An ehealth Blueprint Setting the Course For Action An Ontario Hospital Perspective - Consultation Document - Ontario Hospital ehealth Council
This work-in-progress document has been developed by the Ontario Hospital ehealth Council as the Ontario Hospitals perspective on ehealth in Ontario health care. It is a consultation document to engage in collaborative discussions with hospitals, other health sectors, and stakeholders around the development of a common vision and framework for ehealth in Ontario. Through a process of stakeholder engagement, this document will be further developed to reflect the collective knowledge, needs, interests, ideas, and principles of other stakeholders across the health care delivery system. We look forward to building this Ontario ehealth Blueprint together. To work with the Ontario Hospital ehealth Council on a coordinated vision and action plan for ehealth in Ontario, please contact Sam Marafioti, Vice Chair of the Ontario Hospital ehealth Council, at smarafioti@oha.com or 416-480-4127. Copies of this document are available online at www.oha.com/info/ehealth Ontario Hospital ehealth Council Page 2
What is the Ontario Hospital ehealth Council? The Ontario Hospital Association (OHA) launched the Ontario Hospital ehealth Council as a vehicle for leadership and direction on ehealth for Ontario hospitals. It was created following a recommendation within the OHA s Information and Communications Technology (ICT) Advisory Committee report entitled Building the Foundation for ehealth in Ontario. 1 This led to a three-year funding commitment of over $2 million from the Ontario Ministry of Health and Long-Term Care for the ehealth Council. The Ontario Hospital ehealth Council s mandate, is to provide leadership in ehealth and support the implementation of ehealth solutions, which can improve health outcomes and the management, and delivery of health care. Since its launch in July 2001, the Ontario Hospital ehealth Council has: 1. Initiated an ehealth Work Team at OHA to support the ehealth Council s initiatives 2. Drafted an ehealth Blueprint for consultation with industry Developed a one-year work plan to move the ehealth Council s agenda forward Why are we building an ehealth Blueprint? When the Council first came together to identify opportunities, objectives and priorities, it was challenged to build an appropriate action plan without a vision of a future ehealth system. The Health Services Restructuring Commission s Information Management Action Plan 2 provided a starting point for a vision with key recommendations focused on a secure network and an electronic health record. The Council looked to a number of other organizations and individuals (including OHA, hospital leaders, Smart Systems for Health and the Ministry of Health and Long-Term Care, Community Care Access Centres, and physician leaders) for a broader vision and action plan for ehealth in Ontario and discovered that it did not yet exist. 1 The final report published in April 2001 is available for download at www.oha.com 2 Available for download at http://192.75.156.24/phase2/ohimaplan.doc Ontario Hospital ehealth Council Page 3
As a result, the Council recognized the need for an ehealth Blueprint to act as a strategic framework and help the Council, hospitals and others in the system create and build consensus around ehealth. The Blueprint would enable the system to begin dialogue towards a collective definition and vision for ehealth, to define what role ehealth plays in the transformation of health care, and to determine what has been done and needs to be done to move towards an ehealth system of health care. The OHA s ICT Advisory Committee advised in early 2001 that health care is well positioned for ehealth given: Numerous ICT and ehealth initiatives underway across Ontario and Canada at local, provincial and national levels A hospital system continuing to make individual investments in ICT but calling for leadership, vision, and a collaborative approach for coordinated health system change enabled by technology New technologies, provincial infrastructure and funding emerging to support systemic ehealth initiatives Recognition and support by the hospital, physician, and Smart Systems for Health stakeholders that a provincial unique patient identifier is needed and is a priority Emerging ehealth Councils within Physician, Community Care Access Centre, Hospital, Laboratory, and Pharmacy communities A need for transformation signalled by powerful drivers of change need for accountability, evolving consumer attitudes and behaviors, increasing demands for cost management and efficiencies, a shift towards consumer-focused health care, quality of care challenges, and the health care priority in Canada Ontario Hospital ehealth Council Page 4
