LABORATORY INFORMATION SYSTEM
INTEGRATION:
A SURVEY OF CURRENT AND PROPOSED LOCAL OR
REGION MODELS OF CONNECTIVITY
A Report Prepared By:
The Ontario Hospital e-Health Council
Hospital Laboratory Information Systems Advisory Group
November 2006
Table of Contents
1.
EXECUTIVE SUMMARY ......................................................................................... 1
2.
INTRODUCTION AND BACKGROUND.................................................................. 2
3.
RESTRUCTURING & HEALTH SYSTEM TRANSFORMATION INITIATIVES:
IMPACT ON LABORATORY INFORMATION SYSTEMS ..................................... 4
3.1. Laboratory Restructuring: Ontario Regional Laboratory Services Planning
(ORLSP) ........................................................................................................................4
3.2. Ontario Laboratory Information System (OLIS) .......................................................6
3.3. Local Health Integration Networks (LHINs) ..............................................................7
4.
SURVEY OF CURRENT & PROPOSED LIS INTEGRATION SOLUTIONS ........... 9
4.1. Environmental Scan Methodology ............................................................................9
4.1.1.
Inquiry Approach ...........................................................................................9
4.1.2.
Constructing the Interview Questionnaire......................................................9
4.2. The Selection Process ..............................................................................................10
4.3. Transforming the Results into Profiles ...................................................................10
4.4. Follow-Up ...................................................................................................................10
5.
MODELS OF INTEGRATION ................................................................................ 11
5.1. Summary of Models of Integration ..........................................................................11
5.1.1.
Strategic Decision-Making Considerations..................................................11
5.2. OLIS & LIS Integration .............................................................................................13
5.2.1.
Interfacing....................................................................................................13
5.2.2.
Nomenclature ..............................................................................................13
5.3. LHINs & LIS Integration ............................................................................................13
5.3.1.
Governance .................................................................................................14
5.3.2.
Finance........................................................................................................14
6.
CRITICAL SUCCESS FACTORS.......................................................................... 15
7.
BENEFITS ............................................................................................................. 15
8.
ACKNOWLEDGEMENTS...................................................................................... 16
9.
APPENDIX A: ANALYTICAL SUMMARY OF ENVIRONMENTAL SCANS ......... 17
10. APPENDIX B: FINAL ENVIRONMENTAL SCAN QUESTIONNAIRE ................. 20
11. APPENDIX C: FINAL ENVIRONMENTAL SCAN PROFILES .............................. 24
11.1.Central East 1 ...........................................................................................................24
11.2.Central West .............................................................................................................28
11.3.East 2.........................................................................................................................30
11.4.Eastern Ontario Regional Laboratory Association ...............................................33
11.5.electronic Child Health Network .............................................................................36
11.6.Grey Bruce Health Services ....................................................................................40
11.7.Hamilton Regional Laboratory Medicine Program................................................43
11.8.InterHospital Laboratory Partnership ....................................................................46
11.9.London Laboratory Services Group.......................................................................49
11.10.Mount Sinai Hospital..............................................................................................52
11.11.North Eastern Ontario Network ............................................................................55
11.12.Northwest Health Network ....................................................................................58
11.13.Pathology Information Management System ......................................................61
11.14.Sunnybrook Health Sciences Centre ...................................................................65
11.15.Toronto Medical Laboratories...............................................................................68
11.16.Trillium Health Centre............................................................................................71
11.17.William Osler Health Centre ..................................................................................74
1. EXECUTIVE SUMMARY
Ontario’s health care environment is changing rapidly, not only with the implementation of the
Local Health Integration Networks (LHINs), but also with a push towards a comprehensive
electronic health record (EHR). These twin processes of regional and information technology
transformation are particularly important for laboratory medicine, where the ability to share
laboratory information and results across multiple care providers has long been deemed an
essential component for the delivery of quality patient care.
Laboratory medicine services are rapidly expanding and increasing in complexity as a result of
advances in technology and the increasing acuity and demands of an aging population. This
“growth” in laboratory medicine, along with the implementation of regional laboratory system
models developed through the Ontario Regional Laboratory Services Planning (ORLSP)
initiative, will increase the demand for integration of Laboratory Information Systems (LIS)
between hospital laboratories and their partners in the coming years.
Laboratory Information Systems (LISs) are the infrastructure backbone for clinical laboratory
operations. Their functionality extends beyond the simple transmission of orders and results.
LISs manage the processes of the laboratory including: communication of specimen collection,
storage and transportation requirements, specimen identification and tracking including directing
specimens to appropriate workstations within the laboratory and identifying those tests which
are referred out to reference laboratories. LIS functionality between participating laboratory
service providers (including hospital laboratories) in a regional laboratory system must be
seamlessly integrated to support key processes including: specimen management, identification
and immediate electronic transmission of orders and results between laboratories
The Ontario Hospital Association’s (OHA) Hospital e-Health Council tasked its Hospital
Laboratory Information Systems Advisory Group (HLISAG) to study regional laboratory service
models in the hospital sector beginning in the summer of 2005. The goal was to gather
information on existing and planned models of LIS connectivity and integration, including data
exchange processes, governance and finance. The resulting report is intended to provide
hospital and regional health care executives with an overview of models and options, identify
key benefits and critical success factors of existing projects, and leverage the wealth of
expertise that exists in Ontario to enhance future plans for LIS connectivity and integration.
This report identifies four main models of LIS integration that have been used by organizations,
each supporting their specific needs. Capital and operating cost considerations were recognized
as major drivers in model selection. Among the regional initiatives surveyed, the identified
benefits included: reduced turnaround time, reduced test duplication, decreased transcription
errors, improved access to patient information and a reduction in time-consuming manual
processes. Critical success factors identified included: laboratory medical, scientific and
technical staff participation, ensuring that benefits are shared with all partners and the ability to
maximize existing technical solutions. This report also notes that regional projects will need to
have an increasing awareness of the role of the Ontario Laboratories Information System (OLIS)
and LHINs, but that these initiatives are best viewed as enhancements to projects, and will not
replace the need for regional LIS integration and connectivity initiatives.
1
2. INTRODUCTION AND BACKGROUND
e-Health is a major component of health care innovation in Ontario and a key element of the
Ministry of Health and Long-Term Care’s (MOHLTC) health system transformation agenda. A
comprehensive electronic health record (EHR) is an essential enabler to the creation of a
patient-centered health care system. It is crucial to achieving seamless quality care from
outpatient primary care to inpatient tertiary and quaternary care in Academic Health Science
Centers.
According to Canada Health Infoway (CHI), laboratory information is a major component of the
EHR and accounts for a significant proportion of the over 2000 transactions that occur every
minute in health care in Canada 1 . In Ontario, laboratory services are delivered through four
distinct providers: a) hospital-based clinical laboratories, b) community-based (“private”)
laboratories, c) physician offices (restricted menu of tests provided only by a physician to their
own patients) and d) public health laboratories. Almost all hospital and private laboratories
utilize Laboratory Information Systems (LIS) not only to collect and store laboratory results but
also to manage and support the operations and business practices of the laboratories.
Laboratory services are tightly regulated in Ontario; individual laboratories and specimen
collection centers must be licensed by the MOHLTC-Laboratories Branch and meet the rigorous
standards of the Ontario Laboratory Accreditation (OLA) program. The importance of LISs in the
delivery of quality laboratory services is emphasized by the inclusion of 50 different LIS
standards and/or recommended guidelines in the OLA requirements.
Despite the critical role LISs play in the delivery of laboratory medicine services, to date there
has been little, if any, standardization of the structure and functionality of these systems. The
situation is further complicated by the required integration between LIS and other clinical,
financial and data systems in hospitals. Ontario hospitals have used varied strategic
approaches to internal information system integration. Many have opted to purchase single
vendor comprehensive “suite” systems while others have adopted “best of breed” strategies,
using foreign system interfaces to integrate multiple systems from different vendors (see Figs.
1a and 1b).
Single Vendor Health Information System Platform
Patient
Management
Laboratory
Radiology
Pharmacy
Integrated Modules
Fig. 1a: Generic Depiction of Single Vendor “Suite” of Systems
1
Canada Health Infoway. End User Acceptance Strategy: Current State Assessment. May 5, 2005.
