukian said she got called on a weekend over a major privacy breach. “I don’t know how they got my home number,” she said teasing.

Cavoukian rushed downtown to Toronto’s Wellington Street to find thousands of patient health records strewn around as part of a set for a mini-series on 9/11. The production company had asked a recycling company to provide some paper for the scene. That they did.

Upon investigation, Cavoukian found that the health care provider had made an error, sending the documents to recycling instead of shredding.

After her story she said it was the CBC who tipped her off and that she had voluntarily given her number to the reporter. No breach after all.

The story was one of many as Cavoukian spoke October 25 at the Longwood’s Breakfast with the Chiefs forum at the University of Toronto.

Cavoukian says that you can avoid privacy by disaster by following privacy by design – by building systems intentionally with security in mind.

Continue reading

Will new health care technology bring a utopia or dystopia?

It’s easy to get carried away with the continual promise of better health care through technology. From the IBM Watson super computer to vending machines that dispense pharmaceuticals, we are likely on the cusp of a new wave of technology that will vastly change the way we deliver health care. Whether that is for better or worse is up for debate.

The public largely buys into the dream of transformation through technology. Even with all the questions raised about problems with electronic health records, for example, surveys still show substantial public support. Are we even aware of what the trade-offs are?

Richard Alvarez, President and CEO of Canada Health Infoway, told an audience this morning that the next big thing will be personal health monitors, easily accessible devices that can be picked up at department stores like Walmart.

Speaking at Longwood’s Breakfast with the Chiefs alongside Dr. Jennifer Zelmer, vice-president of clinical adoption and innovation at Canada Health Infoway, the two argued that technology can be a case of the good, the bad and the ugly. Not surprisingly given the speakers, the presentation got specific on the good and much more vague on the bad and the ugly.

Canada Health Infoway is an independent not-for-profit corporation created by Canada’s First Ministers in 2001, and funded by the Government of Canada. CHI has a mandate to work with governments, health care stakeholders and the technology industry to “improve access to health information for better care.”

After enthusing about personal health monitors, Alvarez pondered who would pay for these items, harkening back to a quote they began the session with from futurist William Gibson – “the future is already here, it’s just not very evenly distributed.” What role does government play in levelling that playing field?

Richard Alvarez, President and CEO of Canada Health Infoway

Richard Alvarez, President and CEO of Canada Health Infoway

The speakers highlighted the ability of technology to make health care more accessible to remote communities, especially ones that face difficulties recruiting specialists. Zelmer specifically made the claim that Telehealth saves Canadian patients from driving 47 million kilometres at an estimated cost of $55 million. The opportunities are certainly much broader. Alvarez said with digital scanning it was possible for pathologists to work out of a single center in Canada. It was interesting that none of the audience members picked up on the implications of this – if it could all be done out of a single center, what’s to say that this center even had to be in Canada? That should be enough to make any pathologist nervous.

Continue reading

Technology: Will docs battle Watson for your diagnosis?

Healthcare has always experienced a love-hate relationship with technology.

New technologies have certainly both contributed to costs and reduced costs.

There has been considerable literature on how expensive new technologies become unnecessarily overused, and as the recent showdown with Ontario doctors demonstrates, can also be a catalyst for savings when procedures take less time and resources.

Can new technologies replace doctors altogether?

IBM’s Dr. Martin Cohn says no, although looking at the company’s healthcare applications for Watson, what is sometimes referred to as “IBM’s artificial intelligence computer,” it is not hard to see it becoming a major part of any doctor’s diagnostic process.

Continue reading