ehealth Partnership with Hamilton Niagara Haldimand Brant (HNHB) LHIN

Transcription

1 Meeting Date: September 23, 2010 Action: Topic Decision ehealth Partnership with Hamilton Niagara Haldimand Brant (HNHB) LHIN Purpose The purpose of this Briefing Note to: To provide the Board with an update on the current status of the Waterloo Wellington and Hamilton Niagara Haldimand Brant LHINs ehealth partnership projects. To seek support from the WWLHIN Board for the continued partnership with HNHB to expand the ehealth systems and advance the ehealth governance and shared services delivery capability in both LHINs. Recommendation THAT the Board of Directors of the Waterloo Wellington Local Health Integration Network (WW LHIN) support the continued partnership with the Hamilton Niagara Haldimand Brant Local Health Integration Network (HNHB LHIN) to expand the ehealth systems and advance their ehealth governance and shared service delivery capability in both LHINs. Background Information ehealth Ontario ehealth Ontario was created in September 2008 out of a merger between the Ontario Ministry of Health and Long-Term Care's (ministry s) electronic health program and the Smart Systems for Health Agency with a mandate to create electronic health records for all patients in the province by To achieve this goal, ehealth Ontario is playing the lead role in harnessing information technology and innovation to improve patient care, safety and access in support of the government s health strategy. On March 19, 2009, ehealth Ontario released Ontario s ehealth Strategy. The strategy focuses on three clinical priorities over the next three years: Diabetes Management - to control and manage diabetes more effectively and reduce associated complications and costs. Medication Management - to implement on-line management of prescription medications to minimize preventable adverse drug events. Wait Times - to reduce waits in Ontario emergency departments and the incidence of inpatients in acute care waiting for alternate levels of care, and to continue improving wait times for acute care services. Page 1 of 6

2 Approximately four months ago, Greg Reed was appointed as the President and Chief Executive Officer of ehealth Ontario. 1 Bringing a wealth of experience and a new focus to ehealth Ontario, he has been pursuing the following priorities: Rebuilding the ehealth Ontario senior management team and putting in place other organizational changes to make the organization as efficient and as responsive as possible. Reaching out and consulting with many stakeholders. This consultation included meetings with ministry s Assistant Deputy Ministers to understand their strategic priorities and get input on how ehealth Ontario can support these priorities. Mr. Reed is also meeting key stakeholders in the field, including representatives from teaching hospitals, community hospitals, community care organizations, LHINs, physicians using Electronic Medical Records (EMRs), various health-related associations, and other agencies such as Cancer Care Ontario and OntarioMD. His early observations identified that a considerable amount of innovative and impressive work, particularly with regard to the use of electronic health records in the delivery of care, is in evidence. He noted that most current electronic health record systems are purpose and facility specific, with little interchange of patient information between systems. These observations led to a new focus about the role of ehealth Ontario which is now seeking to respect and leverage the knowledge of those organizations and individuals who understand the clinical interface with patients and work in partnership with them. Specific areas where ehealth Ontario can make a difference include: Chronic Disease Management - In accordance with the ehealth Ontario strategy, the initial focus is on diabetes. This focus will not only address the needs of the growing number of diabetics in the province but will also put in place key building blocks need to accelerate other electronic health record initiatives. These building blocks include registries and repositories such as a client registry, a provider registry, OLIS, etc. and the links between them. Putting these building blocks in place is a top priority and a critical path item. Encouraging interoperability - The electronic health record systems currently in use have been developed and deployed independent of one another. ehealth Ontario is shifting their focus to fund projects that can be replicated beyond the institution where they were initially developed. Promoting the use of electronic health records A large proportion of healthcare is delivered within relatively small geographic areas defined by natural referral patterns. More effort will be devoted to local initiatives that link organizations across these referral patterns. It is not necessary to wait for all relevant standards to be finalized in order to do so. What does this mean for the LHINs? Partnerships will be established to deliver ehealth solutions including those across LHINs. ehealth Ontario may help fund local or regional solutions that can be leveraged to advance electronic Health but that align with ehealth Ontario directions. Clinicians will be engaged early and often to ensure project success. 1 Mr. Reed earned a B.Sc. in Computer Science at the University of Toronto. He began his career as a Systems Engineer with IBM. He then attended Harvard Business School where he earned an MBA, after which he spent 20 years with international strategy consulting firm McKinsey & Company in New York, London (UK) and Toronto. He worked to turn around distressed companies, assisted telecom and technology firms, and co-founded McKinsey s global Electronic Commerce Practice. During the past several years Mr. Reed has been the CEO of both a wealth management company and a Canadian bank. Page 2 of 6