2
Patient
Management
System
Interface Engine
Interface Engine
Interface Engine
Laboratory
Information
System
Radiology
Information
System
Pharmacy
Information
System
Fig. 1b: Generic Depiction of “Best of Breed” Systems
Until recently, the functionality, configuration and integration of hospital LISs with other clinical
and financial systems has largely been internally focussed within individual hospital
corporations. However, three major health transformation initiatives are shifting the focus to
regional and provincial connectivity and integration of LISs:
i)
Ontario Regional Laboratory Services (ORLSP) planning initiative
ii)
Local Health Integration Networks (LHINs)
iii)
Ontario Laboratory Information System (OLIS)
This report by the Ontario Hospital Association (OHA) Hospital Laboratory Information Systems
Advisory Group (HLIS AG) provides an overview of the impact and relationship of these major
restructuring initiatives on hospital LISs and a survey of current and planned solutions.
3
3. RESTRUCTURING & HEALTH SYSTEM TRANSFORMATION INITIATIVES:
IMPACT ON LABORATORY INFORMATION SYSTEMS
3.1.
Laboratory Restructuring: Ontario Regional Laboratory Services Planning
(ORLSP)
Since the Laboratory Services Restructuring initiative in the early 1990s to the more recent
ORLSP project, clinical laboratories in Ontario have been the subject of almost continuous study
and restructuring planning. Throughout the 1990s the principle driver behind laboratory
restructuring was the search for financial efficiencies. However, over the last few years,
strategic planning for laboratories has shifted to focus on three additional key issues:
i)
Shortages of laboratory staff, including technical, management and
medical/scientific personnel,
ii)
Increasing demands for new tests and technologies
iii)
Ensuring laboratory medicine services meet the quality standards of OLA
In response to these new challenges, representatives of hospital laboratories (OHA), physicians
(Ontario Medical Association, OMA), the community laboratories (the Ontario Association of
Medical Laboratories, OAML), and the MOHLTC developed an agreement in May 2000 for a
regional planning approach to laboratory services delivery. The ORLSP initiative was
established by the MOHLTC to bring together representatives of laboratory providers in each of
nine planning regions to develop a coordinated regional laboratory services system. A Steering
Committee for each region was established with members appointed by the OHA, OMA and
OAML. Each region was responsible for preparing a laboratory services plan, taking into
account all of the services required for the region, and ensuring all options for service delivery
were fully explored. Guiding principles for the planning initiative included:
I.
Each region would develop a laboratory services plan that:
•
Included hospital and community lab services
•
Ensured accessibility
•
Limited duplication of operations and services
•
Met quality standards
•
Ensured an appropriate critical mass where testing is performed.
II.
Funding systems would allow funding to follow service.
III.
Consistent structures would be established in each region to oversee access to
services and quality standards.
IV.
Where testing could be centralized, it would occur in an orderly manner.
V.
A laboratory physician and scientist human resources (HR) plan would be
established to ensure availability of expert consulting and services.
VI.
An accountability framework would be created for each region to ensure consistent
tracking and reporting of statistical and financial information.
VII. Contractual arrangements, with obligations for quality and service delivery, would be
implemented for each service provider.
4
The ORLSP reports identified many opportunities for the consolidation and sharing of laboratory
services between hospital laboratories. However, throughout the ORLSP discussions, in every
region, connectivity and integration of LISs was identified as one of the most important enablers
for the successful implementation of regional laboratory service delivery models. As previously
mentioned, LISs are the infrastructure backbone for clinical laboratory operations. Their
functionality extends beyond the simple transmission of orders and results.
LISs manage the processes of the laboratory including:
•
Communication of specimen collection
•
Storage and transportation requirements
•
Specimen identification to support automated instrumentation (e.g. bar coding,
container identification and differentiation, aliquoting)
•
Specimen tracking, including directing specimens to appropriate workstations within
the laboratory and identifying those tests which are referred out to reference
laboratories
•
Collecting workload and volume data (by patient type and by clinical area or client)
•
Supporting reflex testing and test utilization management
•
Monitoring turnaround time
•
Documenting required action of laboratory staff (e.g. communication of critical
results)
•
Supporting workload management by tracking specimens awaiting
•
Facilitating the transfer of workload from one workstation to another, where
necessary
LIS functionality between participating laboratory service providers (including hospital
laboratories) in a regional laboratory system must be seamlessly integrated to support key
processes including: specimen management (standardization of collection, tracking during
storage and transportation between laboratories), identification (bar code commonality and
recognition) and immediate electronic transmission of orders and results between laboratories
(see Figure 2).
To date, some regions of the province have made limited progress towards connecting and
integrating hospital LISs to support the regional laboratory service delivery models (as evident in
the survey results illustrated in Section 4 of this report). More extensive integration has been
impeded by funding constraints, the technical challenges of integrating multiple legacy LISs and
limited availability of laboratory and Information System/Information Technology (IS/IT) staff
resources.
In addition, the Ontario Laboratory Information System (OLIS) initiative and the LHINs have
been established and both require significant consideration in the strategic planning around
regional integration of LIS.
5
Client Lab Hospital
Client Lab Hospital
Clinical Area
Clinical Area
results
orders
orders
rerouted orders
Client Lab
specimens
specimens
Reference Lab Hospital
results
rerouted orders
Reference Lab
Client Lab
results
results
specimens
specimens
Fig. 2: Generic depiction of exchange of orders and results and movement of specimens between
laboratories in a regional laboratory model.
3.2.
Ontario Laboratory Information System (OLIS)
The idea of a province-wide laboratory information system was originally envisaged in the early
1990s. Following more than 10 years of discussions and planning, implementation of OLIS
officially began in 2005 with the selection of the system vendor (Capgemini Canada Inc.) and an
invitation to hospital and community laboratories to apply to become “early adopters”.
OLIS aims to be an integrated, province-wide system for the electronic exchange of laboratory
information among authorized practitioners (physicians, nurse practitioners, midwives, dentists,
Public Health Units), laboratories (hospital, community and public health laboratories) and the
MOHLTC. It is important to note that OLIS is not a replacement for LIS, hospital information
system (HIS) or clinical management systems (CMS), and will not be a substitution for LIS
integration in regional laboratory service delivery models. Its primary role will be to serve as a
vehicle for the transfer of laboratory orders (e.g. from an ordering community based physician to
a provider laboratory) and a repository of laboratory results (from all laboratory providers in the
province) (See Figure 3).
6
Practitioners
Order
Result Submission
Query
Hospitals
Query
Order
Result Submission
Query
Query
Order
Response
Order Retrieval
Result Retrieval
Query Response
Result Submission
Query
Public Health
Labs
Query Response
Order Retrieval
Order Retrieval
Result Retrieval
Query Response
OLIS
Clinical
Repository
Order
Order Retrieval
Community
Labs
Order Retrieval
Specimen
Collection
Centres
Order
MOHLTC,
Planners,
Researchers
Report Request
Report
Response
Phase I
Pseudonymous
Repository
Phase II OLIS
Orders
Repository
Fig. 3: High-level depiction of OLIS functionality and relationships
As of February 2006, Smart Systems for Health Agency (SSHA) completed a major milestone in
connecting all public hospitals in Ontario to the managed private network (MPN), thereby
providing all hospitals with the ability to securely exchange and share electronic health
information related to e-Health initiatives, including SSHA-hosted solutions like OLIS.
On behalf of OLIS, SSHA is working with community laboratories and their main corporate sites
where the laboratory information systems reside, to connect community laboratories to the MPN
and enabling the secure sharing of laboratory information. The provincial e-Health strategy
includes establishing SSHA network connectivity to all hospital and community medical
laboratories.
3.3.
Local Health Integration Networks (LHINs)
In 2004, the MOHLTC announced that LHINs will be responsible for planning, integrating and
funding local health services. There are 14 LHINs with specific geographic boundaries. The
LHINs will be responsible for the following health care providers:
•
•
•
•
•
•
Hospitals
Divested psychiatric hospitals
Community Care Access Centres
Community Support Service
Organizations
Community Mental Health & Addictions
Agencies
Community Health Centres
•
•
•
•
•
•
7
Long-Term Care Homes
Public Health
Physicians
Ambulance Services (emergency
& non-emergency)
Laboratories
Provincial networks and programs
On March 1, 2006, the government of Ontario passed The Local Health System Integration Act,
2006. This legislation defines the roles, responsibilities, accountability and governance of the
LHINs.
As the LHINs move forward with the development of Integrated Health Service Plans (IHSPs)
there will be increasing pressure to integrate and connect health care information systems
across providers throughout each LIHN.
For hospital clinical laboratories, there will likely be significant differences between the nine
original regional laboratory plans developed under the ORLSP process and the model of
laboratory services which will evolve through the 14 LHIN IHSP processes. Regardless of the
final models for laboratory service delivery, it is clear that the integration of LISs will be an
essential enabler for health care transformation.
8
4. SURVEY OF CURRENT & PROPOSED LIS INTEGRATION SOLUTIONS
Laboratories and LIS are essential components of the health care system. As restructuring and
transformation of the health care system proceeds, it is clear that LIS integration must be
included in the strategic planning processes.
