Advancing digital health systems to meet Ontario’s future care needs

Ontario is aging rapidly: by 2041, nearly one in four residents will be over the age of 65.

As more Ontarians express the desire to live and age at home, the province now faces a defining challenge: its current digital infrastructure is not equipped to support the future of care in the home.

Despite Ontario’s policy commitments to expand access to home and community care, the systems used today were not designed for the scale and complexity of current needs. Existing digital health systems struggle to meet demands for real-time visibility, interoperability, or integrated care delivery. As a result, service provider organizations (SPOs), hospitals, and community support services organizations are operating in silos, missing the full picture of a client’s health journey.

This lack of a connected ecosystem doesn’t just slow things down; it puts real strain on frontline workers, delays care, duplicates effort, impacts clients and families, and limits the province’s ability to plan system-wide improvements.

Ontario’s policy commitments to home and community care

Ontario has long recognized the importance of helping seniors receive care and live independently at home. The province’s 2017 Aging with Confidence strategy set this direction, calling for expanded home and community care, as well as stronger supports for independence.

That commitment is reinforced through more recent national funding agreements with dedicated Ontario allocations, including the Canada–Ontario Aging with Dignity Funding Agreement and Canada–Ontario Agreement to Work Together to Improve Health Care for Canadians. Together, these agreements provide targeted federal investments to expand home and community care services, strengthen caregiver supports, and modernize digital health systems, including the connected systems needed for coordinated care.

The goal remains consistent: deliver an integrated, digitally connected system that meets the needs of an aging population. Yet even with aligned priorities, Ontario’s home and community care still relies on outdated technology that no longer meets its needs.

Why outdated digital health systems are straining Ontario’s care network and hospital-to-home transitions

Ontario’s current digital infrastructure is putting financial, operational, and human capital pressure on the entire system. Without modern health technology, frontline staff spend valuable hours navigating disconnected systems and duplicating work. This reduces efficiency and worsens burnout in an already strained workforce. For clients and families, the result is fragmented care, repeated information sharing, and greater responsibility for managing logistics, often leaving caregivers to fill gaps in the system.

The impact is system-wide. According to CIHI’s 2023–24 data, nearly one in five hospital bed days in Ontario were tied up by Alternate Level of Care (ALC) patients (individuals who no longer required acute treatment but could not be safely discharged). This represents almost 1.5 million hospital days in Ontario alone, out of 3.2 million across Canada (excluding Quebec), placing significant strain on the province’s health system capacity.

While not all ALCs can be resolved through home and community care, AlayaCare’s internal research suggests that likely up to 25% of cases are linked to patients awaiting discharge into home care. Fragmented coordination between hospitals, public care coordinators, and SPOs slows down these transitions. Together, these factors contribute to billions in excess costs and continued pressure on hospital capacity, underscoring the need for digital health technology that supports integrated care.

Why interoperability must include home and community care

As The Honourable Jean-Yves Duclos states in a Health Canada bulletin: “Data saves lives. Better access to health information will empower patients and is essential for health workers to provide high-quality care.”

The federal Pan-Canadian Interoperability Roadmap aims to enable secure, real-time data sharing across systems and jurisdictions. In Ontario, home and community care involves a complex web of hospitals, primary care teams, SPOs, community support agencies, frontline care teams, and family caregivers. Each plays a role in supporting clients through the care continuum, but they often work in silos.

Without a connected health system, coordination across these groups is limited. Outdated tools make it difficult to share records, track progress across care settings, or use modern capabilities such as real-time referrals and proactive risk alerts. Providers want to do more to support more clients at home, but without the right technology they lack the foundation to succeed.

Ontario has committed to interoperability, yet its current technology is not equipped to meet this goal, keep up with the expansion of home and community care, or be prepared for the province’s evolving future needs. Without modern, interoperable digital health solutions that bridge visibility across the care continuum, the national vision risks remaining a policy promise that never reaches the front lines.

What modern digital health systems could unlock for Ontario home and community care

A modern system isn’t just about supporting day-to-day operations. It’s the foundation for better system-wide decision making. When client information is accessible across care settings, Ontario can generate more reliable population-level data. This supports better insight into what works, where gaps exist, and how to target funding based on real-world needs.

Improved visibility also enables value-based care. The aim is not just to deliver services, but to achieve meaningful outcomes while making efficient use of public resources. This depends on integrated systems that track progress across the full care journey and measure results against what matters most to clients.

Modern digital health tools can provide:

• A unified view of the client across care settings
• Automation of referrals and shared care planning
• Real-time visibility to all care team members
• Family and caregiver engagement tools
• Outcome tracking linked to funding and policy
• Predictive analytics and AI alerts to flag risks and enable earlier interventions.

These are not bells and whistles. They are essential capabilities that reduce hospital reliance, improve coordination, and support independence at home, while keeping the system forward-looking and prepared for the future. Canadian providers are already demonstrating the results that come from investing in the right digital health system.

Examples include:

• Health PEI, Prince Edward Island’s single health authority, was the first in Canada to integrate hospitals and home care province-wide, enabling real-time updates, better coordination, and proactive planning.
• Bien Chez Soi in Quebec used optimization algorithms to cut vacant visits by 42% and boost scheduling productivity by 68%.
• Nucleus Independent Living in Ontario achieved a 76% family portal adoption rate with 83% satisfaction, demonstrating the strength of digital tools in building stronger client and caregiver engagement.
• Integrity Home Health Services in New Brunswick increased reassessments by 79% and achieved a 360% ROI in just two years after investing in new software, ensuring timely care plan updates and stronger alignment with public sector partners.

Together, these examples show how digital investments in home and community care deliver measurable outcomes across Canada.

How Ontario can lead on digital health modernization

Modernizing digital health systems for home and community care is not just a technical decision. It is an opportunity to align Ontario’s systems with its vision for equitable, effective, and people-centred care.

Investing in the right systems supports provincial priorities while delivering measurable results. Modern tools can reduce administrative burden, strengthen coordination, identify risks earlier, and improve discharge planning, easing pressure on hospitals and better leveraging home and community care. Ontario can begin by piloting these improvements regionally, measuring outcomes before scaling province-wide.

Ontarians deserve more than basic service delivery. They deserve meaningful outcomes, better health, greater independence, and care that reflects their needs. That means giving providers access to the full picture of a client’s goals and progress, reducing administrative barriers so care teams can focus on what matters most, and ensuring the tools are in place for people to receive care in the place they call home.

The window is open. Now is the time to act. From ministry leaders to providers, stakeholders across the system have the opportunity to align in vision. What’s needed now is the shared will to act.