ehealth Services Plan Building an Integrated ehealth Framework

Transcription

1 ehealth Services Plan Building an Integrated ehealth Framework

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3 Acknowledgements The North West Local Health Integration Network (North West LHIN) acknowledges the contributions of Health Service Providers (HSPs) from Northwestern Ontario to the North West LHIN ehealth Services Plan. Through online surveys, engagement sessions and interviews, many organizations and individuals provided input and validation to this plan, which provides a roadmap for ehealth within the Northwestern Ontario region for the next three years. The North West LHIN wishes to acknowledge the contributions of the North West LHIN ehealth Advisory Committee: Bruce Sutton, North West Health Alliance, Thunder Bay Regional Health Sciences Centre / St. Joseph s Care Group Andrée Robichaud, Thunder Bay Regional Health Sciences Centre Dr. Gordon Porter, Thunder Bay Regional Health Sciences Centre Terry Moore, Canada Health Infoway Joanne Lacourciere, Thunder Bay Regional Health Sciences Centre John Emond, ehealth Ontario Tuija Puiras, North West Community Care Access Centre Marcia Scarrow, Community Counseling and Addictions Services Henry Gauthier, Riverside Health Care Facilities Dave Murray, Sioux Lookout Meno-Ya-Win Health Centre Cindy Gasparini, Lake of the Woods District Hospital J.J. Hupka, Ontario Telemedicine Network Mark Perrault, Northwestern Health Unit Maurice Fortin, Community Mental Health Association Daniel McGoey, Wesway Adam Brown, Wilson Memorial General Hospital John Woronkewych, Children s Centre Thunder Bay Tanis Palko, Pharmacist Brian Ktytor, North West LHIN Andrew Wehrstedt, North West LHIN Karen Malench, North West LHIN Heli Mehta, North West LHIN David Newman, North West LHIN Nicole Reid, North West LHIN North West LHIN ehealth Services Plan 1

4 Table of Contents 4 Chapter 1: Executive Summary 8 Chapter 2: Introduction 10 What is ehealth? 10 The North West LHIN ehealth Department and Project Management Office 12 The North West LHIN ehealth Advisory Committee (eac) 13 Chapter 3: Approach to Establishing ehealth Service Plan Priorities 14 Ontario s Action Plan for Health Care 14 Ontario s 2015 ehealth Blueprint 14 The North West LHIN Health Services Blueprint 15 The North West LHIN Integrated Health Services Plan (IHSP) Chapter 4: ehealth Landscape Northern Ontario e-health ICT Blueprint Tactical Plan 19 The North West Health Alliance (NWHA) 19 Regional Shared Hospital Information System (HIS) 21 Regional Shared Picture Archiving and Communication System (PACS) 21 Electronic Medical Record Adoption Model (EMRAM) 22 Electronic Medical Record (EMR) Adoption 22 Physician Office Integration (POI) 23 Continuing Care Information Management (CCIM) Assessment Tools Adoption 23 ehealth Ontario ONE Mail Deployments 23 Connecting Northern and Eastern Ontario (cneo) 24 Drug Profile Viewer (DPV) 24 Medication Management System (MMS) 24 Ontario Laboratories Information System (OLIS) 25 Northern and Eastern Ontario Diagnostic Imaging Network (NEODIN) 25 Telemedicine/Telehomecare 25 Electronic Resource Matching & Referral (RM&R) 26 Remote First Nation Communities 26 First Nation Client Registry 26 Regional Skills & Expertise 27 Regional Collaboration & Sharing 27 Regional Privacy & Security 27 Community Services 27 Business Intelligence 28 Decision-Support 28 Mobile Devices North West LHIN ehealth Services Plan 2

5 29 Chapter 5: ehealth Priorities 33 Transformation: Current State -> Future State 34 Priority 1: Integrate regional Electronic Health Records (EHRs) to improve patient-centred care 36 Priority 2: Build regional capacity to accelerate adoption of ehealth systems and technologies to gain system-wide benefits, as rapidly as possible 38 Priority 3: Advance the use of innovative technology solutions to improve access to care and health outcomes, resulting in healthier people 40 Summary of ehealth Initiatives to Build an Integrated ehealth Framework 42 Chapter 6: What Does Success Look Like? 43 Desired Outcomes of the ehealth Services Plan 45 Chapter 7: Appendices 46 Appendix A North West LHIN ehealth Governance 47 Appendix B North West LHIN ehealth Advisory Committee 51 Appendix C Electronic Medical Record Adoption Model (EMRAM) Scores 52 Appendix D Supporting Documents North West LHIN ehealth Services Plan 3

6 1 Executive Summary Approach to Establishing ehealth Service Plan Priorities North West LHIN ehealth Services Plan 4