Information and communications technologies (ICT), in particular the Internet, are understood to be a key element in this transformation process in health care. But determining what, how, when, and where ehealth solutions can add maximum value is not easy. This difficulty is evidenced by the time the health care community has spent discussing needs, the number of challenges we face, and the limited progress we have made in moving recommendations for ICT and ehealth into action. In addition to the need for funding and leadership, one of the most significant barriers to making progress is the lack of a strategic framework for action. Without this framework, system stakeholders are not able to move forward in a coordinated manner. This Blueprint is therefore meant to be a tool for: the Ontario Hospital ehealth Council to engage in a collaborative dialogue with hospitals and other health system stakeholders to develop and support a collective vision for ehealth and a 3-5 year action plan for implementation Ontario hospitals and other providers to utilize a strategic framework for applying ehealth concepts in their organizations, building collaborative relationships with other sectors, developing plans, and initiating change towards ehealth the health system to understand the direction of ehealth transformation in Ontario health care and ensure the strategic deployment of resources to enable that transformation What is ehealth? ehealth is much more than an overlay of technology on the current health care system. The Ontario Hospital ehealth Council defines ehealth more broadly to encompass significant change towards a new model of care: ehealth is a consumer-centred model of health care where stakeholders collaborate utilizing ICTs including Internet technologies to manage health, arrange, deliver, and account for care, and manage the health care system. Ontario Hospital ehealth Council Page 5
Although ehealth can be defined as a new model of care the five major functions that constitute the delivery of health care remain the same 3 : 1. Manage Health disease management, prevention, population health management 2. Arrange Care register, schedule, manage medical resources 3. Deliver Care clinical treatment, clinical research and development, monitoring, best practices, decision support, self-care 4. Account for Care decision support, patient satisfaction, financial transactions, expense and outcome reporting 5. Manage the Health Care System health system performance and accountability, strategy, cost management, provider satisfaction, utilization management, health services research and development, continuous quality improvement, human resource management, process management, training and development Supporting these five major functions of health care with ICT empowers providers and consumers to use new care and management processes to improve health delivery and ultimately health outcomes. The shift towards ehealth as a new model of care is therefore a shift in who does what, when, how, with what information, and enabled by what tools. What does an ehealth system look like? An ehealth system is enabled by ICT at 3 levels as illustrated in Figure 1. At the foundation of an ehealth system, the transactional level represents independent organizations that have invested in ICT to develop local networks sharing local data in order to deliver, arrange and account for care within their physical facility. At the collaborative level ICT begins to bring independent organizations that have a sufficient transactional base to work together across shared networks to share data and manage health care across providers. At the consumer level, organizations, providers, and consumers work together to consolidate, manage and share personalized information utilizing the Internet to empower consumers to take a significant role in the management and delivery of their health and health care. 3 Modified from Gartner Group, www.gartner.com Ontario Hospital ehealth Council Page 6
Figure 1 A framework for an ehealth system ICT alone will not succeed in moving health care to an ehealth system. It must be coupled with managed change to support new relationships, processes, behaviors, data, information and knowledge exchange to support all five major functions of health care delivery. Ontario Hospital ehealth Council Page 7
By leveraging the transactional systems in organizations such as hospitals, physicians offices, and community care access centres, providers and consumers can be connected through shared private networks and the Internet to enable better health information and integrated health management. Some examples of data sets, applications, and processes that may be enabled through an ehealth system are outlined in Figure 2. Figure 2 Examples of data sets, applications, and processes enabled by an ehealth system Ontario Hospital ehealth Council Page 8
Where can an ehealth system add value? Some important needs of key stakeholders in health care relate to access to care, information quality, communication, knowledge sharing, and accountability: Patients want timely, accurate health information to facilitate informed decision-making and extend their care into the community and the home Providers want enhanced quality of worklife through workflow optimization, access to information, and communications tools Government wants accountability and transparency in operations to set expectations around and measure effectiveness, efficiency, and responsiveness ehealth is the key enabler to meeting these needs. Within the context of a well-defined systemic ehealth strategy and action plan, ehealth has the potential to bring many benefits such as: EMPOWERING PATIENTS through a consumer-centred model of health care ENABLING BETTER CARE through clinical decision support tools REDUCING DUPLICATION and IMPROVING EFFICIENCY through secure patient records IMPROVING HUMAN RESOURCE PLANNING through enhanced analytical capabilities PROVIDING ON-LINE LEARNING and MENTORSHIP for training and workplace satisfaction of providers IMPROVING ACCESS and CONVENIENCE through technologies like telehealth, wireless monitors, robotic surgery CREATING BETTER DATA for health and health system research INCREASING SYSTEM ACCOUNTABILTY for consumers, providers, and government Ontario Hospital ehealth Council Page 9
