North West Local Health Integration Network Information and Communication …/media... · 2015-04-08 · North West Local Health Integration Network Information and Communication

North West Local Health Integration Network

Information and Communication Technology

Background Paper

October 2006


Information and Communication Technology Background Paper i

Table of Contents

1.0 Introduction ......................................................................................................................1

2.0 National, Provincial, and Industry Context.....................................................................2

2.1 National Context ........................................................................................................2

2.1.1 Canada Health Infoway (CHI) ........................................................................3

2.2 Provincial Context......................................................................................................5

2.2.1 Ontario e-Health Strategy ..............................................................................5

2.2.2 e-Health Governance and Management ........................................................7

2.2.3 Ontario e-Health Council ................................................................................9

2.3 Provincial Initiatives ...................................................................................................9

2.3.1 Privacy / Security ...........................................................................................9

2.3.2 Public Health................................................................................................10

2.3.3 Smart Systems for Health Agency (SSHA)...................................................11

2.3.4 Drug Programs ............................................................................................12

2.3.5 Laboratories.................................................................................................13

2.3.6 ePhysician Project .......................................................................................14

2.3.7 Children’s Health..........................................................................................14

2.3.8 Wait Time Strategy / Enterprise Master Patient Index (EMPI) ......................14

2.3.9 Continuing Care e-Health Readiness Survey Results ..................................15

2.3.10 Sector Specific Initatives ..............................................................................16

2.4 Industry Context and Enabling Technologies...........................................................16

2.4.1 Patient Safety and Information Technology..................................................16

2.4.2 Web Based Technologies ............................................................................17

2.4.3 Data Repositories and Decision Support......................................................19

2.4.4 Wireless Technologies, Point of Care and Personal Data Assistants ...........19

2.4.5 Voice Recognition ........................................................................................20

2.4.6 Telemedicine ...............................................................................................20

3.0 Current Northwestern Ontario Information and Communication Technology (ICT) Initiatives ........................................................................................................................21

3.1 Coordination and Integration: Ontario North e-Health (ONe-Health) ........................23

3.2 Electronic Health Record (EHR) ..............................................................................25

3.2.1 Background..................................................................................................25

3.3 Northwest EHR Readiness ......................................................................................27

3.3.1 ICT Blueprint ................................................................................................27

3.4 EHR Readiness Survey Report for Hospitals...........................................................28

3.4.1 Overview......................................................................................................28

3.4.2 Report for North West LHIN .........................................................................28

3.5 Northwest Health Network (NWHN).........................................................................33

3.6 Digital Imaging / Picture Archiving Communications Systems (DI/PACS) ................34

3.7 Pan-Northern Ontario PACS Project (PNOPP) ........................................................35


ii Information and Communication Technology Background Paper

3.8 Northwestern Ontario Teleradiology Service............................................................38

3.9 Telemedicine in the North West LHIN......................................................................38

3.9.1 Ontario Telemedicine Network (OTN) ..........................................................38

3.9.2 Keewaytinook Okimakanak Telehealth (KO Telehealth)...............................42

3.10 Northern Ontario Hospital Back Office Services (NOHBOS)....................................42

3.11 Northwest Information and Communication Technology Collaboration ....................43

3.12 Current Implemented ICT Applications ....................................................................44

3.13 Current Information System – Vendors....................................................................46

4.0 Information Management Strategy................................................................................47

4.1 Ontario MOHLTC Information Management Strategy ..............................................47

4.2 Data Quality in the North West LHIN .......................................................................48

5.0 Northwest ICT Planning.................................................................................................48

5.1 Northern Ontario Information & Communication Technology Planning Project (ICT Blueprint) – Phase 1 ................................................................................................48

5.2 Northern Ontario Information & Communication Technology Planning Project (ICT Blueprint) – Phase 2 ................................................................................................53

6.0 Challenges and Opportunities for the North West LHIN .............................................54

7.0 Acronyms .......................................................................................................................56

List of Figures

Figure 1: Infoway Projects – January 2006 ....................................................................................................4

Figure 2: The Relationship of e-Health to Ontario’s Health Transformation Agenda ..................................6

Figure 3: Benefits of a Renewed Ontario e-Health Strategy, May 2006 ......................................................7

Figure 4: Ontario e-Health Governance Framework......................................................................................8

Figure 5: SSHA Framework ..........................................................................................................................12

Figure 6: ONe-Health Steering Committee Governance Structure, May 2006..........................................23

Figure 7: Provincial Comparison - Information Infrastructure Use..............................................................29

Figure 8: Provincial Comparison - Information Sharing with Other Hospitals............................................30

Figure 9: Provincial Comparison - Interoperability Use with EHR or Other EPR ......................................30

Figure 10: Provincial Comparison - Information Sharing with Other Physicians .........................................31

Figure 11: Provincial Comparison - Information Sharing with Other Healthcare Organizations.................31

Figure 12: Provincial Comparison - EPR Leadership and Planning .............................................................32

Figure 13: Provincial Comparison - Clinical Documentation Use .................................................................32

Figure 14: Northwest Hospital - EPR Priorities ..............................................................................................33

Figure 15: Current State of PACS in Northern Ontario, May 2006 ...............................................................35

Figure 16: PNOPP Conceptual Architecture, May 2006................................................................................37

Figure 17: Telemedicine-Enabled Communities Partnering with NORTH Network ....................................40

Figure 18: Current NORTH Network Sites with the North West LHIN..........................................................41

Figure 19: Patient Management Application Vendors by Hospital................................................................46

Figure 20: Northern Ontario ICT Planning Model (source: Healthtech) .......................................................49


Information and Communication Technology Background Paper 1

1.0 Introduction

Information and communications technologies (ICTs) can facilitate the sharing of information throughout the health care system. In recent years, there has been considerable progress made towards the development of an ICT infrastructure in the Northwest, including:

• Northern Ontario ICT Blueprint, 2005 (Phase 1) - which focused on hospital, tertiary in-patient mental health hospitals/programs, Community Health Centres (CHC), Community Care Access Centres (CCACs) and regional hospital/program ICT needs and strategies

• Ontario North e-Health Steering Committee which was established to implement the ICT Blueprint and is active in the areas of Picture Archiving and Communication System (PACS), Electronic Health Record (EHR) and back office initiatives

• Innovative e-Health and related models such as the Northwest Health Network’s joint ventures in electronic health records and Diagnostic Imaging (DI)/PACS, the Ontario Telemedicine Network (OTN), Northern Ontario Hospital Back Office Services project (NOHBOS), and participation in the provincial Electronic Children’s Health Network (eCHN).

ICT is viewed in the Northwest as a strategic tool that is capable of improving the access to and quality of health services. To discuss these emerging possibilities, this background paper provides an overview of the following:

• National, Canadian and Industry Landscape

• Ontario e-Health Strategy

• Industry Context and Enabling Technologies

• Current Northwest ICT Initiatives

• Information Management Strategy

• Northwest ICT Planning

• Challenges and Opportunities for the North West Local Health Integrated Network (North West LHIN).

The current interest in expanding the use of telemedicine coupled with the significant implementation and planning activities to date has created a real opportunity for the North West LHIN to assume a leadership role to promote and collaborate full integration of ICT into health care delivery. Such collaboration should focus on:

• enhancement of patient care services or access to services

• alignment with a broader regional strategic e-Health plan

• use of a multi-agency or multi-sectoral partnership approach

• sound business case principles


2 Information and Communication Technology Background Paper

• leverage as a foundational element in the creation of an electronic health record. Opportunities for the North West LHIN going forward will include:

• continue the collaboration with the NE LHIN on Phases 2 and 3 of the Northern ICT Blueprint planning process

• engage stakeholders to develop LHIN wide standards, interoperability and best practices

• identify high potential e-Health initiatives

• support the Northern EHR

• support the use of ICT in the community

• encourage the development of initiatives designed to optimize resource allocation

• monitor and support Local Data Management Partnerships (LDMPs)

• facilitate strong linkages between ICT projects

• work with other LHINs and the Ministry of Health and Long Term Care (MOHTLC) to secure access to high quality data.

2.0 National, Provincial, and Industry Context

It is essential that health service organizations and the North West LHIN have an accurate understanding of the ICT context and directions of the broader system in which they must operate on national, provincial and industry levels. The proper alignment between North West LHIN initiatives and the directions of the main public policy makers is critical to advancing the state of ICT in the region.

2.1 National Context

There are many forces driving change in the health sector in Canada including efforts towards restructuring, regionalization alignment with initiatives in primary care reform and the development of community based partnerships. Human resources are held as a primary concern for the industry in terms of recruitment, shortages, and upcoming waves of retirements. The focus of healthcare is shifting from an intervention based model, to disease management and an emphasis on education and prevention. Patients are now educated consumers with higher expectations as to the quality, reliability, and accessibility of service. This new paradigm is characterized by an increased emphasis on evidence-based practice and outcomes and a dependence on reliable information and technologies to support it. e-Health is an overarching term that has been coined to describe this new approach in healthcare. The increasing and broad use of technologies in the healthcare industry is evident in new diagnostic procedures and instruments, administrative, financial, and clinical applications and information systems, and the use of internet technology. For example, the Canadian Medical Association (CMA) reports that almost 80% of doctors use the internet either at home or in their offices, with 30% referring patients to internet sites on occasion.



2.1.1 Canada Health Infoway (CHI)

Canada Health Infoway Inc. (CHI) is an independent, not-for-profit organization whose members are Canada's 14 federal, provincial, and territorial Deputy Ministers of Health. Infoway invests with public sector partners across Canada to implement and reuse compatible health information systems that support a safer, more efficient healthcare system. Launched in 2001, Infoway and its public sector partners have over 100 projects, either completed or underway, delivering EHR solutions to Canadians – solutions that bring tangible value to patients, providers and the healthcare system. CHI’s vision is a high-quality, sustainable and effective Canadian health care system supported by an infostructure that provides residents of Canada and their health care providers with timely, appropriate and secure access to the right information when and where they enter into the health care system. Respect for privacy is fundamental to this vision. CHI’s mission is to foster and accelerate the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan-Canadian basis, with tangible benefits to Canadians. Infoway will build on existing initiatives and pursue collaborative relationships in pursuit of their mission. Infoway is a strategic investor that works in partnership with health ministries, regional authorities, other health care organizations and information system vendors to best align Infoway’s investments with jurisdictional plans and to leverage existing solutions. Once investment decisions are made, public sector partners lead the development, implementation, and use of electronic health record solutions (EHRS). Infoway provides leadership by establishing a strategic direction for electronic health record implementation in Canada in collaboration with the provinces and territories. Infoway is not a granting agency or a venture capital fund, nor is it a builder, direct implementer, or holder of proprietary solutions. In the view of Infoway, a network of interoperable electronic health record solutions across Canada – linking clinics, hospitals, pharmacies and other points of care – will help improve Canadians’ access to health care services, enhance the quality of care and make the health care system more productive. Benefits can be summarized under the following categories:

Access

• Ability to access care - improved wait times and capacity to deliver needed services

• Patient participation - patient access to the EHR

• Availability - greater access to health care services in the home and community

Quality

• Safety - fewer medical errors and adverse drug events

• Effectiveness - achieving desired health outcomes

• Appropriateness - informed prescribing and clinical decision-making



Productivity

• Efficiency - reduced administrative time and costs

• Care coordination - complete patient information for sharing across the continuum of care.

CHI is currently working with its public sector partners on projects in nine targeted program areas: registries, diagnostic imaging systems, drug information systems, laboratory information systems, telemedicine, public health surveillance, interoperable EHR, innovation and adoption, and infostructure. With the exception of the Telemedicine Program, Infoway’s funding percentage has increased to 75% of eligible costs. In January 2006, Infoway reported there were 141 active and completed projects valued at $427 million in all nine programs. Of those, 59 are national projects with the remainder being joint initiatives with provinces and territories. Northwestern Ontario is involved in an Infoway-funded PACS initiative – the Pan-Northern Ontario PACS Project (PNOPP) – as well as the Ontario Laboratory Information System (OLIS) and telemedicine projects. Figure 1 shows the extent of Infoway projects across Canada.

Figure 1: Infoway Projects – January 20061

141 active and completed projects valued at $427 million in all 9 investment programs. The 82 projects jointly developed with provinces and territories are shown.

In addition, 59 national projects are also underway.

