Electronic Health North Simcoe Muskoka LHIN North Simcoe Muskoka Overcoming the Challenge! When the North Simcoe Muskoka Local Health Integration Network first opened its doors, it was recognized that meeting the challenge of electronically connecting our health service providers was going to take hard work and commitment by everyone across the health care system. In a survey conducted by the Ontario Hospital Association in 2008 assessing how ehealth ready our North Simcoe Muskoka hospitals were, we placed 4 th last out of the 14 LHINs polled. In order to address this shortfall, beginning in 2008 and continuing today through the work of the Care Connections Partnering for Healthy Communities Information and Communications Technology / ehealth Council, we have seen some amazing technology solutions implemented by our hospitals and other providers. Some examples include: Hospital Report Manager (HRM) an automated download for hospital reports (such as Medical Records, Diagnostic Imaging, Cardio Respiratory, Lab, Pathology, Microbiology, Blood Bank Reports,) to Electronic Medical Records (EMR) at Family Health Team (FHT) offices. To date, Royal Victoria Regional Health Centre, Georgian Bay General Hospital and Collingwood General and Marine Hospital and their associated FHTs implemented HRM as part of the provincial pilot in 2011. The pilot has been an overwhelming success and continued implementation to the remaining LHIN hospitals is taking place. Orthopaedic Patient and Complex Continuing Care Bed Registries software applications that enable enhanced tracking, referral and data collection regionally. The registries are based out of Waypoint Centre for Mental Health Care and being used by all 7 NSM hospitals. E Prescribing software application and connectivity that enables pharmacists to safely fill patient prescriptions by receiving the prescription order electronically. This application reduces the chances of inaccurate, duplicate or lost prescriptions and provides more timely and direct communication between physicians and pharmacists. This is a collaboration between the Georgian Bay Family Health Team, all local Georgian Bay pharmacies, the NSM LHIN, ehealth Ontario, OntarioMD and the Electronic Medical Record vendor. Information on all ehealth projects underway in North Simcoe Muskoka is attached to this update. If you have questions about LHIN ehealth initiatives or partnerships, please contact Gary Hurd at 705 326 7750 x205 or by email at gary.hurd@lhins.on.ca.
1. Hospital Report Manager (HRM) Hospital Report Manager (HRM) pilot was completed in 2011. HRM is an automated download for hospital reports (such as Medical Records, Diagnostic Imaging, Cardio Respiratory, Lab, Pathology, Microbiology, Blood Bank Reports,) to Electronic Medical Records (EMR) at Family Health Team (FHT) offices. 3 NSM LHIN hospitals (Royal Victoria Regional Health Centre, Georgian Bay General Hospital and Collingwood General and Marine Hospital), and their associated FHTs implemented HRM as part of the provincial pilot in 2011. The pilot has been an overwhelming success. b. Implementation Successes Improved Delivery Time Pre Implementation 12 days for hospital report delivery and input into the physician s EMR Post Implementation 30 minutes for hospital report to be transmitted directly into the physician s EMR Productivity Improvement 2.5 hours per day saved by the physician with the elimination of the need to scan, file and input hospital reports manually Hospital Cost Savings Printing, paper and ink budget for Health Records Department c. Next Steps Phase II The next phase of the Hospital Report Manager (HRM) expansion kicked off in October 2011 and will see 2 additional NSM LHIN hospitals, Orillia Soldiers Memorial Hospital and Muskoka Algonquin Healthcare, and their associated FHTs, integrated into the HRM, as well as the beginning of a roll out more broadly across the province. Other EMR users, such as the NSM CCAC, Community Health Centres, Nurse Practitioner Led Clinics, Specialist offices, and other approved physician organized groups, are also being considered for inclusion. This phase will also see the migration from the pilot environment for existing users to a new production environment hosted at the ehealth Ontario Data Centre.
Page 2 2. Orthopaedic Patient and Complex Continuing Care Bed Registries The NSM LHIN recently completed the Complex Continuing Care (CCC) Bed Registry project. This tool builds upon the existing mental health bed registry to meet the needs of the CCC group to enhance tracking, referrals and data collection regionally. The tool is based out of Waypoint Centre for Mental Health Care but is used by all 7 hospitals across the LHIN. Orthopaedic users saw the rollout of the tool to the Orthopaedic User Group to enhance tracking, referrals and data collection across the LHIN. The tool went live on March 26, 2012. The next phase will see the inclusion of robust reporting functionality as well as further enhancements to both the CCC and Orthopaedic tools. The next phase is scheduled to go live in early June 2012. 3. ufirst.cc Physician ehealth The ufirst project extends child and adolescent outpatient psychiatry referral services to approximately 37 family physicians in the Georgian Bay Family Health Team (FHT). The application allows for e referrals from physicians through their own EMR or FHT to convey specific information for their patient s care. The tool supports timely clinical intervention when and where needed. ufirst provides for an electronic notification to a child psychiatrist of a client in crisis. 4. Telemedicine Expansion The Telemedicine Adoption Initiative continues to broaden the implementation of telehealth and telemedicine capabilities across the LHIN, including the Ontario Telemedicine Network (OTN), Ontario Telehealth Service, and other capabilities such as the Virtual Hospital Ward (remote monitoring of patients using telehealth technology). As a result of the initiative, funding for 10 additional OTN FTE staff was approved in November 2011. In Q4 2011/12, health service providers (HSP) did bring on these 10 new resources across the LHIN. The LHIN and all stakeholders will continue to look at expanding access further.