3 As part of his stakeholder consultation, Mr. Reed and his senior Vice President, Alice Keung, met with the HNHB and WW LHIN Chief Information Officers (CIOs) and Project Management Office (PMO) Leads on August 17, This meeting was an extension of the key stakeholder interview approach that Mr. Reed has been pursuing since being appointed Chief Executive Officer. The HNHB and WWLHINs celebrated our ongoing partnership and provided evidence of the success of this partnership, bringing together the synergy of the HNHB LHIN focus on the clinical/facility components of an electronic medical record, EMR, and WW LHIN highlighting their work on developing portals for patients to access this information. Evolution of the WW LHIN ehealth Strategic Plan The WWLHIN released its initial ehealth Blue Print in The plan outlined how the LHIN would deliver a comprehensive, patient-focused and secure electronic system that would improve the way patients receive care. The plan proposed principles to guide business planning and grow ehealth: build on existing and scalable solutions seize opportunities and align with current or planned initiatives and resources choose solutions that promote ease of integrations and operation with other systems equip stakeholders with a minimum level of computerization to enable their participation all providers who stand to benefit and improve patient care should share implementation and sustainability costs. In 2007, recognizing that the funding required to achieve the WWLHIN s ehealth Strategic Plan would likely not be available, the LHIN began to look at partnership opportunities to facilitate planning and achievement of our e-health strategic direction. The WWLHIN ehealth Project Management Office (PMO) was created to coordinate the range of projects for health system improvement consistent with the Integrated Health Services Plan and the ehealth Strategic direction. The PMO continues to make progress in a number of areas. Examples of projects completed or underway include: Diagnostic Imaging Repository (DI-r) Provide hospital-based clinicians and other health care providers with access to patient images and diagnostic imaging reports acquired from any participating hospital in the HNHB and WW LHIN. 100% participation achieved in June ClinicalConnect Provider Portal The secure, physician portal enables timely provider access to patient and client information, across hospitals, other health care organizations, physicians and providers, i.e. a Virtual EMR. ClinicalConnect gives physicians and healthcare providers real-time, anytime & anywhere access to their patients electronically stored records via the internet. With well over 2,000 physicians in the HNHB and WW LHINs. During the course of this year integration of data from LHIN hospitals is planned for completion. Physicians have the option to electronically download hospital data into their EMRs. A link to the CCAC CHRIS patient information system has added HNHB CCAC client demographics, personal and medical contacts, placement and services details and information related to the patient s in-home CCAC services and long-term care placement. Enhancements underway: a single, sign-on web-based interface has been created to download to physician office medical record systems, CCAC data, and St. Joseph s Healthcare Hamilton. Mobile Access via Blackberry, iphone and Windows Mobile is under development. Next data sets for inclusion include information from other HNHB LHIN hospitals and oncology data from the Waterloo Regional Cancer Centre.eHealth is an important technology that links residents, providers and decision makers to the right data and information for the right care and quality improvement. Page 3 of 6

4 Facilitating the above work, a LHIN Data Sharing Agreement has been developed to allow providers, privileged at any LHIN Hospital and other eligible LHIN participants Family Health Teams (FHTs), Community Health Centres (CHCs) to access a patient s results. To continue the above work and to meet other key deliverables, the PMO office is being strengthened with the hiring of additional project managers. Funding for the PMO is provided from a number of sources: LHIN The ministry has approved an annualized allocation of approximately $600,000 to offset some of the costs of a PMO. Hospitals Implementation of many projects requires in-kind contribution from participants to ensure the ongoing viability of that project, e.g. Diagnostic Imaging Repository, Canada Health Infoway Funding from the federal agency leading Canada s ehealth implementation was received in response to winning an Request for Proposal (RFP) process for four projects. Ministry/eHealth Ontario The PMO is receiving funding to investigate the development of community ehealth clusters. WW LHIN ehealth Partnerships Since the creation of the LHIN model, both the HNHB and WWLHIN have recognized the importance of ehealth as a key enabler for achieving the health system transformation priorities set forth in their respective Integrated Health Service Plans (IHSP). Independently, HNHB and WWLHIN and their health service providers (HSPs) began making strategic investments in ehealth to address their priority needs. Concurrent with the evolution of ehealth Ontario to support clustered partnerships, the HNHB LHIN is working to establish a shared direction/vision for an integrated ehealth service delivery and governance model for the HNHB and WW LHINs that will guide the design, implementation efforts and investments that are already in progress. Key ehealth funders (Canada Health Infoway and ehealth Ontario) have recognized that regional approaches to ehealth integration can yield significant results and benefits and can complement provincial and national strategies. Significant future funding is being allocated to support the development of integrated regional ehealth Systems The ehealth collaboration between HNHB and WW LHINs was born several years ago when the two LHINs began a highly successful partnership on implementation of the shared Diagnostic Imaging Repository: An online storage system to allow instant access to stored digital images. Building upon this success, several ehealth initiatives ensued, including, ClinicalConnect, HEALTHeCONNECTIONS, and Resource Matching and Referral. Geographic adjacency, physician and patient referral patterns, common IHSP priorities and similar HSP technology environments make this a natural partnership. The LHINs, working with a common Academic Health Science Centre (Hamilton Health Sciences) and a range of HSPs, create a synergy to build capacity that can be leveraged for operational ehealth service and program delivery in the short and medium terms. In addition the partnership provides sufficient critical mass for efficiency and economies of scale without being so large as to make solutions intractable. On the strength of this partnership and demonstrated delivery of ehealth initiatives, the two LHINS were successful in obtaining significant funding for 2010/11 from all four ehealth Ontario LHIN funding programs to expand this work. It is particularly noteworthy that these two LHINs were the only ones successful at obtaining the maximum amount of funding, i.e. all four project streams, available to LHINs through this initiative. The following represents the combined scope of the four proposals, one proposal to each of ehealth Ontario s Funding Programs. Page 4 of 6

