Archived: Recent interview about my Candidacy in The Medical Post – by Dr. Sunny Malhotra

January 3, 2018

I recently had the opportunity to speak with Dr. Darren Larsen. He is Chief Medical Information Officer at OntarioMD, and a candidate for the position of President-Elect Nominee of the Canadian Medical Association. Dr. Larsen has leading-edge insights about the state of medical care in Canada and the application of technologies that could solve current problems.

1. M:  Tell us about yourself.
2. L:  I have been a comprehensive care family physician for 26 years, along with my wife Janet (also a FP).  We practiced first in rural Alberta in a remote rural location at the edge of Banff’s wilderness, then in the GTA (Thornhill) taking over a 56-year-old practice from two retiring physicians, joining a group of 4 in a classic medical style with hospital inpatients, ER work, obstetrics and palliative care.  That group grew with maternity leave coverage locums staying on to five then six physicians.  We became a Family Health Network in 2004 and then a FHO when that contract was offered.  It was easy to step into these models as we were already practicing everything the model demanded in full comprehensive care.  Thornhill Village FHO is now 9 physicians, with 5 women and 4 men.  I departed that clinic in 2014 handing my practice over to a younger colleague to become CMIO initially at the OMA and now at its digital health subsidiary OntarioMD.  I joined Women’s College Hospital Family Practice Health Centre in 2015 doing urgent care in an integrated FHT.

Creating the role of Chief Medical Information Officer at OntarioMD has been an amazing career progression.  This job puts me squarely in contact with physicians as I bridge the gap between medical practice, technology and innovation for clinicians.  It is also rewarding to sit at 23 provincial advisory and steering tables from quality with HQO and CCO, to policy as with the Clinician Digital Health Council. I witness incredible advances in practice using technology mentoring and nurturing startups who are trying to navigate the maze of attachment to EMR products and services. I work with an amazing executive team of big thinkers and doers.  I am very lucky.

DR.M: What are the areas you would focus on as President Elect of the CMA?

DR.L: I have three pillars to my CMA election platform.   The first is Creating a Culture of Respect, Diversity and Inclusion.  Ontario physicians have had a difficult few years.  We are feeling beleaguered and are being bombarded with so many stories of the negative aspects of our health care system.  Long waits, no physician services contract, downloading onto primary care, excessive paperwork, more chronic disease in our practices, less time to connect with our patients. Much of this is related to system level change which we feel little control over.  We forget about incredible stories of the very real relationships we have with patients; the trust placed in us by our community and practice population; the daily positive influence we have on people’s lives.  We have forgotten to talk about the joy we felt entering medical school, and still feel when things go well, which they very often do!  When feeling beleaguered, we have conversations that begin to define us negatively, with pessimism, helplessness and hopelessness.  We start to internalize these negative feeling and this leads to a much higher risk of burnout, and defensive behavior.  This issue, I believe, is responsible for the rash of incivility and bullying we saw last year directed at our young colleagues.  Some lashed out behind the cloak of nameless avatars on social media.  Things were said publicly, virtually, that would never have been said to a colleague face to face.

There is a different way.  Connecting to the unique joy of being a doctor again, connecting to the strongly positive relationships we have with our patients, connecting to the development of our peers and younger colleagues — these are all ways to change the conversations that define us.  I want to see this happen and am trying hard to lead with optimism and respect.
The second pillar stems from the first.  It involves supporting colleagues and standing up for them when they are under attack, either real or imagined.  It comes from working closely with medical students and residents, seeing them as peers and equals. Learners need support in their leadership thinking and work; they benefit from strong mentorship.  I am lucky to be able to mentor many younger colleagues whose histories are complex and fascinating.  We must also be there with advocacy over issues that affect them directly like massive debt loads post-training (many have $300k in loans now!), uncertainties over matching through the CaRMS process (68 med students were unmatched this year!) and a nonexistent national Health Human Resources strategy that mismatches demands for care in specialties with supply, as well as regional differences in training and job availability post-graduation.

The third pillar is strong advocacy and action during the federal election in 2019. High on my radar screen is national Pharmacare, the need for expanded and coordinated indigenous health care, a seniors’ healthcare strategy involving more home and community care, and improved access for young patients with mental health challenges. Although some of this is a provincial responsibility, it is clear that federal government transfer payments for healthcare play a strong role in the direction of each of these priority areas.  The Canadian Medical Association is already working assertively promoting each of these domains, however vigilance and due diligence is required as the federal government undertakes to expand programs to ensure that they match the needs of the community. Also, equity has to be taken into account.  The CMA has a vital role to play in guaranteeing that equitable access to services is available to all Canadians. We are a strong lobby. We must always respect that responsibility.  I feel confident that I am able to lead this work with humility, respect, and bold leadership.

