Mid-West Toronto Family Practice Network Newsletter
Winter 2025
From the Co-Chairs
Faye Goldman
Co-Chair
Michelle Naimer
Co-Chair
Dear Family Medicine Colleagues,
Happy New Year. We hope everyone had a chance to unwind over the holidays. We are thrilled to share this winter newsletter and update you on the recent activities of your Mid-west Toronto Family Practice Network (MWT-FPN).
It has been an exciting time for the MWT-FPN as funding from Ontario Health through the Mid-West Toronto Ontario Health Team is being directed to support local primary care initiatives. This funding will help us in our mission to be your resource to solve local system issues and to proudly support you in continuing to provide high quality comprehensive primary care in the Mid-West Toronto region.
Here are highlights of projects we are working on:
We encourage you all to complete the Family Medicine/Primary Care census. The census is an important first step to better understand primary care in our region and identify gaps for future planning. Complete the census for a chance to win one of 15 gift cards for dinner for two at a local restaurant!
The MWT-FPN is receiving funding to purchase a Client Relationship Manager (CRM). This tool will allow us to securely manage MWT-FPN members’ practice information (such as impending retirements, who can accept new patients and which practices need more access to team based care) and improve communication and connection with you, our members.
We have received funding to support leadership activities within the MWT-FPN. This means we have additional funds to pay family doctors for their time and involvement on committees and pay board members for leadership roles. This funding will also permit us to create a strategic plan to help us focus our priorities in the coming years.
The MWT-FPN Board made the decision to use extra funds available from Ontario Health’s Online Appointment Booking funding (OAB) to pay family doctors who adopted OAB before funding was made available from OH (early adopters), and who didn’t qualify for OAB funding at the time. We will be contacting qualifying practices to arrange payment.
Primary Care Attachment remains an important area of work for the MWT-FPN and the OHT. We have pursued several different avenues to apply for funding to support a “patient concierge” who could help with the administrative load of connecting and onboarding unattached patients to practices and expanding team-based care. We will keep you posted with work in this important area.
We have solved some local HRM related concerns, such as UHN endoscopy reports that were too large to send through HRM.
We are working with Connected Care at UHN to explore the feasibility of a regional central intake program for diagnostic imaging (MRI and CT) and orthopedic surgeries (hip, knee, spine).
And finally, the Mid-West Toronto FPN has a new logo! The logo options were presented and voted on at our November Board meeting open to all members. We are pleased to reveal the logo in this newsletter. Whenever you see our MWT-FPN logo, you can be confident that the information or project has been vetted by your family medicine colleagues and aims to improve family practice and primary care in our region.
Our next Open Board meeting (open to all MWT-FPN members) will be on April 29th 5-6:30 pm. Please RSVP to Melanie Yang if you would like to attend: myang@kensingtonhealth.org.
We look forward to seeing many of you there, and we hope to see everyone at our Annual General Meeting in person in June. We will be in touch with more details.
Take good care of yourselves,
Michelle Naimer and Faye Goldman
Co-Chairs, Mid-West Toronto Family Practice Network
Day in the Life:
Dr. Ellie Morch MD
MyFamilyMD is the clinic where I work alongside my husband Dr. Jason Baker. I have worked as a Family Physician since 1997. Since the start of my career, I have completed my notes in the evenings after work.
In November of 2023 we attended the Mid-West Toronto Family Practice Network education session on Artificial Intelligence for the Office Practice. The following spring we signed up for a month free trial of an AI scribe tool. Microphones were added to rooms that didn’t already have one.
In the beginning I felt awkward asking patients for consent to use the program that listened and recorded the visit. In those first couple months only 2 patients did not give consent and one was a doctor and one was a lawyer! Most patients are intrigued and glad to consent. “Anything to make your work easier,” is what they say. Others are familiar with these types of programs from their own workplace. After logging in and clicking I have consent, the program shows the recording in speech bubbles so you know it's working. Getting logged in to the program before you see patients helps save time. I make a point of going into the exam rooms and logging in when I arrive at the office. I’ve made a few mistakes along the way: forgetting to start the program for the visit or forgetting to stop the recording and ending up with 2 patient visits in one encounter. I make fewer errors like that now. The benefits in time saving have outweighed the glitches and errors. There are a lot of options for formatting and after testing them out, the SOAP note (bullet) is the template I use the most. There are some errors that I correct right in the program and the program is learning from those corrections e.g. changing lay terms I used with the patient for medical terms. I usually correct and add to the examination section. Once I have reviewed the note, I click submit and copy. I paste it into the patient’s chart.
