health + tech in law = mixing chalk + cheese
On February 26, 2019, the Ontario government introduced Bill 74, The People’s Health Care Act, 2019, which would make drastic changes to the health care system. Schedule 1 of the Bill, The Connecting Care Act, 2019, (the “CCA”) provides most of the substance to the Bill.
In the Minister’s announcement for the Bill, the intent is to address the fragmentation and gaps in care. As a solution, the Bill contains multiple pieces (some of them controversial), but today I’ll be concentrating on the digital health aspects. Digital health seems to be an important part of the new healthcare system, but let’s take a closer look.
The Minister in her announcement discussed the formation of Ontario Health Teams, which would be essentially a coordinated team of local health providers. In this context, she expressed a vision where healthcare would be provided like it should be in 2019:
Through Ontario Health Teams, patients would finally have a say in their health care journey. With safeguards in place, of course, to protect information, patients would have an option to securely access digital health services, such as making online appointments, talking to a specialist virtually, or having access to your own electronic health records.
So to link the different players, connectivity will have to play an important role in healthcare delivery. This is clearly something for the realm of digital health. Therefore, we could potentially see a greater range of and greater adoption of digital health solutions.
Although the Minister’s statement sounds like we will experience a giant leap in the use of technology, we should remember eHealth Ontario has already worked on a number of projects. Despite the excessive costs and time spent on building it, Ontario’s EHR system might finally be (mostly) complete. Progress has also been made on non-core projects.
In fact, the CCA provides that eHealth Ontario may be rolled into a “super-agency”. The super-agency may also include a number of other provincial healthcare bodies including local health integration networks, Cancer Care Ontario and Trillium Gift of Life Network (section 40(2)). Thus, we might expect (or at least hope) that the government will continue to build on eHealth Ontario’s experience. Also, perhaps by being part of this super-agency, eHealth Ontario will be more effective in deploying digital health projects across the province than its record as a standalone agency.
Finally, I note that the Minister’s statement might be read to mean that the government’s digital health strategy will focus mainly on electronic health records (EHR), telehealth/telemedicine, and administrative services. In the proposed legislation, one objective of the super-agency will be to manage health service needs through, among other things, “digital health, information technology and data management services” (section 6(b)). However, “digital health” is not defined. On the plus side, we could also say the CCA does not limit any digital health initiatives to EHR or telehealth/telemedicine. Other technologies such as digital therapeutics or AI may still have a role in the new system. It could just be that there’s no mention of such technologies in this particular Bill or its announcement since it deals mainly with providing healthcare services rather than actual medical treatment (although in digital health this can be a fine line).
It’s great that the Ontario government has recognized that digital health tools could improve the delivery of healthcare. However, it’s not clear if in practice it will expand the adoption of innovations beyond the EHR and telehealth space.