1. M:  Can you elaborate on senior care, Pharmacare and indigenous health goals?

DR L.:  National Pharmacare is likely to be on the agenda for election 2019. Although this may already be in play, the way the program will be rolled out in partnership with provincial ministries of health will have a lot to do with it success. The CMA needs to be front and center in these conversations to ensure that pharmacare meets the needs of all Canadians. It should not be political. This should be purely an equity conversation. There are huge economic factors influencing decisions to endorse pharmacare. It’s clear from multiple studies that this would be a financial benefit, by incorporating bulk buying, reducing the retail price of drugs. There are many citizens who cannot afford to pay for the medicines we prescribe for them now and therefore are being treated sub-optimally for many of their chronic complex diseases. This is unacceptable in a nation as wealthy as ours.

In terms of indigenous healthcare issues, it is fantastic that the health portfolio for our First Nations people has moved from Health Canada to Indigenous Affairs under Dr. Jane Philpott. She is a huge champion of improved living conditions and health service provision on First Nations. As a physician, she understands the problems well. As an incredible policy planner she has the capacity to incorporate care, social determinants of health, and broader areas like education justice and social services, to produce the best fighting chance for Indigenous people living autonomously, healthily and well. I am very happy about this transition. If elected president I will do my utmost to ensure that her policies are enacted in a most robust way.

DR M: What is the biggest move in technology you hope to see, and the appropriate use of health data you have, as a goal for CMA?

1. L: As was highlighted in a recent article in CMAJ by Drs. Mamdami and Laupacis, it is clear that there is room for a national perspective on healthcare data being used for strong public planning and policy purposes. Although this data is collected very locally in Canada leadership is required around the reuse of patient data at the health system level. I have worked hard championing the appropriate use of EMR data and how it might be liberated. For two years I co-led a program for the OMA called Insights4Care (I4C). In this program, we wanted data collection by physicians to be unobtrusive.  We sought to make our EMR systems more intuitive and yet produce higher quality data sets.  OntarioMD is still working on this today.  In I4C data would be extracted standardized and anonymized.  It could then be shared for research, policy, and planning. We foresaw feeding it back to clinicians for clinical quality improvement work, benchmarking against peers, and clinical decision support. This was a fantastic opportunity for our profession, but it ended as an unfortunate victim of bad timing. I would love to see this resurrected in some form. It could well happen provincially, as most care is delivered locally, but the rules of engagement and policy surrounding privacy and security, for example, are also within the federal domain. As well, money is spent funding agencies like Canada Health Infoway, CPAC, CADTH, etc. and some of this should be earmarked for big data planning. It is no longer be necessary to move data to large repositories in order to do analytics. The Cloud has changed everything in the business world but has hardly been adopted in healthcare. It is possible to source data when required, keeping it intact in its local environment, and then move the analytic engine to the data rather than the data to the analytic. All of this is possible with current, technology.

Another major tech shift in healthcare is the implementation of virtual care tools. Although much of our work as physicians involves hands-on, face-to-face, and real-time meetings, there is a fair bit of work that can be moved into the virtual space. This allows care to be delivered where patients require it, or to be moved to times that are convenient for both patients and physicians and ensures that timeliness, access and appropriateness are maintained in the physician-patient interaction. Small startups have quickly become national players here. We must promote and assist some of these companies in either development, incubation, or marketing of their services. This is a perfect a role for the CMA’s subsidiary Joule. My three years on the Board of Directors of Joule has given me insight into this. I want to see more opportunities given to Canadian physicians to promote their own innovation in the development of policy, social and tech innovation. Both CMA and Joule have the capacity to scale and spread. This will be one of the biggest things we can show our physician members in terms of value.

1. M: What advice do you have for younger doctors who want to get involved?
2. L: Leadership by our younger colleagues is both desired and appreciated. They have a unique perspective on the future of healthcare. They understand technology and new models of care better than many of us who have been working for years. They have a sense of wonder and joy around their career that needs to be nurtured. They have a strong voice and ability to act collectively, especially on items like social justice, social determinants of health, and equity. They have tremendous energy. They want to contribute. It is our job as senior leaders to both encourage their leadership potential and training, and to promote them when their ideas need to be seen on the national stage. We must also create a space where leadership is welcomed from groups of physicians who find it more difficult to take on leadership roles. This includes woman leaders, those from underrepresented populations, and those who simply have a diverse position that may not be part of mainstream medical thinking. All of these ideas are welcome under my leadership. I believe we are stronger in diversity and inclusiveness. I feel challenged by views that are not my own, in the most positive way. I love listening to stories and having my opinion changed by people who have thought through issues with a lens that I do not possess. This makes my life as a leader and my career as a physician more rewarding and enriched. Advocacy and leadership begin on the ground. It is our responsibility to ensure that it is promoted and encouraged in our younger leaders. We do this best through mentoring their development. More senior physicians need to take on this role with great clarity and a sense of duty. Mentorship of younger colleagues is one of most rewarding parts of my career. It is incredibly rewarding to see young physicians who I have mentored launch their own successful paths. They are taking on big challenges and have become strong voices in the healthcare space. I’m incredibly proud of their stands and their bravery. I want to do more of this in a more advanced leadership role if I become president of the CMA.