ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for
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11/25/2020 Title Page ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 CAUTION: This Stakeholder Report (the “Report”) from OntarioMD Inc. (“OntarioMD”) is being made available to its Stakeholders. No representa on, warranty or covenant of any kind is made in favour of any Stakeholders or any third party respec ng the contents of the Report. By reviewing this Report, the reader acknowledges and confirms the foregoing. The Stakeholder must rely on its own independent inves ga on and analysis in connec on with the ma ers addressed in the Report. 1/1
11/25/2020 Table of Contents ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for March 2020 Table of Contents 1. EXECUTIVE NOTES 3 2. INTRODUCTION 4 3. ONTARIOMD, ONTARIO HEALTH AND ONTARIO HEALTH TEAMS 4 4. ONTARIOMD PRODUCTS AND SERVICES 4 5. QUARTERLY GROWTH BY PRODUCT/SERVICE 5 6. PRODUCTS AND SERVICES BY VENDOR AND LHIN VIEW 6 FIGURE 1: EMR ADOPTION BY PHYSICIAN TYPE AND CERTIFIED EMR VENDOR 6 FIGURE 2: EMR ADOPTION BY PHYSICIAN TYPE AND LHIN 7 FIGURE 3: PHYSICIANS PARTICIPATING IN PROVINCIAL PRODUCTS/SERVICES BY LHIN 8 FIGURE 4: PHYSICIANS LIVE ON HRM BY LHIN 9 FIGURE 5: PHYSICIANS LIVE ON OLIS BY LHIN 10 FIGURE 6: CLINICIANS WITH ONE ID 11 FIGURE 7: PHYSICIANS USING ENOTIFICATIONS BY VENDOR 12 FIGURE 8: PHYSICIANS USING ENOTIFICATIONS BY LHIN 13 FIGURE 9: ONTARIO ECONSULT PENETRATION BY INDICATOR 14 FIGURE 10: ONTARIO ECONSULT PENETRATION BY LHIN 15 FIGURE 11: ECONSULTS SENT 16 FIGURE 12: PHYSICIANS LIVE ON DASHBOARD BY LHIN 17 FIGURE 13: ONTARIOMD PRIVACY AND SECURITY TRAINING COMPLETED BY LHIN 18 7. APPENDICES 19 1.1 APPENDIX A: LHIN 1 – ERIE ST. CLAIR 19 1.2 APPENDIX B: LHIN 2 – SOUTH WEST 21 1.3 APPENDIX C: LHIN 3 – WATERLOO WELLINGTON 23 1.4 APPENDIX D: LHIN 4 – HAMILTON NIAGARA 25 1.5 APPENDIX E: LHIN 5 – CENTRAL WEST 27 1.6 APPENDIX F: LHIN 6 – MISSISSAUGA HALTON 29 1.7 APPENDIX G: LHIN 7 – TORONTO CENTRAL 31 1.8 APPENDIX H: LHIN 8 – CENTRAL 33 1.9 APPENDIX I: LHIN 9 – CENTRAL EAST 36 1.10 APPENDIX J: LHIN 10 – SOUTH EAST 37 1.11 APPENDIX K: LHIN 11 – CHAMPLAIN 39 1.12 APPENDIX L: LHIN 12 – NORTH SIMCOE MUSKOKA 41 1.13 APPENDIX M: LHIN 13 – NORTH EAST 43 1.14 APPENDIX N: LHIN 14 – NORTH WEST 45 1/1
11/25/2020 Executive Notes p.3 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 1. Execu ve Notes for April On April 1, 2020 OntarioMD entered into a new Transfer Payment Agreement with Ontario Health to con nue to assist and support clinical users, including physicians and OHTs, in the adop on and enhanced use of EMRs and other web-based and virtual digital health tools and services on behalf of our provincial partners. OntarioMD will con nue to deploy these services using our streamlined and bundled approach to meet new targets for this fiscal year, as well as con nue to support EMR maturity with our change management approaches used by staff and Peer Leaders. We will also con nue to manage the EMR Cer fica on Program and Specifica ons to ensure that EMRs meet the func onal and clinical requirements required for func onal consistency across cer fied EMRs and in alignment with provincial integra on priori es, as well as help Ontario Health and the Province advance new virtual care standards. Suppor ng Clinicians and Pa ents During COVID-19 Clinician Engagement & Training on Virtual Care Tools OntarioMD con nues to raise awareness on virtual care tools to support physician prac ces during COVID-19. Soon a er the onset of COVID-19, OntarioMD hosted weekly webinars presented by our Chief Medical Officer and Peer Leaders to educate and train physicians on the use of virtual tools in their prac ces. The webinars were a ended by more than 800 physicians and the recordings are available for ongoing reference. A new series of webinars are planned