The Hospital Laboratory Information Systems Advisory Group (HLISAG) recognized that
information on current and planned regional laboratory data sharing and LIS integration
solutions would provide valuable information for strategic planning and decision-making for the
on-going implementation of regional laboratory systems and the LHINs. To this end, the
HLISAG initiated an Environmental Scan.
4.1.
Environmental Scan Methodology
The goal of the Environmental Scan was to create an inventory document that identified:
•
Current or planned lab data exchange initiatives/models
•
Details of models including: LIS vendors involved, governance models,
relationships to laboratory operational models, funding, key success factors,
approach to Quality Assurance (QA)
•
Planned approach to OLIS
•
Key contacts
4.1.1. Inquiry Approach
A standard list of specific questions was developed to capture the key elements of each
regional laboratory information integration model, such as:
•
Purpose
•
Transactional model details
•
Data shared
•
Stakeholder involvement
•
Administrative control model
•
Funding model
•
Standards
•
QA
•
Privacy and security
•
Critical success factors
•
Best practice outcomes
The intended outcome of the environmental scan was a compilation and comparison of
responses from each region to illustrate key areas of commonality and difference
between each regional LIS integration and connectivity initiative. The actual scan was
conducted in the form of a guided interview with the key contact for each
project/initiative.
4.1.2. Constructing the Interview Questionnaire
The HLISAG utilized the expertise within its membership (see Section 8 for membership
list) to conduct an iterative writing process. Once the target areas for further exploration
were identified, members worked collaboratively to develop specific questions. A series
of meetings were held to establish the initial set of questions.
9
The preliminary series of questions was tested in guided interviews at two pilot sites:
Central West - West Node Microbiology and the North Eastern Ontario Network (NEON).
Both pilot sites were initiatives represented by HLISAG members and fit the selection
criteria (outlined below). Pilot feedback was analyzed and the Environmental Scan
questionnaire revised (see Appendix B: Final Environmental Scan Questionnaire).
4.2.
The Selection Process
The group selected to complete the questionnaire was not tasked with providing a
comprehensive inventory of all LIS integration and connectivity projects in Ontario but was
designed to be representative of the different laboratory regions and diverse hospital sizes. The
impact of OLIS early adoption projects at hospital sites was also taken into account and
included in the selection.
The final selected group included representation from:
•
17 total initiatives
•
2 province-wide initiatives
•
All 5 OHA regions
•
All 9 ORLSP regions
•
Small, Community and Teaching Hospitals
•
All 4 OLIS early adopter hospitals
A complete summary of the selected group can be found in Appendix A: Analytical Summary of
Environmental Scan Profiles.
4.3.
Transforming the Results into Profiles
Once results from the Environmental Scan were collated and analyzed by HLISAG members,
answers from the guided interviews were transferred to a table for comparison. Four categories
were developed to describe the overall integration and connectivity models and to facilitate
evaluation:
•
Multi-Vendor, Multi-System (completely separate systems and LIS databases,
with distributed control, but interfaced to each other)
•
Single-Vendor, Multiple-System (multiple LIS instances of a single vendor
solution, connecting via interface engines)
•
Single-Vendor, Single-System (complete integration of lab systems)
•
Province-wide Data Repository (interfacing multiple LISs to a common
provincial database, providing access to that data via a portal)
4.4.
Follow-Up
To support the descriptions of the above integration and connectivity models and to identify key
strategic decision making rationale, two areas for follow-up work were identified:
•
Diagrams were created to complement each profile and, where necessary, show
the differences between variations within models
•
In-depth interviews were conducted at selected sites, focusing on the strategic
decisions made in establishing regional LIS connectivity and integration initiatives
Queries were made with representatives of each of the major categories.
10
5. MODELS OF INTEGRATION
Historically, the factors which drove the selection of one LIS integration model over another
were largely related to laboratory business operations. “Point to point” connectivity approaches
were common between laboratory providers, with the primary focus of transmitting orders and
results.
As health care transitions to EHR’s, strategic decision-making for LIS integration has increased
in complexity in terms of model options and factors for consideration.
5.1.
Summary of Models of Integration
Detailed Environmental Scan information for each initiative surveyed and profile created can be
found in Appendix C: Final Environmental Scan Profiles.
Analysis of the data revealed four distinct models of LIS integration:
A) Single vendor with a single LIS platform serving multiple sites
B) Single vendor with multiple LIS platforms integrated/connected through an interface
engine
C) Multiple vendors with multiple LIS platforms integrated/connected through one or
more interface engines
D) Interface to a province-wide data repository.
5.1.1. Strategic Decision-Making Considerations
In the course of research for this report, the decision-making processes involved in
selecting each model of integration were studied. Certain considerations tended to drive
the selection of one model over the others, and frequently depended on the
environmental situation existing prior to integration. This section is a compilation of the
key issues that were identified in the decision-making process.
Although province-wide interfacing projects such as electronic Child Health Network
(eCHN) and Pathology Information Management System (PIMS) were studied, strategic
decision-making processes for such integration models were considered separate from
regional lab services sharing, and thus are not studied in detail in this section.
5.2.1.1
Single Vendor-Single LIS Platforms
a) Operational and Implementation Considerations:
•
Facilitates and supports regional standardization of laboratory policies,
procedures and processes. Facilitates inter-site rotation of laboratory
staff.
•
Requires strong governance and regional decision-making for
implementation and operation. Individual sites must forfeit some or all of
their autonomy.
11
•
•
Single LIS places entire regional laboratory system at high risk for
unscheduled “downtime” or system failure.
Requires single nomenclature standard for region.
b) Financial Considerations:
•
Requires significant initial investment (e.g. $6-10 million).
•
Requires regional Enterprise Master Patient Index (EMPI).
•
Requires restructuring of existing LIS-HIS/ADT integration at each site
(unless single IS suite system is implemented throughout region).
•
Once implemented, on-going operating costs are less than multiple
vendor/system models.
•
Minimally leverages existing LIS investments. Highly advantageous for
regions with a large number of legacy systems, which require
replacement.
5.2.1.2
Single Vendor-Multiple LIS Platforms
a) Operational and Implementation Considerations:
•
Does not require costly re-engineering of LIS-HIS/ADT and other system
integration at each site.
•
Requires development of interface solution compatible with multiple
versions of the same software.
•
Allows for phased-in approach to further integration.
b) Financial Considerations:
•
Leverages existing LIS investments.
•
Controls cost of upgrading exiting LIS installations.
•
Operational resources focused on maintaining the interface engines.
5.2.1.3
Multiple Vendors-Multiple LIS Platforms
a) Operational and Implementation Considerations:
•
Requires minimal restructuring of current laboratory business practices.
Allows each laboratory site to maintain current structures, policies and
procedures.
•
Autonomy of individual sites and institutions maintained.
•
Easiest to implement in absence of regional governance or decision
making authority.
•
Individual site LISs function independently, failure of one LIS does not
affect core laboratory services at all sites.
•
Utilizes existing LIS implementations, existing interface solutions and
available technical expertise at hand.
b) Financial Considerations:
•
Does not require costly re-engineering of LIS-HIS/ADT and other system
integration at each site.
•
May be phased in throughout a region depending on each site’s
readiness and business case (e.g. implementation prioritized by order
and result transaction volumes).
•
Highly scaleable for future expansion.
•
Leverages existing LIS investments.
12
•
•
•
5.2.
Does not require regional EMPI for implementation.
Once implemented, requires significant resources and expertise to
maintain (i.e. dynamic nature of Laboratory Medicine requires constant
changes to test menus, instrumentation, reference intervals, reporting
limits etc.).
Both fee-for-service and shared services models of reimbursement may
be appropriate. Factors to consider include the level of variation among
system usage and whether the sharing of lab services is sufficient to
warrant financial integration.
OLIS & LIS Integration
The OLIS project is a province-wide repository of laboratory data. On its own, it is not a
replacement for regional LIS integration and connectivity. However, OLIS represents both a
requirement and an opportunity in laboratory services planning. LIS integration initiatives must
consider how their data will integrate with OLIS when it connects with the organizations
involved. At the same time, planners may consider how to leverage the connectivity that OLIS
provides. This study found one example of an initiative that proposed to use the connectivity of
OLIS to act as an interface gate between laboratory partners.
In all cases, there are two main issues which much be considered when determining how a
regional LIS network will fit with OLIS. These are interfacing and nomenclature.
5.2.1. Interfacing
OLIS has provided interface specifications developed based on the HL7 2.3.1 Standard,
which will form the basis for any data interactions between OLIS and laboratory service
providers. OLIS also plans to support a chosen version of HL7 (between 2.4 and
2.7). Version 3.0 will be supported when it is sufficiently defined and accepted in the
laboratory domain by the HL7 standards organization.