7 Executive Summary The North West Local Health Integration Network (LHIN) is one of 14 LHINs in Ontario. It is responsible for planning, funding and integrating health care services for approximately 231,000 people in Northwestern Ontario. Because it has at once the largest geography but the lowest population of any LHIN, the North West LHIN faces several unique challenges to the delivery of health care in its region. Overall, the North West LHIN experiences a higher rate of chronic disease. People smoke and drink more, and are generally more ill than the rest of the province. People in the North West LHIN have a lower life expectancy than Ontarians overall, and the LHIN spends more money on health care per capita than anywhere else in the province 1. In response to these challenges, the North West LHIN is in the midst of transforming the health care system throughout Northwestern Ontario. The LHIN s Health Services Blueprint, released in 2012, is a comprehensive 10-year plan to integrate and improve health care in the Northwest, so that the system can continue to be able to provide the kind of first-class health services that patients and their families in the Northwest have come to rely on. Sweeping, transformational change in how health care will be delivered is now underway, and electronic health (ehealth) is a critical enabler of that change. ehealth can be defined as any use of technology to improve patient health outcomes, increase accessibility to quality health care, and ensure the effective and efficient delivery of health care services all in a manner that protects privacy and security. Jurisdictions all over the world are embracing ehealth. It is understood to be the key, both to improving quality of care and making the delivery of that care more efficient and cost-effective. The North West LHIN has released this ehealth Services Plan (ESP) for , under the guidance of the North West LHIN ehealth Governance structure and with the leadership of the North West LHIN ehealth Advisory Committee, in order to advance ehealth in this region. The plan was informed by ongoing consultation with stakeholders in the region. It is also aligned with four important documents currently guiding health care in this region, and this province. These are: Ontario s Action Plan for Health Care, the Ontario 2015 ehealth Blueprint, the North West LHIN Health Services Blueprint, mentioned above, and the North West LHIN Integrated Health Services Plan This ehealth Services Plan establishes three overarching priorities that will guide activities over the coming three years ( ) to advance and improve the state of ehealth within the North West LHIN region, and outlines various initiatives, both planned and in progress, designed to help our LHIN achieve these priorities. The three priorities are: 1 Integrate regional Electronic Health Records (EHRs) to improve patient-centred care; 2 3 Build regional capacity to accelerate adoption of ehealth systems and technologies to gain system-wide benefits, as rapidly as possible; and Advance the use of innovative technology solutions to improve access to care and health outcomes, resulting in healthier people. 1. North West Local Health Integration Network. Population Health Profile. December Executive Summary North West LHIN ehealth Services Plan 5

8 Supporting these priorities are a number of initiatives that have been chosen because they not only advance ehealth in this region, but also align with the overall direction for health care being taken by the province of Ontario. Over the next three years, as we strive towards world-class health care in our region, we will continue to transform our system into an innovative, high-tech, knowledge-based industry and these initiatives are key to enabling this progression. They will enable: an improved patient care experience, where the patient is at the centre of all that we do; improved population health, by putting the technology in-place that enables people to access the care they need, when and how they need it; and, value for money, by supporting effective use of resources, lower costs, higher quality, improved safety, and, increased, equitable access to care. The following table presents a summary of all the ehealth initiatives outlined in this plan, in alphabetical order, and shows the main ehealth priority they advance. e HEALTH INITIATIVES TO BUILD AN INTEGRATED e HEALTH FRAMEWORK ehealth Initiatives Integrate EHRs (Priority 1) Build Capacity (Priority 2) Advance Innovation (Priority 3) 1. Back-Office Integration Activities 2. Closed Loop Medication Administration 3. Compliance with Provincial Technical Standards 4. Computerized Physician/Practitioner Order Entry (CPOE) 5. cneo/clinical Data Repository (CDR) cneo/health Information Access Layer (HIAL) cneo/provider Portal 6. Consumer ehealth 7. Document Management System 8. ehealth Shared Service Offering 9. Electronic Health/Medical Records (EHRs/EMRs) 10. Electronic Medication Administration Record (emar) 11. Electronic Resource Matching & Referrals 12. Emergency Department Information System (EDIS) 13. Geographical Information System (GIS) Technologies 14. Hospital Information System (HIS) Consolidation and Capability Advancement Executive Summary North West LHIN ehealth Services Plan 6

9 ehealth Initiatives Integrate EHRs (Priority 1) 15. Integrated Assessment Record (IAR) Build Capacity (Priority 2) Advance Innovation (Priority 3) 16. Medication Management System (MMS) 17. Mobile Technologies 18. ONE Mail 19. Ontario Laboratories Information System (OLIS) 20. Project Management Office (PMO) 21. Provider Registry 22. Provincial Client Registry 23. Telemedicine/Telehomecare 24. Utilization Management System 25. Wait Time Management System (WTMS) Total: Table 11. ehealth Initiatives to Build an Integrated ehealth Framework Executive Summary North West LHIN ehealth Services Plan 7