to cover addi onal topics related to virtual care as well as new webinars for clinicians joining OHTs to become more familiar with the digital health tools cited in the Digital Health Playbook and deployed by OntarioMD. OntarioMD staff are con nuing to engage with physicians to ensure prac ces are well-supported and trained in their use of digital health tools and services to care for pa ents in person and virtually. The proven efficiency and effec veness of digital tools such as HRM, OLIS, provincial viewers, i4C Dashboard and eConsult con nues to generate demand for these services. In collabora on with the OMA, OntarioMD also regularly sends communica ons directly to physicians across the province about virtual care developments, and new educa onal resources. Virtual Care Resources and Billing Advice OntarioMD con nues to develop virtual care resources for physicians on OntarioMD.News and OntarioMD.ca adds relevant informa on from partners and vendors. While OntarioMD does not specifically endorse any of the tools listed, physicians are finding the curated list valuable to help them select tools that are right for their prac ces and their pa ents. Prac ces are encouraged to contact vendors directly for product-specific ques ons. Physicians are also directed to the OMA for guidance on policy and billing and to Ministry InfoBulle ns for the latest direc ves. Ontario Virtual Care Clinic OntarioMD and the OMA con nue to support the Ontario Telemedicine Network’s Ontario Virtual Care Clinic (OVCC) at seethedoctor.ca to serve pa ents who cannot access their family physician. The OVCC was launched on April 3 with the goal of reducing the wait for pa ents who were accessing Telehealth Ontario services. Ini ally, demand was modest. On April 15, the OVCC was launched directly to the public and Telehealth Ontario and Health Care Connect implemented changes to simplify the referral process to the OVCC. OntarioMD provides support to OVCC physicians; is monitoring referral volumes and adjusts the schedule of physicians (using MetricAid scheduler) on shi to meet pa ent demand. Health Report Manager: Contribu ng to Timely Care During COVID-19 OntarioMD collaborated with Ontario Health to implement HRM delivery of no fica ons to physicians’ EMRs to tell them that COVID-19 test results are available in the Ontario Laboratories Informa on System (OLIS). HRM also delivers discharge informa on to EMRs from hospitals that are COVID-19 assessment centres. This is in addi on to the pa ent informa on in the 2 million other reports per month HRM delivers from more than 500 hospital and specialty clinic sites across Ontario to EMRs. Reports that are COVID-19 related are clearly iden fied to get physicians’ a en on. HRM has also begun delivering consulta on reports for referrals generated through the Ocean eReferral Network, developed by CognisantMD, to community-based physicians’ EMRs. Physicians no longer have to rely on fax to receive these reports and know what the next steps are in their pa ents’ treatment. While HRM makes regular enhancements to increase the electronic delivery of pa ent informa on into EMRs, the value of this integra on is especially important during the current pandemic. 3 1/1
11/25/2020 Executive Notes Cont. ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 1. Execu ve Notes for April Con nued Other Digital Health Products & Services Connec ngOntario ClinicalViewer Bundle – OntarioMD has now connected over 1,500 community-based, primary care clinicians provincially to obtain a ONE® ID, ONE Mail and the Connec ngOntario ClinicalViewer. OntarioMD Privacy and Security Training Module – Physicians are health informa on custodians (HICs) under the Personal Health Informa on Protec on Act (PHIPA) and need to be kept up-to-date on this privacy legisla on and educate themselves and their staff on how to fulfill their