OLIS supports flexible deployment options. In an integrated regional LIS model, it can be
deployed through a single connection point shared by each stakeholder in the regional
environment, or may be deployed using separate connections at each location. Each
region may choose a deployment option that meets its needs.
5.2.2. Nomenclature
OLIS has defined standard nomenclature for orders and results. These standard
nomenclatures can be deployed for use within organizations or can be mapped to local
nomenclatures. To facilitate the introduction of standard nomenclatures, it is
recommended that stakeholders review and understand the OLIS nomenclatures. OLIS
provides a mapping tool to facilitate mapping, if this option is selected.
5.3.
LHINs & LIS Integration
As a system of governance that integrates multiple health care sectors in a region, there are
parallels between the LHIN IT strategy and regional laboratory data sharing strategies. Although
LHINs may not directly affect the strategic decisions of regional sharing initiatives, any planning
needs to consider how an initiative may affect LHIN IT planning and whether the involvement of
13
LHIN governance may be leveraged to benefit the formation and funding of a LIS integration
model.
5.3.1. Governance
To date, LIS integration initiatives have been governed and managed through existing
regional structures or specific inter-institutional agreements. However, as LHIN
implementation proceeds and LIS connectivity and integration expands, it is anticipated
that the governance and management of LIS integration networks will transition and
evolve into the LHIN governance structures.
There are three distinct scenarios of LIS connectivity which must be accommodated
within future LHIN governance structures:
i)
Intra-LHIN LIS connectivity involving the integration of two or more hospital
LISs within the same LHIN
ii)
Inter-LHIN LIS connectivity involving two or more hospital LISs across two
or more LHINs
iii) Connectivity of integrated LIS networks with provincial systems such as
OLIS, PIMS and eCHN
For each of these scenarios, a LIS integration management and governance structure
that supports and compliments the laboratory medicine and institutional structures, will
need to be developed. Governance may consist of simple service level agreements
(SLA) that spell out the required levels of performance and the consequences of failure
or a full memoranda of understanding (MoU) that provides a detailed understanding of
ownership, control, and protection for partners.
5.3.2. Finance
To date, most LIS integration initiatives have employed one of two financial models:
costs are either apportioned out by usage of the system or by the relative size of the
organizations involved (e.g. total budget or bed size). Regardless of the model, LHIN
boundaries should not affect the financial governance of these projects. The key
consideration is that existing partnerships not impede LHIN integration and planning and
vice versa.
14
6. CRITICAL SUCCESS FACTORS
Throughout course of this research, contacts for each initiative were asked to highlight the
issues encountered in the process of implementing regional LIS integration and connectivity
solutions that had the most impact on the success of the project. Although all of the initiatives
approached their solutions in different ways, many commonalities were observed in these
critical success factors. The most prominent included:
•
Strong leadership from top of corporate structure
•
Joint vision
•
Sufficient funding
•
Laboratory medical/scientific and technical staff support
•
Rigorous project management
•
Standardization
•
Vendor participation
•
Sufficient resources for ongoing operation and maintenance
7. BENEFITS
The importance of ensuring that the benefits of regional initiatives were seen by all partners and
communicated to organizations and their staff was emphasized by many. The benefits of
regional lab data sharing most commonly illustrated included:
•
Timely information to those that need it
•
Faster turnaround times
•
Reduction of transcription errors
•
Cost sharing to help smaller institutions take advantage of economies of scale
•
Improved data quality
•
Enhanced data mining possibilities
•
Future projects better able to build upon success (key enabler for future
consolidation)
15
8. ACKNOWLEDGEMENTS
The OHA and its Ontario Hospital e-Health Council would like to recognize the important
contribution of the HLISAG in the development of this report.
The OHA and Hospital e-Health Council would also like to thank those contributors who
generously volunteered their time and efforts by completing an Environmental Scan and
reviewing other materials, such as profiles and diagrams. A special thanks to Lewis Hooper,
CIO Central East LHIN, for sharing his insights on the LHINs in relation to lab data sharing. In
addition, many thanks to the OLIS project and staff, and SSHA for their support and assistance.
Hospital Laboratory Information Systems Advisory Group (HLISAG) Members:
Dr. Sherry Perkins (Chair)
The Ottawa Hospital
Lindsay Campbell
Ontario Laboratory Information System (OLIS) Project
Lan Djang
Ontario Hospital Association
Derek Graham
Temiskaming Hospital
Dr. Tadaaki Hiruk
Ontario Association of Pathologists
Bev Junnila
Thunder Bay Regional Health Sciences Centre
Murray Kaufman
Sunnybrook Health Sciences Centre
Susan Kewin
Smart Systems for Health Agency
Dr. Robert Lannigan
London Health Sciences Centre
Susan Leask
Lakeridge Health Corporation
Cheryl MacInnes
Cambridge Memorial Hospital
Martha Murray
Ontario Hospital Association
Christine Probst
Hamilton Regional Laboratory Medicine Program
Bonnie Reib
The Hospital for Sick Children
Melissa Tamblyn/Pat Mason
Cancer Care Ontario
Cathie Trayner
Kingston General Hospital
16
9. APPENDIX A: ANALYTICAL SUMMARY OF ENVIRONMENTAL SCANS
1. Sum Total of the Survey
•
17 total:
•
2 single organization profiles (William Osler Health Centre [WOHC], Trillium Health
Centre [Trillium])
•
2 single organization profiles that include regional sharing of lab services (Sunnybrook
Health Sciences Centre [SHSC], Mt. Sinai Hospital [MSH])
•
11 regional sharing initiatives
•
2 province-wide initiatives (Pathology Information Management System [PIMS],
electronic Child Health Network [eCHN])
2. Which ones had current interchange and which ones were future plans?
•
13 profiles were of current regional data sharing
•
4 profiles described planned future regional data sharing, with only limited data sharing
in current context
3. Types of solutions
•
Multi-LIS Vendor, Multi-System (completely separate systems and LIS databases,
with distributed control, but interfaced to each other)
•
9 total (most regional sharing initiatives fall under this category)
•
Single-LIS Vendor, Multi-System (Single vendor with multiple LIS platforms
integrated/connected through an interface engine)
•
2 profiles exclusively fell under this category, while the single vendor/multiple
system elements were found in one other profile that fell under the multivendor/multi-system category overall
•
Single-LIS, Single-System (complete integration of lab systems)
•
4 total (including 2 region-wide sharing initiatives)
•
Province-wide Data Repository (unidirectional data feed, with a bidirectional viewer
functionality)
•
2 total (PIMS, eCHN)
4. Governance
•
Cooperative governance was not applicable to single organization profiles or provincewide profiles (though some form of cooperative decision making does take place at
the operational level)
•
Most common strategic governance involved a cooperative structure, with a single
board or steering committee oversight (8 out of 10 regional sharing initiatives)
•
Exceptions were Toronto Medical Laboratories (TML), which, while a joint
partnership exists, is governed as a separate service provider with clients
purchasing services; and East 2 (E2), where each organization governs their
own lab services
17
5. Funding
•
Capital costs may be funded under different models from operational costs
•
Cost sharing plan under cooperative governance used in 3 models (Hamilton Regional
Laboratory Medicine Program [HRLMP], Northwest Health Network [NWHN], London
Laboratory Services Group [LLSG])
•
Fee for service used in 6 models (SHSC, MSH, TML, Central West Microbiology [CW
Micro], E2, Inter-Hospital Laboratory Partnership[IHLP])
•
2 examples of regional level governance with a single combined budget (North Eastern
Ontario Network [NEON] and Eastern Ontario Regional Laboratory
Association[EORLA])
6. Primary LIS Vendors
•
Listing of primary LIS vendors involved in each profile
Profile
Hamilton Regional Laboratory Medicine
Program (HRLMP)
Sunnybrook Health Sciences Centre (SHSC)
Mt. Sinai Hospital (MSH)
Toronto Medical Laboratories (TML)
Central West Microbiology (CW Micro)
East 2 (E2)
Central East 1 (CE1)
Eastern Ontario Regional Laboratory
Association (EORLA)
Pathology Information Management System
(PIMS)
electronic Child Health Network (eCHN)
Inter-Hospital Laboratory Partnership(IHLP)
Northwest Health Network(NWHN)
North Eastern Ontario Network (NEON)
London Laboratory Services Group (LLSG)
William Osler Health Centre (WOHC)
Grey Bruce Health Services (GBHS)
Trillium Health Centre (Trillium)
Primary Vendor(s)
Meditech, HBO McKesson
MISYS (General Lab & CoPath),
Mediware (Blood Bank)
SCC
GE Healthcare, Cerner (CoPath),
SCC, Mediware
Meditech, HBO, McKesson
Meditech, MISYS
Meditech, GE Healthcare (Triple G)
Cerner, Lab Vision
Proprietary
Proprietary
Meditech
Meditech
Meditech
Cerner
Meditech
Cerner
Meditech
Notable: 10 involved Meditech, 5 involved Cerner
7. HL7 version
•
Version 2.3 was most commonly used
•
Only NWHN (v.2.2) did not support v.2.3
•
Most common versions were 2.1, 2.2, and 2.3, largely dependent on the systems
involved in the integration projects
•
Only PIMS reported support for higher versions of HL7 (up to v.4.9)
8. Network Connectivity
•
SSHA was the primary network connectivity provider for 11 profiles, and was also used
for connectivity with certain TML clients
•
The other provider noted was Bell
18
9. Key Common Critical Success Factors
•
Strong leadership from top of corporate structure
•
Joint vision
•
Sufficient funding
•
Physician and staff support
•
Rigorous project management
•
Standardization
•
Vendor participation
•
Sufficient resources for ongoing operation and maintenance
10. Key common Benefits
•
Timely information to those that need it
•
Faster turnaround times
•
Reduced transcription errors
•
Cost sharing helps smaller institutions take advantage of economies of scale
•
Improved data quality
•
Enhances data mining possibilities
•
Future projects better able to build upon success (key enabler for future consolidation)
19
10. APPENDIX B: FINAL ENVIRONMENTAL SCAN QUESTIONNAIRE
Guidelines for Investigation
PURPOSE
•
•
To understand the different models currently employed, or to be implemented, in the field for
lab data exchange between hospitals and other external institutions and providers.