10 2 Introduction Introduction North West LHIN ehealth Services Plan 8

11 Introduction The North West Local Health Integration Network (LHIN) is one of 14 LHINs in Ontario and is responsible for planning, funding and integrating health care services for approximately 231,000 people in Northwestern Ontario. The North West LHIN has the largest geography of any LHIN (47% of the province) but the lowest population. Due to the vast geography and low population, our region experiences unique challenges in health care service delivery in areas such as: providing equitable access to care; having access to appropriate health human resources; the need for extensive travel; and ultimately, higher costs of care (per capita) than other LHINs. Overall, our region is more ill than the rest of the province, has higher Challenges in delivering health care services exist in our region, such as providing equitable access to care including access to specialty care, and general access to care for people living in rural and remote communities. rates of smoking and alcohol consumption, and has higher rates of chronic disease 2. In addition, people here have a lower life expectancy than Ontarians overall, and we spend more money on LHIN provided health care services per capita than any other LHIN in the province. Our overall population is shrinking and the average age of the people in our LHIN is growing 3. The North West LHIN s Board of Directors has set the following four strategic directions for the North West LHIN: 1. Improved health outcomes resulting in healthier people 2. Access to health care that people need, as close to home as possible 3. Continuous quality improvement 4. A system-wide culture of accountability The North West LHIN has released this ehealth Services Plan (ESP) for under the guidance of the North West LHIN ehealth Governance structure (Appendix A) and with the leadership of the North West LHIN ehealth Advisory Committee (Appendix B). The plan was formulated through ongoing engagement with stakeholders in our region, by means of surveys, meetings and discussions, interviews, and analysis and alignment of regional, provincial and national planning documents. This plan supports the LHIN s Strategic Directions as set by the board of directors, and is aligned with the Integrated Health Services Plan ( ). This plan enables health service providers to align local initiatives with regional priorities in order to advance ehealth in our region. It outlines various initiatives, both planned and in progress, designed to help us achieve the priorities for our region through to In alignment with these initiatives, the North West LHIN s Annual Business Plan will identify tactical projects that are occurring during the fiscal year to advance ehealth. This ehealth Services Plan establishes three overarching priorities that will guide activities over the coming three years ( ) to advance and improve the state of ehealth within the North West LHIN region. These priorities are to: Integrate regional Electronic Health Records (EHRs) to improve patient-centred care; Build regional capacity to accelerate adoption of ehealth systems and technologies to gain system-wide benefits, as rapidly as possible; and Advance the use of innovative technology solutions to improve access to care and health outcomes, resulting in healthier people. 2. North West Local Health Integration Network. Population Health Profile. December North West Local Health Integration Network. Integrated Health Services Plan ; p. 9. April Introduction North West LHIN ehealth Services Plan 9

12 By focusing on these priorities and continuing to work with local health service providers and key stakeholders, the North West LHIN will build an ehealth framework to support a more integrated, safer and efficient health care system that will lead to more accessible, higher quality care in the region. What is ehealth? Electronic health (ehealth) can be defined as any use of technology to improve patient health outcomes, increase accessibility to quality health care and ensure the effective and efficient delivery of health care services all in a manner that protects patient/ client privacy and security. Health care must be treated as an innovative, high-tech, knowledge-based industry. It is widely accepted that world-class health care must be treated as an innovative, high-tech, knowledge-based industry. It is noted that the highest quality organizations are usually the most efficient, and rely on leading-edge technologies to enable them to achieve their goals 4. They employ innovative service delivery models that utilize new technologies to drive efficiencies. They demonstrate lower costs, higher quality, improved safety, as well as increased and equitable access to care. Ontario is anticipating a health care spending crisis and is looking at ehealth to remove duplication and improve the efficiency of service delivery. In , total health care spending was consuming 42% of the provincial budget. It was noted that if nothing changed, this would escalate to over 70% of the budget by This is not sustainable, and ehealth is viewed as an essential component to containing and reducing these costs. The North West LHIN, together with its health care partners, is in the midst of transforming the health care system throughout Northwestern Ontario, under the guidance of the North West LHIN Health Services Blueprint. Sweeping transformational change in how health care will be delivered is now underway, and ehealth is a critical enabler of that change. The North West LHIN ehealth Department and Project Management Office The North West LHIN has a department dedicated to strategic planning and advancement of ehealth for the region. In addition to ehealth, the department also acts as a Project Management Office (PMO), providing project management and change management standards and best practices, tools and coaching, and mentoring services, to health service providers. One of the goals of the department is to increase adoption of ehealth solutions in the region by increasing adherence to project management and change management disciplines, so projects are completed on-time, within budget, are sustainable, and deliver the expected benefits. The PMO offers a project management toolkit which consists of a set of tools and templates, based on project management standards and best practices from the Project Management Institute. These tools are available to health service providers to use for their own projects, or as a starting point for the development of their own project management tools. A change management toolkit is currently under development. 4. Falk W, Mendelsohn M, Hjartarson J. Fiscal Sustainability & the Transformation of Canada s Healthcare System: A Shifting Gears Report [Internet]. Mowat Centre and the School of Public Policy & Governance at the University of Toronto; 2011 Oct 31 [cited 2013 Feb 27]. Available from: mowatcentre.ca/research-topic-mowat.php?mowatresearchid=59 5. Ministry of Health and Long Term Care. Results-based Plan Briefing Book [Internet]. Queen s Printer for Ontario; [updated 2012 Jul 27; cited 2013 May 1]. Available from: Introduction North West LHIN ehealth Services Plan 10

13 Every year, the department conducts an annual survey to assess and determine the value of the services it offers to its constituents the health service providers in the North West LHIN. The most recent evaluation, conducted in March 2013, provided the following results: 75% of respondents indicated they were satisfied or very satisfied with the level of engagement performed by the department 70% of respondents indicated that performance was above average or excellent 85% of respondents indicated that working with the department has helped them achieve their organizational goals 93% of respondents indicated that success was achieved when utilizing the department s services 81% of respondents indicated that the ehealth department s services are valuable In 2011, the health service providers in the North West LHIN region identified attributes that they felt were important to them. In 2013, the respondents evaluated the department s performance against those important attributes on a scale of 0 to 5 with 5 being the highest rating: NORTH WEST LHIN e HEALTH DEPARTMENT PERFORMANCE ( ) Key Attribute Results-oriented Value-added Efficiency Responsiveness Expertise Knowledge Quality Trust Strategy Leadership Engagement Easy to work with Collaboration Clear communications Average Rating Table 1. The North West LHIN ehealth Department Performance Ratings Overall, the North West LHIN s ehealth Department and Project Management Office has been rated as performing highly in every key attribute that our health service providers have indicated are important to them. Introduction North West LHIN ehealth Services Plan 11