obliga ons to protect Personal Health Informa on (PHI) on an ongoing basis. OntarioMD’s online Privacy and Security Training Module meets this need by offering educa on on key topics such as safeguarding PHI from breaches and security incidents, and how to comply with PHIPA obliga ons. The training is more important than ever as clinicians move to quickly adopt new virtual care tools. More than 2,500 clinicians and their prac ce staff have completed the training, which is available at OntarioMD.ca. The module is frequently updated with the latest informa on and can be accessed from any internet-connected device. OntarioMD Cer fied EMR Update The transi on of OSCAR 19 EMR cer fica on from OSCAR EMR to the WELL EMR Group was completed on April 30, 2020, and moving forward, OSCAR clients will be supported by WELL EMR Group. EMR Communi es of Prac ce Four EMR Communi es of Prac ce (CoPs) were successfully transi oned from the Associa on of Family Health Teams of Ontario (AFHTO) to OntarioMD. The CoPs bring together clinicians, prac ce staff, advisers and vendors to collaborate and leverage their collec ve wisdom to improve access to, and use of, EMRs and other digital health tools. The four EMR CoPs are: PS Suite EMR (TELUS Health), Accuro® EMR (QHR Technologies), OSCAR and Clinic Informa on System (P&P Data Systems). OntarioMD is excited to host and par cipate in the CoPs s on a regular basis to facilitate the sharing of informa on and knowledge. OntarioMD Conference OntarioMD will be taking its EMR: Every Step Conference virtual in the Fall of 2020 offering the same relevant virtual care content and its popular Peer Leader-led EMR roundtables for which physicians would receive con nuing medical educa on credits. Our objec ve is to provide an excellent learning and networking experience for all prac ce staff to match the in-person EMR: Every Step Conference, which recently won a gold Hermes Crea ve Award for Print Media, Integrated Marke ng Materials. Well done team! 1/1
11/25/2020 Introduction p.4 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 2. Introduc on The purpose of this report is to provide a monthly update on the provincial view of community-based family physicians’ and community specialists’ adop on and op mized use of cer fied EMRs and digital health tools and services integrated with cer fied EMRs. Except where indicated, this report does not include informa on about adop on of the referenced digital health applica ons by nurse prac oners or other health care service providers. By helping physicians become increasingly proficient EMR users, OntarioMD assists physician prac ces in realizing more clinical value and the full poten al of digital health tools and services to enhance pa ent care. These tools and services are also improving Ontarians’ access to care and improving clinical outcomes in an increasingly integrated and coordinated health care system. 3. OntarioMD, Ontario Health and Ontario Health Teams OntarioMD is focused on the delivery of digital health products and services that translate into clinical value for physicians and their pa ents. OntarioMD has the infrastructure, rela onships and experience to deliver cost-effec vely the full spectrum of high-quality digital health programs and services for clinicians and Ontario Health Teams across the province in alignment with Ontario’s Digital First Strategy. It works closely, and in partnership, with health care organiza ons across Ontario. OntarioMD staff take a holis c approach to working with physician prac ces, bundling products and change management services on behalf of our stakeholders for efficient visits to prac ces regionally and locally. This reduces mul ple touchpoints to the physician office and streamlines training and onboarding, so physicians can spend less me on administra on and more me on pa ent care. What We Do · Connect