Health System Transformation
through
Information Management
March 2015
2
Session Agenda
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Background: Please see HIMSS-COACH eHealth Update 2014 AOHC presentation!
CHC Information Management Strategy (IMS)
Current State
IMS Benefit Evaluation
IMS v2.0
Next Steps
Q&A
Association of Ontario Health Centres
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A Unified Network Working Together
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AOHC membership is unified and organized to
serve as transformation enablers.
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75 or 100% of Community Health Centres (CHCs)
10 or 100% of Aboriginal Health Access Centres (AHACs)
15 Community Family Health Teams (CFHTs)
8 Nurse Practitioner-Led Clinics (NPLCs)
• We work together for better outcomes
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AOHC Mission (under revision)
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Transformative change;
Improve health and wellbeing;
With People/Community-centred;
For those facing barriers to health.
Strategic Directions 2020 (under revision):
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Champion Health Equity and Population Needs-Based Planning;
Advance Primary Health Care as the health system foundation;
Increase access to Appropriate services for people facing barriers;
Demonstrate value, effectiveness and improved health outcomes through
the experience of people and communities
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Model of
Health &
Wellbeing
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Information Management Strategy
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Overarching Principles:
“Information Management Owners
acting as a unified sector”
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Information Management Strategy
The Information Management Strategy is designed to support optimal client service
and care provided by AOHC member organizations through the strategic management
of information and information systems.
Work Streams
Strategic Objectives
Improving client health
through high-quality care
Improving the health of
communities
Alignment to the broader
provincial healthcare sector
Accountability and
sustainability
Association of Ontario Health Centres
eHealth Alignment
(Electronic Medical Record
System, Drug Profile Viewer,
HRM, cGTA, IDS, etc)
Effective and
efficient
information
management
tools and
processes
1. “Get Electronic”
2. “Share your Data”
3. “Promote Collaboration”
4. “Improve Health”
Non-Operational
Reporting and Analytics
Community Initiatives
Online Resource
Ontario Healthcare
Reporting
Standards/Management
Information System
Legacy Systems
Management
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IM Strategy Portfolio: Mar/15
Electronic Medical Record Project
(84/90 complete)
eHealth
Alignment
Drug Profile Viewer Project
(completed May 2012)
Non-Operational Reporting & Analytics:
Business Intelligence & Reporting Tool
Community Initiatives On-Line Resource v.2
(completed July 2014)
MIS & OHRS Project- Project
(completed Mar/13)
Legacy Systems Management
(on-going)
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EMR Project Scope
Current release ‘Nightingale on Demand’ 9.2.4:
– Hospital Report Manager/SPIRE/POI/TDIS integration;
– OLIS (Lab) integration;
– Personal Development Groups;
– ENCODE-FM classification system;
– OCAN/RAI-CHA & Integrated Assessment Record capabilities*
Next release: ‘Nightingale v.10’ due in Summer/15:
 Bilingual ASP EMR in Ontario;
 Complimentary Practices EMR
– Traditional Healing Working Group
* Awaiting ministry approval
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EMR Implementation Plan
As of March 1/15
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EMR Project: Apr/15
‘Nightingale on Demand’:
 84 Centres Implemented - Over 93% Completed
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62 CHCs, 10 AHACs, 10 NPLCs, 2 FHTs
4,100 NOD users
1,271,042 Clients have been migrated
61,823,212 Client Records have been migrated
Hospital Report Manager/SPIRE/POI/TDIS integration (~37 centres)
OLIS (Laboratory) integration – Provider Query
Personal Development Groups custom coding
ENCODE-FM classification system embedded in NOD
Appointment Reminder system integration
‘Nightingale v10’ - Summer/15:
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Only OntarioMD bilingual ASP EMR in Ontario
OCAN/RAI-CHA capabilities*
Traditional Healing Working Group incorporate Traditional Healing minimum dataset
* Seeking approval & funding
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Information
Holdings
Analytics
Information
Consumers
NORA Strategy & BIRT Project
Operational
Systems
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Who
MOHLTC
Why
LHINs
Consumers
CHCs / AOHC
Partners
Performance
Management
Knowledge
Transfer
Planning
Funding &
Accountability
• Standards
• Security &
Privacy
Analyzing
Score carding
Data Mining
Sector Specific Holdings
CHC Provincial
data store
Current
CMS
Other
ASP
Association of Ontario Health Centres
• Business
Processes
Health System Holdings
Health Data
Branch
Data Mart
Local data
store
• Data
Sharing
Agreements
Forecasting
Local
Accounting
TBD
CIHI
HR
Local
TBD
LHINs
CI
Current
Web
Inventory
Other
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Evidence-Based Data Quality
Pre/Post Data Quality Improvement
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Data Remediation - Client Service Event and Average MSAA Variance to LMIS
and NOD to BIRT Load Errors
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NOD
3%
ECR Service Events
Number of CHCs
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ECR MSAA
NOD Service Events
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30
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Industry DQ Norm: ± 5%
BIRT DQ Standard: ± 3%
10
0
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Percent of Errors vs total records submitted
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BIRT: From Vision to Reality
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BIRT: From Vision to Reality
(cont’d.)
