Towards Patient-Centered Integration:
Hôpital Montfort’s Clinical Informatics Plan
An Overview of
Clinical Informatics
at Hôpital Montfort
Carl Balcom RN BScN MBA CHE
Clinical Director
Emergency, Critical Care, and Clinical Informatics
Agenda
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Introduction
Background
Current State
Future state
Strategic Plan
Conclusion
Questions
Introduction
• Hôpital Montfort
– Francophone hospital that provides bilingual care
– Only health institution that offers clinical training
in a Francophone environment in Ontario
– Full spectrum general hospital
• 300+ inpatient beds (medicine, surgery, ICU, OB/GYN,
mental health, rehabilitation, geriatrics)
• 12 operating rooms, 20 recovery room bays
• High volume emergency room (60,000 visits/year)
Introduction
Mission
“Hôpital Montfort is a Francophone
institution that delivers quality care in both
official languages, within an academic
setting and works with its partners to
improve communities’ health”
Introduction
Vision
The excellence of the institution’s
personalized patient care and the quality of
its workplace, teaching and research make
Montfort the hospital of choice.
Introduction
• Strategic Directions
– Exemplary Care and Clinical Services
– Organizational Performance
– Workplace of Choice
– Academic Identity
– Relationships with Communities and Partners
Background
• History of Hôpital Montfort:
– 1940’s: need for a francophone hospital identified
• Resistance from local government (anglophone)
• Local support raised majority of capital in fundraising
• Daughters of Wisdom mortaged all Canadian properties
– 1953: Hôpital Montfort opened its doors
– 1956: Nursing School opened beside the hospital
Background
• History of Hôpital Montfort
– 1961: First affiliation agreement with University
– 1964: Governance transferred to lay committee
– 1969: Hospital becomes public corporation
– 1970’s : Expansion of clinical services
• Intensive care unit, Psychiatry
– 1980’s : Expansion of Clinical Services
• Ambulatory Care and Day Surgery
Background
• 1990’s: Physical Expansion
– New South Wing, CT scan, Birthing Unit
• 1997: Montfort slated for closure
– Health Services Restructuring Commission
– Large campaign with major community support
• “Montfort fermé: jamais!”
• 2002 : Court of Appeal – Victory for Montfort
– Provincial government chose not to appeal
Background
• History of Hôpital Montfort
– 2005: Major Funding Announcement ($175M)
• Physical expansion coupled with rebranding
• More than double square footage and capacity
– 2010: Construction and Moves Complete
• “Le Nouveau Montfort”
– 2013: Designation as “Class A” University Hospital
Background
• Regional Context
– Local Health Integration Networks (LHIN)
• Decentralized decision-making
• Emphasis on inter-agency collaboration and
streamlined services; avoid duplication
– Champlain Association of Meditech Partners
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Partnership of 6 hospitals within the LHIN
Common EMR using the Meditech 6.0 platform
Seamless transitions and standardization of practices
Montfort looked to as a leader
Background
• Clinical Informatics at Hôpital Montfort
– Traditionally managed primarily by IT
– Clinical oversight by professional practice
• Reorganization
– Transversal approach to portfolio distribution
– Clinical Informatics became a separate portfolio
• Changing philosophy and organizational approach to
advancing the EPR
Current State
• Historical Context
– Have a problem or a need? Buy a solution.
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Nursing = Meditech Magic NUR
Laboratory = TD Synergy
Diagnostic Imaging = Meditech Client Server
Material Management = Smart Stream
– Result? Silo approach and Inefficiency
• Systems don’t communicate well
• Wasted money and talent
Pharmacy
Medical Imaging
Laboratory
Nursing & Allied
Current State
Current State
• Challenges
– Availability of information heavily reliant on
people and internal processes
• Delay in accessing information
• Data quality issues
• Inefficiencies resulting in delay to end-user
– Departmental vs. Corporate Ownership
• “This is the lab’s system in place for the lab” vs. “This is
the Hospital’s system in place to better patient care”
Future State
• The Perfect Storm for Change
– Visionary Chief Nursing Executive
• Advocate of clinical informatics and its direct link to
evidence-based practice and high-quality care
– New IT director
• Focus shift to meeting the needs of the clinicians
– Reorganization – Clinical Informatics Department
• Separate department within clinical programs division
– Joining the CHAMP partnership for Meditech 6.0
Future State
• Strategic deliverable:
– To have an integrated
Electronic Medical
Record that links the
patient, the provider,
and the system in a
single area.
– Transition from “Silos” to
a “System”
Patient
EMR
System
Provider
Pharmacy
Medical Imaging
Laboratory
Nursing & Allied
Future State
A recap of our current state…
Future State
Enterprise EMR
Integration Software Engine
Point of
Care Testing
Nurse Call
System
Monitors
Direct
Link
End-User
Device
Future State
Enterprise EMR
Non-Clinical
Services
MM
FIN
CSR
Clinical End-Users
MD
RN
PT
OT
PHA
Future State
System-Level EPR
Data Repository with Integrated
Software Engine
Facility
EMR
Outcome
Reporting
Process
Reporting
Partner
Reporting
Strategic Plan
“To support high-quality patient care
by providing clinicians with the
informatics tools that they need to
deliver evidence-based care following
best practices”
Strategic Plan
Clinical
Care
Clinical
Informatics
Information
Technology
Strategic Plan
Clinical Informatics
Professional Practice
(Director)
(Director)
Clinical Informatics
Steering Committee
Information Systems & Technology
Medical Informatics
(Director)
(Director + MD)
Strategic Plan
• Strategic goals
– Meet and exceed clinician requirements
– Support evidence-based care and clinical best
practices
– Enable seamless transitions through the
continuum of care
– System integration to provide a single point of
access for end-users and patients
Strategic Plan
MT6
upgrage
• HIMSS-3
Winter
2014
Advanced
Clinical
• HIMSS-4
Fall 2014
Advanced
Clinical
• HIMSS-5
Winter
2015
CPOE and
P-Doc
• HIMSS-6
Fall 2015
Paperless
Hospital
• HIMSS-7
2016
Strategic Plan
STRENGTHS
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Organizational Culture and Design
Cohesive matrix structure for CI
Existing Connexall customer
Strong senior leader support
Visionary VP/CNE
OPPORTUNITIES
• Recent upgrade to Meditech 6.0
• Member of the CHAMP
• Innovations and advances in
clinical informatics occurring daily
• “Middleware” technology
WEAKNESSES
• Multiple existing legacy systems
• Finite resources internally
• Multiple competing priorities
(internally and externally)
THREATS
• Major health funding reform
underway
• Recent leadership shift in
provincial government
• Lack of regional standardization
Conclusion
• Hôpital Montfort is well on its way to reaching
the goal of becoming a paperless hospital
• Strong collaboration between IT and Clinical
programs is a key success factor
• “Middleware” solutions such as Connexall
support system integration and patient-centric
solutions
• With a strong and engaged team, anything is
possible.
Questions
Mr. Carl Balcom, RN BScN MBA CHE
Clinical Director
Emergency, Critical Care, and Clinical Informatics
Hôpital Montfort
713 ch. Montréal Road
Ottawa, Ontario (Canada), K1K 0T2
Email: carlbalcom@montfort.on.ca
Thank you