Posted on December 14, 2017
Dr. Jim Swan: Presentation to the Standing Committee on Finance and Economic Affairs
Legislative Assembly of Ontario
December 14, 2017
Posted on November 8, 2017
New Cardiology EMR Specification Released in Ontario
November 8, 2017
New Cardiology EMR Specification Released
EMR Cardiology 1.0 Gives EMR Vendors Information They Need To Meet the Clinical Practice Needs of Ontario’s Cardiologists
Toronto, ON: OntarioMD and the Ontario Association of Cardiologists (OAC) are pleased to announce the release of EMR Cardiology 1.0 – Draft for Use, a set of functional and non-functional requirements that are fundamental and unique to an Electronic Medical Record (EMR) offering used by cardiologists.
EMR Cardiology 1.0 – Draft for Use embodies a minimum set of incremental requirements for inclusion in certified EMR offerings used by cardiologists to enhance cardiac patient care and clinical practice efficiency. The requirements, which complement those found in other Ontario EMR Specifications, fall into the following categories:
- Forms, Reports, Letters and Templates
- Device Integration
- EMR Training
- Workflow Management
EMR Cardiology 1.0 – Draft for Use is the culmination of more than two years of collaboration between OntarioMD and the OAC aimed at improving EMR products for cardiology practices across the province.
“Until now, Ontario’s cardiologists have had to individually customize and modify their EMR products, through extensive trial and error to meet their clinical practice needs,” said OAC President Dr. James Swan. “With the emergence of EMR Cardiology 1.0 Draft for Use, EMR vendors will now know what cardiologists require in an EMR product to improve patient care and run their practice efficiently. We hope vendors will take the opportunity to build these features into their products.”
The OntarioMD-OAC working relationship created a “win-win” solution for Ontario’s cardiologists, their patients, and Ontario vendors with certified EMR offerings. “We are very pleased with the end result of this collaboration with the OAC,” stated OntarioMD CEO Sarah Hutchison. “The EMR Cardiology 1.0 Draft for Use EMR Specification defines a consistent and repeatable set of requirements for EMR vendors deploying EMR solutions to Ontario’s cardiologists. It’s a solution that will not only lead to enhanced care for cardiac patients in Ontario, but can serve as a model for other specialties and jurisdictions.”
For more information about EMR Cardiology 1.0 – Draft for Use, please visit www.ontariomd.ca/emr-certification/specifications-and-validation/specifications/current#dfuor e-mail firstname.lastname@example.org.You can also contact Tim Holman, OAC Executive Director at 416-487-0054 or email@example.com.
OntarioMD is the leader in primary care digital health in Ontario and is a valuable system partner for other organizations who wish to implement their solutions to the primary care sector. It manages programs and services that connect physician practices that use certified EMRs to more patient data collected outside primary care settings. OntarioMD also supports Ontario’s physicians with practical advice from Peer Leaders and experienced Practice Advisors who help them optimize their EMR use to enhance patient care and achieve greater practice efficiency. The organization offers valuable, fully-accredited educational opportunities for physicians annually at the EMR Every Step Conference series.
Over 14,000 physicians are participating in OntarioMD services: Health Report Manager (HRM), eNotifications, Provincial eConsult Initiative, OLIS Deployment, EMR Physician Dashboard, Peer Leader Program, EMR Practice Enhancement Program, EMR Adoption Program. For more information about these services, please visit www.OntarioMD.ca
The OAC is a voluntary professional organization that represents the majority of academic and community cardiologists in Ontario. Founded in 1995, the OAC exists to advocate for the protection and enhancement of patient access to cardiac care in Ontario and ensure that fair remuneration is provided for these services. For more information about the OAC, please visit: www.ontarioheartdoctors.ca.
Posted on September 29, 2017
OAC Recognizes World Heart Day: 29 September 2017
Today, 29 September 2017, the Ontario Association of Cardiologists recognizes World Heart Day (#WorldHeartDay).