LegendRegistriesDiagnostic ImagingDrug Info SystemsLab Info SystemsTelehealthInteroperable EHRPublic Health Surv.LegendRegistriesDiagnostic ImagingDrug Info SystemsLab Info SystemsTelehealthInteroperable EHRPublic Health Surv. 1 Presentation by Infoway to the Yukon iEHR Project Phase 0. Yukon EHR Advisory Committee.



2.2 Provincial Context

2.2.1 Ontario e-Health Strategy

e-Health is a fundamental component of the Ontario government's transformation agenda. Quite simply, e-Health will be an integral part of all future activity within Ontario's health system. While all the system transformation initiatives require e-Health, the health care strategies that are underlined in Figure 2 depend on the e-Health strategy. Ontario's current e-Health strategy is undergoing renewal. This renewal will help e-Health better support Ontario's health transformation agenda, and allow the benefits of e-Health to make a positive impact on our health system and the people it serves. As a result of this renewal exercise, the draft e-Health vision is: “By 2015, Ontario’s health system is the safest, highest quality and the most sustainable

in Canada because people have the right information, at the right time and in the right place. Ontarians are confident that:

• they have the information they need to make decisions about their health and health care

• providers and clinicians are freed to focus on timely and highest quality care

• government and LHINs ensure an accountable, equitable, effective and efficient health system.”



Figure 2: The Relationship of e-Health to Ontario’s Health Transformation Agenda2

The goal of renewing the e-Health strategy is to support the continued transformation of the health system to achieve better outcomes and to develop a comprehensive approach to managing information across the health care system. While technology is important to all of this, the emphasis and focus is on finding better ways of delivering health care and managing information. While the means to that end may be technology, computers and technology are not ends in themselves. An effective strategy must have the right balance. Achieving this means addressing the needs of different and complementary aspects of our health care system. The following chart depicts the four categories of benefits the renewed e-Health strategy will deliver. These are:

• improved population health outcomes

• improved health system performance

• improved client and patient health outcomes

• improved service delivery efficiency.

2 Queen’s Printer for Ontario, 2005.

Reduce wait times for key services

More Ontarians with access to Primary

Health Care

Increased rate of healthy

behaviours including physical activity and

reduced smoking

Transformation Results Transformation Strategies

Increased immunization rates

A health care system

that lives within its means

Healthier Ontarians

in a Healthier Ontario

! Wait Time Strategy ! Critical Care Capacity ! Hospital Alternatives

! Primary Health Care Renewal ! Chronic Disease Management ! Increasing Community Capacity ! Health Human Resource Strategy

! Population Health (Tobacco, physical activity, nutrition, childhood obesity, and low birth weight)

! Public Health Renewal

! Creating a system incl. Local Health Integration Networks

! Managing Drug Program Growth ! Quality and Accountability ! e-Health ! System Multi-Year Funding ! Change Management

e-Health is a critical

component of many elements

of system transformation.

Strategies underlined

indicate elements

where e-Health is a

cornerstone in achieving change.



Figure 3: Benefits of a Renewed Ontario e-Health Strategy, May 20063

2.2.2 e-Health Governance and Management

In 2005, Ontario restructured the governance and management of its varied e-Health initiatives into two main functional areas, as illustrated below in Figure 4: Ontario e-Health Governance Framework.


Improved

Population Health

Outcomes

Improved Health

System Performance

Improved Service Delivery

Efficiency

Improved Client and Patient

Health Outcomes

Better Stewardship

Better Efficiency Better Health

Better Service



Figure 4: Ontario e-Health Governance Framework4

The above framework is currently under review as part of the e-Health renewal and will incorporate a strengthened role for LHINs. A significant element of the new structure will be the LHIN e-Health Leads council. The Ontario LHIN e-Health Leads Council is intended to address e-Health issues at a local and regional level and to make recommendations to the LHIN Chief Executive Officer (CEO) Council, where appropriate. This Council shares information on projects and plans within each LHIN, provides advice on e-Health strategies and priorities to the MOHLTC, identifies provincial e-Health priorities, provides high-level governance for identified e-Health initiatives, fosters communications among the LHINs and discusses current and emerging common e-Health policies and practices. Membership on the Council includes the e-Health Lead from each LHIN, the MOHLTC's e-Health Lead, representatives from Smart Systems for Health Agency (SSHA), the Chief




Information Officer (CIO) of Cancer Care Ontario and a LHIN CEO. This Council reports to the LHIN CEO Council.

2.2.3 Ontario e-Health Council

The Ontario e-Health Council, supported by the e-Health Office, develops and coordinates e-Health policy, strategy, and standards. Advisory councils have also been created to plan and oversee the development of e-Health initiatives in each sector. There are currently sector councils for:

• Hospitals

• Physicians

• Continuing Care

• Public Health

• Laboratories.

2.3 Provincial Initiatives

2.3.1 Privacy / Security

In May 2004, the Ontario Government passed Bill 31- the Personal Health Information Protection Act (PHIPA) and the Quality of Care Information Protection Act (QCIPA). Bill 31 has been developed to provide comprehensive and consistent rules for the collection, use, and disclosure of personal health information. The Bill clearly indicates that health information – either paper based or electronic - is to be kept private, confidential, and secure. Ontario’s Information and Privacy Commissioner (IPC) is responsible for overseeing compliance with this regulation. The government has delayed the implementation of the “lockbox” component. The lockbox provisions will ultimately allow patients to withhold certain health information from specific care providers and healthcare organizations. The processes to meet the requirements of this provision will be very difficult as most organizations rely on paper-based records with multiple encounters bound together. In addition, the majority of vendor systems in use within Ontario healthcare organizations do not currently have the functionality to lock out a specific episode of care. The stated goals of the legislation are to protect the privacy of individuals, and the confidentiality and security of personal health information in the health sector in a manner that facilitates the effective provision of healthcare.5 Organizations will need to implement a privacy infrastructure to address the requirements of this act. A Privacy Officer will need to be identified. In addition, processes related to patient consent for access to their records will need to be clearly documented. Provisions for patients

5 Ontario Ministry of Health and Long-Term Care – Health Information Act; Compendium.



to request access to, review, and potentially contribute to the record will be required. As outlined in the Act, the “Health Information Custodians” must make a written statement available to the public explaining their information practices, how they can access their personal information, how to contact a Privacy officer for clarifications/concerns, and how they can make a complaint.

2.3.2 Public Health

Integrated Public Health Information System for Ontario (iPHIS)

Ontario is well underway with the development and implementation of an Ontario version of iPHIS, the Integrated Public Health Information System. iPHIS is a key deliverable in the MOHLTC’s Operation Health Protection initiatives. Operation Health Protection is a comprehensive plan to restore public health in Ontario and to prevent threats to our health. iPHIS is an example of the government’s overall strategy to improve healthcare by transforming health systems and business practices through the investment in, and more comprehensive use of information technology. iPHIS is a web-based application owned by the Public Health Agency of Canada. iPHIS is managed through the Canadian Integrated Public Health Surveillance (CIPHS) Collaborative, a Federal, Provincial and Territorial body that provides overall strategic direction for the development and ongoing maintenance of the iPHIS application. The new system for communicable disease management and reporting will provide:

• accurate data collection

• full case management for reportable diseases

• linked contact, quarantine and follow up management for cases

• client information and demographics

• reporting and analysis of information. Ontario has developed a new outbreak management module in iPHIS to better track the path of infectious diseases and to manage quarantines. The Public Health Division of the Ministry installed the application in November 2004. Health units in Ontario began using iPHIS to collect and manage information about reportable diseases starting in February 2005.

Integrated Services for Children Information System (ISCIS)

The Healthy Babies, Healthy Children program is also supported by SSHA technologies. SSHA securely hosts the Integrated Services for Children Information System (ISCIS) in its data centres. The combination of secure network connections and hosting allows the1200 users at the 160 head and satellite offices of Ontario’s Public Health Units to eliminate cumbersome paper records and securely access client information quickly and completely.

Pan-Canadian Public Health Communicable Disease Surveillance and Management System

Recently a pan-Canadian project has been started to implement an Electronic Public Health System solution. The system will have the following functionality:



• outbreak management

• communicable disease case management

• health alerts management

• immunization management

• materials/vaccine inventory management

• work management. The project is funded by CHI, however each territory and province will make its own decisions on whether or not to adopt the pan-Canadian solution.

2.3.3 Smart Systems for Health Agency6 (SSHA)

After several years of operation, SSHA was established as an independent agency in January 2003, to provide the secure, integrated, province-wide information infrastructure to allow electronic communication among Ontario’s health service providers. SSHA is electronically connecting doctors, hospitals, laboratories, public health units, community care access centres, and pharmacies to improve the flow of patient information. SSHA is developing information technology services such as secure hosting, network, registration management, directory, portal development, messaging, and information management services (e.g. standards, privacy and security). SSHA provides a Privacy and Security Portal with information and training materials for health providers. All of Ontario’s 256 hospital sites are connected to the SSHA network, which they use to securely share patient and administrative information.7 Provincial healthcare organizations are also ‘plugging into’ SSHA to help in collecting province-wide data for system planning and to manage their services and waiting lists. These include:

• Cancer Care Ontario

• Cardiac Care Network of Ontario

• Trillium Gift of Life (organ donation)

• Ontario Air Ambulance Base Hospital Program.

SSHA services are also being used for government applications, such as health card validation, secure email, on-line healthcare directories and Voice over Internet Protocol (VoIP). SSHA services can also provide better service continuity in the event of a power blackout, network error or equipment malfunction. All CCAC main offices and many satellite offices across Ontario are connected to the SSHA network. SSHA securely hosts their financial and statistical systems, as well as 20 CCAC websites. Currently, SSHA is helping CCACs automate their business functions and standardize the tools they use to allocate resources. Work is also underway to offer secure

6 SSHA website.

7 “SSHA Connects Hospitals to Improve Patient Care in Ontario”, by Anne Lawrence and Danny Faria in

Healthcare Information Management & Communications Canada, February 2006, pp. 35-37.



email. In the longer term, SSHA technologies will allow every CCAC to link with hospitals, long-term care facilities, family physicians, and others. SSHA is putting in place computer technology products and services so continuing care sector workers can access information and connect to each other, and soon, to doctors, hospitals, laboratories, public health offices, and pharmacies. As well, SSHA will support the new Ontario Laboratories Information System (OLIS) by providing secure email, network connectivity, and hosting applications in the data centres. Figure 5 indicates the SSHA framework and how the various initiatives fit and support each other.

Figure 5: SSHA Framework 8

2.3.4 Drug Programs

The MOHLTC has provided most Ontario hospital emergency departments with electronic access to the drug claims history of patients receiving benefits through the Ontario Drug Benefit Program (ODBP) and the Trillium Drug Program. The initiative was targeted for phased implementation beginning in September 2005 with full provincial rollout to be completed by May 2006. Electronic access to a patient's drug history is immediate – in real time – and simple to use. The new system involves the development and implementation of a Drug Profile Viewer (DPV)

8 Smart Systems for Health, e-Health Leaders Forum, October 2005.



System. It enables the sharing of drug program recipient prescription drug histories currently maintained through the MOHLTC Health Network System (HNS) to healthcare providers in hospital emergency rooms. It can help healthcare providers to quickly identify and prevent adverse drug reactions, and provide more informed emergency care. Potentially it can shorten medical assessments and allow for a faster diagnosis. This disclosure can provide missing information if a patient is incapable or cannot remember their medications. It can help ensure a patient's current medications are continued in hospital if needed. It can also reduce the need for patients to repeat their drug information to multiple providers involved in their care. The web-enabled application of the system was offered to all hospitals sites with 24/7 emergency departments connected to the SSHA secure network. The application is designed to be replicable by CHI in other jurisdictions. The system will include software to support the project’s operational needs as well as security and privacy requirements. SSHA is also in the process of replacing the HNS which electronically links the MOHLTC’s Ontario Drug Benefit Program with retail pharmacies, allowing them to identify possible adverse drug reactions and speed up payments.

