Revolutionizing Primary Care: A Reflection on a Vision for the Future

At the recent OMD conference, I had the opportunity to attend keynote addresses delivered by Dr. Jane Philpott and Helen Angus. Both delivered powerful presentations on the critical gaps in Ontario's healthcare system, particularly around the lack of access to primary care for millions of Ontarians, and the need to embrace AI and technology to enhance capacity to deliver better and more efficient care.

A Bold Vision for Digitally Optimized Healthcare

Philpott’s vision of creating a digitally optimized and accessible primary care system not only spoke to the current challenges but also offered a roadmap to address the healthcare inequities and inefficiencies that plague our province and the rest of Canada. Angus recognized that transformation is difficult and requires thoughtful implementation and collaboration among various stakeholders, from healthcare providers to government bodies and tech innovators.

As I reflect on this commentary, it brings me back to the work that we did in Ontario when we first envisioned Primary Care Networks a number of years ago. Back then, we were already considering how we could use these networks to ensure patients all had access to primary care. The challenges with moving the system were monumental and they still are, though I would argue that the system seems more ready for change now than ever, with the recognition that the status quo is unsustainable and the fact that we finally have the technological backbone to help us get there more efficiently.

The Challenge of Access to Primary Care

Philpott highlighted a stark reality: over 4 million people in Ontario are without access to primary care, resulting in delayed treatment, worse health outcomes, and higher healthcare costs. She emphasized that while our system has prioritized hospitals, the foundation of healthcare should be primary care, and I would agree. Our system was built on acute care, conceived when Tommy Douglas, then Premier of Saskatchewan, first introduced the Hospital Insurance Act in 1947, followed by the Medical Care Insurance Act in 1961. As our population ages and chronic diseases become more prevalent, the vision she proposed—a community-based, digitally optimized primary care system that ensures universal attachment—resonates, as it is the only way that we can most efficiently care for our entire population, including our providers.

One of the key takeaways from the conference was the potential for technology to radically transform primary care delivery. Philpott pointed out that the barriers to a digitally optimized health system are not technical but cultural. We need to ask ourselves, why is it that healthcare is the only sector that still consistently uses a fax machine? I would also argue that many of the barriers that we see are a result of lack of connectivity across the system, process duplication, collaboration challenges rooted in provider behaviors, and data blockage disguised as privacy concerns.

Earlier this year, Primary Care Needs OurCare was released. It was the largest survey of primary care ever conducted in Canada. 94% of respondents said that a single health record that was accessible to all healthcare providers was important; and 73% felt it was important that all primary care teams in Canada should be required to accept any person living in their neighborhood as a patient. How do we get there when our providers are burning out as our population increases and ages?

Empowering Healthcare Providers with Technology

The OMD conference brought attention to the strain on healthcare providers who are struggling to meet the needs of an increasing number of patients. Philpott acknowledged the moral distress experienced by clinicians who have to turn patients away due to resource limitations. Angus further reminded us that AI should not be viewed as a replacement for healthcare workers but as a tool that empowers them to work more effectively. She emphasized the importance of AI improving the experience for both healthcare workers and patients and the need for collaboration across sectors with compassion for both providers and patients, to successfully implement AI solutions in healthcare.

As our healthcare future is increasingly dependent on technology and artificial intelligence, including AI scribes and co-pilots, we have an opportunity to increase efficiencies and build a system around the patient, collaborating across healthcare professionals through technology and reducing stress for our primary care providers, so they have the cognitive capacity necessary to provide the highest standard of care while also improving access for underserved populations.

Philpott's vision for Ontario's healthcare system is bold but achievable with the right technological infrastructure. She called for the creation of 250 new primary care teams across the province, supported by a digitally optimized system that can manage patient data, facilitate timely care, and ensure accountability. Ensuring these new models of care are learner-friendly will provide opportunities for future healthcare professionals to train in environments that use cutting-edge technology.

Angus further pointed out that the future of healthcare will rely on our ability to scale AI solutions effectively. This means not only developing the technology but also ensuring that it is implemented in a way that benefits both healthcare providers and patients, ensuring that our AI algorithms are equitable and free from bias.

Conclusion

The future of healthcare depends on our ability to reimagine and redesign the primary care system such that we recognize that the acute care system supports, but primary care must be the meso-level, with public health and focus on the social determinants of health as the foundation. Digital health and AI are the keys to unlocking this potential across all systems that support our health, and we need to embrace them to drive transformation.