Page 3 5. Resource Matching & Referral The current referral landscape in Ontario is characterized by inconsistent workflow, forms and templates and terminology for referring patients to programs and services. To address this, the LHINs have formed 3 Clusters across the province to plan, design, implement and maintain a Resource Matching and Referral (RM&R) program. Early in 2011 the Current State Assessment work for the RM&R project was updated with a new LHIN RM&R asset list being identified and collected. The latest phase (completed in March 2012) of the Alternate Level of Care Resource Matching and Referral Project (ALC RM&R) included all LHINs participating in the ConnectingGTA Cluster initiative. This work included a current state asset review, a refresh of the existing provincial reference model, a cluster business process re design and the population of a toolkit. The plan for later phases will include the completion of a future state report and the eventual procurement and rollout of a solution for the LHIN, cluster and province. The current best case scenario rough estimate target date for deployment is late fall 2013. 6. Community Care Information Management / Doorways / Integrated Assessment Record The provincial Integrated Assessment Record (IAR) being deployed by Community Care Information Management (CCIM) was a major focus in 2011. The NSM LHIN took part in the initial Doorways pilot project which concluded June 30, 2011. This pilot was the first of its kind in Ontario for the sharing of Personal Health Assessment Information across organizations and sectors. It involved 4 LHINs and 22 participating Community and In Patient Mental Health service providers. Implementation work continues within the NSM LHIN for the provincial Integrated Assessment Record (IAR), Resident Assessment Instrument (RAI) and the Ontario Common Assessment of Needs (OCAN) expansion. This project has been mandated by the LHIN. The next phase expands the implementation to additional inpatient and community mental health organizations, as well as additional sectors including Long Term Care, Community Care Access Centres, Community Health Centres, Community Support Services and Addictions organizations.
Page 4 7. Greater Toronto Area (GTA) West Diagnostic Imaging Repository The NSM LHIN joined the GTA West Diagnostic Imaging Repository Project after merging its Comprehensive Clinical Information Diagnostic Repository Study. Royal Victoria Regional Health Centre (RVH), Orillia Soldiers Memorial Hospital (OSMH), Georgian Bay General Hospital (GBGH) and Muskoka Algonquin Healthcare (MAHC) are all part of the GTA West project in our LHIN. The initial pilot for the GTA West project included implementation at 2 hospitals located in the Central West LHIN in February 2012. OSMH, GBGH and MAHC are part of the next group of sites to implement with a deployment scheduled for September/October 2012 timeframe. The GTA West project will send the data (daily) from the regional Picture Archiving and Communication System (PACS) located in Orillia to the GTA West repository. RVH is targeted to implement the GTA West interface early in 2013. 8. e Prescribing The e Prescribing initiative continues to provide benefits to physicians, pharmacists and clients. This is a collaboration between the Georgian Bay FHT, all local pharmacies, the NSM LHIN, ehealth Ontario, OntarioMD and the EMR vendor. The e Prescribing pilot project has been utilized by ehealth Ontario to develop lessons learned in support of the Medication Management strategy along with implementation of the Drug Information System of Ontario in 2013 9. ConnectingGTA The NSM LHIN was officially announced as being included in the GTA Cluster as part of the ConnectingGTA project in February 2012. This initiative will see the implementation of a common cluster wide Clinical Data Repository (CDR), web portal and Health Information Access Layer (HIAL). This will give our health service providers access to a common data source and portal for individual LHIN, cluster and provincial initiatives. As part of this initiative, the implementation of the Ontario Laboratory Information System (OLIS) will continue across our LHIN.
Page 5 10. Provincial Association of Ontario Health Centres (AOHC) Electronic Medical Record (EMR) Deployment Enabling the strategy is deployment of a state of the art electronic medical record (EMR) supplied by Nightingale Informatix Corporation. Each and every Community Health Centre (CHC) and the AOHC will use the Nightingale system, creating new opportunities for research and quality improvement initiatives, as well as cost efficiencies. The new EMR rollout began in the NSM LHIN in February at Midland s Chigamik Community Health Centre (CHC). One of the largest EMR implementations in Canada, Chigamik went live with Nightingale on Demand (NOD) in March 2012. Other early adopters in the two year plan include South Georgian Bay CHC. Throughout the deployment process, AOHC is providing intensive support, with efforts guided by the CHC and AOHC led Information Management Strategy Committee. The new EMR complements an inter professional approach by enabling use by a wide range of health providers including pharmacists, mental health workers, chiropodists, social workers, dietitians, diabetes educators, physiotherapists and health promoters. 11. Knowledge Sharing with Other LHINs All electronic health (ehealth) projects being managed at NSM LHIN are entered into Eclipse (project portfolio management) and are rolled up through the Information and Communications Technology/eHealth area of focus in Care Connections. These system enablers are focused on data sharing of Personal Health Information across all HSPs and as such provide a platform for all clinical projects. A few Eclipse facts in NSM LHIN: o 28 organizations trained o 410 registered users o 331 projects currently active Working closely with ehealth Ontario (trained in Eclipse) and 6 other LHINs using Eclipse (ESC, WW, CW, MH, CE, SE) through the Project Management Office (PMO) Leads meetings to develop an enterprise approach to manage all projects. ehealth Ontario likes the idea of reporting from a common platform. Working with LSSO to look at supporting and hosting an Enterprise Eclipse PPM system for the province. Discussions with Solution Q and LSSO have been initiated. ConnectingGTA project has approached NSM LHIN to investigate the buddy system of implementation strategy being deployed through the BSO project. This is significant in that we are recognized as having a process for implementation of a provincial project and they would like to leverage our methodology for the ConnectingGTA project. LYNC server has provided an electronic collaboration platform between all NSM LHIN staff and between all LHINs who have signed onto this enterprise service. The licensing is provided for our use through Champlain LHIN and the service is provided by the Winchester Hospital and it is FREE! Not supported by LSSO, so each LHIN needs to provide a LYNC administrator to manage the personnel. There are 400 licenses available for the remaining LHINs who are not on LYNC.