2.3.5 Laboratories

The Ontario Laboratories Information System (OLIS) is another project with a vision for linking patient information – in this case, all the orders and results for laboratory tests carried out by all laboratory service providers in Ontario (community, hospital, public health). With the recent awarding of the contract, the project is proceeding to implementation. OLIS will electronically link practitioners, specimen collection centres, and laboratories so that all laboratory information can be exchanged electronically between practitioners and laboratory providers and provide the MOHLTC and other payers with program management information. Personal result information will only be disclosed to a practitioner who is identified on a test order, or who has the patient’s explicit consent to view his/her tests. OLIS will be implemented in three phases over a two-and-a-half year period after contract award. Phase 1 – Creation of a transaction delivery system to handle the messaging and transaction

processing for all laboratory test orders and results, including on-line validation of practitioner, patient, laboratory and service data; repositories to store clinical laboratory data and de-personalized laboratory utilization data; and integrated functions to record and maintain patient consent. There will be a web application and application servers to provide for order, specimen collection and result data entry and retrieval using a web browser

Phase 2 – Development of an MOHLTC adjudication application and orders repository for services that are publicly funded

Phase 3 – A comprehensive MOHLTC financial management and reporting sub-system

including a laboratory financials repository, and demographic information from external sources.

Six foundation adopters have engaged OLIS. By January 2007, OLIS will start working with the second wave of organizations.



2.3.6 ePhysician Project

The ePhysician Project is a partnership between the MOHLTC, the OMA, and the Ontario Family Health Network to develop and implement a comprehensive Information Technology Program for Ontario primary care physicians. The program is called the Physician IT Program and includes:

• a list of Clinical Management Systems products that have been approved by the program as meeting specified functional standards

• a Transition Support Program designed to help physicians acquire and use information technology, including access to transition specialists and workshops and to tools such as best practice guidelines and checklists

• Network Services provided by SSHA to provide doctors with secure internet connections over a secure network which will connect all doctors in the province

• OntarioMD.ca, an internet portal hosted by Smart Systems for Health that provides free access for all physicians to health alerts, journals, drug interaction databases and information on clinical trials

• a Primary Care IT Funding Plan designed to assist eligible primary care physicians acquire information technology.

The Physician IT Program is now managed by OMA e-Services Inc., a subsidiary of the OMA.

2.3.7 Children’s Health

The electronic Child Health Network (eCHN) arose from a project at the Hospital for Sick Children. eCHN’s Health Information Network (HiNet) is an operational enterprise master patient index (EMPI) and an EHR in use at 25 member sites and approximately 100 physician offices in Ontario. eCHN’s solution is based on a central repository that assembles consented

pediatric patient data to form a longitudinal electronic medical record. HiNet encompasses various tools such as Medical Entities Dictionary tools which eCHN uses to build an enterprise dictionary of laboratory test orders, panels, sub-panels, and reference ranges. HiNet accepts standard HL7 data feeds Admissions, Discha



regarding utilization of procedures; and provides information to assist in the management of wait lists. The success of the WTIS depends on a provincial EMPI and in June 2005, the Deputy Minister of Health announced the development of both. Although implementation of the patient index will first focus on meeting the needs of the wait times system, it will be designed to support the needs of other critical transformation initiatives such as LHINs. In order for the WTIS to function there must be a way to uniquely identify individuals receiving health care services and treatment in Ontario. There is currently no such province-wide system available that uniquely identifies patients. Although there are several institution specific information systems which uniquely identify patients, such as the electronic record systems and ADT systems found at many hospitals, these systems have limited capacity to “talk” to one another or to the MOHLTC.

2.3.9 Continuing Care e-Health Readiness Survey Results

The Ontario Long-Term Care Association (OLTCA) submitted a response to the MOHLTC e-Health Strategy Renewal input survey. Highlights of the survey response (April 2006) are presented as an example of the work being done in all health care sectors in Ontario to identify e-Health challenges and opportunities. The areas identified by the OLTCA as most likely to benefit from e-Health included:

• The referral process (currently a paper based manual process, with subsequent data entry into multiple computer systems by many service providers)

• Wait time standardization and tracking (inconsistencies in how wait list information is tracked compromises the LHINs’ and the MOHLTC’s ability to measure service levels and plan for future needs).

The current multiple processes of referring and access tracking must be remedied in order to implement the transformational agenda of e-Health and improve the delivery of health care in the long-term care sector and the overall continuing care sector. An e-Referrals and Access Tracking solution will introduce an electronic referral business model, using internationally accepted data standards and standardized nomenclature that will increase the accuracy and efficiency of the referral process for clients and care providers. It will provide meaningful access tracking and wait list status information to enable planning for sustainable health care services as well as protect the privacy and security of sensitive personal health information. The benefits of e-Health solutions for the continuing care sector include:

• Consistent and comparable information about wait lists times to enable better list management and reporting

• Ensuring compliance with Personal Health Information Protection Act (PHIPA) requirements for referrals, which will assure the privacy and security of client information

• Smoother transition to and from the hospitals and long-term care

• Sector standardization of data collection and definitions in use across the continuing care sector resulting in better communication, reduced delays and connected business processes within the long-term care sector and with other health sectors



• Enabling a consistent implementation of a referral and access tracking solution across the LHINs

• Decrease in the risk of errors in resident care because of occurrences of inaccurate information

• Streamlined referral processing and reduced data to support improved service to the client

• Decreasing overall costs to the sector by providing an integrated solution and avoiding the proliferation of uncoordinated solutions being developed and used in attempts to integrate stand-alone systems. This promotes decisions based on sectoral as well as local priorities

• Enabling faster and more accurate provision of services, relieving acute care use

• LTC homes are the most paper-intensive of the service provider groups (according to the e-Referral and Access Tracking business case). The sector should see significant benefit in replacing fax/courier documents with electronic transmissions.

2.3.10 Sector Specific Initiatives

In addition to the many initiatives discussed above, there are a wide variety of provincial e-Health projects identified below which are more sector-specific. They are either focused on specific providers or specific problems such as responding to communicable disease outbreaks.

• Hospital e-Health Council

• Electronic Health Record Working Group

• Network Operations Working Group

• Unique Patient Identifier Working Group

• e-Health Privacy and Security Working Group

• Home Telemedicine Working Group.

2.4 Industry Context and Enabling Technologies

The last decade has seen a significant shift in the adoption of technology in the healthcare sector. Information systems and technologies have emerged as essential components of the infrastructure and day-to-day operations of healthcare organizations. The following section highlights some of the emerging technologies that are evident across the healthcare industry.

2.4.1 Patient Safety and Information Technology

The topic of patient safety and employing technology to reduce/address “adverse events”, and “errors” is forefront in the healthcare industry. In the United States, the issue of patient safety has gained considerable momentum since the release of the Institute of Medicine’s report, To

Err is Human (2000) and Crossing the Quality Chasm: A New Health System for the 21st Century (2003).



In Canada, Baker and Norton9 discuss the Canadian – specific environment, noting that there is very little data available today that outlines the extent of errors in Canadian healthcare. The authors note three strategies to address errors. Two of the strategies are policy driven - i.e. instituting non-punitive approaches for reporting errors and creating cultures within the organization with an emphasis on teamwork. It is notable that the third strategy supports the development and deployment of technologies such as physician order entry and electronic medication administration.10 Order entry is the automation of the requisition processes for an organization – relevant to any or all of laboratory and diagnostic imaging, pharmacy, allied health services, and even maintenance services. This may be within an organization, and may also involve external service providers (i.e. a contracted laboratory services provider). Order entry is extremely important to the development of an EHR, and also to operational efficiency and risk management within a healthcare organization.

2.4.2 Web Based Technologies

The maturation of web-based technologies has led to wide-spread adoption both at the individual desktop and in the organizations’ data centres. Healthcare organizations can leverage this ubiquity in a variety of ways.

e-Consumerism

Organizations and consumers look towards the internet for “context” or content based information. Web sites with recent research findings, literature and on line chat rooms are examples of how the internet is used by the public to locate health information. Studies have

shown that more than 40% of internet users access the web for health related information.11

No doubt one of the biggest challenges for healthcare professionals today is to educate themselves and the public on how to discriminate between evidence-based research and other less reliable sources. In 2001, the Change Foundation conducted a study of consumer practices and satisfaction with healthcare delivery. Some of the notable findings include:

• 97% of respondents accessed at least one source of health information

• 66% look to sources other than primary care physician

• 33% report “so much conflicting information”.

Portal Technology

Web Portals are another adaptation of web-based technology in healthcare. The portal concept provides a toolkit that forms the base of an integration pathway, allowing organizations to integrate information from diverse vendor systems within, across facilities, and outside of the walls of the traditional hospital. A portal, for example, could be developed to allow a physician to access information for his/her private practice record system and the local hospital system. In addition, he/she could link his/her site to reliable health information databases and provide links for his/her patients.

9 Baker, G.R., Norton, P., (2001), “Making Patients Safer! Reducing Error in Canadian Healthcare.” Healthcare Papers 2(1):10-31.

10 As above.

11 Eliasoph, H., e-Health Consumer: A Diminishing Tolerance of Hospitals, Hospital Quarterly, Winter 2000/2001.

Pg 31.



As hospitals and other care delivery organizations increasingly seek to simplify access to clinical data stored in multiple systems – either within the hospital or across groups of hospitals - adoption of portal technology is accelerating. Some of the Canadian portal projects which are either currently underway or are complete are identified below:

• Calgary Region (Orion)

• Capital Health (Edmonton) (Orion)

• Chatham Kent Health Alliance (McKesson)

• Grand River Hospital (McKesson)

• Halton Health Services (MEDSEEK)

• Hamilton Health Sciences (MEDSEEK)

• Lakeridge Health (Data Glider)

• Newfoundland/Labrador (Quovadx/Initiate)

• The Ottawa Hospital (Dinmar Oasis)

• The Scarborough Hospital (MEDSEEK)

• Toronto Academic Health Science Network (TAHSN) / St. Joseph’s Health Centre (SJHC) and Toronto East General Hospital (TEGH)

• Trillium Health Centre (IBM/WebSphere)

• William Osler Health Centre (MEDSEEK)

• Windsor Regional Hospital (McKesson). Many of the challenges faced by Canadian healthcare IT systems are only peripherally addressed by portal technology. As portals are typically read-only with links to the underlying systems, workflow improvements and computerized physician order entry require additional underlying technology. Further, since a portal integrates systems only at the user interface, functionality requiring deeper integration (such as issuing of order sets across multiple systems or strong clinical decision support) is not inherently provided. Nevertheless, Canadian healthcare organizations are rapidly adopting portal technologies to realize the following benefits:

• Portals provide a consistent user interface that can pull together information from multiple underlying heterogeneous systems (from one or more institutions), centralizing information and reducing the need to transfer files or repeat procedures. Further the portal simplifies access for clinicians who work at multiple institutions

• Because portals pull information together at the user interface level, underlying data structures do not need to be modified or integrated together. Portal-to-application interfaces are much simpler and faster to develop than traditional HL7 interfaces between clinical applications

• Web technology standards mean that portals can be easily deployed beyond institutional boundaries. They provide an excellent mechanism for sharing between and beyond institutions and will lead eventually to patient accessible portals

• Portals can be implemented quickly and with reasonable expense, providing rapid integration of multiple institutions. Some organizations have implemented portal



solutions spanning multiple institutions and technologies from project inception, through vendor selection, design, and go-live in less than 9 months12.

It is expected that the industry will see the continued rapid adoption of portals. Increasingly sophisticated web-service links to clinical applications will continue to advance portal functionality well into the future.

e-Business

The third influence of the internet within heath care is evidenced in the area of e-commerce. The web-based technologies are employed to facilitate the exchange of information at a business-to-business level. e-Commerce is transforming processes for inventory management and supply requisition. The same standards and technologies that permit businesses to safely connect their systems together, can also be leveraged to connect internal systems together. This approach leads to applications that can be easily integrated with each other (because they all follow web standards), permitting greater use of best-of-breed solutions. Infoway has built this model of application interaction (called a Service Oriented Architecture) into their EHRS blueprint.

2.4.3 Data Repositories and Decision Support

Data repositories are powerful tools that support the reporting and decision-making requirements of an organization. Data from clinical, financial, and administrative systems can be brought together for analysis and trending. Data repositories are essential tools for research-based activities and outcomes tracking. Several healthcare organizations in Ontario have developed “online” dashboards with key indicators for the manager displayed in a real time format.