LHIN OHRS Dashboard Mock-up
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Community Initiatives On-Line Resource
• A web-based system documents the effectiveness of
CIs in improving health within communities that are
engaged in community development work
– Inventory: shares knowledge of community initiatives by
capturing CI objectives, planned activities and health conditions
addressed
– Evaluation: Assess community initiatives in terms of community
response, enablers/barriers to success, lessons learned
– Alignment: Incorporating Canadian Index of Wellbeing indicators
for external benchmarking and Quality Improvement
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Governance Structure
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IMS Mid-Point Benefit Assessment
• Funded by AOHC members
• Sponsored by the Information Management Committee
• The IMS Benefit Assessment will align with Canada Health Infoway’s Benefits
Evaluation Framework
• A Project Advisory Group will include representation from CHC IMS
Committee, LHINs, eHealth Ontario, Canada Health Infoway and AOHC
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Glenn Alexander, Champlain LHIN CIO, N&EO LHINs Cluster CIO
Tamara Shewciw, NE LHIN CIO, IMC Liaison Member
Brian Ktytor, NW LHIN Sr. Dir/eHealth Lead
Mel Casalino, Sr. Director, Physician eHealth Program, eHealth Ontario
Dr. Wei Qiu, Chief Medical Informatics Officer, eHealth Ontario
Simon Hagens, Director, Benefits Realization
• The evaluation was undertaken by Deloitte, an independent firm
• Completion: February/15
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Infoway’s Benefit Evaluation Framework
Infoway's Benefits Evaluation Framework focuses on the causal relationship between the
implementation of an effective solution, the adoption of that solution and the resulting
impacts: an effective, manageable approach for understanding progress towards objectives,
identifying barriers, and communicating successes.
https://www.infoway-inforoute.ca/index.php/programs-services/benefits-evaluation
The framework will be adapted, with indicators defined that are most relevant to the sector.
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Major Activities from IM Strategy v1.0 as of March 2015
eHealth Alignment
Activities
Planned
Unplanned
Update
Status
Nightingale NOD deployment
84 sites live
Hospital Report Manager
equivalents with EMR
Over 9 sites implemented
Hospital Report Manager within
Nightingale
13 sites live, 12 in-progress
Drug Profile Viewer
20 sites implemented
Completed
NightingaleRemind
5 sites implemented
Completed
OLIS Patient Query
Standard NOD implementation
Completed
Nightingale on Demand Product
Improvement
Resolved client safety, privacy
issues, and functional issues
In Progress
Read Only Environment
For sector-wide outages
Completed
Governance Structures
New: Operations Committee,
RUGs and Privacy Working Group
In Progress
Traditional Healing
New fields for NOD/N10 and
ENCODE-FM
In Progress
Connecting GTA
cGTA to integrate with NOD
In Progress
Nightingale v10
Development of Nightingale v10
Association of Ontario Health Centres
93%
In Progress
In Progress
36%
70%
In Progress
In Progress
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Major Activities from IM Strategy v1.0 as of March 2015
Non-Operational Reporting and Analytics
Activities
Planned
Unplanned
Update
Status
BIRT 1.0
Developed the platform
Completed
BIRT 2.0
Initial reporting capabilities
Completed
BIRT 3.0
Advanced reporting capabilities
95%
In Progress
BIRT 4.0
OHRS statistical data in BIRT
25%
In Progress
Enterprise licensing
June 2014
AHAC and NPLCs
Awaiting MOHLTC approval
In Progress
Enterprise Cognos Training
March / April 2013 & January 2015
Completed
Association of Ontario Health Centres
Completed
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Major Activities from IM Strategy v1.0 as of March 2015
Community Initiatives Online Resource
Activities
Planned
Update
Status
CI Tool 1.0
Initial platform
Completed
CI On Line Resource 2.0
Second generation application and
new platform
Completed
Alignment with Canadian Index of
Wellbeing domains and indicators
Sense of Community Belonging,
Physical Activity and Poverty Index
Unplanned
Association of Ontario Health Centres
66%
In Progress