clinician prac ces to OntarioMD’s digital health tools that improve access to care, clinical outcomes and decision-making, such as Health Report Manager (HRM), eNo fica ons and the i4C Dashboard. · Connect clinician prac ces to eConsult on behalf of the Ontario eConsult Program; eVisits (Enhanced Access to Primary Care) on behalf of OTN; eNo fica ons in collabora on with Ontario Health’s Shared Services (formerly HSSO); the DHDR and DHIR (when ready for deployment) on behalf of the Ministry; and deploy the Ontario Laboratories Informa on System (OLIS), Connec ngOntario ClinicalViewer, ONE®ID and ONE Mail on behalf of Ontario Health’s Digital Services (formerly eHealth Ontario). · Provide physicians with trusted advice, guidance and onboarding support from OntarioMD staff, located across Ontario, to op mize EMR and digital health use. · Provide in-depth, hands-on support for physicians’ quality improvement and popula on health management goals through our i4C Advisory Service’s experienced staff. · Mentor physician prac ces with prac cal EMR ps from physician, nurse and clinic manager Peer Leaders who understand how physicians prac ce and share their exper se with the same EMR. · Advise public and private sector partners on how to develop and advance digital health tools and services for clinicians leveraging our OntarioMD Clinician Advisors for focus groups, and product feedback. · Deliver the OntarioMD Vendor Management Program and associated Cer fica on Program to provide assurance to physicians that their EMRs are con nuing to evolve with health system priori es and meet ongoing clinical requirements and func onality; assess and monitor EMR offerings for alignment with the Ontario EMR Specifica ons and broader provincial priori es. 4. OntarioMD Products and Services OntarioMD products and services are provincial digital health assets for clinicians and centred around pa ents. Enabling the flow of pa ent informa on directly to OntarioMD-cer fied EMRs supports: ▪ Access to care, services and health informa on ▪ Enhances the efficiency of the health system ▪ Strengthens quality, effec veness and accountability ▪ S mulates innova on and growth OntarioMD receives funding from the Ministry of Health (MOH), with a mandate to support connec vity, interoperability, and integra on of EMRs with the digital health delivery system more broadly and to work with clinicians to op mize the clinical value of their cer fied EMRs to provide enhanced care to their pa ents. For an overview of all OntarioMD products and services, please read our Products & Services brochure. 4 1/1
11/25/2020 Quarterly Growth p.5 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 5. Quarterly Growth by Product/Service Quarterly Growth by OMD Product or Service Total Physicians (December 31, 2019) Total Physicians (March 31, 2020) Quarterly growth 10% 26034 26034 10.2% 9.2% 25000 22633 5% 1.6% 1.8% 1.9% 1.2% 20000 0% 0.9% 0.5% 0.0% 16674 16824 16918 -5% 15000 13852 14096 -10% 10117 10276 10186 10241 10000 -15% 5000 -20% 1578 1723 1531 1687 -25.3% 931 942 894 911 -25% 0 Cer fied EMR Connec ng eConsult eConsult eNo fica ons HRM i4C Dashboard OLIS ONE ID* Privacy & Security Ontario Clinical Reques ng Specialists Training Viewer Providers Registered Note. Source of the data is eHealth Ontario. 5 1/1
11/25/2020 Figure 1 p.6 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 6. Products and Services by Vendor and LHIN View Figure 1: EMR Adop on by Physician Type and Cer fied EMR Vendor EMR Adop on by Physician Type and Cer fied EMR Vendor Physician type General Prac oner Specialist Not Specified 6,133 6,000 5,000 4,000 3,000 2,219 2,000 2,264 1,462 1,293 1,000 605 614 325 383 196 262 131 140 151 125 5 53 20 1 13 3 1 1 98 1 6 13 16 80 3 38 4 1 17 45 2 26 72 2 0 ABELMED Alpha Global Avaros AwareMD Canada Health Indivica Inc. OSCAR EMR P & P Data QHR Telus Health WELL EMR YES Medical YMS iT Inc. Systems Inc. Systems Inc. Technologies Solu ons Group Inc. System Inc. *Source of the data is OntarioMD’s CRM system. 6 1/1