Surprisingly, the AI scribe also generates some differential diagnoses in the encounter record that have been helpful. The aspect I have really found invaluable is when I have forgotten what I said and the transcribed notes are there reminding me what the plan is. The transcription is easily accessible right beside the AI generated note to go back and check what you said as well
At this point we are 8 months into our experience with the AI scribe and I am totally hooked. I find it lowers my stress knowing the recording is being made and notes will be generated. It saves me time and takes the work out of note taking during the visit. I am better able to focus on the patient.
Digital Update
What's New with eReferral and eConsult
Introducing Toronto’s Digital Health Desk.
The Toronto Region is streamlining how primary care providers access and adopt over 15 provincially funded digital health tools (including eConsult, eReferral, HRM, and more) with the aim of reducing paper and fax-based workflows. Visit digitalhealthdesk.ca to get started!
eReferral
Mid-West Toronto OHT continues to lead the way in eReferral adoption, with the highest rates in the Toronto Region! The Toronto Region Deployment Team continues to support eReferral in Mid-West Toronto to bring new sites live and re-engage the Ocean eReferral network.
Women’s College Hospital’s Cardiology Clinic and Cardiology Rehab Program is now live on Ocean eReferral, and Toronto Acquired Brain Injury (ABI) Network is coming soon!
If your office needs help getting set-up on any of these tools, visit digitalhealthdesk.ca to request tailored re-engagement support or refresher training on Ocean eReferral for your team!
eConsult
We are excited to introduce 2 new self-managed groups* now accepting eConsults on OTNhub!
The Hypertension e-Consult Faculty Group consists of experienced staff general internists and nephrologists who attend hypertension clinics at major teaching hospitals. Group members have extensive experience providing consultation to primary care providers in traditional and novel formats. The group offers advice for clinical cases, focusing on hypertension workup, secondary causes, and management.
The Hospital Based Addiction Medicine Group, part of the Toronto Opioid Overdose Action Network, will use eConsult to support hospitals without an inpatient addiction consult service. This group of experienced addiction medicine specialists offers advice for any patient admitted to a hospital who uses substances (e.g., fentanyl, alcohol stimulants etc.). Specialists provide suggestions on the assessment and treatment of substance use, strategies to help patients remain in the hospital for medical care, and guidance on transitioning them back into the community.
*This option allows you to submit consults to a group of specialists in a specific specialty who are typically from the same organization (e.g. UHN). The group’s case assigner reviews your consult & assigns it to the most appropriate specialist.
As of January 2025, the Toronto Region has 29 self-managed groups accessible through eConsult!
Toronto Region Self-Managed Groups LIVE on OTNhub
Specialty Area
Pediatrics
SickKids Clinical Genetics
SickKids Pediatric Clinical Pharmacology & Reproductive Toxicology
SickKids Pediatric Endocrinology
SickKids Pediatric Rheumatology
Mental Health
CAMH Geriatric Mental Health
CAMH Telepsychiatry - Integrated Care Model
Perinatal Mental Health Program
Psychotherapy Matters eConsult Group
UHN Outpatient Mental Health
Diagnostic Imaging
Joint Department of Medical Imaging
Medicine
General Internal Medicine e-Consult Faculty Group
Glomerulonephritis Specialty Clinic Group
Michael Garron Hospital Endocrinology Group
Princess Margaret Cancer Care Network
Sinai Health – Mount Sinai Hospital and Hennick Bridgepoint Hospital Internal Medicine eConsults
St. Michael’s Hospital Endocrinology
The St. Michael’s Hospital Geriatric Medicine eConsult Program
Toronto Lung Transplant Program
Toronto UHN Hepatology (Liver) Consult Group
UHN General Nephrology Specialty Group
UHN/Sinai Health Geriatric Medicine eConsult Service
UHN Transplant Nephrology Specialty Group
UHN/Mount Sinai Academic Hematology
Hypertension e-Consult Faculty Group
Hospital Based Addiction Medicine Group
Other
Dorothy Ley Hospice Community Physicians
Michael Garron Hospital/TEHN Addiction Physicians
Mount Sinai Hospital Oculoplastics Group
West Park Tuberculosis (TB) Nontuberculous Mycobacteria (NTM) Service
HRM eNotifications: Opt-Out Now Available!
Good news! Clinicians can now manage their HRM eNotifications preferences. If you prefer not to receive alerts about patient admissions and discharges, you can opt out using this form. Learn more on the OMD HRM Preference Management page.
Opt-Out from Partial Lab Reports
Call LifeLabs (1-877-849-3637 ext 2) and ask to “turn off partial labs” to stop duplicate partial reports coming into your inbox through HRM.
Online Appointment Booking
Funding has been approved and payments will be transferred to clinics for OAB for the FY 2024/2025. Expect to receive funding from the Family Practice Network in the next couple of months.