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Major Activities from IM Strategy v1.0 as of March 2015
Ontario Healthcare Reporting Standards (OHRS) /
Management Information System (MIS)
Activities
Planned
Unplanned
49 Centres using MS Dynamics GP
Advocating for remaining Centres
and for HRIS
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Update
n/a
Meeting with ADM in Jan/15
Status
Completed
In Progress
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Major Activities from IM Strategy v1.0 as of March 2015
Legacy Systems Management / Contract Management
Activities
Planned
Not part of original IMS plan
Unplanned
Update
Status
n/a
Enterprise read-only licences
Managing five legacy systems
contracts
Completed
Enterprise Up-To-Date licences
Contract completed with premium
service at25% cost reduction and
enterprise licensing
Completed
Development of applicationindependent solution
Proof of Concept completed for
3/5 legacy EMRs
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55%
In progress
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Summary
• CHC sector’s IM Strategy is directly aligned with Ministry and
LHIN priorities
• CHC IM Strategy is a cost-effective approach to eHealth
• Largest and most complex EMR deployment in Canada
• CHCs are the only sector able to report MSAA’s through a
single Business Intelligence Solution
• Frozen budgets, and downloading of IT/IM costs put
significant financial burden on member organizations.
• Aligning to the Canadian Index of Wellbeing
• The IM Strategy enables a person/community-centric
approach that will empower and help improve health
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IM Strategy v2.0
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Influencers
• CHC, NPLC, AHAC & CFHT Sectors
– SWOT/SOAR analysis
– Sector meetings
– IMS Benefits Evaluation
• Health Quality Ontario
– HQO will develop a publicly available catalogue of health system indicators used for their
performance monitoring and reporting.
• Ministry Priorities
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A focus on upstream interventions
Emphasis on community wellness
Enhanced services for mental health and addictions issues
A system that really is a system
Guaranteed access to primary care
Focus on measurement and evaluation to drive quality improvement
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Influencers
• Local Health Integration Networks
– New MSAAs
• Ministry of Health and Long Term Care
– Minister’s Action Plan 2.0
– Health Links - coordination of care for high needs clients
• eHealth Initiatives
– eHealth Ontario provincial solutions (e.g. HRM/cGTA)
– Canada Health Infoway (e.g. ebooking)
• Aboriginal Communities
– Traditional Healing programs
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Please refer to Appendix 1 (attached)
Next Steps
• Confirm Priorities
– Work through the committee structure
– Prioritize/approve list of projects
• Develop Budgets & Business Cases
– Determine project timelines
– Validate staffing model
– Create and approve budgets
• Document and Share IMS v2.0
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Next Steps
• Finalize IMS v2.0
• Complete EMR implementation
• Funding: 1-time and Operating
• Governance
• Performance Management & Quality Improvement focus
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IM Strategy Lessons Learned
• Voluntary collaboration…
• Underestimate complexity…
• Privacy…
• Power of leadership & vision…
• Communicate, communicate, communicate…
• Stakeholders expect more than they pay for…
• Keep your eye on the goal…
• Time is your arch-nemesis…
• Communicate - some more…
• This has been continues to be a blast!
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The journey continues…
Thank you / Merci / Miigwetch!
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Appendix
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Information Management Strategy v2.0 Concepts
EMR:
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NOD: Nightingale on Demand is an ASP-based electronic health record solution for
healthcare professionals.
N10: Nightingale version 10 (aka Nightingale v10) is the new platform of
Nightingale Informatix Corporation’s (NIC) electronic health record solution.