14 The North West LHIN ehealth Advisory Committee (eac) The North West LHIN ehealth Advisory Committee is a multidisciplinary committee with membership from across various sectors of the health care system throughout Northwestern Ontario, and includes representatives from ehealth Ontario and Canada Health Infoway (Appendix B). The committee provides advice to the North West LHIN on planning and implementation within the context of the Integrated Health Services Plan and the ehealth Services Plan, and champions key implementation and adoption initiatives. Vision The eac has a vision for ehealth - ehealth enables the improvement of patient health outcomes, the increase of patient safety, the accessibility to health care and an efficient and effective health care system in Northwestern Ontario. Guiding Principles The eac has established a set of guiding principles for ehealth in our region. These principles were used to guide the development of the ehealth Services Plan and will frame the decision-making process when implementing the strategy. 1. Value transparency, integrity, and stewardship 2. Ensure collaboration amongst stakeholders in the region 3. Reflect what is unique about our LHIN, both in terms of needs and capabilities, while respecting the provincial vision 4. Recognize that initiatives must have clearly defined measurable benefits that demonstrate value for money 5. Develop and advance solutions focused on patients and families 6. Consider and ensure privacy and security at all times 7. Apply best practices and follow industry standards 8. Leverage existing assets wherever possible and feasible 9. Keep solutions simple and easy to use Introduction North West LHIN ehealth Services Plan 12

15 3 Approach to Establishing ehealth Service Plan Priorities Approach to Establishing ehealth Service Plan Priorities North West LHIN ehealth Services Plan 13

16 Approach to Establishing ehealth Service Plan Priorities The ehealth Services Plan will advance, support and enable a variety of planning efforts for our region, but it will not do so in a vacuum. There are a number of other plans and initiatives, both in our LHIN and in the province, with which we have aligned our ehealth plan (Appendix D). Ontario s Action Plan for Health Care Ontario s patient-centered Action Plan for Health Care is built on the three foundations of: better access to care, higher quality care, and better value for money. The action plan states that the patient should expect the following from their health care system: 1. Support to become healthier 2. Faster access and a stronger link to family health care 3. The right care, at the right time, in the right place The Action Plan also emphasizes integration of the health care system at the local level, which meets the growing needs of our complex and aging population. The ehealth Services Plan directly enables and addresses the three priorities of the Action Plan by: getting source data in an electronic format so it can be immediately shared across the care continuum and used to improve patient care decisions; building regional capacity to increase integration and collaboration to improve the standard of care and equitable access to quality care; and, using innovative technology to remove barriers and improve access to care and health outcomes. Ontario s 2015 ehealth Blueprint In September 2011, ehealth Ontario released Ontario s 2015 ehealth Blueprint, which establishes a foundation for ensuring that patients are at the centre of care in the health system. It enables many different information systems, used by health service providers, to securely exchange and access patient information. Ontario s 2015 ehealth Blueprint provides a framework for communication and collaboration, establishes a set of standard architecture principles and guidelines, identifies components required to allow for secure information exchange, and helps to clearly illustrate progress made on each component. The Health Services Blueprint is a 10-year plan to transform the health care system in Northwestern Ontario. Moving to this new model of care, necessitates that the appropriate ehealth systems be put in-place to support it. Ontario s ehealth Blueprint is foundational to all of the ehealth decision-making in the North West LHIN and provides local direction to help Ontario achieve its vision of an Interoperable Electronic Health Record (iehr) for all people in Ontario. The North West LHIN Health Services Blueprint The Health Services Blueprint is a 10-year plan to reshape, strengthen and sustain the health care system in Northwestern Ontario. The Blueprint was informed by research and analysis of current and future health service requirements across the continuum of care. That research and analysis reveals that the North West LHIN has a fragmented health care system with high costs, largely attributed to a high burden of preventable disease that is being cared for in the wrong setting. The North West LHIN also has the highest rate of acute hospital use in Ontario and has not reduced hospital reliance to the same degree as the rest of the province. Approach to Establishing ehealth Service Plan Priorities North West LHIN ehealth Services Plan 14