5 Our goal in submitting this integrated suite of proposals was to rapidly build upon advances to date that are moving the LHIN towards its vision. Furthermore, these next steps position the LHIN to support and deliver on specific Ontario ehealth Strategic priorities such as Wait Times (RM&R) and Diabetes Management (Registry), as well as deliver immediate and significant value and benefit to the HSPs and their patients of HNHB and WW LHINs. More specifically, these objectives include: Advancing the integration framework with respect to Identity and Access Management Services, i.e. Data security and protection of privacy in the linking of various clinical datasets. Developing an interface between ClinicalConnect and PointClickCare - used by many LTC, CCC and Rehab organizations. Integrating Clinical Connect with acute care hospital health information systems thereby making their health information available across the continuum. Developing interfaces with additional Clinical Management System products to enable a larger community of primary care providers and specialists to incorporate information accessible through ClinicalConnect. Deploying ClinicalConnect to additional FHTs and all CHCs, enabling them to access the information available through ClinicalConnect and incorporate this information into their EMRs. Designing and developing a Physician Landing page or Dashboard that will integrate clinical information via ClinicalConnect and non-clinical information (a key feature that will enhance physician adoption). Piloting the use of wireless technology (already supported by the Medseek framework) with physicians (a key feature that will enhance physician ehealth adoption). Building upon the extensive needs assessments that have been completed to date to evaluate alternatives and develop business cases and implementation plans for Shared IT Support and Service Delivery capabilities, thereby simplifying and advancing the IT capacity across the continuum of care and readying our HSPs (particularly community-based organizations) for ehealth implementation and adoption. Building on the extensive current state assessment work done to date with respect to technologies and information flows associated with care pathways to drive out the details regarding the four Wait Times priority pathways and rapidly initiate a joint Resource Matching and Referral project. The scope of this project will consider alignment with adjacent LHINS to facilitate cross boundary referrals. ehealth governance and delivery across HNHB and WW LHINs are evolving in response to the increasing number of shared ehealth services and initiatives which are leading to a common, integrated ehealth system across both LHINs. The degree of funding allocated to a region or cluster is linked to their track record of delivery and their ability to build on existing investments. HNHB and WW LHINs are extraordinarily well positioned. In Ontario, it is recognized that creating 14 regional ehealth systems is unaffordable and unsustainable. Funding for initiatives is already becoming restricted to LHINs that partner or collaborate with other LHINs The five GTA LHINs have clustered for the creation of an integrated ehealth System. They are completing an architecture and implementation blueprint which will be submitted to ehealth Ontario for funding. Page 5 of 6

6 ehealth Ontario is undertaking an initiative to cluster the remaining nine LHINs into ehealth regions. Once clusters have been defined, the project will support them in current state assessment, future state design and implementation planning with respect to regional ehealth governance, service delivery and ehealth solutions/services. The expectation is that this work will form the basis of multi-year funding proposals to ehealth Ontario. HNHB and WW LHIN ehealth Leads are sponsoring this project on behalf of ehealth Ontario and HHSC is the Transfer Payment Agency. As a result of work done to date, HNHB LHIN and WWLHIN have been working together as a cluster. To complement the ehealth clustering project described above, these two LHINs have been given pilot funding to continue to expand their ehealth system and advance their ehealth governance and shared service delivery capability. These efforts are expected to provide valuable input to the broader provincial project (i.e.) real world experience rather than simply just theory. 1. To achieve a common understanding of the drivers for evolving an integrated ehealth governance and service delivery model across HNHB and WW LHINs. 2. To establish a shared direction/vision for an integrated ehealth governance and service delivery model across both LHINs that will guide the design and implementation efforts that are being launched. Diagnostic Imaging Repository - collaborative effort with HNHB and WW LHINs, hosted in a server located in Southwest LHIN HealtheConnections - Waterloo Wellington LHIN is involved in a Canada Health Infoway funded project. HealtheConnections is a two year demonstration project - enhanced ehealth enabled model of care for diabetes. Deployed a Personal Health Record portal for the secure sharing of patient provided data. (patients upload data to the PHR). Physician access and download WWLHIN hospital data via ClinicalConnect o Waterloo Wellington LHIN approached HNHB LHIN to extend ClinicalConnect to WWLHIN o WWLHIN Diabetes Collaborative leverages ClinicalConnect ClinicalConnect - Collaborated with WWLHIN on funding submissions to ehealth Ontario for expanding ClinicalConnect Resource Management and Referral (RM &R) - Understand and improve organizational readiness to implement the RM&R solution for ALC patients referred to i) home care, ii) long term care, iii) complex continuing care and iv) rehabilitation pathways. HNHB LHIN and WWLHIN leading additional project on behalf of ehealth Ontario composed of two related components: o Regional Planning and Analysis for Integration (RPAIP) o ehealth Integration Services Enhancement Project (EISEP).