Enabling Systems:
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OHRS/MIS: Ontario Health Reporting Standards/Management Information System
involves the development of reporting standards by Community Health Centres
(CHCs) throughout Ontario to ensure consistent and accurate financial and
statistical reporting to the province. The first phase of the project revolved around
the development of standards.
HRIS: Healthcare Incident Reporting Services offers institutions in the healthcare
industry with an accurate and efficient incident reporting and tracking system.
Risk Management (Comply Track): Risk Management software available through
the AOHC.
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Information Management Strategy v2.0 Concepts
Decision Support:
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BIRT Development: Business Intelligence Reporting Tool is an open source
technology platform used to create data visualizations and reports that can be
embedded into rich client and web applications.
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AHAC (BIRT Phase I): Aboriginal Health Access Centre are Aboriginal community-led,
primary health care organizations. They provide a combination of traditional
healing, primary care, cultural programs, health promotion programs, community
development initiatives, and social support services to First Nations, Métis and Inuit
communities. There are currently ten AHACs in Ontario, providing services both on
and off-reserve, in urban, rural and northern locations.
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NPLC (BIRT Phase I): Nurse Practitioner-led Clinic are primary health care models in
which Nurse Practitioners work collaboratively with an inter-professional team,
including a consulting physician, to provide comprehensive, accessible, and
coordinated family health care services to people who formerly did not have access
to a primary care provider (i.e. unattached patients). Patients register with the clinic
to receive primary care on a long term basis, as in other primary care models. All of
Ontario’s 25 NPLCs are not-for-profit organizations. Some are led by a community
board of directors and, of those community-governed NPLCs, 13 are members of
AOHC.
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Information Management Strategy v2.0 Concepts
Community Development:
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CIOR: Community Initiatives On-Line Resource – the replacement for the former CI
Tool. Capturing evidence of impact on health status of communities.
CIW: Canadian Index of Wellbeing is a composite index, composed of eight
interconnected domains that measures stability and change in the wellbeing of
Canadians over time. These domains include community vitality, democratic
engagement, education, environment, healthy populations, leisure and culture,
living standards, and time use. The CIW acts as a companion measure of societal
progress to the Gross Domestic Product (GDP), which is based solely upon
economic productivity.
Consumer ‘Health-e’ Strategy:
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Personal Health Record: a person can add their own health information and
results and share their PHR with other providers as required. A PHR includes a
subset of EMR data as well as data fro mother providers such as hospitals, longterm care homes, mental health and addictions, etc.
Care Coordination: facilitating a person’s journey through the health system.
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Information Management Strategy v2.0 Concepts
Integration:
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OCAN: The Ontario Common Assessment of Need - is a standardized, consumerled, decision-making tool that assists with mental health recovery.
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InterRAI-CHA: InterRAI Community Health Assessment System is an international
collaborative to improve the quality of life of vulnerable persons through a
seamless comprehensive assessment system. This is the standardized assessment
tool used for Community Support Service programs.
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OLIS: Ontario Laboratories Information System. eHealth Ontario is leading the
implementation of OLIS across the province as part of its provincial eHealth
strategy.
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HRM: Hospital Report Manager is one of the value-added services for clinicians
who have adopted an OntarioMD-certified EMR. HRM provides the functionality to
receive hospital reports electronically from hospitals or Independent Health
Facilities (IHFs) directly into the EMR. This will eventually replace regional
solutions such as POI, TDIS and SPIRE.
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Information Management Strategy v2.0 Concepts
Integration (con’t):
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IDS: Integrated Decision Support System
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Clinical Connect: A portal for providers that consolidates client health information
across all providers including hospitals, CHCs, CCAC, Long-Term Care and other
providers.
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Care Coordination Tool: Health Links enabling clinical data sharing solution from
the Ministry
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cGTA: Connecting Greater Toronto Area, is a regional eHealth solution that will
evolve to become the provincial EHR infrastructure.
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cSWO: Connecting South West Ontario, is a regional eHealth solution that will
evolve to become the provincial EHR infrastructure.
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cNEO: Connecting Northern and Eastern Ontario, is a regional eHealth solution
that will evolve to become the provincial EHR infrastructure.
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THANK YOU / MERCI / MIIGWETCH
RODNEY BURNS, BSc (Hons Phys), MHA, CHE, CPHIMS-CA
CHIEF INFORMATION OFFICER
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