In the words of the World Heart Federation,
“Heart health is at the heart of all health. When you look after your heart it means eating and drinking well, exercising, stopping smoking… all the things that make you not only healthier, but also feel good and able to enjoy your life to the fullest.
Cardiovascular disease (CVD) is the leading cause of death and disability in the world, killing 17.5 million people a year. That’s a third of all deaths on the planet and half of all non-communicable-disease-related deaths. Around 80% of these deaths are in low- and middle-income countries where human and financial resources are least able to address the CVD burden.
World Heart Day plays a crucial role in changing all of this. It is a vital global platform that we, as well as our members and supporters, can use to raise awareness and encourage individuals, families, communities and governments to take action now. Together we have the power to reduce the burden of, and premature deaths from, CVD, helping people everywhere to live longer, better, heart-healthy lives.”
For more information click here: https://www.worldheartday.org/
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Posted on September 25, 2017
Federal Government’s Tax Reforms: Media Coverage
Federal Liberal Tax Reforms | Media Coverage
André Picard | Ottawa’s new tax measures unfairly target many doctors
David Reevely | Feds’ tax crackdown will nail Ontario doctors and cure care, medical association warns
Allan Lanthier | Morneau turns to class warfare to justify a massive attack on high earners. Does the 73-per-cent tax rate represent fairness, or is it confiscation?
Dr. Charles Shaver | Tax changes proposed by Trudeau government are unfair and could have many unintended consequences
Dr. Shawn Whatley | Overpaid and Under-Performing
Posted on August 29, 2017
2nd Annual Education Day in Adult Congenital Heart Disease (ACHD) – September 25, 2017
The Toronto Congenital Cardiac Centre for Adults (TCCCA) is holding its second annual Education Day in Adult Congenital Heart Disease (ACHD) on September 25, 2017 at the MaRS Discovery District, Conference Room CR-3.
To learn more visit: http://achdeducationday.ca/index.html.
Posted on July 20, 2017
New Standards for the Provision of Electrocardiography (ECG)-Based Testing in Ontario Now Available
In May 2017, the Cardiac Care Network of Ontario (now CorHealth Ontario) released long-awaited standards for the provision of ECG-Based Diagnostic Testing in Ontario (2017). The OAC congratulates all involved, including those OAC members serving on the primary and secondary review panels, for their hard work in developing these important standards.
To read the standards, click here: http://bit.ly/2reQM5o
James Swan, M.D. F.R.C.P.(C) F.A.C.C.
President, Ontario Association of Cardiologists
34 Eglinton Ave. West
Toronto, ON M4R 2H6
Posted on July 4, 2017
OMA vote breakdown shows which types of doctors rejected framework deal – Toronto Star (July 3, 2017)
By Theresa Boyle, Health Reporter
Mon., July 3, 2017
The OMA has released a breakdown of how 48 physician specialty groups voted on new rules of engagement for contract negotiations with the province — and to the surprise of no one who follows Ontario medical politics closely, radiologists and cardiologists were among the minority who opposed the deal.
The agreement, which sets out a framework for how the two sides will reach a new fee contract, was endorsed by 65 per cent of the 10,261 physicians, residents, students and retirees who cast ballots in a ratification vote last month. (Only 24 per cent of the almost 43,000 eligible to vote did so.)
The deal includes a provision for binding arbitration, something the government had long resisted because it didn’t want to turn over to a third party control of an $11-billion-plus physician services budget.
But with an election on the horizon, the government capitulated on this point earlier in the year. It did so after Premier Kathleen Wynne personally reached out to the Ontario Medical Association’s leadership, the Star’s Queen’s Park columnist Martin Regg Cohn recently reported.
Of eight specialty groups that rejected the deal, radiologists were the most strongly opposed. A voting breakdown report, released last week by the OMA, shows 84 per cent of diagnostic imaging specialists and 80 per cent of neuroradiologists voted against it.
Next came the cardiologists, 71 per cent of whom were opposed. More than 50 per cent of physicians in the following specialty groups also gave it the thumbs down: plastic surgeons, geneticists, nuclear medicine specialists, gastroenterologists and chronic pain doctors.