The technology exists today to support these possibilities. The necessary structures, processes, funds, standards, and collective strategy to achieve them do not. Where do we go from here? This ehealth Blueprint was developed with a health system focus, from an Ontario hospital perspective. Our next step is to take this Blueprint to the field and broaden its perspective to encompass the needs, interests, and ideas of the health system. For a successful evolution towards ehealth that leads to improved coordinated care and better outcomes for patients, it is essential for a common vision to emerge across the health system. This Blueprint can act as the starting point for that evolution towards a collective message and strategy. The Council and its work team will initiate a process of extensive dialogue and interaction with stakeholders in early 2002 to learn about each other s needs, accomplishments to date, and priorities for continued progress towards ehealth. Ideas for a common vision will be shared and developed. In addition to working collaboratively with system stakeholders around a common vision for ehealth, an important parallel activity of the Council is to work closely with Ontario hospitals to gain a clearer understanding of where hospitals stand, what they are doing, and what their plans for the future are. This information gathering and analysis activity will assist the Council in setting priorities, making effective decisions around projects and initiatives to pursue, and advising the hospitals on how they can best continue their progress towards ehealth. Good information will enable an evidence-based action plan. The Council will ensure its work over the next year is carried out reflecting the realities of the broader health system environment. It will do so by basing its activities on the following assumptions that will be continually revisited to determine how they will impact on the health system s ability to move the ehealth agenda forward. Ontario Hospital ehealth Council Page 10
The key assumptions are: 1. Smart Systems for Health/MOHLTC will deliver in a timely fashion on key ehealth infrastructure components including: A. A provincial network connecting hospitals as well as CCACs, physicians, pharmacies and labs B. Security infrastructure in the form of policies, interoperability tools, and processes C. Secure messaging to provide email, directories and gateways for the exchange of information between health system providers D. Appropriate data and technical standards 2. Specific incentives for collaboration and innovation will be available to support change and required investments 3. Ontario hospitals are prepared to participate, support and take action around ehealth to transform patient care 4. The hospital community recognizes the critical role of each of the players in the broader ehealth system and is prepared to work in a collaborative model with all key industry stakeholders including the consumer 5. Current investments in ICT within hospitals will be utilized as building blocks for regional and provincial initiatives 6. Stakeholders agree that managed change is required in order to improve the quality, optimize all resources (financial, human, and other), satisfy consumers, create new ehealth opportunities, and ensure the health system is accessible 7. Focus will be placed on understanding population health needs and consumer expectations 8. Primary care reform initiatives will facilitate the adoption of information technologies at the physician practice level, and the movement towards an electronic patient record 9. A system perspective is necessary but consumer, provider, community, and regional needs may differ 10. A multi-sectoral ehealth Council will emerge (including hospitals, CCACs, physicians, and others) to support a shared vision for ehealth Ontario Hospital ehealth Council Page 11