2.4.4 Wireless Technologies, Point of Care and Personal Data Assistants

Radio frequency networks have been commonplace in the automotive and food industry throughout the past decade. The private sector employed this technology to support streamlined inventory management and supply tracking processes. Radio frequency technology allows the worker to become mobile: information is available in a real-time, online basis. In healthcare, the ability to access the EHR from any location at any time is revolutionizing care delivery models. The use of advanced technologies such as radio frequency allows care providers to access clinical records and to enter assessments and observations at the location of treatment – therefore eliminating the need to record data on paper and input it into the system at a centralized location. Significant strides have been seen in the use of wireless technology and mobile point of care devices in healthcare. There are now a variety of device options – some cart mounted, others hand held. Organizations are able to select technology to support the workload of a unique environment.

12

Healthtech, Information and Communication Technology: Current State & Environmental Scan – North West Local Health Integration Network, March 2006.



Recent development efforts on behalf of software vendors are focusing on how to employ the smaller Personal Data Assistants type devices to provide quick profile type information. An example of this is the development of applications to support physician rounds.

2.4.5 Voice Recognition

Voice recognition technology, also referred to as speech recognition, has been available in some fashion throughout the last decade. Early adopters of this enabling technology have traditionally been the pathology and radiology departments of hospitals and small physician office systems. There are a wide variety of products on the marketplace today that provide a voice recognition interface to software systems. Introduction of voice recognition in the healthcare environment has met with moderate success – the technology has not yet proven robust enough to meet the unique aspects of the healthcare vocabulary, processing speed requirements and volumes. It is expected that this technology will develop extensively over the next few years.

2.4.6 Telemedicine

Telemedicine refers to the use of communications and information technology to deliver healthcare services over a distance. Telemedicine is supported by a variety of technologies including digital image transmission and video conferencing. The ability to transmit images, physiologic data and clinical data to remote care providers is a technology that is more reliable as infrastructure projects improve accessibility of secure, high speed connections. A comprehensive telemedicine project has several key program features:

1. Selfcare/Telecare - The use of telephone to provide evidence-based health information to enable people to make informed decisions about their health.

2. Chronic Disease Management - Telemedicine can assist the healthcare system in the management of chronic diseases through use of telemedicine technology to access care, support, and education at a distance.

3. Access to Specialists and Specialty Services at the Primary, Secondary and Tertiary Levels - Telemedicine technology can provide access to the services currently not available in some communities or assist in providing enhanced access to services. Some examples from Ott ario’s NORTH Network (a legacy network of the Ontario Telemedicine Network - OTN) are:

! Electrical burn project – increase healthcare professional awareness about the nature of high and low voltage electrical burns and provide clinicians with a mechanism to determine when additional expertise is required to treat these kinds of burns and the appropriate action to take to access these resources

! Telestroke – providing support to emergency physicians when a patient with acute ischemic stroke presents in an emergency department, including access to a consultation with a neurologist



! TeleCorrections – basic telemedicine model to provide healthcare to prison inmates, thereby alleviating the unnecessary risk to the community of transporting inmates outside of a secure facility to access healthcare

! Teleprimary Care – support the linkage of Nurse Practitioners with Physician mentors via telemedicine

! Osteoporosis Telemedicine (pilot project) – support family physicians in identifying and providing osteoporosis care in under-serviced areas, and to ensure continuity of osteoporosis care for individuals without access to a family physician

! Ontario Critical Care Telemedicine Knowledge Network Project – linking staff from 16 Intensive Care Units (ICU’s) at 15 participating hospitals via telemedicine for the purposes of sharing best practices and knowledge translation strategies to improve patient safety and quality of care

! Telesign Language Service – after-hours provision of emergency room interpreter services for health and mental health emergencies for deaf, deafened, and hard of hearing individuals.

4. Home Care - Technology can be brought directly into the home to assist patients/clients in self-management of their diseases, to provide education to them and to improve the access to healthcare professionals. Healthcare providers can also use technology while in the field to access schedules, update care plans, document and transmit progress notes or receive important information from the central office.

5. Point of Care Learning - Technology can provide access to continuing education and professional development at a distance, to healthcare professionals where they work and live. Education is critical to healthcare providers to enable them to increase/maintain the skills and knowledge they require when providing care in rural and remote communities.

3.0 Current Northwestern Ontario Information and Communication Technology (ICT) Initiatives

This section of the report presents the current state of ICT systems in Northwestern Ontario. The analysis is based on several sources of information:

• Northern Ontario ICT Blueprint, 2004

• Northern Ontario ICT Blueprint – Northwest Ontario Tactical Plan and Funding Proposal,

2004

• Electronic Health Record Readiness Survey for Hospitals, conducted by the Ontario Hospital Association, 2005

• Northwestern Ontario Public Sector ICT Collaboration project, 2006

• Northern Ontario Hospitals Back Office Systems project, 2006

• Project updates from the Pan-Northern Ontario PACS Project, 2006

• Updates from ICT initiatives such as the Ontario Telemedicine Network.



The Northwest is fortunate to have a significant number of current initiatives aimed at applying information and communication technology solutions to provide better and more accessible services to the region’s residents. Given the level of hospital-related ICT planning completed to date (i.e. ICT Blueprint Phase 1) and the magnitude of hospital expenditures on ICT relative to other sectors, much of the focus of this section will be on hospital based projects. This situation will change as further ICT planning occurs related to the community sector (i.e. ICT Blueprint Phase 2) and existing initiatives reach a point where successful expansion of scope is possible. Although there are many examples of organizations individually, or in small groups, implementing innovative ICT solutions, the projects described in this section were selected for discussion because:

• they cross a significant number of organizations (typically hospitals) within a sector and/or

• there is significant potential for the projects to evolve to a point where they cross sectors and involve an array of providers within a limited geographic area (e.g. district) or across the region.

Please note that there is a relationship between a number of the projects, but for the purpose of providing a description of the various initiatives they are presented separately on the following pages. From a planning perspective, all of the projects link back to the ICT Blueprint in one of two ways. Either they arose from the Blueprint (e.g. ONe-Health) or they are important partners in the realization of the Blueprint’s vision and core strategies. By topic, the following projects are reviewed:

• Coordination and Integration

! Ontario North e-Health (ONe-Health)

• Electronic Health Record

! North West LHIN EHR Readiness

! Northwest Health Network (NWHN)

! Electronic Child Health Network (eCHN)

• Digital Imaging / Picture Archiving and Communication System (PACS)

! Pan-Northern Ontario PACS Project (PNOPP)

! Northwest Health Network (NWHN)

• Telemedicine

! OTN (NORTH Network)

! Keewaytinook Okimakanak Telehealth (KO)

• Back Office Services

! Northern Ontario Hospital Back Office Services (NOHBOS)

• Northwest ICT Collaboration

• Implemented Systems.



3.1 Coordination and Integration: Ontario North e-Health (ONe-Health)

In mid-2005, an organizational structure was developed to guide the implementation of the ICT Blueprint. An incorporated organization already existed in the Northwest (i.e. the NWHN) that was overseeing the development of the ICT plans for its member organizations. A corresponding Northeast ICT network organization was developed to oversee projects of common interest to both regions. With the establishment of the LHINs, the two ICT network structures representing their respective LHIN areas were connected by the ONe-Health ICT Steering Committee that is currently overseeing the Northern Ontario ICT Blueprint implementation (moving towards a regional EHR).

Figure 6: ONe-Health Steering Committee Governance Structure, May 2006

ONeHealth Steering

Committee *

DI/PACS

Other Projects,

e.g., NOHBOS

ICT Blueprint

Implementation

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Work Effectiveness

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Systems

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infrastructure

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Services

Northeast ICT

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Work Effectiveness

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Technology and

infrastructure

Information

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Services

• The role of the Steering Committee will be as follows:

! Coordinate and guide Northern ICT strategies

! Establish appropriate linkages to Winnipeg, the North Simcoe Muskoka LHIN and Southern Ontario

! Undertake/lead joint pan-northern initiatives.



Mission

The mission of the ONe-Health Steering Committee is to build on existing investments to provide partner organizations with coordinated and interoperable information systems, building toward an integrated information system - as outlined in the Northern Ontario ICT Blueprint - that supports the provision of care within Northern Ontario.

Reporting Relationship

The ONe-Health Steering Committee will report to the Northern Ontario hospital CEOs group through reports to regional committees or networks and through summary reports to CEOs in the North. The ONe-Health Steering Committee will also provide an advisory role to the CEOs of the North East and North West LHINs.

Functions

The primary functions of the ONe-Health Steering Committee are to:

• oversee the implementation of the Northern Ontario ICT Blueprint through the implementation activities of the Northeast and Northwest ICT networks and through specific task groups established to implement specific pan-northern strategies identified in the Blueprint

• guide the planning, implementation and management of the Northern Ontario ICT Blueprint, including a shared EHR and PACS for health care service providers in the North, in conjunction with planning and implementation work done by the Northwest and Northeast subgroups

• be the champion for ICT initiatives in Northern Ontario and actively promote initiatives at regional, provincial and national levels

• promote linkages with community-based health care providers and organizations, tertiary care centres, and other referral sources related to Information Systems (IS), EHR, PACS and other ICT Blueprint initiatives

• oversee the completion of Phase 2 of the Northern Ontario ICT Blueprint with the objective of expanding it to the non-acute care health sectors.

Membership

The committee is composed of up to eighteen members plus one chairperson. Membership is established to ensure various healthcare groups are represented while keeping an even split between Northeastern and Northwestern Ontario. It is anticipated that committee composition will be based on the following:

• all 5 Class C hospitals in Northern Ontario each have 1 representative

• other hospital representatives including at least one member from a community hospital

• at least one primary care representative

• at least one CCAC representative

• at least one member representing Aboriginal interests

• at least one member representing mental health

• other members representing sectors such as public health, long-term care, physicians, and cancer services.



Completed Work/Projects:

ONe-Health has completed, and is pursuing, a number of projects as follows:

• Pan-Northern Ontario PACS Project (PNOPP) – An Infoway proposal was submitted and approved for the detailed planning of a regional PACS strategy (approximately a $1 million project). The planning phase was completed in April 2006. A Memorandum of Understanding and letter of intent for the operations of the regional PACS system has been prepared and documents have been brought forward to the five individual level C hospitals (hubs) involved for approval. Funding has now been requested for implementation of the regional PACS model which should go to the Infoway board in late 2006. The proposed overall investment in the region is nearly $75 million over 5 years and funding sources beyond Infoway will be required for implementation. A governance transition plan for the group will be required to become an incorporated entity once Phase 2 of PNOPP has been approved. This will help support the long-term operations of PNOPP, in conjunction with the NOHBOS initiative

• In collaboration with the two Northern LHINs, ONe-Health is sponsoring the second phase of the Northern ICT planning project which involves the community-based health sectors

• There are negotiations with Meditech to change the model for licensing of software from being provider based (e.g. number of hospital beds) to a patient centred regional licensing approach based on population

• NOHBOS – ONe-Health continues work with all Northern Hospitals in the NOHBOS project to collaboratively examine the feasibility of sharing and leveraging resources, people and information to improve efficiency and reduce operating costs of back office services.

3.2 Electronic Health Record (EHR)

3.2.1 Background

CHI released its electronic health record solution blueprint – EHRS Blueprint.13

The blueprint was developed to outline the business and technical considerations for EHR solutions. The Blueprint report provides a succinct definition of electronic health records:

An electronic health record provides each individual in Canada with a

secure and private lifetime record of his or her key health history and

care within the health system. The record is available electronically to authorized healthcare providers and individuals anywhere, anytime, in

support of high-quality care.14

Generally, it is agreed that the EHR needs to contain the following pieces of information (CHI,

EHR Standards Analysis, March 31, 2004):

13

Canada Health Infoway Pan-Canadian EHRS Blueprint. An interoperable EHR framework. www.knowledge.infoway-inforoute.ca.

14 As above.



• Client demographic and identification information

• Health history and clinical summary information

• Problem lists and diagnoses

• Diagnostic information (values and interpretation)

• Medication information (past and present)

• Care plan and decision support information

• Treatment information

• Consent information

• Vital signs and alerts

• Provider identification information

• Clinical document for chronic diseases

• Existence/encounter information

• Immunization information

• Primary care and community care information

• Quality and safety information. The Guiding Principles of the EHRS are:

• Patient centric – making patient/person clinical data available to authorized caregivers for the purpose of caring for them

• Mass customized views of all clinical data – EHR must be able to provide customized views of data aligned with each requestor’s needs and purpose

• Value-add for the provider to support mission critical activities

• Timely and accurate information – to be viewed as an authoritative and reliable source of clinical information

• Think, build and act at all levels (local, regional, national) – support provider across the continuum of care in the local and regional jurisdictions

• Interoperable and integrated – among different jurisdictions, providers types and provider delivery settings

• Standards-based, secure and private

• Replicable solution – patterns, components – solutions to be reusable

• Leverage legacy systems and solutions

• Design for a phased rollout with near term results

• Comprehensive, cost-effective, scalable, and extensible to support future growth.