Attachment in Mid-West Toronto
Ontario Health has announced an $1.8 billion investment over the next three years to support primary care teams and connect the population to primary care. Under the leadership of Dr. Jane Philpott, the Primary Care Action Team (PCAT) is working towards connecting 2 million people to primary care by 2029. In alignment with this goal, Ontario Health Teams and Primary Care Networks are being invited to collaborate and develop plans to ensure 100% attachment for local populations, and to address the Health Care Connect Waitlist by Spring 2026.
The Mid-West Toronto Ontario Health Team Attachment Working Group has been dedicated to closing the attachment gap and are eager to expand these efforts in partnership with our community and our FPN. We’re committed to ensuring the FPN plays a significant role in shaping the direction of primary care in our region. Stay tuned for more updates!
Upcoming Mid-West Toronto Education Event
Come join us for the update to the management of mood disorders (CANMAT Guidelines).
THURSDAY, FEB. 27 | 5:00 - 6:30 PM
Delivered by CAMH & Mid-West Toronto Family Practice Network
Moderated by Mid-West SCOPE Primary Care Lead: Dr. Hedi Erenrich
Presented by Two Experts Who Contributed to the Canadian Network for Mood and Anxiety Treatments (CANMAT) Guidelines
Dr. Ishrat Hussain
Lead, Mood Disorders Service, CAMH
Scientific Head, Clinical Trials Unit, Campbell Family Mental Health Research Institute, CAMH
Cameron Wilson Chair in Depression Studies, Department of Psychiatry, University of Toronto
Dr. Daphne Voineskos
Medical Lead, rTMS Clinic & Psychiatrist, Poul Hansen Family Centre for Depression, UHN
Clinician Scientist, Temerty Centre for Therapeutic Brain Intervention, CAMH
Labatt Family Professor in Depression Biology, University of Toronto
What to Expect:
Dr. Voineskos – Management of Major Depressive Disorder
Dr. Hussain – Management of Bipolar Disorder
Case studies for discussion
Interactive Q&A session
Registration Required:
Note Webinar eligible for 1.5 CME credits
Once registered, you will receive a confirmation email with the Zoom link.
Resources for You
The SCOOP on SCOPE
SCOPE is a virtual interprofessional care team that supports primary care providers through a single point of access. Dr. Hedi Erenrich, Mid-West Toronto SCOPE Primary Care Lead Since its inception in 2012, SCOPE has been a crucial support system for primary care providers, whether working solo or without formal team affiliations. What began with just 30 practices in the Mid-West has now grown to 296. Our pioneering site in the Mid-West set the foundation for 17 additional sites across the province, collectively serving nearly 3,500 primary care offices. By the end of February, we will expand to 23 SCOPE sites.
Key Highlights of SCOPE Support:
Support at Your Fingertips
With just one number, email, or fax, you can access our Mid-West Toronto SCOPE team which includes:
Two nurse navigators to connect you with resources in our region and beyond.
An internist for urgent point-of-care consultations and non-urgent advice.
The TIP (Telemedicine IMPACT Plus) program provides case consultation and management for complex patients.
Direct access to radiology for urgent imaging and consultation.
Headache clinic for chronic headache diagnostics and management.
Ontario Health at Home – direct consult with follow-up.
RN health coaches for complex and vulnerable patients.
Mental health support with social workers and consulting psychiatrists.
Consulting pharmacist for medication management and advice.
2. Streamlined Clinical Pathways for Family Physicians:
Direct referral to UHN Fracture Clinic for uncomplicated fractures.
UHN intensive short-term support for diabetic patients.
Women’s College Hospital (WCH) hernia program.
WCH ano-rectal program.
TAPMI program for pain control.
UHN Independence at Home program for isolated older adults.
Kensington Health Diagnostic Imaging for FNAs.
Danforth Neurology for expedited general neurology consultations
"Thinking, 'I won’t remember all of that'? No need to – just give our nurse navigator a call, and we’ll take care of the rest!"
Maximizing Your SCOPE Registration If you're registered with SCOPE, I bet you're not making the most of it! We're often underutilized, so please don't hesitate to call. There are no stupid questions! If you are practicing in MWT and not a part of a team based care clinic, we welcome your registration at SCOPEhub.ca.
CAMH Primary Care Pain Hub
The CAMH Primary Care Pain Hub is a rapid access referral pathway for team based care designed to support primary care clinicians in managing patients with complex chronic pain who may have concurrent problematic medication or substance use and/or significant mental health conditions. This initiative aims to provide continuous guidance for both patients and providers, supported by a technology-driven tool that delivers advice and facilitates one-on-one patient engagement with care coordinators. This blend of relationship-based care and digital processes ensures that healthcare providers can access a streamlined digital care pathway. Currently the project is expanding its scope to primary care providers that would benefit from this program.
Key goals of the program include:
Engaging healthcare providers and enrolling their referred patients at multiple primary care sites across the province.
Enhancing the quality and efficiency of healthcare management for patients with complex chronic pain and/or substance use disorders through improved patient engagement, effective condition management, and better communication among healthcare providers.