To understand the purpose, transaction model details, data shared, stakeholders involved,
and best practice outcomes from each existing model.
SCOPE
Transactions
To examine the full spectrum of business processes included in a lab information exchange
transaction. This includes:
•
Uni-directional exchange (e.g. Health care Provider/Lab / LIS data repository)
•
Bi-directional exchange (e.g. Health care Provider/Lab ' Lab/Health care Provider; Orders
and Results)
•
Requisite peripheral information and materials that must move with lab data (e.g.:
specimens/patients)
Participants
•
The focus of the scan was on acute care hospitals as stand-alone institutions or as members of
regional networks/partnerships.
•
Selection criteria for participation in the survey centered on hospitals/hospital groups who were
currently, or had plans to, electronically exchange laboratory data between laboratory providers
(e.g. other hospitals, private laboratories, public health laboratory).
•
Hospitals that only exchange laboratory data internally with clinical repositories or “niche” clinical
systems were not included.
METHODOLOGY
•
Identify target respondents based on existing lab information exchange projects and
network via HLISAG membership.
•
Informal one-on-one discussions with representatives from each lab info exchange
project to be carried out by identified HLISAG members.
•
Following semi-structured interview guide to obtain qualitative and quantitative
description of model to include process flows of both data and specimen/patient
exchanges.
DRAFT INTERVIEW GUIDE
1) “Screener Question”: Do you currently share laboratory data electronically (either
unidirectionally or bidirectionally) with other laboratory service providers and other health
care providers who exchange lab data on a regular basis (e.g. CCO, external QA/QC
monitoring, other institutions and individual providers)?
If not, proceed to Question 7 (which asks about future plans).
20
2) A) What type of regional information exchange are you participating in?
•
Repositories and clinical “niche” systems (unidirectional)
•
Orders & Results (bi-directional)
•
Laboratory to Administrative systems (e.g. Finance/General Ledger, ADT, HIS,
Pharmacy etc).
B) If “yes” to any part of A, does your information exchange model support movement of
specimens, patients or ancillary information beyond the message exchange (e.g.
Information beyond the order/results, like image data, Pedigree file extracts, etc.)?
3) Information Exchange Model:
Probes to include:
•
Who is involved? (names of institutions)
•
Governance model
•
Did you consider more than one model? If yes, why did you choose the one you
are currently using?
•
Do you use more than one model? If yes, why?
4) How is the system administratively controlled (i.e.: planning and governance)?
5) How is the system funded (one-time start up costs vs. ongoing operational costs)?
6) Describe the lab data exchange model.
(This section will provide the most detail for the environmental scan)
Please describe the following:
•
LIS (vendors, application software products and current versions, installation
configuration, interfaces to other systems)
•
Measures that have been taken to support accurate patient identification and matching
•
Process Model: Flow of orders, specimens, patient movement and results. (obtain flow
chart if possible; see attached diagram)
•
Relationship to all the systems involved (clinical, pharmaceutical, ADT, administrative)
(obtain diagram if possible)
•
How quality assurance is addressed:
•
Testing of data transmission prior to go live
¾ Is there a test plan to validate information sharing prior to implementation?
¾ Is there a procedure to document and approve the validations of
information sharing prior to implementation?
•
Integrity of data transmission (data integrity)
¾ Are the formats and methods for transmitting shared information
standardized?
¾ Are data connections periodically checked for functionality, and how?
•
Correctness of data transmitted (data validation)
¾ What mechanism is in place to verify that shared information is accurately
transmitted?
21
¾
•
•
Are mapping tables that are required for information sharing periodically
verified in all locations, and how?
•
Tools and processes necessary to ensure quality data
¾ What backup procedures are in place to ensure that loss of shared
information is prevented?
¾ What mechanism is in place to report malfunctions in information sharing?
¾ What mapping tools and processes are in place to enable automated (or
partially automated) table updates of items such as nomenclatures when a
new release becomes available?
¾ What processes are in place to add a new code or value required for
reporting against to a coding scheme on a temporary basis? (i.e. before a
scheduled release or update?)
•
Process for correcting data quality issues
¾ What support mechanism is in place to address malfunctions in information
sharing?
Standards employed to support the exchange, and future plans to implement standards:
•
Physical (connectivity, security, audit)
•
Data types (discrete data, report image, structured report)
•
Messaging (e.g. HL7 and what version, other)
•
Nomenclature/Coding (LOINC, ICD-10, SNOMED, other)
How is security/confidentiality of patient information and access to the LIS addressed?
•
Is the SSHA Pipeline used at your organization for data transfer of laboratory
results? Yes/No
•
Does your organization have a firewall? Yes/No
•
Do you have controlled access for internal staff to the LIS utilizing User ID and
Passwords? Yes/No
•
Do you have a system in place to control and monitor the external access of
laboratory data by health care professionals? Yes/No
•
Do you have a quality assurance program to monitor the access to laboratory
results for clinical use only? Yes/No
•
If yes, how often do you monitor this access?
Weekly/Monthly/Annually/Other please specify________________
•
Lab accreditation status (OLA, CAP, ISO, other)
•
Pre/Post operational & clinical benefits published?
7) If you have a plan for regional interaction between now and the next 24 months, please tell
us about it:
1. Describe the planned exchange model as per the questions above, in as much detail
as is currently available.
2. Indicate the planned timing of this project.
3. How will this integration be funded?
a) One-time costs for building integration
b) Ongoing operations and support
4. For existing interface engines, how will change be managed as associated systems
are upgraded?
22
8) Please describe how your lab data “information exchanges” have benefited your institution.
9) What have been some of the critical success factors/hurdles that were overcome for
successful implementation?
23
11. APPENDIX C: FINAL ENVIRONMENTAL SCAN PROFILES
11.1. Central East 1
Central East 1 (CE1) Laboratory Sharing Initiative
As of August 2006
Lab Reform Region
Central East
Description
Proposed interface of orders and results between CE1 hospital LISs and
main reference lab provider (MDS).
Category
Multiple LIS Vendor/Multiple System Integration
Extent of Sharing
Electronic sharing of orders and results between each CE1 hospital and
MDS.
Status/Timeframe
Proposed project.
Planned to take place over next 12 - 24 months.
Organizations Involved
7 CE1 hospital sites. See attached list below.
MDS
Governance Model
Initiative will be governed as part of Lab IS functions at each member
hospital.
Funding
TBD
Assume start-up costs and operating costs will be separately funded by
each hospital.
Data Sharing Model
Model 1: Individual hospital LISs will connect point-to-point with MDS.
Model 2: Individual hospital LISs will connect to MDS via hub and spoke
interface using OLIS.
Link to Diagram
Model 1
Model 2
LIS’s used
Individual hospitals have their own LISs, which are either Meditech or Triple
G. MDS has a proprietary system.
HL7 Version
2.3
Network Connectivity
CE1 will use SSHA pipelines provided to each hospital and MDS for
connectivity.
