Beyond the Algorithm: Reimagining Digital Health Leadership in Ontario
Beyond the Algorithm: Reimagining Digital Health Leadership in Ontario
This post is a summary of a class I gave yesterday to the Master’s eHealth students at McMaster Univeristy. I think it might apply to all of us though, as we try to lead change in digital health and healthcare across the board.
Introduction
Ontario’s health system is under enormous pressure. Every part of the system — from primary care to acute care, from digital health vendors to government agencies — is trying to survive unprecedented demand, workforce shortages, and structural fragmentation.
credit: @gapingvoid
Amid this turbulence, digital health is often positioned as the solution.
But technology alone cannot fix a brittle system.
The future of digital health in Ontario will not be decided by algorithms.
It will be decided by leadership, governance, and trust.
This talk explores how policy, innovation, and clinical reality intersect — and where the next generation of eHealth leaders can have a transformative impact.
Ontario Health System 2025: Pressure Points
Ontario’s system is behaving exactly as complex systems do under chronic strain: each institution becomes protective and inward-focused.
Patients get caught in the middle — navigating silos, repeating their histories, waiting for tests or referrals that fall through cracks. In this environment, innovation tends to become tactical rather than strategic. We solve immediate problems with quick fixes instead of building coherent, long-term solutions.
Major challenges include:
fractured primary care
rising wait times and ER crowding
inequities in access
a paradoxical decline in virtual care
medical inflation and financial instability
tensions around public vs. private models
data silos and lack of interoperability
Digital tools can help — but only when thoughtfully integrated. Poorly designed solutions can worsen inequity, increase fragmentation, or add administrative burden.
This leads to the central question: Where does digital health truly improve care, and where might it unintentionally make it worse?
credit: @gapingvoid
Policy Meets Innovation: The Collision Zone
Innovation and policy operate on different clocks.
Innovators want speed.
Government wants safety.
Procurement requires months of process; innovation cycles move in weeks.
Ministries request evidence; innovators need access to data to create that evidence.
This misalignment forms the innovation valley of death — where many promising solutions go to die after a successful pilot, unable to cross into real-world adoption.
A founder recently remarked, “It’s easier to sell into a US hospital chain than a single Ontario clinic.” And they weren’t wrong.
Ontario’s decentralized purchasing, variable readiness, and heavy administrative overhead make scaling innovation extremely difficult. This is not a failure of technology — it is a failure of system design.
Your role as emerging leaders is to bridge this gap.
You are not just building tools; you are building the conditions that allow tools to succeed.
Clinician Reality Check
credit: @gapingvoid
To understand digital health adoption, you must understand clinicians’ lived experience.
A typical family doctor might toggle between nine different systems in a single day:
EMR, labs, imaging, eConsult, billing, secure messaging, hospital viewer, patient portals, scheduling tools… each with different logins, interfaces, and workflows.
No one designed these tools to work together.
This is not “resistance to innovation” — it is exhaustion from fragmentation.
Facts on the ground:
40% of clinician time is administrative
Up to 60% of digital tools increase workload
Workflow is the real barrier, not technology
As one colleague put it: “Every new digital tool feels like another straw on the camel’s back. Where is the tool that removes one?”
Reducing burden — not adding features — is the next frontier of successful digital health.
credit: @gapingvoid
Beyond the Scribe: The Next Digital Wave
AI scribes are receiving massive attention, and rightfully so: they help, they save time, and they reduce cognitive load.
But they do not transform the system — they restore clinicians to baseline functioning.
The deeper transformation comes from connected AI, such as:
triage automation
predictive analytics
care coordination support
population risk models
real-time decision support
system-level intelligence
When AI is siloed, it amplifies existing fragmentation. When it is integrated — into workflows, data flows, and governance — it can help orchestrate a more coherent, responsive health system.
Human oversight remains essential.
Algorithms lack context. Clinicians understand nuance. The future is human-in-the-loop.
creating parallel workflows instead of integrated ones
Again, the differentiator is leadership.
credit: @gapingvoid
Where Emerging Leaders Step In
Digital health in Ontario now requires a new kind of professional — one who connects clinical needs, policy realities, workflow design, and technological capabilities.
The new leadership roles include:
The Workflow Architect
Someone who understands both patient journeys and data flows — and designs tools that fit clinical reality.
The Evidence Translator
Someone who measures impact, distinguishes hype from value, and communicates findings in ways decision-makers understand.
The Governance Designer
Someone who builds safe, scalable pathways for adopting innovation — including privacy, ethics, evaluation, and procurement frameworks.
The Interoperability Advocate
The rare leader who champions data standards, integration, and shared infrastructure over isolated solutions.
These roles didn’t exist a decade ago.
They are essential today.
Digital health efforts in Ontario often resemble children building isolated piles of sand on a beach — each using their own bucket, shaping their own mound.
The result? Piles, not castles.
True system transformation requires:
shared tools
shared plans
shared governance
shared goals
A sandcastle isn’t built by accident — it’s built through collaboration.
The message: Stop building silos. Start building castles.
Call to Action
Innovation is the spark. Leadership is the oxygen.