What can Ontario hospitals do to continue progress towards ehealth? Ontario hospitals have been making investments in ICT for many years. The foundations they are establishing within their institutions are necessary building blocks towards ehealth and should continue. The following call to action provides some ideas for how Ontario hospitals can support progress towards ehealth within their organizations and across the system. We look forward to hearing about your progress over the coming months 1. Actively support provincial initiatives that will bring benefits across the system 2. Continue building and investing in strong local networks 3. Prepare to connect to the Smart Systems for Health network when it reaches your door 4. Support the creation of a provincial unique patient identifier 5. Share and discuss your IT strategic plans with your local community care access centres, primary care physician groups, other hospitals and community agencies 6. Reach out to your community partners, fellow hospitals, and suppliers to champion ehealth initiatives in your community 7. Share your learning and best practices with your colleagues across the system and the ehealth Council 8. Use the ehealth Blueprint to understand and promote ehealth in your hospital, with your Board, and in your community 9. Identify champions of ehealth change and innovation in your organization and bring them on board 10. Participate in the ehealth Council s information gathering activities and join the ehealth Council s workgroups as they evolve Ontario Hospital ehealth Council Page 12
By taking local leadership and participating at a systemic level with the Ontario Hospital ehealth Council as it reaches out to the broader health industry each hospital can play a significant role in the progress towards ehealth. Building and supporting a collective vision for an improved health system for consumers and providers enabled by technology is an important first step. Where can the Ontario Hospital ehealth Council add value? This Blueprint was used the guide to build the Council s year one work plan 4. It demonstrates that the Ontario Hospital ehealth Council can play a leadership role in moving the ehealth agenda forward by focusing on: Strategy Advocacy Information Gathering, Research & Analysis Marketing & Communications Stakeholder Engagement Investment & Partnership ehealth Project Implementation 4 Find more information on the Council s work plan at www.oha.com/info/ehealth Ontario Hospital ehealth Council Page 13
The Council and its supporting work team will move its workplan forward by applying the following guiding principles. The Council s strategy and activities will: 1. Be inclusive of the needs and interests of key stakeholders 2. Engage stakeholders within hospitals, across other health sectors, in academia, government, and private sector to move an ehealth strategy and provincial agenda forward 3. Work collaboratively with the other ehealth Councils, Smart Systems for Health and MOHLTC to align strategy and coordinate action 4. Be based on evidence from stakeholders on progress, needs, interests, and plans and reflect knowledge from other successes and research to date 5. Through input from stakeholders, identify and develop a few critical short and long term initiatives where the Council can add particular value 6. Be supported by the principles of change management, stakeholder engagement, and effective marketing and communications 7. Ensure timely results and measured success based on a defined action plan and accountability framework 8. Work to enhance the scarce human capital in the system Ontario Hospital ehealth Council Page 14
Getting Involved The Ontario Hospital ehealth Council looks forward to working with you to further develop a collective Blueprint and vision for ehealth in Ontario. To engage in this process with the Council or support its streams of activity as it moves its workplan forward please contact Sam Marafioti at smarafioti@oha.com or 416-480-4127. We welcome your participation. The Ontario Hospital ehealth Council s web site can be found at www.oha.com/info/ehealth Ontario Hospital ehealth Council Page 15
Membership of the Ontario Hospital ehealth Council Chair of the Ontario Hospital ehealth Council Closson, Tom Chief Executive Officer, University Health Network Vice Chair Marafioti, Sam Vice President, ehealth and Chief Technology Officer, Sunnybrook & Women s College Health Sciences Centre Beattie, Diane Vice President & CIO, LHSC & St. Joseph s H, London Brunskill, Ian Senior Vice President Planning and Administration, Cancer Care Ontario Connolly, Mike Chief Executive Lead, Smart Systems for Health Georgiou, Vas St. Joseph s Health Centre, Toronto Humphries, Peter MacDonald, Bill MacLean, Dr. Jim Chief Information Officer, Royal Ottawa Health Care Group Vice President of Finance and Information Systems, Hotel Dieu Grace President & CEO, Markham Stouffville Hospital Murray, Gale President & CEO, The Change Foundation Murray, Scott Director of Information Systems, Canadian Institute for Health Information Napier, Burt President, Napier & Associates Consulting Inc. Penny, Randy Schwartz, Dr. Brian Taylor, Lorelle Ure, Gail CEO, Renfrew Victoria Hospital and St. Francis Memorial Director, Division of Prehospital Care (Air Ambulance), Sunnybrook & Women s College Health Sciences Centre Chief Information Officer, Human Services I & IT Cluster, Ministry of Health and Long-Term Care Executive Director, Health Care Programs, Ministry of Health and Long-Term Care ONTARIO HOSPITAL EHEALTH COUNCIL AUGUST 27, 2001
ehealth Team Lesley Beneteau ehealth Consultant, Edge Resources D. Scott Campbell Council Advisor, D. Scott Campbell & Associates Inc. Eva Lannon Communications Advisor, OHA Steve Orsini Director Policy and Research, OHA Kurt Rose Director ehealth Strategies, OHA Fausto Saponara Vice President Corporate Management & Business Development, OHA ONTARIO HOSPITAL EHEALTH COUNCIL AUGUST 27, 2001