11/25/2020 Figure 2 p.7 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 Figure 2: EMR Adop on by Physician Type and LHIN EMR Adop on by Physician Type and LHIN Physician type General Prac oner Specialist Not Specified 1,390 1,400 1,366 1,200 1,103 1,011 1,000 956 901 862 855 805 800 614 608 600 582 559 530 448 450 426 397 395 400 325 286 280 268 236 187 199 194 200 164 127 88 79 17 34 13 5 7 7 7 4 9 11 4 4 7 4 0 Erie St. Clair South West Waterloo Hamilton Central Mississauga Toronto Central Central East South East Champlain North North-East North-West Not Wellington Niagara West Halton Central Simcoe Specified Haldimand Muskoka *Source of the data is OntarioMD’s CRM system. Brant 7 1/1
11/25/2020 Figure 3 p.8 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 Figure 3: Physicians Par cipa ng in Provincial Products/Services by LHIN Physicians Par cipa ng in Provincial Products/Services by LHIN Physician type General Prac oner Specialist Not Specified 1,600 1,540 1,427 1,400 1,305 1,276 1,200 1,107 1,119 1,067 1,000 873 888 819 800 683 663 647 610 600 585 507 515 424 435 396 376 400 326 334 298 282 284 264 241 207 200 149 110 76 57 22 20 22 12 15 21 22 12 35 11 7 7 0 Erie St. Clair South West Waterloo Hamilton Central West Mississauga Toronto Central Central East South East Champlain North North East North West Not Wellington Niagara Halton Central Simcoe Specified Haldimand Muskoka Brant 8 1/1
11/25/2020 Figure 4 p.9 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 Figure 4: Physicians Live on HRM by LHIN Physicians Live on HRM by LHIN Number of physicians with HRM % of physicians with HRM that are OLIS users 1,400 1,364 92.4% 89.7% 1,266 89.6% 90% 1,200 1,151 87.2% 86.9% 85.9% 85.2% 84.5% 991 85% 1,000 85.4% 933 83.3% 841 82.6% 82.1% 800 81.2% 80% 80.1% 677 659 600 563 75% 449 449 398 400 270 70% 200 108 117 63.9% 65% 0 Erie St. Clair South West Waterloo Hamilton Central West Mississauga Toronto Central Central East South East Champlain North Simcoe North-East North-West Not Specified Wellington Niagara Halton Central Muskoka Haldimand Brant *Source of the data is OntarioMD’s CRM system. 9 1/1
11/25/2020 Figure 5 p.10 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 Figure 5: Physicians Live on OLIS by LHIN Physicians Live on OLIS by LHIN 2,237 2,000 1,720 1,543 1,500 1,349 1,272 1,184 1,000 969 648 685 593 548 499 500 455 267 178 0 Erie St. Clair South West Waterloo Hamilton Central West Mississauga Toronto Central Central East South East Champlain North Simcoe North East North West Not Specified Wellington Niagara Halton Central Muskoka Haldimand Brant *Source of the data is eHealth Ontario. 10 1/1
11/25/2020 Figure 6 p.11 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 Figure 6: Clinicians with ONE ID® Clinicians With ONE ID Clinician Type Nurse Physician 6,345 6,000 5,000 4,000 3,000 2,448 2,190 2,268 2,000 1,745 1,729 1,445 1,540 1,428 1,069 1,061 1,049 1,035 951 896 924 1,000 794 780 733 656 627 591 602 588 491 516 414 311 0 Erie St. Clair South West Waterloo Hamilton Central West Mississauga Toronto Central Central East South East Champlain North North East North West Wellington Niagara Halton Central Simcoe Muskoka *Source of the data is eHealth Ontario. 11 1/1
11/25/2020 Figure 7 p.12 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 Figure 7: Physicians Using eNo fica ons by Vendor Physicians Using eNo fica ons by Vendor 6,000 5,481 5,000 4,000 3,000 2,028 2,000 1,121 1,000 560 232 94 50 45 134 45 7 16 30 0 ABELMED Alpha Global Avaros AwareMD Canada Indivica Inc. OSCAR EMR P & P Data QHR Telus Health WELL EMR YES Medical YMS iT Inc. Health Systems Inc. Technologies Solu ons Group Inc. System Systems Inc. Inc. *Source of the data is internal files for tracking eNo fica ons. 12 1/1