3.3 Northwest EHR Readiness

3.3.1 ICT Blueprint

According to the ICT Blueprint readiness to implement the EHR in the Northwest varies by health care providers in three groups:

• Hospitals that have invested heavily in the clinical applications of a shared Meditech hospital information system and are well positioned to achieve a totally paperless environment. They are Thunder Bay Regional Health Sciences Centre and St. Joseph’s Care Group in Thunder Bay

• Nine hospitals outside of Thunder Bay that have taken advantage of the large investment above and implemented some core applications that will facilitate the eventual implementation of the EHR

• Those organizations that need to make investments in new core systems to position themselves for the EHR.

There are several major implementation projects that will have to be undertaken prior to full EHR implementation in the Northwest. The following is a brief list of applications that “build up” to the electronic medical record (EMR) locally and subsequently an EHR regionally.

• On-line pharmacy information system and automation – automated drug profiles and medication administration records

• Information management systems for surgery and emergency

• Clinical decision support

• Electronic clinical documentation for nursing and allied health – both inpatient and outpatient

• Order entry (non physician and physician)

• Documentation (non physician and physician)

• Systems for “positive patient identification”, using bar-coding technology (e.g. patient arm band, specimens, medication, blood and blood products)

• Document scanning

• Access to images (e.g. ECGs, etc.)

• Physician enhanced viewing

• MPI (master patient index).



3.4 EHR Readiness Survey Report for Hospitals

3.4.1 Overview

Released on August 12, 2005, the objectives of the Ontario Hospitals Connected for Care: EHR

Readiness Survey were to measure Ontario hospitals’ capability and use with respect to EHR solutions by specifically investigating the following areas:

• the key Electronic Patient Record (EPR) and EHR-enabling functional capabilities

• the level of EPR use among Ontario hospitals

• the level of EPR organizational and human capacity

• the level of regional/inter-organizational EHR readiness. This research was intended to gather a baseline understanding of Ontario hospitals’ needs to interact with provincial and pan-Canadian EHRS and to integrate patient information in the context of LHINs. This survey was not an inventory of hardware or software applications but rather an analysis of the current state of hospitals’ capacity and use with respect to ICT as well as a means of identifying existing electronic information exchanges among health institutions in Ontario. The survey definition of EHR is consistent with the definition used by Health Canada and CHI: An Electronic Health Record is a secure and private lifetime record of an individual’s key health

history and care for view, order entry and decision support. The survey also distinguishes an Electronic Patient Record (EPR) as a clinical information system for a single organization. The Ontario Hospitals Connected for Care: EHR Readiness Survey was entirely funded through the Ontario Hospital e-Health Council, a body established by the OHA and funded by Ontario’s MOHLTC. In total, 156 surveys were distributed electronically to the hospitals of Ontario. 144 responses were received, representing a provincial response rate of 91%. The survey was hosted by the OHA on a secure website between March 7 and April 4, 2005.15 The reporting emphasis throughout the survey was on the progress required to achieve complete capability and use of an EHR. Results are presented as the gap between the hospitals’ actual rating and a maximum score, indicating a fully functional EPR/EHR for the particular functional area as defined by the survey.

3.4.2 Report for North West LHIN16

The report suggests that the key priorities for the hospitals of the North West LHIN are:

• implement a computer-based EPR

• upgrade network infrastructure and train and support personnel to use systems

15

The specific questions that hospitals answered can be found in the report.

16 The report can be found at:

http://www.oha.com/Client/OHA/OHA_LP4W_LND_WebStation.nsf/resources/EHR+Readiness+Survey+LHIN+Reports/$file/LHIN14+Report.pdf



• replace/upgrade clinical systems

• reduce medical errors.

Barriers to implementing an EHR were identified as follows:

• lack of financial support

• lack of staffing resources

• difficulty in achieving end user acceptance. Overall, the key findings for hospitals in the North West LHIN are described below. (Note: In the report the North West LHIN was identified as LHIN 14.)

Information Infrastructure Use

The northwest hospitals are slightly ahead of the provincial average in the use of information infrastructure (authentication, privacy, security audits, authorization, secure e-mail, high speed network connections, remote access, extraction of EPR data) (Figure 7).

Figure 7: Provincial Comparison - Information Infrastructure Use

Information Sharing with Other Hospitals

The northwest hospitals are above the provincial average for electronic clinical data sharing. Only the hospitals in two other LHINs exceed this level of information sharing (Figure 8).



Figure 8: Provincial Comparison - Information Sharing with Other Hospitals

Interoperability with an EHR or Other EPRs

This indicator measures the gap in interoperability between organizations – sharing of laboratory results, diagnostic imaging reports and other clinical reports. Northwest hospitals scored highest in interoperability (Figure 9).

Figure 9: Provincial Comparison - Interoperability Use with EHR or Other EPR

Information Sharing with Other Physicians

The North West LHIN is above the Ontario average for the sharing of information by hospitals with the consulting physicians in their communities (Figure 10).



Figure 10: Provincial Comparison - Information Sharing with Other Physicians

Information Sharing with Other Healthcare Organizations

North West LHIN hospitals are above average for sharing information with other healthcare organizations (Figure 11).

Figure 11: Provincial Comparison - Information Sharing with Other Healthcare

Organizations

ICT Leadership

The northwest hospitals are below average in terms of EPR leadership (Figure 12). The functions covered under this indicator include completed readiness assessment to support the EPR strategy and approved change management methodology to encourage end user adoption of an EPR.



Figure 12: Provincial Comparison - EPR Leadership and Planning

Use of Electronic Clinical Documentation

The northwest hospitals are slightly below the provincial average for use of electronic clinical documentation (Figure 13).

Figure 13: Provincial Comparison - Clinical Documentation Use

EPR Priorities

For the northwest hospitals the top three priorities in EPR are the implementation of the EPR system, reduction of medical errors, and training personnel (Figure 14).



Figure 14: Northwest Hospital - EPR Priorities

3.5 Northwest Health Network (NWHN)

The NWHN is an incorporated body whose vision is “together, improve access to care.” Members of the corporation include all 13 hospitals in Northwestern Ontario, the two CCACs, NorWest Community Health Centre, the George Jeffrey Children’s Treatment Centre, Thunder Bay District Public Health Unit, Mary Berglund Community Health Centre, and the Kenora/Rainy River District Mental Health and Addictions Network. Ex- officio members are the MOHLTC and the North West LHIN. In addition to being a regional planning and communications vehicle, the NWHN promotes opportunities for the members to work together on projects that benefit patient care or increase efficiency. One of the major joint ventures undertaken by the NWHN is the creation of a regional EHR. Based on the shared Meditech hospital information system in place at Thunder Bay Regional Health Sciences Centre and St. Joseph’s Care Group, nine hospitals outside of Thunder Bay have implemented Meditech Phase 1 which provides health records, ADT, EMR and diagnostic imaging modules. Initial discussions are underway to implement Meditech Phase 2 in some of those hospitals. Phase 2 will provide laboratory, pharmacy, order entry, blood bank and pathology modules. Once this work is completed, those hospitals with both phases will have a solid foundation for the creation of a complete regional electronic health record. Some of the benefits of a regional EPR are already being realized by those hospitals that have implemented Phase 1. For example, hospitals in the region can electronically access diagnostic test results for patients seen at Thunder Bay Regional Health Sciences Centre. This provides clinicians in the region with additional information to be considered in the treatment of their patients. In terms of connections with sectors of the health system beyond acute care, many of the hospitals operate long-term care or complex continuing care beds and the entire Meditech system was recently installed in the Lakehead Psychiatric hospital site of St. Joseph’s Care



Group, which provides a variety of mental health programs. In addition, Thunder Bay Regional Health Sciences Centre allows select access to the health record to CCAC staff and numerous physician offices. Initial discussions have been held with the Port Arthur Health Centre to import hospital Meditech data into the health centre’s own electronic record. The major challenge facing the NWHN group at present is the general lack of funding available to support implementation and ongoing operations of additional Meditech modules. For the most part, those hospitals involved in the regional electronic health record have been required to self-finance the project.

3.6 Digital Imaging / Picture Archiving Communications Systems (DI/PACS)

The introduction of PACS combined with computerized and/or digital radiography in the healthcare environment is enabling the development of the film-less organization. PACS offers distribution of images throughout the organization with the assistance of the appropriate network infrastructure. Viewing of images is accomplished with the assistance of diagnostic and clinical workstations, and web-enabled applications. A PACS environment offers many benefits to the clinicians such as the manipulation of the image to maximize image quality and diagnosis, viewing of the same examination at multiple locations, and the ability to have the image at any location, at any time. Numerous successes have been achieved in Northern Ontario in the development of common regional PACS platforms and the collaborative management of medical images across the enormous geographic expanse. A critical success factor for the realization of an even broader vision of image management throughout all of Northern Ontario will be to leverage these successes towards a shared new model that supports regional patient referral patterns and is aligned with the movement towards a Northern Ontario EHR. A PACS model must effectively facilitate the delivery of electronic images both within the North and to other hospitals in Southern Ontario. The marriage of the image, diagnostic interpretation, and other pertinent information required to provide patient care and its accessibility, are components of the Northern Ontario PACS strategy (ICT Blueprint, 2005).



Figure 15: Current State of PACS in Northern Ontario, May 2006

Note: West Nipissing General Hospital is part of Sudbury hub, and the Timiskaming Hospital is technologically part of the Sudbury hub.

3.7 Pan-Northern Ontario PACS Project (PNOPP)

The development of the regional PACS model noted above has been moved forward through ONe-Health and its PNOPP. Initiated in August 2005 as a project of ONe-Health, the objectives of the PNOPP are:

• to create a film-less DI/PACS environment for Northern Ontario

• to use technology for the purpose of maximizing the use of limited resources (transfer pictures not people)

• to establish a deep archive that will meet current and future storage needs

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Généra l de

Nip issing

Ouest

Tem iskam ing

Hospi ta l

M attawa

Genera l

Hospi ta l

Saul t Sainte

M arie Genera l

Hospi ta l

Tim m ins and

District Hospi ta l

Sudbury Regional

Hospi ta l - St. Joseph's

Heal th Centre Si te

Sudbury Regional

Hospi ta l - M em oria l Si te

North Bay Genera l

Hospi ta l - M aclaren Si teGroup Heal th

Centre

Saul t Area Hospi ta l -

Thessalon Si te


Richard 's Landing Si te

Bl ind River District

Heal th Centre


Plum m er M em oria l

Sault Ste Marie HubPopulation Served:

Exam Volume:

Number of Beds:

PACS Status:

119,500

80,716

297

AGFA Planned

KenoraPopulation Served:

Exam Volume:

Number of Beds:

PACS Status:

30,500

41,076

96

AGFA Implimented

Thunder Bay HubPopulation Served:

Exam Volume:

Number of Beds:

PACS Status:

238,500

223,032

1,027

Philips Implimented

Timmins HubPopulation Served:

Exam Volume:

Number of Beds:

PACS Status:

84,000

141,306

606

AGFA Implimented

North Bay HubPopulation Served:

Exam Volume:

Number of Beds:

PACS Status:

185,000

123,919

345

Philips planned

Sudbury HubPopulation Served:

Exam Volume:

Number of Beds:

PACS Status:

312,000

183,217

705

AGFA Implimented

West Parry Sound

PACS Status: Siemens



• to maximize current funding opportunities. The project has 3 phases:

