The Ontario Partnered Support Table is a group of health system agencies intent on ensuring physicians have the support they need to feel more confident caring for patients with pain. Over the next several issues of Dialogue, we take a close look at how data, practice reports, facilitation and education developed by the Partnered Table’s participants can help physicians better understand the complexity of pain management. In this issue, we examine the work by Health Quality Ontario, OntarioMD, and the Ministry of Health and Long-Term Care.
Treating patients with complex problems, pain, high doses of opioids, addiction — these are all difficult issues, with no easy answers. But having access to information, such as meaningful prescribing data and patients’ medication histories, can help physicians make informed, rational prescribing decisions.
Below, we describe several different initiatives to give physicians the tools they need.
The Digital Health Drug Repository
The Ministry of Health and Long-Term Care’s contribution is the Digital Health Drug Repository (DHDR), which represents a foundational component of the Ministry’s approach to enable a comprehensive digital drug profile for Ontarians.
The DHDR supports authorized health-care providers’ secure electronic access to a patient’s available drug and pharmacy service information, thereby enabling clinicians to develop the best possible medication history at the point of care.
The information available in the DHDR to authorized health-care providers includes:
- Over eight years of information about dispensed publicly-funded drugs;
- Over eight years of information about publicly-funded pharmacy services e.g., MedsCheck program, influenza vaccinations;
- Over six years of information about all dispensed monitored drugs (narcotics and controlled substances) regardless of payor, when the approved identification used was a valid Ontario Health number.
For drugs, health-care providers are able to view the dispensed date, name, strength, dosage form, quantity and estimated days’ supply of the drugs which have been dispensed to a patient. In addition, prescriber and pharmacy information is displayed.
For pharmacy services, providers will see the service date, a description of the service and the pharmacy information. In some instances, prescriber information will be available, which may be the name of the pharmacist that provided the pharmacy service.
The DHDR information is currently available through two provincial clinical viewers which are ClinicalConnect in South West Ontario and ConnectingOntario in the Greater Toronto Area and Northern and Eastern Ontario regions.
Health Quality Ontario
Health Quality Ontario’s contribution to self-assessment using prescribing data is MyPractice Reports, a customized report that can provide family physicians and orthopedic surgeons with a snapshot of their practice patterns. Nearly 3,000 family physicians across Ontario have already used the confidential report to view their care patterns in relation to their peers at the regional and provincial levels. Orthopedic surgeons who have signed up will be able to receive their first report in Spring 2019.
These reports also include suggestions and tools, like pain management resources, alongside their data, so clinicians can spend less time looking for solutions and more time helping their patients.
MyPractice Reports offers helpful cumulative data, but doesn’t identify individual patients.
For opioid prescribing, these four indicators are looked at:
- What percentage of your patients are receiving opioids?
- What percentage of these patients are just starting opioids?
- What percentage of patients are on high-dose opioids (90 ml equivalent of morphine or more)?
- What percentage of patients on an opioid have also been prescribed a benzodiazepine (by anyone)?
“From a quality improvement approach, we don’t know the right amount of people who should be on an opioid. But if you’re vastly different, you should probably think whether your prescribing is clinically appropriate,” said Dr. David Kaplan, a Toronto family doctor and Chief of Clinical Quality for HQO, in an interview with Dialogue in 2017.
For the last year, OntarioMD has been hosting interactive On the Road with OntarioMD seminars. To date, the On the Road seminars have been focused on safe opioid prescribing, beginning with a presentation that highlights the Canadian guideline and describes useful resources available to clinicians.
The second part of each evening gathering is devoted to EMR-focused learning with Peer Leaders. These Peer Leaders — physicians who are advanced EMR users – sit with small groups of other clinicians to demonstrate how EMR data can be used to identify patients who may be at risk of opioid abuse, prescribe opioids safely and monitor these patients. These sessions have the added benefit of allowing physicians a forum to share and compare experiences with peers who also want to derive the most benefit from their EMRs.
On the Road with OntarioMD seminars are complimentary, and are accredited by the Ontario College of Family Physicians for two hours of Mainpro+ credits. Physicians can get additional support after the seminars by requesting a meeting with a Peer Leader at a mutually convenient time or doing a deeper dive of their EMR data with OntarioMD staff through the EMR Practice Enhancement Program (EPEP).
OntarioMD is also currently working – in partnership with EMR vendors TELUS Health Solutions and OSCAR EMR – to develop an EMR-connected dashboard that will provide clinicians with real-time visual access to their patient data. The EMR Quality Dashboard initiative will allow clinicians to easily see their patient data measured against a range of recognized clinical indicators for chronic conditions, cancer and other health issues. A series of opioid-related indicators are also in development.
In addition to providing a view of indicator data across a physician’s entire patient population, the dashboard will give physicians the ability to drill down to patient level data, enabling them to take immediate proactive steps by accessing lists of patients associated with each indicator. Also of significant clinical value to physicians will be the ability to opt in to trend and compare their aggregate indicator results over time with other dashboard users who’ve chosen to opt in to this feature. This feature would allow physicians to see, for example, whether they have a higher percentage of patients on high dose opioids than their peers at any given time. Having that information available may lead a physician to consider whether they need to make changes to the pain management care of their patients.
Planning is currently underway for a provincial rollout.
For More Information
Please visit the Digital Health Drug Repository for more information.
To find out more about OntarioMD Peer Leaders, EPEP or the On the Road with OntarioMD seminars, visit ontariomd.ca. Ontario doctors can sign up for MyPractice at hqontario.ca. The reports go only to the e-mail address you provide upon registration, to help you understand your patients and how to support them.