17 INTEGRATED DISTRICT NETWORKS IN THE NORTH WEST LHIN The Blueprint will create an integrated health system model, one in which health service providers work together to organize services and care delivery at three levels within the North West LHIN: local, district and regional/lhin-wide. Kenora Red Lake Emo Rainy River Fort Frances Sioux Lookout Dryden Atikokan km Greenstone Nipigon Manitouwadge Terrace Bay Thunder Bay Marathon Kenora Integrated District Network Rainy River Integrated District Network Thunder Bay District Integrated District Network City of Thunder Bay Integrated District Network Northern Integrated District Network Figure 1. Integrated District Networks in the North West LHIN The Blueprint makes 44 recommendations for our region to transform our health system over the next 10 years. These include shifting the planning areas for the LHIN to five Integrated District Networks (IDNs) (figure 1). Implementation of Health Links in the North West LHIN will align to these five IDNs to focus on coordinated planning for improved access, transitions and patient experience. Appropriate ehealth systems (as defined in the Integrated Health Services Plan) will be required to enable the transformation to this new care model. While ehealth will enable the achievement of all the Blueprint recommendations, the following three recommendations are directly aligned: Recommendation #41 - Health Service Providers across the North West LHIN will support the implementation of the Connecting Northern and Eastern Ontario (cneo) project across the North West LHIN. Recommendation #42 - Patients across the North West LHIN will have maximum access to a broad range of innovative health care services as close to home as possible. These services will include the expansion of Telehomecare and Telemedicine. Recommendation #43 - The development of an integrated back office will be explored in the northwest region to conduct the transactional aspects of numerous functions across all health service providers. The North West LHIN Integrated Health Services Plan (IHSP) The Local Health System Integration Act, 2006 requires all LHINs to produce three-year Integrated Health Service Plans for their regions. The North West LHIN has recently released its third plan, which outlines the priorities and strategies for the three-year period April 1, 2013 to March 31, The IHSP identified four priority areas to advance system transformation over the next three years. These are: Priority #1 Building An Integrated Health Care System Priority #2 Building An Integrated ehealth Framework Priority #3 Improving Access to Care i. Enhancing Access to Primary Care ii. Reducing Wait Times iii. Reducing Percentage of Alternate Level of Care (ALC) Days iv. Improving Access to Speciality Care and Diagnostic Services v. Improving Access to Mental Health and Addictions Services Priority #4 Enhancing Chronic Disease Prevention and Management Approach to Establishing ehealth Service Plan Priorities North West LHIN ehealth Services Plan 15

18 The North West LHIN ehealth Services Plan is an enabler to not just the building of an integrated ehealth framework, but to all of the priority areas identified in the IHSP. Figure 2 helps to visually depict the relationship between these important planning documents. It shows the alignment between them, and how each is an integral component to the advancement and achievement of all of them. NORTH WEST LHIN PLANNING DOCUMENTS 1 ehealth Ontario Blueprint ehealth Ontario s 2015 Blueprint is the foundation for innovation and action INFORMS ALIGNS INFORMS ALIGNS Ministry Strategic Plan Ontario s Action Plan for Health Care sets the direction for the health system provincially 2 3 INFORMS ALIGNS Ministry Priorities: Keeping Ontario Healthy Faster Access and a Stronger Link to Family Health Care Right Care, Right Time, Right Place 4 5 ehealth Services Plan (ESP) The LHIN planning document that sets specific priorities and directions for ehealth, in our region, over the 3 year period ESP Priorities : Priority 1: Integrate regional Electronic Health Records (EHRs) to improve patient-centred care Priority 2: Build regional capacity to accelerate adoption of ehealth systems and technologies to gain system-wide benefits, as rapidly as possible Priority 3: Advance the use of innovative technology solutions to improve access to care and health outcomes, resulting in healthier people INFORMS ALIGNS INFORMS ENABLES INFORMS IMPLEMENTS North West LHIN Strategic Plan The LHIN Board s strategic plan that sets the direction for the health care system in Northwestern Ontario 7 Integrated Health Services Plan (IHSP) The LHIN planning document that broadly identifies and describes priorities and directions, over the 3 year period INFORMS INFORMS ALIGNS IMPLEMENTS Annual Business Plan (ABP) Plan that describes the annual activities and associated spending plans that will be executed in order to implement the IHSP and ESP, for the next 3 years, with emphasis on the upcoming fiscal year 6 North West LHIN Board Priorities: Improved health outcomes resulting in healthier people Access to health care that people need, as close to home as possible Continuous quality improvement A system-wide culture of accountability North West LHIN 8 Priorities: Building an Integrated Health Care System Building an Integrated ehealth Framework Improving Access to Care Enhancing Chronic Disease Prevention and Management Figure 2. Relationship between Planning Documents Approach to Establishing ehealth Service Plan Priorities North West LHIN ehealth Services Plan 16

19 4 ehealth Landscape Approach to Establishing ehealth Service Plan Priorities North West LHIN ehealth Services Plan 17

20 ehealth Landscape The North West LHIN actively engages its constituents to understand the current state of technical ehealth environments, determining what challenges exist and what opportunities are being identified to advance the use of ehealth. Many other ehealth initiatives (e.g. Doorways, and Connecting Northern and Eastern Ontario (CNEO)) in the province of Ontario have assessed the readiness and current state of our systems, and of our health service providers (Appendix D). These assessments have been used to inform and to identify gaps and possible strategies, to define the future state of ehealth for our region. After reviewing the assessments, mentioned above, a current state assessment of the various components of our ehealth infrastructure was performed. The findings follow Northern Ontario e-health ICT Blueprint Tactical Plan In 2007 the North West and North East LHINs released a combined technology Blueprint Tactical Plan for advancing ehealth within the two Northern LHINs for the period of The blueprint was created after extensive engagement and current-state assessments performed in both the hospital and community sectors. The 2007 ICT Blueprint Tactical Plan identified 16 priority projects that would advance ehealth for the two Northern LHINs. The 2007 ICT Blueprint was used to inform the creation of the ehealth Services Plan ICT Blueprint Tactical Plan Priority Projects Status 1. Establish a Project Management Office for the Northern Ontario e-health ICT Tactical Plan 2. Develop a regional ICT infrastructure, support and integration program, including the development of a technology integration framework; architecture and standards 3. Enable Smart Systems for Health Agency (SSHA) connectivity 4. Implement SSHA s ONE Mail 5. Leverage the provincial Enterprise Master Patient Index (EMPI) 6. Increase access to Tele-Health 7. Implement a Clinical Provider Portal (Clinical Viewer) 8. Support the referral processes through e-referrals 9. Implement an e-physician strategy 10. Continue to develop organizational electronic records and the regional Electronic Health Record 11. Implement the Pan Northern Ontario PACS Project (PNOPP) 12. Continue to implement administrative information sessions ehealth Landscape North West LHIN ehealth Services Plan 18