• Phase 0 - Conceptual Planning

• Phase 1 - Detailed Planning

• Phase 2 – Implementation. CHI has provided funding support to undertake and complete phases 0 and 1. The required deliverables included the identification of the current state, the identification of the future state and a gap analysis of DI/PACS in Northern Ontario. CHI has also required the development of a shared DI governance model supported by a memorandum of understanding, the design of DI repository architecture to support a film-less state and the creation of a migration plan which outlines the steps required to achieve a Northern Ontario shared DI repository. The PNOPP Service is based on a vision of an integrated diagnostic imaging electronic health record (DI EHR) that will serve the patients and providers operating in all health facilities in Northern Ontario. The DI EHR will be developed in concert with patient referral patterns to support the movement of the images and reports to the centres that receive the patients. The PNOPP Services will be based on two active, mirrored DI EHR repositories located in data centres in Thunder Bay and Sudbury. The PNOPP service relies on the existing investments in PACS in Northern Ontario hubs, spokes, and sites. This is in keeping with the guiding principles developed by the PNOPP Technical Advisory Team whereby existing services and systems will be leveraged, where possible, for both economies of scale and functional design. That is, systems that are in operation and are proven to be effective in delivering the technical and clinical required functionality will be expanded in scale to meet the PNOPP services vision. Architectural design of a system that sees the implementation and integration of six imaging hubs located across the North is a technical challenge. Geography, dispersed populations, and a large number of remote Northern communities make a technical solution all the more complex. Added to this complexity are the existing implementations of imaging systems from an assortment of vendors that traditionally have not been integrated in a seamless fashion as envisioned by the PNOPP Technical Advisory Team. However challenging, solutions must be found to accomplish the DI EHR vision for the North, which is to provide clinical and technical support for clinicians who require diagnostic images, interpretation, and results no matter where a patient resides in Northern Ontario. The envisioned system must support existing and future referral patterns. Northern Ontario has the unique challenges of referral across the North, Southern Ontario, Quebec to the east, and Manitoba to the west. Therefore, design and architecture of the solution must incorporate the systems external to Northern Ontario. Building the Pan-Northern DI Vision will be grounded in applicable national and international standards. The specific tactical implementation plan is pending funding confirmation. The following figure illustrates the PNOPP concept. Although a number of hubs are or will be using different PACS vendors, PNOPP will enable information sharing within/between the hubs,



and a level of redundancy and data storage that would not be possible on an individual hospital or hub basis.

Figure 16: PNOPP Conceptual Architecture, May 2006

Timmins

Thunder Bay Sudbury

North Bay

Sault Ste Marie

Kenora

Parry

Sound

AGFAOP PACS DBMS

REPLICATION

PHILIPS

OP PACS DBMS

REPLICATIONSIEMENS

OP PACS DBMS

REPLICATION

LHIN 14 Data Centre LHIN 13 Data Centre

LiveLive

Mirror

LiveDICOM

HL7

Op PACS DBMS Redundancy

for Business Continuity

Archives

Sudbury

Primary

Thunder Bay

Mirror

Agfa -

planned

AGFA

AGFA

Philips -

planned

Philips

Spoke

CacheSpoke

Cache

Spoke

Cache

PNOPP Conceptual Architecture

Thunder BaySudbury

AGFA

Siemens

Live

DICOMHL7

DICOM

Stage

DICOM

Stage

Teleradiology

TeleradiologyDI Viewer - DI Image Viewer

- DI Text Reports

Integration Layer

DataRedundancy

DBMS Redundancy

PACS Application

Redundancy

21

Spokes

6Spokes

8

Spokes

17Spokes

4

Spokes

Spoke

Cache

SpokeCache

Prov. EHR

Services

Data Centre Redundancy

Privacy

DI

EMPII

Replication of

Database Structure

(Oracle, SQL)

Access/ Retrieval/Transmission of

Images

DICOM

HL7

HL7



3.8 Northwestern Ontario Teleradiology Service

The second of the NWHN’s joint venture projects is the Northwestern Ontario Teleradiology Service. Initially led by NORTH Network, the service is based on a central PACS system housed at TBRHSC. All thirteen Northwestern Ontario hospitals, five First Nations communities, and two independent health facilities have installed state-of-the-art digital imaging technology allowing them to move to a film-less environment. The service delivers diagnostic imaging services to 150,000 people living across 526,000 square kilometres in a region extending up to Hudson’s Bay, making it geographically the largest such service in Ontario. The Service uses local area networks to carry diagnostic images and reports between referring physicians, radiologists and emergency staff within each hospital while images and reports are shared between hospitals using the SSHA network. A partnership has been struck with KO Telehealth to use their K-Net network and satellite technology to transfer images from the far-North nursing stations to the PACS system in Thunder Bay and a radiologist in Sioux Lookout. The benefits of using this system have been immediate and extensive:

• The time between taking an image, having it interpreted by a radiologist and reported on has been reduced from as long as 14 days down to one or two days

• Image clarity is much enhanced

• Because all images are stored on the central PACS, there is no need for repeat testing if a film is lost

• Historical studies are available immediately to clinicians for comparative purposes

• The images can be read by radiologists anywhere. In fact nine of the hospitals are using a radiologist service in Burlington.

Physician reaction to the PACS service has been tremendously positive and requests for additional viewing stations continue to increase.

3.9 Telemedicine in the North West LHIN

3.9.1 Ontario Telemedicine Network (OTN)

The new OTN was recently formed through the amalgamation of the three large telemedicine programs in the province (NORTH Network, CareConnect and VideoCare). The following section provides detail on the legacy network, NORTH Network. Since 1998, NORTH Network’s telemedicine program has allowed patients to consult with medical specialists and allied health professionals across more than 80 different disciplines in regional or tertiary care centres across Ontario without leaving their home communities. NORTH Network now includes over 225 telemedicine-equipped sites in more than 120 communities across the province.



Using videoconferencing technology and electronic diagnostic equipment such as otoscopes, digital stethoscopes, and patient exam cameras for close-up examinations, patients can be assessed just as if they were in the health professional's office. X-rays and other diagnostic tests can also be viewed during consultations and a telemedicine coordinator helps to facilitate the entire consultation. Telemedicine is particularly effective for follow-up appointments, triage decisions, pre-admission work-ups, and initial consultations in many specialties. The NORTH network also supports continuing profess nal development and continuing medical education activities, with up to 3,000 people participating in more than 275 educational sessions a month. The network encompasses more than 11 Ontario members, including academic health sciences centres, community hospitals, psychiatric hospitals, clinics, nursing stations, long-term care homes, CCACs, public health units, and educational facilities. Funding comes primarily through the MOHLTC, although the network has received growth funding from more than 90 organizations. The membership model is based on a ph ophy of collaborat e partnership and open communication. Members are encouraged and supported in their efforts to develop telemedicine initiatives in their organization and are invited to guide and validate NORTH Network's initiat es. In this way, members are assured that their needs and expectations are addressed. In addition, the number and variety of members rovides a rich environm within which common object es are identified and advanced. NORTH Network’s provision of comprehens e, effective, and efficient support to its various partners is achieved through the c ralized management of all technology (such as the network itself, videoconferencing activity, bridging and procure ent) and core business processes (such as referral management, scheduling and help desk supports). Centralizing these functions allows the regional leadership to focus on developing appropriate telemedicine programs and assume responsibility for clinical and educational operations. NORTH Network's emphasis on regional development of telemedicine programs supports an alignment with the evolving LHIN structure in Ont o. By ensuring common practices an minimum standards, the quality of clinical and educationasessions ensured for all NORTH Network member participants.



Figure 17: Telemedicine-Enabled Communities Partnering with NORTH Network

NORTH Network is engaged in providing innovative telemedicine services including the Emergency Telestroke Program, Emergency Electrical Burn Telemedicine Program, and Teleradiology.

Northern Ontario hospitals’ connectivity to SSHA is supported by the NORTH Network. NORTH Network acts as the hospitals’ technical support desk around the clock. It provides an extensive array of network engineering services. These network-related services allow member hospitals to treat their SSHA applications as a “turnkey” service as well as providing them with “on-call” expertise with which to engage other inter-hospital applications such as videoconferencing, Voice over Internet Provider (VOIP), PACS, EHR and others.



Figure 18: Current NORTH Network Sites with the North West LHIN17

In the future, the OTN would like to be able to access electronically all of the contents of a patient’s medical record prior to the telemedicine consultation, including digital images, ECGs, and physiologic indicators.

Within the North West LHIN, all of the hospital sites are members of the OTN and federal nursing stations within the LHIN have also been connected to the network. The OTN also continues to explore connectivity opportunities with the telemedicine services offered by the Winnipeg Health Sciences Centre, due to the patient referral patterns to Winnipeg from Northwestern Ontario.

Further information on the OTN is available at www.otn.ca.

17

Source: NORTH Network.



3.9.2 Keewaytinook Okimakanak Telehealth18

(KO Telehealth)

KO Telehealth is a First Nations owned and operated service that coordinates delivery of telemedicine services to the most isolated First Nations in Ontario. KO Telehealth services 24 remote sites and currently coordinates more than 100 telemedicine sessions each month. KO Telehealth works in partnership with First Nations and Ontario telemedicine services to coordinate and support comprehensive clinical, educational, and community-based health services. K-Net maintains a service level agreement with Ontario Telemedicine Network, manages the regional First Nations broadband network, provides help desk services for all First Nations schools in Ontario, and operates Industry Canada’s National Satellite Initiative for Ontario and Quebec.

3.10 Northern Ontario Hospital Back Office Services (NOHBOS)

Back office services can be generally described as any common transactional processes that hospitals may share. Networking in the North and the NWHN which includes the CEOs of Northern Ontario hospitals, have agreed to jointly examine the feasibility of sharing and leveraging resources, people and information to improve efficiency and reduce operating costs of back office services. This is a collaborative model in which participation is voluntary. Cost savings and value generation are based on economies of scale and scope in transaction processing through collaboration, integration and sharing of services. The model is such that any Northern Ontario hospital is open to participate on an initiative-specific basis. The NOHBOS vision is that hospitals in Northern Ontario will coordinate their efforts and enhance their partnership opportunities to improve efficiencies of back office services. Participants will share in the savings that result from reduced operating costs. NOHBOS is led by a steering committee, which provides overall strategic and operational direction and guidance to the project. The steering committee is responsible for aligning projects with the group’s interests, and resolving barriers, conflicts and major issues. It includes nine members, who are hospital Vice Presidents, Chief Operating Officers, Chief Financial Officers, Chief Information Officers, and CEOs. Six hospitals in major Northern Ontario communities are represented and two smaller hospitals are included – one each from Northeastern and Northwestern Ontario. The steering committee establishes a project plan for each initiative that identifies: the project structure; goals and objectives; and a project initiation budget to plan, design and facilitate the project. NOHBOS liaises directly with the MOHLTC and other funders to gain support for research into the viability of shared back office services and implementation of viable initiatives. NOHBOS has elaborated a set of principles, including commitments to:

• maintain or enhance service levels for each participating hospital

• seek funding to support all phases of each initiative – from planning to implementation

18

http://telehealth.knet.ca.



• share costs appropriately with participating hospitals, who can use their savings as they choose

• be sensitive to job loss within any community. In addition, NOHBOS principles indicate that in exploring ways to achieve project objectives, the group will consider:

• expanding existing collaborative efforts as an option for meeting project objectives

• using common technology to support the shared services initiatives, consistent with the principles and recommendations of the Northern Information and Communication

Technology Blueprint.

Phase 1

Supported by OntarioBuys, NOHBOS completed due diligence analyses pertaining to the following functions:

• Integrated Supply Chain Management

• Information Technology

• Clinical Technology Management (Biomedical Engineering)

• Payroll/Scheduling

• Pan-Northern Ontario PACS Project. As of May 2006, the results of the business case analyses have been circulated to all northern hospitals. There is agreement to move forward with more detailed implementation planning or analysis with the support of OntarioBuys.

3.11 Northwest Information and Communication Technology Collaboration19

Sponsored by the Ministry of Northern Development and Mines, the Northwest ICT Collaboration envisions a consolidated public sector IT infrastructure in Northwestern Ontario. The project involved the following partners in Thunder Bay:

• Thunder Bay Regional Health Sciences Centre

• St. Joseph’s Care Group

• Lakehead University

• Confederation College

• City of Thunder Bay

• Ontario Government

• Thunder Bay Catholic District School Board

• Lakehead District School Board

19

The associated survey results are available under a separate cover: NW Ontario Consolidation Survey Data February 6, 2006.