11/25/2020 Figure 8 p.13 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 Figure 8: Physicians Using eNo fica ons by LHIN Physicians Using eNo fica ons by LHIN 1,400 1,229 1,245 1,200 1,065 1,037 1,000 840 800 713 629 605 600 491 446 429 402 400 344 268 200 100 0 Erie St. Clair South West Waterloo Hamilton Central Mississauga Toronto Central Central East South East Champlain North North-East North-West Not Wellington Niagara West Halton Central Simcoe Specified Haldimand Muskoka Brant *Source of the data is internal files for tracking eNo fica ons. 13 1/1
11/25/2020 Figure 9 p.14 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 Figure 9: Ontario eConsult Penetra on by Indicator Ontario eConsult Penetra on Number of registered users Number of ac ve users % of registered users that are ac ve users 38.5% 10,098 10,000 35% 8,000 30% 6,388 25% 6,000 21.0% 20% 4,000 15% 2,119 2,116 2,000 10% 815 339 5.3% 0 Champlain BASE ® Ontario eConsult OTN Teledermatology *Source of the data is the Ontario eConsult Centre of Excellence. 14 1/1
11/25/2020 Figure 10 p.15 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 Figure 10: Ontario eConsult Penetra on by LHIN Ontario eConsult Penetra on by LHIN Number of registered users Number of ac ve users % of registered users that are ac ve users 1,697 39.18% 36.41% 1,600 35% 1,400 30% 1,200 1,066 1,082 25.92% 1,000 27.30% 25% 22.75% 787 800 755 710 640 638 600 18.80% 572 586 20% 17.57% 470 18.77% 387 386 15.96% 400 351 14.97% 291 305 15% 233 250 204 15.08% 200 139 113 110 68 66 64 12.85% 68 75 46 0 11.19% 9.58% 10% Erie St. Clair South West Waterloo Hamilton Central West Mississauga Toronto Central Central East South East Champlain North North-East North-West Wellington Niagara Halton Central Simcoe Haldimand Muskoka Brant *Source of the data is the Ontario eConsult Centre of Excellence. 15 1/1
11/25/2020 Figure 11 p.16 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 Figure 11: Ontario eConsults Sent Ontario eConsults Sent April 2020 May 2019 to April 2020 Rate per 1000 18000 17242 12 16000 14000 10.0 10 12000 8.8 8 10000 7.3 8000 6.8 6 6166 6000 5747 4728 5001 4942 4.8 4 4000 3523 3.2 3.9 3.6 2465 1858 2085 1888 2000 1484 1394 1597 1157 566 564 1.6 675 2 123 374 127 226 269 217 399 171 295 104 0 1.5 Erie St. Clair South West Waterloo Hamilton Central West Mississauga Toronto Central Central East South East Champlain North North-East North-West Wellington Niagara Halton Central Simcoe Haldimand Muskoka Brant *Source of the data is the Ontario eConsult Centre of Excellence. 16 1/1
11/25/2020 Figure 12 p.17 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 Figure 12: Physicians Live on Dashboard by LHIN Number of Physicians Live on Dashboard by LHIN 152 140 120 110 107 100 98 80 80 70 67 60 56 50 47 39 40 25 21 20 14 0 Erie St. Clair South West Waterloo Hamilton Central West Mississauga Toronto Central Central East South East Champlain North North-East North-West Wellington Niagara Halton Central Simcoe Haldimand Muskoka Brant *Source of the data is internal files for tracking dashboard par cipa on. 17 1/1
11/25/2020 Figure 13 p.18 ONTARIOMD STAKEHOLDER REPORT: Products and Services by LHIN for April 2020 Figure 13: OntarioMD Privacy and Security Training Completed by LHIN OntarioMD Privacy & Security Training Completed by LHIN Number of physicians Number of sponsored users 299 300 250 234 217 207 200 184 168 160 150 139 111 100 93 92 97 86 73 73 71 63 64 50 37 33 26 21 23 19 13 2 6 0 0 Erie St. Clair South West Waterloo Hamilton Central West Mississauga Toronto Central Central East South East Champlain North North-East North-West Wellington Niagara Halton Central Simcoe Haldimand Muskoka Brant *Source of the data is OntarioMD’s CRM system. 18 1/1
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