Nomenclature
TBD
QA
Data/ Patient Identifiers
TBD
Connectivity
TBD
Nomenclature/Mapping
TBD
Corrective Actions
TBD
Comments on Privacy &
Security
User access will be based on each individual site’s policies. Daily auditing
occurs based on random sampling.
24
11.1. Central East 1
Central East 1 (CE1) Laboratory Sharing Initiative
As of August 2006
How SSHA Fits in the Picture
SSHA will be the primary network infrastructure provider.
How OLIS Fits in the Picture
OLIS will be interfaced to the hospitals and (in Model 2) would provide the
interfacing and routing between hospital sites and MDS.
Critical Success Factors
Capital funding for IT projects.
Sufficient resources for ongoing operation and maintenance of data
sharing.
Benefits of This Initiative
Eliminating manual transcription of results into the LIS.
Eliminate transcription errors.
Provide real-time results thus improving turnaround time.
Save operating dollars, through the reduction in paper purchased.
Reassign MLT hours to other tasks within the laboratory.
Key enabler for further regional consolidation.
Contact Info
Susan Leask
Program Manager
Lakeridge Health Corporation
sleask@lakeridgehealth.on.ca
905-576-8711 x3464
Participating Central East 1 Hospitals
•
Campbellford Memorial Hospital
•
Lakeridge Health – Oshawa
•
Lakeridge Health – Bowmanville
•
Lakeridge Health – Port Perry
•
Northumberland Hills Health Centre
•
Peterborough Regional Health Centre
•
Ross Memorial Hospital
25
CE1 Model 1 (Point to Point)
Clinician
Electronic
connection
Clinician
Manual/physical
connection
Client Site 1
(LIS 1)
Client Site 2
(LIS 2)
HL7 Interface
HL7 Interface
Orders/Results
Specimens
Specimens
OLIS
HL7 Interface
Orders/Results
MDS
(Proprietary LIS)
26
Same model
is used for all
sites
CE1 Model 2 (Hub and Spoke)
Electronic
connection
Clinician
Clinician
Client Site 1
(LIS 1)
Client Site 2
(LIS 2)
HL7 Interface
Manual/physical
connection
HL7 Interface
Specimens
Specimens
Orders/Results
MDS
(Proprietary LIS)
27
Same model
is used for all
sites
11.2. Central West
Central West Region – West Node Microbiology (CW Micro.)
As of August 2006
Lab Reform Region
Central West
Description
Regional consolidation of microbiology lab services at Grand River Hospital
(GRH).
Category
Multiple LIS Vendor/Multiple System Integration
Extent of Sharing
Full sharing of microbiology orders/results and specimens to and from a
regional referral lab.
Status/Timeframe
Implemented project. Plan to extend to more hospitals in the region and find
more regional opportunities in other lab divisions.
As of late 2005, Groves Memorial Hospital (GMH) to be integrated and
planning for further regional opportunities is ongoing.
Organizations Involved
GRH, St. Mary’s General Hospital (SMGH), Cambridge Memorial Hospital
(CMH)
Governance Model
Contract fee-for-service arrangement between separate organizations.
GRH is responsible for the microbiology service. Each partner organization
is responsible for their own interface to the system.
Funding
Contract fee-for-service. The system has been funded by each hospital’s
global budget.
Data Sharing Model
Microbiology orders and results are interfaced between client hospital’s LIS
and referral lab’s LIS, with specimens transported to referral lab and re-bar
coded at lab.
Link to Diagram
Click here for SMGH-GRH process diagram.
LIS’s used
Meditech 4.9, McKesson Horizon Laboratory System
HL7 Version
2.3
Network Connectivity
SSHA network is used for transmitting orders and results.
Nomenclature
ICD 10
QA
Data/Patient Identifiers
Faxed results are confirmed at receiving site for the first few weeks.
Connectivity
All interface errors are printed and reviewed.
Nomenclature/Mapping
There is a defined customer managed process of change control, unit and
integrated testing which allows for tabular values to be changed in test,
then production as needed.
Corrective Actions
There are standardized procedures for reporting any issues requiring
attention via a 24/7 helpdesk.
Comments on Privacy &
Security
The system has audit capabilities and there are random audits of routine
processes and VIP audits performed routinely by the Information Services
Department.
28
11.2. Central West
Central West Region – West Node Microbiology (CW Micro.)
As of August 2006
How SSHA Fits in the Picture
Network connectivity provider
How OLIS Fits in the Picture
TBD
Critical Success Factors
Technology: development of the bidirectional Meditech/McKesson interface
for the microbiology regionalization.
Change management.
Quality business cases.
Organizational buy-in.
Benefits of This Initiative
Creation of a platform to facilitate the building of further successful
laboratory reform plans.
Increased regionalization opportunities: The Waterloo Wellington
Laboratory Services Strategic Planning Team is currently working on
several initiatives to be reported on in September 2006.
Contact Info
Cheryl MacInnes
Director DI & Health Care Support Services
Cambridge Memorial Hospital
cmacinnes@cmh.org
519-621-2330 x2277
Process Diagram (SMGH-GRH Interface)
Electronic
connection
Manual/physical
connection
HL7 interface
Clinician
Orders/results
Client Hospital
(Client LIS)
Grand River Hospital
(McKesson LIS)
Client barcode
McKesson barcode
Specimens
29
Centralized
Micro. Lab
Same model
is used for all
client sites
11.3. East 2
East 2 (E2)
As of October 2006
Lab Reform Region
East 2
Description
Kingston General Hospital (KGH) is the reference laboratory for most
testing in the region. The Outreach business unit of KGH receives
specimens from clients and facilitates the reporting and billing. At present,
there is no standardized electronic connectivity in the region.
Category
Multiple LIS Vendor/Multiple System Integration
Extent of Sharing
Full sharing of results for referred pathology and esoteric tests through a
mixture of non-standardized electronic connection and delivery of hard
copy.
Status/Timeframe
Integration discussion ongoing.
Organizations Involved
Kingston General Hospital (KGH), Brockville General Hospital, Quinte
Healthcare Corporation, Lennox and Addington County General Hospital,
Hotel Dieu Hospital (HDH), Perth and Smith Falls District Hospital,
Weneebayko General Hospital, Providence Continuing Care Centre
(PCCC), St. Mary of the Lake Hospital, Kingston Psychiatric Hospital,
Canadian Forces Base.
Hospitals In-Common Laboratory (HICL)
Governance Model
Each hospital corporation operates independently. Kingston General
Hospital maintains a Rapid Response Lab at Hotel Dieu Hospital.
Funding
Individual global budgets; KGH bills HICL and client hospitals.
Data Sharing Model
All orders are on paper, results are sent back to clients via difference
modes (i.e. electronic download to client HIS, HL7 interface, remote printing
or paper reports via courier).
Link to Diagram
Click here for process diagram.
LIS’s used
Meditech, Misys, Rubicon (HICL proprietary), Health Vision (being phased
out).
HL7 Version
2.x, depending on system
Network Connectivity
SSHA provides network connectivity between all the hospitals
Nomenclature
LIS dependent. SNOMED-CT for pathology at KGH. KGH will incorporate
OLIS nomenclature standards with new LIS.
QA
Data/Patient Identifiers
Reference samples sent to KGH are entered into either the LIS or Patient
Care system of KGH
Connectivity
KGH is connected to Quinte Health Corporation via VPN, to Perth and
Smiths Falls via dial-in Modem, and to Lennox and Addington and HICL via
HL7 interface. Lennox and Addington uses HICL proprietary system.
Nomenclature/Mapping
n/a
30
11.3. East 2
East 2 (E2)
As of October 2006
Corrective Actions
Regional partners notify KGH, and Outreach customer service staff
addresses the problem.
Comments on Privacy &
Security
Courier or print on demand for hard copy reports. Electronic access is by
username and password.
How SSHA Fits in the Picture
Network connectivity provider. Limited functionality enabled to date.
How OLIS Fits in the Picture
TBD
Critical Success Factors
Persistent cooperation and collaboration within the region
Strong leadership and planning
Vision of integration identified in E2 Lab Alliances Strategic plan
Benefits of This Initiative
Improved access to patient lab information across the region
Reduced duplication of work
Improved turnaround times for referred tests
Contact Info
Norma Layno
Kingston General Hospital
laynon@kgh.kari.net
613-533-2828
Cathie Trayner
Kingston General Hospital
traynerc@kgh.kari.net
613-549-6666 x3662
31
E2 Process Diagram
Perth & Smiths Falls
District
(Meditech)
Brockville General
(MISYS)
Pathology
Reports
(secured fax line)
Paper Results
Quinte Healthcare
(Meditech)
Weneebayko
General
Canadian Forces
Base
Lennox & Addington
County General
(Rubicon, shared w.