• Smart Systems for Health Agency

• Northern Ontario School of Medicine. These partners envision a connected Thunder Bay and Northwestern Ontario region in which all partners share in the cost of a modern ICT infrastructure. The collaboration would provide opportunities to create comprehensive and enhanced ICT services. They envision a shared infrastructure that not only provides superior services to the partners, but creates a region that is highly attractive to other provincial initiatives and to knowledge industries, therefore creating economic spin-offs. This initiative is aligned with other strategies taking place within the provincial government, such as the e-Ontario strategy, and other agencies such as the SSHA. Consultants were engaged to prepare a high level business case to assess moving forward with the implementation of an ICT collaborative strategy for the public sector in Northwestern Ontario. The business case focused on two areas:

• A high-level discussion of the impact on economic development in the region

• The identification of potential collaboration opportunities with specific focus on preparing a cost benefit analysis in the following areas:

! Service management including data centre consolidation

! Infrastructure standardization and procurement including hardware, software, and network standardization, and establishing a single point of purchase

! Help desk consolidation

! Network consolidation. The cost-benefit analysis identified over $9 million in potential savings that would be realized over seven years with the adoption of the shared approach to ICT.

3.12 Current Implemented ICT Applications

Information on the current information and communication systems across Northern Ontario was gathered through the administration of an inventory questionnaire sent to all project participants in 2004 as part of the ICT Blueprint. The results were validated through focus groups. A wide variety of applications are used among study participants. Almost all organizations have the basic array of administrative systems such as patient registration, records, payroll, office automation, and core financial applications (general ledger, accounts payable, accounts receivable). The least utilized applications are in the domain of enhanced clinical applications such as physician and clinician order entry, EMR, clinical documentation and specialized applications such as case management or operating room management.

Patient Management and Administrative Applications

Figure 19 presents the patient management and administrative applications currently implemented among the survey participants. Phase I of the NWHN Meditech Project involved seven hospitals. The hospitals went live with Meditech's registration, health records, electronic reports, imaging, and billing and accounts



receivable applications during the spring of 2005. These hospitals were Manitouwadge General Hospital, Wilson Memorial General Hospital (Marathon), Atikokan General Hospital, Geraldton District Hospital, Nipigon District Memorial Hospital, Red Lake Margaret Cochenour Memorial Hospital, and McCausland Hospital (Terrace Bay). Dryden and Sioux Lookout Meno-Ya-Win Health Centre implemented the same set of Phase I applications in the spring or 2006 while Riverside Health Care Facilities (Fort Frances/Emo/Rainy River) has deferred implementation. Lake of the Woods District Hospital in Kenora has opted out of the project. Phase II of the project involves the implementation of order entry, pharmacy and all of the laboratory modules and is in the initial discussion stages.

Patient Management Applications

Almost all participants reported having admission/intake, patient registration, and discharge systems. All organizations providing continuing complex care reported using automated application for acquiring Minimum Data Set information. Most organizations, with the exception of CCACs, have electronic patient record management (80%), and abstracting and coding systems. The patient management system in use by the CCACs is the Patient Management Information (PMI) application. The patient management and scheduling system in use by the community health centres is the Purkinje system.

Administrative Applications

The next most prevalent application among the participating organizations was workload management (65%). All participants reported utilizing office automation (100%).

Financial/Resource Management Applications

While there is a prevalence of financial and resource management applications implemented, other applications such as materiel management, decision support, patient scheduling, staff scheduling have been implemented in less than 50% of the responding organizations. Less than 30% of the organizations have automated incident reporting and quality/utilization management applications.

Clinical Applications

The most prevalent clinical applications are laboratory (68%), diagnostic imaging (62%), pharmacy (61%), and PACS (52%). Another application tracked with the clinical applications was automated transcription/dictation systems, which are used by 60% of the organizations. More advanced applications, such as clinical documentation, clinician order entry, have low occurrence – less than 30%. Although EMR applications were reported by 32% of the respondents, these have limited functionality.

Technology Infrastructure

The majority of organizations within the North West LHIN have connectivity established with SSHA. Generally there is a high level of satisfaction with the service provided by SSHA; however, some sites have reported performance issues. As well, there is some concern that the provisioned bandwidth at some sites may be greater than the actual amount delivered. Overall there is a lack of redundant linkages in place for wide area network (WAN) connections across the North. This is for the most part due to high bandwidth costs or lack of sufficient infrastructure in remote areas. While some organizations are utilizing their existing SSHA



connections, the majority of sites are using local service providers to supply internet connectivity. Generally internal local area networks or LANs throughout the North are functioning well and are able to support the requirements of their respective organizations. However there are some concerns surrounding the operating environment of networking and server equipment at several organizations. Many sites do not have dedicated server rooms, network closets, and fire suppression/detection systems for equipment or sufficient backup practices. There is also a significant need for disaster recovery and business continuity planning.

3.13 Current Information System – Vendors

As part of the current state analysis, the status of many of the Northern Ontario major systems vendors was reviewed. The detailed analysis is presented in appendices attached to Northern Ontario ICT Blueprint.

Figure 19: Patient Management Application Vendors by Hospital

Sudbury

Smooth Rock Falls

Matheson

Timmins Englehart

Hearst

Mindemoya Little Current

Espanola

Blind River

Moose Factory

Kapuskasing Cochrane

Iroquois Falls

Kirkland Lake Thunder Bay

North Bay

Sault Ste. Marie

Atikokan

Moosonee

Wawa

Sturgeon Falls

New Liskeard

Dryden Geraldton Manitouwadge

Nipigon Fort Frances

Rainy River

Sioux Lookout

Terrace Bay

Marathon

Kenora

Red Lake

Emo Hornepayne

Elliot Lake

Parry Sound

Bracebridge

Chapleau

Thessalon

Vendor

Mattawa

Patient Management Application Vendors by Hospital

Meditech

MediSolution

Eclipsys

Heron

Anzer Ormed Encom Momentum

Huntsville



4.0 Information Management Strategy

4.1 Ontario MOHLTC Information Management Strategy

Health care in Ontario is an enormously complex system that depends on information. At the most fundamental level, it is used by doctors to decide on the best possible treatment options for their patients. At a systems level, where decisions about the management and delivery of health care services are made, the data that health care providers across the province collect about patients is studied and analyzed to identify trends in population health, such as the incidence of stroke and obesity. This evidence is then used to plan for and make decisions about which health care services will be provided where. Over the last decade, advances in technology have dramatically increased the capacity to collect, store and analyze a large volume of health-related data. The reality is that collecting all of these data is placing a considerable burden on many health care providers. With close to 100 separate health information databases in operation, health care planners, researchers, and analysts are finding it more difficult to access the information they need. At the end of the day, when system planners and managers are looking to evaluate how the system is performing, the data itself is inadequate. Key pieces of information are missing to evaluate basic things such as the overall quality of care in the province.

Less Data, Better Information, Better Decisions

The MOHLTC’s Information Management (IM) Strategy involves setting standards for data quality, better coordination of data collected by health care providers, and the consolidation of information into a common, integrated knowledge base. It is focused on producing better data, supporting accountability and quality improvement through performance measurement, and supporting evidence-based decision-making. The goal of the strategy is to build a system that people can count on – one that is more efficient, effective, and accountable. A system that provides objective, timely and accurate information is the basis for sound decisions that are in the best interest of patients. With better information and through enhanced information management, the government will be able to accurately measure and track how the system is performing, so that people can assess its quality and progress.

Turning the Strategy into Results

In its first year, as part of the effort to produce better data, the Ministry’s Information Management team documented all the data that the MOHLTC had by identifying:

• Where and how data is collected and by whom

• Where the data is stored, and how the data flows between the various databases and data warehouses

• Who has access to what information

• Who makes decisions based on that information.



The end result is the Ontario Health Planning Data Guide, the first comprehensive index of all health planning data.

4.2 Data Quality in the North West LHIN

In December 2005, the Health Results Team for Information Management released the Report on the State of Health Records Departments in Ontario Hospitals20 that include sub-reports by LHIN. The findings were based on a survey of current practices in Ontario hospitals’ health records departments. The survey was designed to assess various aspects of health records, including: organizational structure, human resources, data management process and practices, education, standards and technology. The survey was distributed to 149 hospital corporations across Ontario; responses were received from 143 of these hospitals, for an overall response rate of 96%. Twelve of thirteen hospitals in the North West LHIN responded, for a response rate of 92%. The results of the survey identified a number of areas that need to be addressed in order to improve the quality and management of clinical data. Based on these results, recommendations were developed in consultation with various stakeholders. In general, the results and recommendations confirm and support previous data quality studies.

5.0 Northwest ICT Planning

5.1 Northern Ontario Information & Communication Technology Planning Project (ICT Blueprint) – Phase 1

Phase 1 of the Northern Ontario ICT project started in January 2004 under the leadership of the three Northern District Health Councils (i.e. Algoma Cochrane Manitoulin Sudbury, Northwestern Ontario, and Northern Shores). The process involved working with health service providers from several sectors in Northern Ontario to develop an integrated vision for information and communication technology. This project was the first of its kind in the province. The sectors involved included hospitals, community health centres, community care access centres, regional in-patient mental health hospitals/programs, regional cancer centres, educational providers, and current regional ICT initiatives in the North (52 participating agencies). The purpose of Phase 1 of the Northern Ontario ICT Project was three-fold:

• Conduct an inventory of the current state of ICT in Northern Ontario hospitals, CCACs, regional in-patient mental health programs, regional cancer centres, and current regional ICT initiatives

20

The full report is available at http://www.health.gov.on.ca/transformation/providers/information/im_dataquality.html.



• Identify opportunities to partner and strengthen ICT linkages between northern health care providers and sectors

• Develop a common vision and strategic blueprint for action for ICT in Northern Ontario. The following planning framework was applied that shows the inter-relationships between the various components of the broader ICT system.

Figure 20: Northern Ontario ICT Planning Model (source: Healthtech)

Strategic Business Objectives

The regional strategic business objectives of the participating organizations served as the primary mechanism in identifying the technology needs of Northern Ontario. An appreciation of the essential business issues is critical in understanding the future needs of the organizations and in identifying how technology might facilitate meeting those needs.

Enabling Technologies

Traditionally, technology has been seen as a mechanism to achieve operational efficiency and effectiveness. However, technologies have become increasingly important in facilitating new and innovative approaches for accomplishing strategic objectives and improving business capability. EHRs, wireless communications, internet-based applications such as portal technologies, voice and imaging systems are examples of enabling technologies which are being applied in healthcare settings.

Technology Infrastructure

The technology infrastructure serves as the foundation for the enabling technologies and for operational effectiveness. Northern Ontario health service providers’ technology infrastructure consists of its applications, hardware, network, data, methods and tools, and human resources. The ICT plan assessed the capability, strengths, and limitations of this infrastructure. Issues

Voice Technologies

Point of Care

E Business

Operational Efficiency

Integrated Health Care

Electronic Health Record

Regional Partnerships

Internet / Portal Technology

PACS

Wireless Communications Document Management

Telehealth

Data Repository

ENABLING TECHNOLOGIES

TECHNOLOGY POLICY

IT INFRASTRUCTURE

Application Systems | Hardware | Network | Data | People | Methods & Tools



such as the application portfolio's capability to support both the current and future service demands of the region, the capacity of the hardware and network to support computing demands, the potential to share data, and the ability of staff to assimilate and apply rapidly changing technologies were some of the factors to be considered.

Technology Policy

The technology policy serves as the decision-making framework that defines the characteristics of the desired state of the technology infrastructure and the direction for acquisition and development. For example, a technology policy may include important elements such as open systems compliance, use of flexible user interfaces, migration to a client/server architecture, a commitment to a core systems vendor, etc.

ICT Blueprint Vision

The vision for the ICT Blueprint is:

“Information and communication technology supports the processes of quality healthcare provision, access to health information and the most effective use of available resources across Northern Ontario, through collaboration and sharing of information amongst providers.”

The vision will be accomplished through collaboration and sharing of information among health service providers, by a system that has the following characteristics:

• A common integrated direction for ICT among health service provider networks across Northern Ontario

• Flexibility to meet changing health needs of residents of Northern Ontario

• Enables integration of care delivery

• Incrementally builds on existing investments and infrastructures developed through the commitment of three levels of Government (regional, provincial, federal)

• Enables and fortifies patient quality care and ensures equity that is based in best practice within the health services sector

• Provides technical tools and enhancements to processes to effectively deliver health services within appropriate standards and outcome measures

• Broadens technology enhancements and development across a wider range of health services

• Leverages technologies to support business processes and operations

• Promotes learning and professional development

• Enable partnership development and greater collaboration across Northern Ontario health networks

• Enables exchange of patient information with referral centres, networks, and centres in Southern Ontario and Winnipeg.



