e-Health -- part III, a disruptive idea

During my recent introduction to the patient flow process at the local hospital, I must admit to being impressed with one thing -- the fact that each patient is assigned to a team of professionals which includes a social worker, physiotherapist, community care representative, doctor, etc.

This begs the question: why is this experience only available in a hospital setting?
I was always amazed at the fact when I attended LHIN meetings that they were only concerned with the operation of the hospitals for the most part, as if doctors were some dangling appendage that automatically takes care of itself.
The situation became even more puzzling after I learnt that the physician community is in fact second only to hospitals in terms of representation in the healthcare budget (see article).

I'm thinking it's time for some disruption -- you see I believe in the concept that states: you can't manage what you don't measure; here's what I'm thinking could work in some form:

• require all doctors to become employees of their respective LHINs, allowing them to earn a guaranteed annual income
• have 24/7 clinics -- just imagine if police stations had the same hours as clinics and you had to report to a jail/prison for any "after hours" incidents
• hold doctors accountable for metrics not limited to:

1. patient quality of life
2. number of drug prescriptions
3. diagnostic tests 
4. use of technology
5. use of nutrition and fitness professionals

• handsomely reward ( over and above their annual salary) those who demonstrate a positive difference 
• continually encourage those who don't
• allow the naysayers to opt-out and go private; however, they'll have no access to the Ministry of Health (MoH) billing system -- their patients will have to deal with government insurance on an individual basis

It struck me that as an employee of an Information Technology company operating in the Greater Toronto Area, the annual review was one tool management used to ensure the ongoing viability of the company; these sessions included a process whereby you were measured in terms of how well you managed your goals that were set the previous year, and the outcome was a big factor in your earning potential (and sometimes your future potential with the company).
Why are we not using a similar process in our LHIN organizations?

Past experience has shown that politicians are averse to risking their popularity, placing the onus instead on some high-profile businessperson to make the tough calls, similar to the ones outlined above -- it'll therefore be interesting to read the Drummond report healthcare recommendations in the coming weeks.

Finally, as this is the last article for the year, I'd like to wish you a happy holiday season and the best of health for the coming year.


Ernest A. James

President & CEO
Regal Informatics Inc.