HICL)
Remote Printing
Paper Results
Paper Results
Paper Results
Unidirectional
Download via
Meditech
Specimens, Paper Orders
HL7
Interface
KGH-HDH
Outreach Service
(Lab Vision)
Results
Results
Electronic
connection
Results
Manual/physical
connection
HL7
Interface
HICL
(Rubicon proprietary)
32
Specimens,
Paper Orders
11.4. Eastern Ontario
Regional Laboratory
Association
Lab Reform Region
Eastern Ontario Regional Laboratory Association (EORLA)
As of July 2006
East 1
Description
Planned full regional integration and connectivity of laboratory services
between all hospital partners in EORLA.
Category
Multiple LIS Vendor/Multiple System Integration
Extent of Sharing
When fully operational, will include sharing of orders/results, regional
integration of laboratory services and consolidation to a single funding
envelope for hospital based laboratory services.
Status/Timeframe
On-going project.
Long history of regional laboratory collaboration. Currently significant
amount of specimen referral within region, however, majority of interinstitution transmission of orders and results is paper based.
LIS integration planning completed (model and connectivity estimates
confirmed through 3rd party review in early 2006). Implementation initiated
in Spring of 2006 through RFP process to select project
management/implementation consultants.
Implementation vendor to be selected early fall 2006, connectivity to be
built and phased in over 12-18 months with regional data repository and
OLIS connectivity to follow.
Organizations Involved
16 member hospitals. See attached list.
Pathology reports are interfaced to CCO (not depicted here).
Governance Model
Non-profit shared services corporation governed by a board representing
member hospitals.
Funding
Some funding received through MOH Back Office Transformation (“Ontario
Buys”) initiative to support start-up costs. Once fully implemented on-going
operations will be funded by global EORLA budget that combines lab
budgets of member hospitals.
Data Sharing Model
All individual hospital LISs are connected to a regional data hub via HL7
messaging, with orders transmitted and results viewed by the individual
LISs at each site.
Link to Diagram
Click here for process diagram of the planned future state, with regional
data repository and OLIS connectivity.
LIS’s used
Each site runs its own LIS. Two regional referral labs use Cerner Classic
3.06 (TOH) and LabVision (CHEO). Other supported LISs include MDS’
proprietary LIS, Triple G, Sysware, Anzer, Medisolution and Meditech
(implementation to be completed Sep. 2006).
HL7 Version
2.1, 2.2, 2.3 (depending on site)
Network Connectivity
EORLA uses SSHA pipelines provided to each hospital for connectivity.
33
11.4. Eastern Ontario
Regional Laboratory
Association
Nomenclature
QA
Eastern Ontario Regional Laboratory Association (EORLA)
As of July 2006
EORLA is establishing its own nomenclature with plans to align closely with
OLIS.
Data/Patient Identifiers
TBD
Connectivity
TBD
Nomenclature/Mapping
TBD
Corrective Actions
TBD
Comments on Privacy &
Security
User access will be based on each individual site’s policies. Daily auditing
occurs based on random sampling. PHIPA.
How SSHA Fits in the Picture
SSHA is the primary network infrastructure provider.
How OLIS Fits in the Picture
The next phase of the project will enhance the regional data hub with a
regional data repository (OACIS). It has yet to be determined whether this
repository will then feed orders and results to OLIS or if individual sites will
feed orders and results directly from their individual LIS.
Critical Success Factors
Capital funding for IT projects.
Agreement on regional governance.
Sufficient resources for ongoing operation and maintenance of data
sharing, especially of the regional data hub.
Benefits of This Initiative
Decreased turnaround time in terms of access to results.
Reduction of data entry errors and erroneous test requests.
Key enabler for further regional consolidation.
Contact Info
Dr. Sherry Perkins
Head - Division of Biochemistry
The Ottawa Hospital
slperkins@ottawahospital.on.ca
613-798-5555 x16107
Participating EORLA Member Hospitals
•
Almonte
•
Kemptville
•
Arnprior
•
Montfort
•
Carleton Place
•
Pembroke
•
Cornwall Community Hospital
•
Queensway Carlton Hospital (QCH)
•
Children’s Hospital of Eastern Ontario
(CHEO)
•
Renfrew
•
St. Francis
•
Deep River
•
The Ottawa Hospital (TOH)
•
Glengarry
•
Winchester
•
Hawkesbury
34
EORLA Process Diagram (Planned Connectivity)
Electronic
connection
Manual/physical
connection
Clinician
orders
Specimens
EORLA Site Lab
(Site Lab LIS)
Results viewing
Specimens
orders/site lab
results
HL7 Interface
Regional LIS Integration HUB
HL7 Interface
orders/results
CHEO Regional Lab
(Lab Vision LIS)
OLIS*
TOH Regional Lab
(Cerner LIS)
* Connectivity to EORLA
system TBD
35
Histology Slides
Lab Data
Specimens
Regional OACIS
Data Repository
Same model
is used for all
16 client sites
11.5. electronic Child Health
Network
electronic Child Health Network – Health Information Network
application (eCHN – HiNet)
As of September 2005
Lab Reform Region
All
Description
eCHN currently shares ADT, Laboratory, Diagnostic Imaging and Health
Records data with 55 member sites via a centralized data repository (as of
September 2005).
Hospital for Sick Children (HSC) connection with eCHN is depicted.
Category
Province-wide Data Repository
Extent of Sharing
eCHN HiNet includes all clinical data (Laboratory, DI, eMAR- electronic
Medication Administration Report, as well as electronic reports including
scanned documents, and ADT information) that the member hospital is
willing to share electronically.
Status/Timeframe
Implemented project.
HSC is working with eCHN to create a direct interface with MDS. This will
allow the direct transfer of referred lab results from MDS to the HSC LIS
and to eCHN HiNet. Anticipated by Q3 2006.
Organizations Involved
55 member child healthcare provider sites and HiNET users in the
community. Click here for a list.
Governance Model
Formally, as a non-profit organization, eCHN must report to, and remain
accountable to, the Ministry of Health and Long-Term Care of Ontario
(MOHLTC).
eCHN manages the data interchange. There is a formal process requiring
approval from both the member organization and eCHN prior to
implementing any initiatives involving both organizations.
Funding
eCHN is fully funded (both implementation of new member sites and
ongoing operating costs) by the MOHLTC.
Data Sharing Model
Unidirectional feed of laboratory data from member sites into a centralized
eCHN repository. HiNET users can then view the data.
Link to Diagram
Click here for connectivity model.
LIS’s used
eCHN is vendor neutral and accepts disparate Lab data in HL7 format from
all LIS vendors, including MISYS, Lab Vision, Meditech, SoftLab, Sunquest,
Triple G.
HL7 Version
2.2
Network Connectivity
SSHA connectivity between eCHN member sites, VPN access also
supported for doctor offices.
Nomenclature
eCHN has normalized all member site clinical data to the LOINC and
SNOMED standard.
36
11.5. electronic Child Health
Network
electronic Child Health Network – Health Information Network
application (eCHN – HiNet)
As of September 2005
QA
Data/Patient Identifiers
All data is thoroughly tested prior to implementation and retested during
every software upgrade. Quality analysis is also preformed during sample
checking.
Connectivity
eCHN checks all data using their suite of ECR (Error Correction and
Recovery) tools and process for day to day verification.
Nomenclature/Mapping
Lab data dictionary extracts are “synchronized” (i.e. checked for changes)
against eCHN-MED on a daily basis (error automatically flagged at part of
ECR tool suite and data dictionary manually evaluated whenever upgrade
takes place. For example, this process was used during HSC’s Softlab to
Sunquest upgrade.
Corrective Actions
eCHN has a 24/7 help desk and works with the member sites to address
and correct any malfunctions or data quality issues.
There is a formal Error, Correction, and Recovery (ECR) process in place at
eCHN to address and resolve any malfunctions in information sharing
between member sites.
Any issues that are discovered are addressed immediately by the eCHN
Data team subject matter experts. The data quality issues are managed via
the ECR tools, which include a mechanism to exchange/review information
with the sites.
Comments on Privacy &
Security
Security- user access and password controlled, 3 factor authentication is
currently being implemented. Audit feature built into application for the user
level, on the network side – firewall audit logs are reviewed both manually
and by automated tools.
How SSHA Fits in the Picture
SSHA provides connectivity between eCHN member sites.
How OLIS Fits in the Picture
TBD
Critical Success Factors
Through funding from the MOHLTC, HSC and eCHN were able to work
together and provide the first successful electronic health record in Ontario.