ICT Blueprint Findings

The first step in the development of the integrated Northern Ontario ICT plan was the development of a comprehensive inventory of the current state of technology across the North. Through surveys and interviews, baseline data was collected to indicate the level of ICT deployment, network architecture, key system vendors, status of PACS and use of telemedicine at all 52 participating agencies. Highlights of the findings and conclusions of Phase 1 include:

• To date the development of the Northern Ontario ICT Blueprint has focused on the hospital sector (including acute care, mental health and continuing care), CCACs and Community Health Centres. Phase 2 involves further data gathering to formulate a full ICT strategy and implementation plan across acute care and community sectors

• An interim northern ICT coordination body has been established – ONe-Health – to sponsor a number of proposals to the MOHLTC’s e-Health Office and Canada Health Infoway that are the direct result of the planning project

• The NWHN has developed and implemented a shared PACS and is in the process of implementing a regional EHR

• Thunder Bay Regional Health Sciences Centre and St. Joseph’s Care Group currently share an information services department. Other parallel processes are occurring with the CCACs and with other regional organizations

• The hospital sector and CCACs are building their EHR capabilities, and the CCACs are upgrading to WebPMI

• The Addictions, Children’s Treatment, Community Health Centre, Long-Term Care, Community Support Service and Mental Health sectors’ ICT capacity will be determined in Phase 2

• TBRHSC and SJCG are implementing systems that are already building up to the EHR. A majority of the other hospitals in the Northwest are implementing the core applications of patient management consistent with the longer-term vision of an organizational EMR and the Northwest EHR

• CCACs, hospitals, LTCHs, CHCs, mental health agencies, and physician groups in the North have all identified the need to share patient information at times of transition of care among care providers – a health profile with demographic, drug, allergy, and clinical/discharge summary is needed

• CCACs and hospitals work very closely together and would like to share information electronically. CCACs use provincially mandated systems and cannot access other systems electronically. A new, web-enabled upgrade of the current software – WebPMI – is currently being developed for all CCACs to use

• Physicians value clinical viewing capability in their offices. Thunder Bay hospitals, for example, have made this feature available. The next step will be the total integration of the health record

• With the large geography and several referral centres, managing access to care is a serious issue. Automation of wait lists for those services that do not have a provincial database and availability of schedules on line, and remote scheduling are ideas being encouraged by service users



• Laboratory services are becoming more regional in the North. Major centres such as Fort Frances, Kenora, Sudbury, Thunder Bay, and Timmins have long been providing reference laboratory services. Smaller centres also provide laboratory testing to community clinics with no laboratory services on site, i.e. NorWest CHC (Longlac) refers testing to Geraldton, Mary Bergland CHC (Ignace) refers testing to Dryden

• Area dependent services are also provided by Hospitals In-Common Laboratory (HICL) and community sector laboratories (MDS, CML, GammaDynacare). Additional reference services are provided by the Public Health Laboratory, Canadian Blood Services, and Winnipeg Health Sciences Centre. There are also three regional laboratory programs (Kenora Rainy River Regional Laboratory Program, Northshore District Laboratory Program, and the Cochrane Regional Laboratory Program). The laboratories need an up-to-date system to provide the connectivity of results and the ability to share information electronically. OLIS will provide connectivity of results, when implemented.

Twelve core strategies evolved out of these findings, thus forming the foundation of a multi-sectoral plan for implementing ICT in the North. The Blueprint contains design and development principles for the applications that will support the twelve core strategies, with high level capital and operational cost assumptions. The core strategies are as follows:

• Build the Northern Electronic Health Record (that supports patient referral patterns and leverages current investments).

• Build the content of the organizational EMR across all sectors.

• Address requirements of integrated services.

• Integrate the diagnostic components/PACS.

• Invest in technology for the regional EHR across the continuum of care.

• Support work effectiveness.

• Leverage web-based technologies.

• Implement decision support and business systems.

• Respond to consumer needs.

• Support research and education.

• Build the infrastructure.

• Optimize available funding. The project was successful in many ways. The Northern ICT Blueprint provides a foundation for the data, methods, and tools required by the participating agencies to achieve the overall vision. The Blueprint articulates distinct directions for technology, and links these back to provincial directions. The plan is also visionary in that it describes the strategies that will be needed to integrate clinical and administrative data across the two LHINs in Northern Ontario. The end result will be improved patient care.



5.2 Northern Ontario Information & Communication Technology Planning Project (ICT Blueprint) – Phase 2

The analysis described above was limited to seven sectors, given the project’s original timeframe and available resources. As Phase 1 has been completed, the ONe-Health Steering Committee and two Northern Ontario LHINs have agreed to expand the ICT Blueprint to cover other sectors. Additional planning will benefit the larger health care system by expanding the number of agencies that can integrate into the common vision, thereby enhancing the usefulness of the Blueprint. The following seven additional sectors will be the primary scope of Phase 2 (this represents over 200 agencies):

• community mental health and addiction services (approx. 85 agencies)

• long-term care facilities (approx. 65 facilities)

• public health units (7)

• independent health facilities providing laboratory and diagnostic imaging services (42)

• children’s treatment centres (5)

• medical practitioners –

! primary care group practices (including minimally: the 28 approved Family Health Teams as of April 2006; and existing Family Health Groups, Family Health Networks and Rural and Northern Physician Group Agreements)

! fee-for-service GPs

! specialists. Additionally, a secondary focus will look at:

• The ICT linkage between pharmacies, the Ontario Drug Benefit Program and the broader health system

• The ICT needs and integration requirements of community support service providers both within the CCAC service framework and broader health system

• Options, opportunities, and requirements to build patient self-management tools into the Regional ICT system.

These areas will be studied by contacting/interviewing/surveying a representative sample of each of the respective broader groups in the North. The nine-month project began in June 2006 and will be completed by March 2007. A Steering Committee has been established with representatives from each sector and across Northern Ontario and funding has been secured from FedNor, the MOHLTC Regional Office, and the e-Health Office.



North West LHIN Planning – Phase 3

It is anticipated that the two Blueprints, once Phase 2 is complete, will provide a solid foundation for a North West LHIN specific ICT plan at a more tactical level. This work will be guided by a North West LHIN ICT Advisory Council that has yet to be formed. System-wide coordination/governance options and a vision of ICT in the future will be key deliverables for Phase 3. It is expected that Phase 3 will be completed in 2007.

6.0 Challenges and Opportunities for the North West LHIN

Given the ICT planning and implementation work that has occurred and continues to be undertaken in the North West LHIN, the area has a significant base of experience, expertise, and success to build upon. Nonetheless, the development of effective and innovative ICT/IM strategies is not without challenges that include:

• The sizable capital and operating investments that would be required to implement a range of coordinated/integrated ICT projects across the health system

• Fear of losing organizational autonomy when ICT projects typically require demonstrated partnerships and organizational interdependence to succeed (either because the funder requires it, and/or the project can only create the necessary economy of scale or viable cost structure when spread over a number of organizations)

• There is a shortage of health-related ICT experts and consultants given that there are many large regional ICT initiatives presently underway across Canada

• ICT/IM decision-making remains a responsibility of individual organizations. Although it is often in their best interest to develop horizontal and vertical partnerships when implementing new ICT, it is not compulsory

• Although there are numerous successful ICT and IM projects occurring in the North West LHIN, the level of coordination between initiatives varies significantly.

Based on the MOHLTC’s broader e-Health and IM strategic directions and transformation agenda, the following provincial recommendations to LHINs have been established:

• Identify an e-Health Lead function for each LHIN

• Focus on establishing the “building blocks” of the EHR (this should be a central component of each LHIN’s e-Health plan)

• Develop an e-Health strategy for the LHIN by the end of year one (this is the responsibility of each LHIN e-Health Lead)

• Establish a LHIN e-Health fund (this is the responsibility of the Ontario e-Health Office)

• Create the Data Management Partnerships. Several opportunities exist for the North West LHIN with respect to ICT. The North West LHIN can balance the provincial directions with the evolving e-Health and information management landscape in the Northwest by focusing on the following:



Planning

1. In collaboration with the North East LHIN and the ONe-Health Steering Committee, the North West LHIN is supporting the Northern Ontario ICT Planning Project (ICT Blueprint)

– Phase 2 planning process so that it can be completed by March 2007. The results will be a system-wide e-Health strategic plan; an important component of which will identify the steps required to achieve an EHR.

2. A subsequent third phase of ICT planning focused on priority setting, tactical and

implementation planning will follow and be completed by the end of 2007. This may involve the establishment of a formal Northwest ICT governance/coordination structure.

Facilitation

1. Engage ICT stakeholders (including health service providers, e-Health funders and the private sector i.e. hardware/software vendors) to develop LHIN-wide:

! ICT standards

! requirements for interoperability

! best practices and sharing thereof.

2. Identify high potential e-Health change and innovation initiatives, and support or facilitate these in moving forward on an appropriate scale (e.g. local, district) with a view to their application on a broader level.

3. Support the Northern EHR project of the NWHN as the basic building block of an

integrated and comprehensive electronic health record.

4. Support the use of ICT to increase community participation in health planning, and patient participation in their care (e.g. web-based patient self-management tools, service inventories).

Implementation / Coordination

1. Support the development of:

! cost/benefit analysis models that include system-level considerations

! guidelines for the allocation of resources to optimize benefits from ICT investments

! incentive structures that are aimed at achieving the North West LHIN e-Health strategy

! evaluation tools to monitor progress towards achievement of outcomes.

Information Management

1. Monitor and support the Local Data Management Partnership in its work to identify best practices, standards, tools, and policies for better data quality and management in the hospital and CCAC sectors in the North West LHIN.



2. Work with partners to facilitate a strong linkage between ICT projects (particularly pertaining to the development of an EHR in the region) and information management activities.

3. Encourage and support initiatives designed to optimize resource allocation across the

system (i.e. staff, computer hardware/software, training) such that accurate MIS/data capture occurs at the agency level per the MOHLTC’s expectations/requirements.

4. In collaboration with LHINs across the province and the MOHLTC, work to secure

access to high quality data at the appropriate level (e.g. raw/record level vs. reports) in a timely manner.

The North West LHIN would like to acknowledge the generous contribution of Phil Kilbertus of

the North East LHIN whose work has formed the basis of this report.

7.0 Acronyms

ADT Admission, Discharge and Transfer

CEO Chief Executive Officer

CHI Canada Health Infoway

CIHI Canadian Institute for Health Information

CIO Chief Information Officer

CIPHS Canadian Integrated Public Health Surveillance

DI Diagnostic Imaging

DPV Drug Profiler Viewer

eCHN Electronic Child Health Network

EHR Electronic Health Record

EHRS Electronic Health Record Solution

EMPI Enterprise Master Patient Index

EMR Electronic Medical Record

EPR Electronic Patient Record

HNS Health Network System

ICT Information and Communication Technology

ICU Intensive Care Unit

IM Information Management

IPC Information and Privacy Commissioner



iPHIS Integrated Public Health Information System

IS Information System

LDMP Local Data Management Partnerships

LHINs Local Health Integration Networks

MDS Minimum Data Set

MOHLTC Ministry of Health and Long-Term Care

MPI Master Patient Index

NOHBOS Northern Ontario Hospital Back Office Services

NORTH Network Northern Ontario Telemedicine Network

NWHN Northwest Health Network

ODBP Ontario Drug Benefit Program

OHA Ontario Hospital Association

OHISC Ontario Health Informatics Standards Council

OLIS Ontario Laboratories Information System

ONe-Health Ontario North e-Health

OTN Ontario Telemedicine Network

PACS Picture Archiving and Communication System

PDA Personal Data Assistants

PHIPA Personal Health Information Protection Act

PMI Patient Management Information

PNOPP Pan-Northern Ontario PACS Project

QCIPA Quality of Care Information Protection Act

SJCG St. Joseph's Care Group

SSHA Smart Systems for Health Agency

TBRHSC Thunder Bay Regional Health Sciences Centre

WTIS Wait Times Information System

Documents

North West Local Health Integration Network Information and Communication …/media... · 2015-04-08 · North West Local Health Integration Network Information and Communication