The 41 specialty groups that supported the deal included ophthalmologists, a surprise to many. They voted 63 per cent in favour. Also endorsing it was the largest specialty group — general and family practice doctors. Of 2,274 who voted, 66 per cent gave it the nod.
Negotiations are expected to start in September. If the two sides fail to make headway on their own — which is highly possible — the dispute would be referred to mediation and arbitration.
“This is something doctors have asked for, for years,” Dr. Shawn Whatley, the OMA’s new president, said of binding arbitration.
In an interview, Whatley said that 65-per-cent voter approval for the framework agreement is strong enough to give the OMA’s negotiating team “clear direction” on how to proceed.
“But we also have to acknowledge that 35 per cent . . . voted against it. So that shows us that we have work to do and we have to engage all of our members to support whatever work happens this fall,” he said.
“We cant be presumptuous here. We have a lot of members who spent many hours informing themselves about this framework and we can’t discount their opinion as we go into negotiations,” he added.
Ontario Health Minister Dr. Eric Hoskins declined to comment for this article.
The ratification of the framework agreement is the latest chapter in the stormy relationship between the province and doctors, and within the medical profession itself.
Doctors have been without a contract for more than three years. During that time, contract negotiations fell apart, the government unilaterally imposed payment cuts on doctors, a tentative contract failed to pass a ratification vote and the OMA board was essentially overthrown in a coup.
The Ontario Association of Radiologists and Ontario Association of Cardiologists both actively campaigned against the framework agreement. Among concerns they and other opponents cited was that it singles out “relativity” as an issue that an arbitrator could have the final say on.
Relativity refers to the large variations in payments to different medical specialties. Radiologists and cardiologists are among the highest paid.
(From their OHIP payments, physicians cover the cost of overhead expenses, for example, staff salaries and rent. Specialists who work outside hospitals and purchase equipment can have particularly high overhead costs.)
Addressing relativity would involve recalibrating the OHIP fee schedule, lowering fees considered overvalued and increasing those considered undervalued.
“Giving prominence to relativity is unfair and will pit groups of doctors against each other,” warns the Ontario Association of Cardiologists on their website.
Dr. James Swan, president of the association and chair of the OMA section on cardiology, said in an interview that his group disagrees with the OMA’s approach to tackling relativity.
Even though cardiologists were disappointed with the outcome of the June vote, they still hope to exert influence by being actively involved in negotiations and in ongoing reforms of the OMA, Swan said.
On a recent blog post, Whatley wrote that “relativity has plagued medicine for a long as doctors have had fees.”
Changing fee codes for work done by different specialists will involve looking at issues of merit, effort, value, equality and democracy, he said.
“Heady concepts, but we must wrestle with them all,” Whatley said.
The Ontario Association of Radiologists did not respond to requests for an interview.
But a concern with the framework agreement cited on the association’s website is “the perpetual entrenchment of the OMA as the exclusive bargaining agent for all Ontario physicians with no alternative mechanism if this (binding arbitration) model does not work.”
The radiologists haven’t always been happy with how the OMA has represented them. In 1998, they tried unsuccessfully to sue the OMA because they were unhappy with a new fee contract, which limited how much they could bill OHIP for technical fees.
Opponents of the new framework agreement are also concerned that it directs an arbitrator, in making decisions of physician compensation, to take into account:
The economic situation in Ontario.
The achievement of a high quality, patient-centred sustainable publicly funded health care system.
The vote breakdown report also shows that 70 per cent of women voters supported the deal, compared to 63 per cent of men.
The age breakdown shows that voters ages 25 and younger were most supportive, with 76 per cent voting in favour. Least supportive were those ages 46 to 50, with 39 per cent rejecting it.
Of 11 geographical areas, district 10, which includes northwestern Ontario, was most supportive with 75 per cent voting in favour.
Most opposed was district 5 which includes parts of Peel Region, Simcoe County and Dufferin County, and where 39 per cent voted the deal down.