Empowering healthcare providers through case-based knowledge translation combined with best practices and resources, ultimately improving patient outcomes and fostering a more informed approach.
The CAMH Primary Care Pain Hub takes a shared-care approach in which our team takes on more complex management of cases while providing comprehensive support to both healthcare providers and patients.
For referrals:
Ph: 416-583-4685
Fax: 416-595-6821
Email: iparc@camh.ca
For more information: Nafeesa Ladha (Program Manager): nafeesa.ladha@camh.ca
Mount Sinai Academic FHT Women’s Health Clinic
The Women’s Health Clinic at the Mount Sinai Academic Family Health Team is open for referrals. We run 2-3 clinics per month and hope to provide timely access for IUD insertions/removals, contraceptive implant insertion/removals (Nexplanon) and endometrial biopsies by our team of family physicians with special interest in Women's Health.
Please find attached the clinic referral form that we ask for you to complete in its entirety and fax back to the number on the form. For those of you in a FHO model, note that completion of this referral form allows the Women’s Health Clinic physician to use a billing code that will not negatively impact your outside use.
When referring your patients:
Please remind your patients that this clinic is being held at the Mount Sinai Academic Family Health Team located at 60 Murray Street, 4th floor – NOT in the main Mount Sinai Hospital building.
Please provide your patient with a prescription for Nexplanon or the IUD.
Please advise the patient to bring the IUD/implant to their Women’s Health Clinic appointment.
Please ask the patient to take 400mg of ibuprofen 1-2 hours before their scheduled appointment time (if no contraindications).
Note that any abnormal laboratory results will be communicated directly to the referring physician to ensure that an appropriate follow up plan is in place.
Please note that Family Medicine residents are integrally involved in this clinic and occasionally we will also have a medical student join us. Please ensure your patients are aware of the central role of the resident in our clinic and confirm they are willing to have a resident (and possibly a medical student) involved in their procedure. We directly supervise the learners during the procedures and are hands-on to the level required for patient safety and as dictated by the learner’s training level.
Unfortunately, we are unable to accept referrals if patients decline learner involvement. We feel strongly that teaching family medicine residents to perform these procedures is critical in creating capacity in our discipline.
Please Fax referrals to 416-586-3175. Referral form can be found here.
If you have any questions please contact admin.familymed@sinaihealth.ca.
Diabetes Education Offered by Mount Sinai Academic Family Health Team for Patients of Community Practices
The Mount Sinai Academic Family Health Team Diabetes Education Program consists of a Registered Nurse and Dietitian who specialize in diabetes care. Our team offers education and counselling to support patient self-management of diabetes. We can answer patient’s questions about diabetes medications including but not limited to insulin and other injectables, self-monitoring of blood glucose, preventative care, foot care and meal planning. Our program accepts referrals for patients with Type 2 diabetes and Prediabetes and is available to community physicians. There is no cost to patients and at present, appointments are available with minimal delay. Here is the referral form. More information about the program for patients can be found here: Diabetes Education and Management Program | Sinai Health
Extensions for Community Healthcare Outcomes (ECHO)
ECHO is a free virtual training and capacity building model accredited by the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada, that supports healthcare providers.
ECHO at CAMH
ECHO Ontario Mental Health delivers high quality, evidence-based mental health and addictions care in their local communities. ECHO links expert interdisciplinary teams with healthcare providers in order to share best practices, jointly discuss practical recommendations for complex client care, and build sustainable communities of practice.
More information on the programs ECHO at CAMH delivers can be found here: camh.echoontario.ca/our-programs/
ECHO at UHN
Echo at UHN hosts weekly online sessions. They include an overview of best practices and discussions of real patient cases, with expert diagnostic and treatment suggestions.
Concussion Program starts February 26: register here: uhn.echoontario.ca/Register
Available to Patients
MyCare Clinic Accepting New Patients
If your practice is full and you have patients seeking attachment, the TELUS Health MyCare Clinic, located near Union Station, is accepting new patients. The clinic offers both in-person and virtual care, providing a flexible option for those in downtown Toronto.
For more details, click here or patients can contact: mycare@telus.com
Toronto Western FHT Community Health Education Workshops
Join our free health education workshops, open to all community members! Topics include nutrition, senior’s health, mental health, and more. Workshops are free of charge, open to the public and available for online registration. For more details and to register, visit Health Education Workshops and Group Education.
Mid-West Toronto Ontario Health Team Patient Resources
A resource toolkit for patients: click here for timely and handy resources for your patients including:
Mental Health Resources
Virtual Urgent Care Resources
811
and more
Be counted! Did you complete the census?
Please complete the Family Medicine/Primary Care Census for a chance to win one of 15 gift cards for dinner for two at a local restaurant!