@gapingvoid
Nothing scales without leaders who:
build trust
connect silos
align incentives
design coherent workflows
translate evidence into practice
guide responsible adoption of emerging tools, especially AI
As eHealth graduates, your careers will shape the next decade of digital health in Ontario — not because you will write the algorithms, but because you will create the environment that allows algorithms to be effective, ethical, and safe.
This is where you can make an extraordinary difference.
Conclusion
Ontario’s digital health future depends on leaders who are systems thinkers, translators, and integrators.
Go beyond the algorithm.
Build trust.
Build capacity.
Build coherence.
Build castles.
6 Replies to “Beyond the Algorithm: Reimagining Digital Health Leadership in Ontario”
The last line says it all – ‘we need you!’ So many emerging health leaders are being channeled by the rip currents in the system. There is, however, a lot of choice implied in Darren’s writing here; the choice not to go with the flow; not to rebuild or reinforce silos. While this may seem like an abstraction, it is critical to align on our collective idea of a coherent and harmonized system. It is ‘brittle’ now, as he writes – so the need is high. The roles he outlines – I’d love to dive into these alone and expand or add new roles – are how we bring this consideration of coming good to ground. Thanks for the insights in this article – a call to systems translators, integrators and thinkers. This is how progress is made.
Julia… we should create a new course JUST ABOUT THOSE ROLES!!! Each one is a masterclass in itself! Thanks for reading!
Well written @DarrenLarsen.com
I agree we need to hard bake in clinician and patient centered approaches to healthcare at all levels and how we collect, share and utilize data is at the core.
Time to mandate interoperability standards and work towards seamless sharing across platforms. I used to call them silos as well. I now call them Cylinders of Excellence.
There is great work being done in each CoE, however unless we collaborate and coordinate better, I fear the admin burden will continue to accelerate. Healthcare providers and the patients we care for will continue to suffer.
Kathleen, I love the Cylinders of Excellence moniker. It really does pay credit to the hard work of the founders doing their thing really well. But the magic is in taking those cylinders and creating a honeycomb. Something that supports the whole hive. And yes to the interoperability. You and I have been singing from the same songbook on this one for quite some time. I think we may soon see some legislation in the revamped BIll C 72!
Thanks for reading and commenting.
I liked this piece, particularly the idea about tactical innovation vs strategic innovation. I remain really nervous about the amount of attention point-to-point digital health tools receive, vs the amount of engagement of those who know the workflows and might offer ideas as to how to think more strategically. I think this is improving over time.
Andrew.. thanks for this thought. Point to point is an easy fix.. this is why. And every startup is making a bright shiny thing that solves usually a single problem. There is little incentive for one bright shiny thing to connect to another. Imagine if our Christmas lights had to be plugged in bulb by bulb?? Would we ever buy that?? We gotta get on with interoperability. This is not a technology problem, it is a policy one!!
6 Replies to “Beyond the Algorithm: Reimagining Digital Health Leadership in Ontario”
The last line says it all – ‘we need you!’ So many emerging health leaders are being channeled by the rip currents in the system. There is, however, a lot of choice implied in Darren’s writing here; the choice not to go with the flow; not to rebuild or reinforce silos. While this may seem like an abstraction, it is critical to align on our collective idea of a coherent and harmonized system. It is ‘brittle’ now, as he writes – so the need is high. The roles he outlines – I’d love to dive into these alone and expand or add new roles – are how we bring this consideration of coming good to ground. Thanks for the insights in this article – a call to systems translators, integrators and thinkers. This is how progress is made.
Julia… we should create a new course JUST ABOUT THOSE ROLES!!! Each one is a masterclass in itself! Thanks for reading!
Well written @DarrenLarsen.com
I agree we need to hard bake in clinician and patient centered approaches to healthcare at all levels and how we collect, share and utilize data is at the core.
Time to mandate interoperability standards and work towards seamless sharing across platforms. I used to call them silos as well. I now call them Cylinders of Excellence.
There is great work being done in each CoE, however unless we collaborate and coordinate better, I fear the admin burden will continue to accelerate. Healthcare providers and the patients we care for will continue to suffer.
Kathleen, I love the Cylinders of Excellence moniker. It really does pay credit to the hard work of the founders doing their thing really well. But the magic is in taking those cylinders and creating a honeycomb. Something that supports the whole hive. And yes to the interoperability. You and I have been singing from the same songbook on this one for quite some time. I think we may soon see some legislation in the revamped BIll C 72!
Thanks for reading and commenting.
I liked this piece, particularly the idea about tactical innovation vs strategic innovation. I remain really nervous about the amount of attention point-to-point digital health tools receive, vs the amount of engagement of those who know the workflows and might offer ideas as to how to think more strategically. I think this is improving over time.
Andrew.. thanks for this thought. Point to point is an easy fix.. this is why. And every startup is making a bright shiny thing that solves usually a single problem. There is little incentive for one bright shiny thing to connect to another. Imagine if our Christmas lights had to be plugged in bulb by bulb?? Would we ever buy that?? We gotta get on with interoperability. This is not a technology problem, it is a policy one!!