How physician specialty groups voted
Six specialty groups most supportive of new negotiations framework (percentage of voters in favour)
Infectious Diseases (87%)
Palliative Medicine (86%)
Geriatric Medicine (86%)
Public Health (85%)
Laboratory Medicine (84%)
Six specialty groups least supportive of new negotiations framework (percentage of voters opposed)
Diagnostic Imaging (84%)
Plastic Surgery (69%)
Nuclear Medicine (61%)
Posted on June 23, 2017
OAC Statement on the Formation of CorHealth Ontario
On June 21, 2017, CorHealth Ontario was announced. CorHealth Ontario (www.corhealthontario.ca) is a new organization formed by the merger of the Cardiac Care Network of Ontario and the Ontario Stroke Network, with an expanded mandate spanning cardiac, stroke and vascular services through the entire course of care.
OAC President Dr. Jim Swan attended the unveiling event and stated, “OAC looks forward to working with CorHealth Ontario, formerly Cardiac Care Network of Ontario, to deliver high quality cardiac patient care in Ontario.”
Posted on June 9, 2017
OAC Recommends Voting “No” to the Tentative BA Framework Agreement
June 9, 2017
Dear OAC member,
Last night, at a meeting of the OAC Board of Directors followed by the Association’s annual meeting of members, the OAC reviewed the 2017 OMA-MOH tentative binding arbitration (BA) framework agreement. While the OAC strongly supports BA in principle, it was the unanimous decision of the Board of Directors and all in attendance at the Annual Meeting to reject this tentative agreement for the following reasons:
- The agreement entrenches the OMA in perpetuity as the bargaining agent for all Ontario physicians.
- The agreement specifies income relativity for arbitration without citing other key issues. Giving prominence to relativity is unfair and will pit groups of doctors against each other.
- The agreement exposes the OMA to conflicts within the profession (i.e. picking “winners” and “losers”) arising from its co-management role (with MOH) of the Physician Services Budgets and expenditures. This will be further amplified by the income relativity clause (see above) and the OMA’s current internal position on the CANDI methodology.
- The agreement entrenches Mediation/Arbitration with the same Chairperson versus having the roles divided to ensure greater transparency. This weakens the OMA’s position within the BA process.
- The agreement exposes compensation of CMPA coverage to arbitration in the future. This coverage will most likely disappear through arbitration in 2023.
The OAC believes that this BA framework agreement contains the vestiges of the OMA’s “old guard”, a group whose approach to government negotiations was resoundingly rejected in August 2016. The agreement places a higher value on OMA organizational self-preservation than on representing the fundamental interests of all grassroots members fairly. It serves to divide and separate, not unify, us. In short, we believe it can be done better.
We must not be hoodwinked into supporting a BA framework agreement now for reasons of expediency. Moreover, we must not feel pressured or bullied to support this agreement to satisfy the political schedule of the Ontario Liberals. Let’s take the time needed to get this right.
Securing a fair BA framework agreement is crucial to the future of our profession in Ontario. We cannot afford to get this wrong. Our collective future, and that of our patients, depend on it.
The OAC is recommending that you vote “No” to this agreement now. Give the new OMA Board of Directors the chance to develop and pursue its own mandate, as an instrument of comprehensive reform, including developing a better BA framework agreement that ensures all doctors are treated fairly in our organization.
James Swan, MD, FRCP(C), F.A.C.C.
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, ON M4R 2H6
Posted on June 6, 2017
An Important Message for Ontario Cardiologists
Our profession has endured a lot. Since 2012, Cardiology has been subjected to attack by misinformation and arbitrary government cutbacks. At every juncture, your association has been there to fight for what is right for cardiologists and their Ontario patients and we have made huge strides. Now, we need to understand the details and consequences of this newly proposed Binding Arbitration agreement before voting on June 17, 2017.
Last year the OAC played a key role in ensuring the temporary Physician Services Agreement (tPSA), which was orchestrated in secret by the Ministry of Health and the past executive of the OMA, was soundly rejected. As part of the Coalition of Ontario Doctors (Coalition) we won the right to Binding Arbitration that we had fought so hard for and now, we need to follow through on very important next steps.