21 2007 ICT Blueprint Tactical Plan Priority Projects Status 13. Expand Ontario Drug Benefit (ODB) Plan Viewer access 14. Develop the Northern Ontario Directory of Services (DOS) 15. Develop a Consumer Portal 16. Align with Ontario Laboratory Information System (OLIS) Table ICT Blueprint - Tactical Plan Priority Projects Objectives Achieved In Progress or Ongoing Initiative The North West Health Alliance (NWHA) The North West Health Alliance (NWHA) is a not-for-profit organization that facilitates the sharing of ehealth services amongst its members. The NWHA currently manages the Shared Hospital Information System (HIS) and the Shared Picture Archiving and Communication System (PACS) on behalf of member hospitals in the region. All 13 of the hospitals in the Northwest are members of the NWHA. Twelve of the 13 hospitals in the region are using the shared HIS and shared PACS, and significant work is underway to have the remaining hospital implement the regional HIS in All 13 of the hospitals in the Northwest are members of the NWHA. Regional Shared Hospital Information System (HIS) The shared Hospital Information Systems (HIS) allows for the seamless sharing of patient clinical information amongst participating facilities. In the North West LHIN region, 12 of the 13 hospitals are currently using a shared HIS. The remaining hospital is on-target to complete a migration to the shared HIS in This will result in the North West LHIN being the only LHIN in the province to have all hospitals on a common HIS. This uniquely positions the region to be in a state of readiness to integrate The North West LHIN will be the only LHIN in the province to have all hospitals on a common HIS. the shared HIS with other provincial systems. In addition to enabling real-time clinical information sharing between hospitals, a common HIS allows for quick and efficient integration of hospital systems and information with other regional and provincial initiatives and assets. Using a common HIS provides an effective way to use system resources, as equipment and the human resources required to support the system can be shared amongst all participating hospitals. The shared HIS is connected to provincial systems including the Wait Times Information Systems (WTIS), the Critical Care Information System (CCIS) and the Enterprise Master Patient Index (EMPI). The shared HIS is also integrated with the region s Physician Office Integration (POI) solution to deliver hospital-generated reports and results directly to clinician EMR systems. The following identifies areas for ehealth advancement, with regards to the shared HIS. Emergency Department Information System In the region, 12 of the 13 hospitals have Emergency Departments. An Emergency Department Information System (EDIS) is an ehealth solution for Emergency Departments that typically automates functions such as triage, patient tracking, orders/results, documentation and discharge. Only one hospital in the region, Thunder Bay Regional Health Sciences Centre, uses an Emergency Department Information System for providing care to their patients and its use is limited in terms of the functionality available in a typical EDIS. ehealth Landscape North West LHIN ehealth Services Plan 19

22 Inpatient Electronic Documentation Two of the 13 hospitals are documenting inpatient clinical information such as nursing assessments, allied health professional assessments, and vital signs electronically in the HIS. For the remaining 11 hospitals, this process is still done manually, on paper, and then filed, making timely access to information and automatic sharing of information across systems, impossible. Information related to inpatient visits that needs to be shared for patient transfers is still being faxed across the region. Significant work is currently underway to implement electronic inpatient documentation at all 11 of the hospitals in the region that are not currently using this functionality. Document Management All hospitals generate information on paper that gets manually filed. Document Management provides the ability to store these paper-based documents, in an electronic system, so they can be more easily viewed and shared system-wide. Soon, all hospitals in our region will be documenting more clinical information electronically, enabling it to be readily shared with other health service providers. One hospital in our region has a documentation management system and two more hospitals are in the process of implementing a shared documentation management system. Given the region s shared use of the HIS, there are opportunities to have a shared documentation management solution. Digital Dictation and Voice Transcription Digital dictation and voice recognition-based transcription systems reduce the turnaround time required to manually transcribe and validate reports and results. However, most hospitals in the region have yet to move to these systems. There are systems in place at hospitals in the region that could be leveraged, as regional solutions, to provide this functionality to all hospitals. Currently, many hospitals in the region are outsourcing their dictation and transcription services to third-party organizations. Utilization Management Utilization management is the collection, assessment and monitoring of data that pertains to patient services and treatment. Features of this type of system typically include a real-time status of patients (along with their estimated date of discharge), beds and resources across departments, hospitals, and regions to ensure effective system-wide utilization, and a level of service coordination appropriate to the care needed. Real-time reporting informs decision-making and contributes to overall system efficiencies by being able to more effectively plan patient hospital discharges and coordinate needed community supports, in a timely manner. In the Northwest, three of the 13 hospitals have implemented Utilization Management Systems. There are opportunities to standardize utilization processes, leverage best practices and lessons learned, and use a common system across our region. Computerized Physician Order Entry (CPOE) Computerized Physician Order Entry (CPOE) is a process of electronic entry of medical instructions and orders for the treatment of patients. Without CPOE, physician orders are generally written on paper. The order is then transcribed by a staff member into the computer system and the original written order remains in the patient s physical paper chart. With CPOE, physicians place orders directly in the electronic system, reducing delays in order completion and errors related to transcription of handwritten orders, thereby improving the patient care experience. Typically, decision-support and error-checking for duplicate orders and incorrect doses are features included in CPOE. ehealth Landscape North West LHIN ehealth Services Plan 20