On June 17, 2017, as a member of the OMA you will be asked to vote on a tentative binding arbitration agreement (BA) with the Ontario government. A general meeting has been called for that day to vote on the tentative “framework appendix for negotiations, meditation and arbitration”. The result of that vote will have major implications for cardiology (indeed all healthcare) for decades to come. Let’s make sure we get it right and vote based on a clear understanding of what this vote is all about.
Recently, the Coalition shared the opinion of Mr. Andrew Lokan, a leading constitutional law expert. He assessed the proposed BA in the context of “how this compares with other BA agreements and how well this proposal would work for Ontario doctors”. Mr. Lokan raised 5 key issues that need clarification before OMA members should cast their votes. These issues are:
5 Key Issues that Need to be Answered Before Voting
This BA entrenches the OMA as the permanent bargaining agent for doctors. Usually there is a mechanism to remove and change an agent if warranted, but this is not provided in this BA.
This BA has the OMA taking on a significant role in the healthcare budgeting baseline. Ask yourself first “Could this generate internal conflicts if cutbacks are forced on a particular group “and second, “what current structure exists within the OMA to deal with this?”
This BA envisions mediation and arbitration as a singularity. During the mediation phase, hints may be intentionally (or unintentionally) dropped that later affect arbitration. It’s best to clearly separate the roles of mediator and arbitrator.
This BA talks about the inclusion of specific criteria for arbitration, including the permanent inclusion of income relativity. Giving prominence to income relativity over other issues has the potential to pit one group of doctors against another, which is divisive and unfair.
This BA says “this is good until 2023” which implies the CMPA supplement will most likely be gone after 2023.
Recent OAC Initiatives and Successes
The OAC exists to stand up for our members and to advocate on behalf of Ontario’s cardiac patients. The OAC is you … and it’s your voice and financial support that have allowed us these recent successes.
Protecting Cardiologists While Ensuring High Quality Care for Patients
The Cardiac Care Network’s Echocardiography Quality Improvement (EQI) program underwent significant changes in 2016-17 to its processes, personnel, and documentation.
The CCN required that a “Facility Agreement” be signed by all facility owners as part of the EQI program. The OAC discovered that it contained an indemnity clause that could expose facility owners to significant cost and legal liabilities, should legal proceedings be initiated against the CCN and/or Ministry in connection with the program.
The OAC worked long and hard to improve the Facility Agreement, to protect cardiologists. In March 2017, we were successful in our efforts to have the clause removed. Some further issues still remain that require our ongoing attention and work. OAC is committed to resolving these quickly with the CCN so that OAC members can feel comfortable signing the document and proceeding through the accreditation process.
OAC Members: A Source of Clinical Expertise
New health care technologies can help improve patient care and reduce costs. Awareness of evolving developments and the ability to measure their actual effectiveness against established parameters is critical.
In April 2017, Health Quality Ontario (HQO), an agency of the Ontario Ministry of Health and Long-Term Care, reached out for OAC’s help in conducting a health technology assessment or (HTA). “Remote cardiac monitoring” is a new and potentially useful tool for health care that will be assessed with OAC input that will culminate in a report to the Minister in May 2018. HQO asked if the OAC could provide clinical experts to assist with its review and recommendations concerning the prospect of extending public funding to technologies that remotely monitor pacemakers, ICDs, and cardiac resynchronization device therapies. The OAC welcomes this government outreach and looks forward to having more opportunities to contribute to public policy development and government funding decision-making in cardiac care in the future.
View our newsletter, The Pulse, to learn more about what OAC has done recently to protect health care of Ontarians. Please remember that June 17, 2017 is a pivotal moment for Ontario cardiologists and their patients. Decisions will be made that day that impact the next decade of cardiac care. Please, let’s all add our voices, pay attention to the FINE PRINT and make the right decisions.
James Swan, MD, F.R.C.P.(C) F.A.C.C.
President, Ontario Association of Cardiologists