23 CPOE is only used, in our region, by the Regional Cancer Centre for Systemic Treatment. None of the hospitals are currently using CPOE outside of the cancer centre. Regional Shared Picture Archiving and Communication System (PACS) The Picture Archiving and Communications System (PACS) is a secure computer system that contains patient radiology reports and images such as CT scans, ultrasounds, MRIs, mammograms and x-rays. The implementation of these systems has eliminated the need for film and paper diagnostic images. A shared PACS allows participating hospitals to review digital images and reports, taken at any of the other participating hospitals, in one application. Twelve of the 13 hospitals in our region are currently using a shared PACS, while the 13 th hospital uses its own PACS. Using a common PACS provides an efficient method to level system resources, as equipment and the human resources required to support the system are shared amongst all participating hospitals. Electronic Medical Record Adoption Model (EMRAM) The Ontario Hospital Association (OHA) has adopted the Health Information Management Systems Society (HIMSS) s Electronic Medical Record Adoption Model (EMRAM). The EMRAM scores hospitals on their progress in completing eight stages (numbered 0-7) of automation and advancement towards a fully paperless patient record environment. The average EMRAM score for the hospitals in the North West LHIN is 2.2. The EMRAM score focuses on how information technology is supporting clinical care within a hospital, and provides acute care hospitals with a benchmark to assess their current state of maturity, identify future goals, and uncover opportunities to learn through peer comparison. As hospitals increase their EMRAM scores, they are increasing patient safety, reducing risk and providing better care. So ultimately, a higher EMRAM score indicates better, safer patient care. Canada EMR Adoption Model SM Stage Cumulative Capabilities 7 Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED; ambulatory, OP 6 Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS 5 Closed loop medication administration 4 CPOE, Clinical Decision Support (clinical protocols) 3 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 2 CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable 1 Ancillaries Lab, Rad, Pharmacy All installed 0 All Three Ancillaries Not Installed Table 3. Canada EMR Adoption Model 6 6. HIMMS Analytics. Canada EMR Adoption Model [Internet] [cited: 2013 Jan 27]. Available from: ehealth Landscape North West LHIN ehealth Services Plan 21

24 The average EMRAM score for the hospitals in the North West LHIN is 2.2 as compared to the average for the province of Ontario which is 2.5, based on the Ontario Hospital Association Q report (Appendix C). The majority of hospitals in the North West LHIN are considered to be Stage 2 hospitals, and significant work is currently underway to progress all hospitals in the region to Stage 3. A shared HIS enables hospitals to advance together at a lower cost and is considered a key factor in supporting this advancement. Electronic Medical Record (EMR) Adoption Electronic Medical Records (EMRs) are computer systems that provide clinical information that would normally be contained in a paper record in an electronic format. EMR systems allow clinicians to spend more time with patients providing care, and less time on administrative tasks like looking for paper reports and results. EMRs also enable better care through the use of automated alerts and reminders, drug interaction checking and electronic medication prescribing, and provide the ability to integrate systems together to facilitate the sharing of clinical information. Clinicians can use EMRs to better manage the overall health of the population that they serve through the use of business intelligence and decision-support functions, by utilizing the technology to increase practice management, and by identifying opportunities for internal process improvements. EMR Adoption is currently tracked and reported by OntarioMD for Medical Doctors within the LHIN region (Family Practice and Specialists). OntarioMD has indicated that all Family Practice doctors should have EMRs in their practice and that approximately 60% of Specialists require EMRs. The adoption numbers for EMRs in our region (shown in the chart below) indicate that our region is ahead of the provincial average for both family doctors and specialists. However, we have a long way to go to reach the targets set forth by OntarioMD, and need to continue to encourage EMR adoption. Type of Medical Doctor Adoption Rate Provincial Average OntarioMD Target North West LHIN Opportunity Family Doctor 72% 68% 100% 28% Specialist 26% 22% 60% 34% Table 4. EMR Adoption Physician Office Integration (POI) Getting clinical information into primary care EMR systems results in better, timelier, patient care. The Physician Office Integration solution in the Northwest provides for near real-time, electronic transfer of reports and results from hospitals directly to clinician s EMRs, resulting in increased efficiency. Twelve of the 13 hospitals in the Northwest send clinical reports from the shared Hospital Information System to clinicians EMRs. The system is transmitting more than 30,000 reports/results per month to approximately 350 clinicians, via their EMRs, located in 35 sites. Once the remaining hospital completes their implementation of the shared HIS, they will be in a position to have access to this regional POI solution as well. ehealth Landscape North West LHIN ehealth Services Plan 22

25 No. of Sites No. of Clinician Subscribers Average Monthly Volume (reports) ,000 Table 5. Physician Office Integration (POI) Usage Continuing Care Information Management (CCIM) Assessment Tools Adoption The strategic vision of Community Care Information Management (CCIM) is to provide seamlessly-integrated, community-based client care where all service providers can securely share and access consistent and accurate information, electronically. In the Northwest, many health care providers have adopted these CCIM systems and are sending their completed assessments into the Integrated Assessment Record an ehealth Ontario repository to facilitate the sharing of this important clinical information. The majority of our community support agencies report being in compliance with the Ontario Healthcare Reporting Standards (OHRS). However, we have very low adoption rates of other CCIM systems and tools including the Human Resources Information System (HRIS), Management Information System (MIS) and the Community Health Assessment (CHA). ehealth Ontario ONE Mail Deployments ONE Mail is an service from ehealth Ontario that lets registered health care professionals share patient information quickly, confidently and securely. Health Service Providers can use ONE Mail, either as direct customers (using ehealth s mail services) or as Partners (continuing to use their own services), to provide secure messaging between ONE Mail organizations. This secure messaging allows organizations to exchange Personal Health Information in secure s as opposed to having to either phone or fax information to each other. ONE Mail enables efficient and timely care delivery to patients, and as more providers start to use the service, the benefits will continue to increase. Currently, the Northwest region has a relatively low adoption rate in terms of implementing and using ONE Mail. Connecting Northern and Eastern Ontario (cneo) The Connecting Northern and Eastern Ontario (cneo) initiative is a foundational program created by ehealth Ontario to have LHINs work together to establish the cornerstone initiatives required to achieve the vision set forth in Ontario s 2015 ehealth Blueprint. The four Local Health Integration Networks (LHINs) in Northern and Eastern Ontario (NEO) have been grouped into an ehealth cluster to implement a provincial standard system integration hub for the region. Aligned with Ontario s 2015 ehealth Blueprint, cneo s primary goal is to provide health care providers with timely and secure access to personal health information, across the continuum of care and at any point-of-care throughout the cluster. cneo is working collaboratively with ehealth Ontario and the four LHINs in NEO (South East, Champlain, North East, North West) to plan, establish and deploy integrated Electronic Health Record (EHR) services. These services would be deployed through a hub composed of provincial standards-based Cornerstone solutions which includes the Portal, Health Information Access Layer (HIAL), and, Clinical Data and Document Repository (CDR). cneo will plan, establish and deploy integrated Electronic Health Record (EHR) services, so health care providers will have access to comprehensive information to deliver better, and more coordinated, patient care. ehealth Landscape North West LHIN ehealth Services Plan 23

26 With reliable and secure electronic health information, health care providers will have access to comprehensive information to deliver better, and more coordinated, patient care. The Northwest region is actively involved in cneo. Representatives are participating in working groups and on steering committees and we continue to monitor readiness activities to ensure plans for implementation are in place when cneo is ready for them. Drug Profile Viewer (DPV) The Drug Profile Viewer (DPV) is a secure, Internet-based application that provides health care providers with patient prescription drug information. As part of the provincial strategy to improve patient care, safety, and access, ehealth Ontario is exploring effective ways to provide prescription drug information to health care professionals. In the Northwest region, the Drug Profiler Viewer has been implemented at all of the hospitals. Medication Management System (MMS) The Medication Management System (MMS) is currently in development within ehealth Ontario and once available will provide a secure and comprehensive record of medications for Ontarians. The provincial MMS includes: eprescribing enables doctors, nurse practitioners and other clinicians to send prescriptions electronically to pharmacists, and a Drug Information System (DIS) allows clinicians access to a comprehensive medication history of prescriptions written and dispensed in Ontario. The MMS initiative is a priority for ehealth Ontario and supports the Ministry of Health and Long-Term Care s goals of healthier people, healthier communities, and healthier systems, by improving patient safety, access to care, and the quality of care. There have not yet been any interactions between the North West LHIN and ehealth Ontario for the planning and implementation of the MMS. However, the implementation of this system will provide many benefits within our region including an accurate, timely and comprehensive source of medication management data, and a reduction in the potential for prescription fraud through electronic authentication, authorization and delivery of prescriptions. OLIS facilitates secure sharing of laboratory test orders and results, across the province. Ontario Laboratories Information System (OLIS) The Ontario Laboratories Information System (OLIS) is a cornerstone information system that connects hospitals, community laboratories, public health laboratories and practitioners to facilitate the secure electronic exchange of laboratory test orders and results. OLIS is one component of the overall provincial strategy to improve chronic disease management in Ontario. Community laboratories and public health laboratories are currently integrated with OLIS. Clinicians who are using OntarioMD certified EMR products (specification 4.0) are able to integrate their EMRs with OLIS to view lab results for their patients. In the Northwest region, none of the hospitals are integrated with OLIS, so hospital generated lab tests and results are not available, in OLIS, to be shared. Hospitals have completed the planning and design needed to integrate their systems with OLIS, but the implementation has not yet commenced. ehealth Landscape North West LHIN ehealth Services Plan 24