Through the process of sharing data, HSC was able to gain access to
industry subject matter experts and therefore improve their own internal
processes. eCHN’s normalization and QA work gives HSC an extra level of
assurance and integrity.
Benefits of This Initiative
The eCHN initiative supports the sharing of paediatric data with the
healthcare provider community. Member sites, such as HSC, can therefore
provide timely and accurate information on all patients to their direct
caregivers without those caregivers being physically present.
Contact Info
Bonnie Reib
Managing Director, Department of Paediatric Laboratory Medicine
The Hospital for Sick Children
bonnie.reib@sickkids.ca
416-813-8958
37
Participating eCHN Sites
•
Bloorview Kids Rehab
•
Smooth Rock Falls Hospital
•
Chapleau Health Services
•
Sudbury Regional Hospital
•
Children's Hospital of Eastern Ontario
•
The Hospital for Sick Children
•
Cornwall Community Hospital
•
Temiskaming Hospital
•
Grandview Children's Centre
•
Thessalon Hospital
•
Englehart and District Hospital
•
Thunder Bay Regional Hospital
•
Kirkland and District Hospital
•
Timmins and District Hospital
•
Lake of the Woods Hospital
•
West Nipissing General
•
Mattawa General
•
William Osler Health Centre
•
North Bay General Hospital
•
Northeast Mental Health Care Orillia Soldiers'
Memorial Hospital
•
Algoma CCAC
•
CCAC of the District of Thunder Bay
•
Rouge Valley Health System (Ajax &
•
CCAC of Timiskaming
•
Pickering)
•
Cochrane District CCAC
•
St. Joseph's Health Centre (Toronto)
•
Manitoulin-Sudbury CCAC
•
St. Elizabeth Health Care
•
Muskoka East Parry Sound CCAC
•
Sault Area Hospital
•
Near North CCAC
•
Sensenbrenner Hospital
•
Ottawa CCAC
•
West Parry Sound CCAC
38
eCHN Process Model
eCHN-HiNet
Client
Combined Data
Clinician
Electronic
connection
Manual/physical
connection
Orders/results
Specimens
Site ADT
System
Site Lab
(Site Lab LIS)
Orders/results
Combined Data
Patient data
Client Site – eCHN Interface Engine
Combined Data
eCHN-HiNet
39
Model
representative
of connectivity
with most sites
11.6. Grey Bruce Health
Services
Grey Bruce Health Services (GBHS)
As of August 2006
Lab Reform Region
Southwest
Description
Installation of a single Laboratory database at GBHS-Owen Sound to serve
eleven hospital laboratories and one emergency aid clinic within Grey and
Bruce Counties. Established links to at least one physician clinic.
Category
Single Vendor/Multiple LIS integration
Extent of Sharing
Grey Bruce Health Network consists of eleven hospitals and one
emergency aid clinic (a Cluster group within the Southwest region).
Status/Timeframe
System testing is currently underway with a projected roll out date for all
sites of August 2006.
Organizations Involved
Hospitals include GBHS-Owen Sound, GBHS-Meaford, GBHS-Markdale,
GBHS-Wiarton, GBHS-Lions Head, GBHS-Tobermory Clinic, GBHSSouthampton, SBGHC-Kincardine, SBGHC-Walkerton, SBGHC-Durham,
SBGHC-Chesley.
Although part of the IHLP Cluster group, Hanover Hospital is also a
member of the Grey Bruce Network and is included in this project.
Governance Model
The relationship is on a contractual basis between GBHS and the other
members of the Grey Bruce Health Network. Services are provided to the
other members by GBHS and governance decisions are made by GBHS.
Funding
Capital costs have been borne by GBHS and portions thereof supported by
user facilities based on volume.
Data Sharing Model
All facilities are linked directly to a single Cerner database at the GBHS Owen Sound site using Citrix software. All of the rural sites are connected
to a central server/database in Owen Sound via Citrix. Citrix use is
necessary for all LIS transactions for the rural sites.
Link to Diagram
Click here for process diagram.
LIS’s used
All sites will be running Cerner PathNet LIS and linked directly to the Cerner
HIS system currently in place.
HL7 Version
HL7 version 2.3
Network Connectivity
Citrix software using encrypted microwave transmissions will provide the
system links to the various sites. The capability of using the SSHA pipeline
is also available. Connectivity should switch to fibre optic cable in the very
near future.
Nomenclature
Most of the nomenclature used on the system was standardized from
previous systems. The Cerner system allows for both Primary and Ancillary
synonyms so any discrepancies can be handled in that fashion. This will
also allow for easy use of OLIS nomenclature once it is in widespread use.
QA
Data/Patient Identifiers
Institution Medical Record numbers, OHIP numbers, Last Name, First
Name and DOB are all used to ensure integrity of data.
Connectivity
Monitored on a continuous basis by the IT Dept. Periodic checks of data
integrity.
Nomenclature/Mapping
Verified as changes require.
40
11.6. Grey Bruce Health
Services
Corrective Actions
Grey Bruce Health Services (GBHS)
As of August 2006
Reported errors are logged both in a local access database and the Cerner
Service Request logs. All instances are handled in a timely fashion.
Comments on Privacy &
Security
Secure network connections, firewalls and encryption combine to ensure
confidentiality of information.
How SSHA Fits in the Picture
TBD
How OLIS Fits in the Picture
TBD
Critical Success Factors
Standardization of data and equipment across all sites has minimized the
amount of build and maintenance required on the system. We see a large
portion of the patient population moving between sites so physicians at all
sites will now see a standard report format with similar ranges for similar
machines.
Use of the Cerner Accelerated Solutions team has dramatically reduced the
timeline required for a project of this magnitude.
Executive support from all three Corporations involved has allowed the
secondment of dedicated personnel to maintain timelines on the project.
The use of senior, knowledgeable Technologists on the team has made
decision making and data gathering much easier than might otherwise have
been the case.
Benefits of This Initiative
Use of a single database and shared laboratory information between all the
Grey-Bruce sites.
Standardized nomenclature and reference ranges across all sites.
Standardized chart reports for all physicians in the area.
A complete specimen tracking system for all samples processed at the
various sites, exchanged between sites or referred to outside laboratories.
Opportunity for extensive data mining using a single database.
Opportunity to move to a paperless reporting system.
Contact Info
Dave Ford
Corporate Lab Manager
Grey Bruce Health Services
dford@gbhs.on.ca
519-376-2121 ext. 2135
41
GBHS Process Diagram
Electronic
connection
Manual/physical
connection
GBHS Referral Site
Lab
(Cerner PathNet LIS)
Citrix
GBHS Owen Sound
Site
Cerner DB
Specimens
Orders/Results
Citrix
Orders/Results
GBHS Client Site
(Cerner PathNet LIS)
Clinician
42
Same model
is used for all
sites
11.7. Hamilton Regional
Laboratory Medicine
Program
Lab Reform Region
Hamilton Regional Laboratory Medicine Program (HRLMP)
As of August 2006
Central South
Description
Lab service amalgamation between two hospital organizations
Category
Single/Multiple LIS Vendor/Multiple System Integration
Extent of Sharing
Lab services are rationalized at different sites depending on clinical
requirements and specialties. In addition, referred orders/results and
specimens are shared within the lab system.
Status/Timeframe
Administratively, integration is complete. From an LIS point of view,
consolidation to one LIS is planned for 2007.
Organizations Involved
Hamilton Health Sciences (HHS) and St. Joseph’s Healthcare (SJHC),
Hamilton. West Lincoln Memorial Hospital, HICL and Canadian Medical
Laboratories (in testing) are client sites. CCO (not depicted).
Governance Model
The Hamilton Regional Laboratory Medicine Program (HRLMP) is a jointly
owned and operated clinical service program of HHS and SJHC
corporations, and is affiliated with the McMaster University Faculty of Health
Sciences.
Funding
There is no interhospital billing for tests. The budget for the participating
hospital laboratories is administered globally and new programs or
relocation of test facilities are funded by budget transfer between the
appropriate hospitals.
Data Sharing Model
Manual orders and results connect tests across the two hospitals. Referred
in tests from HRLMP clients to HHS site labs use bidirectional HL7
interfaces for orders/results. A set of Medinet proprietary HL7 interfaces
connect HHSC with West Lincoln, one to send orders and receive results at
West Lincoln, the other to receive orders and send results at HHSC.
Link to Diagram
Click here for process diagram.
LIS’s used
Meditech Magic 5.5 at HHS. McKesson Star 8.0 at SJHC.
HL7 Version
2.3
Network Connectivity
Direct connection to a node on a common fibre backbone which is behind a
firewall.
Nomenclature
The Meditech and McKesson Star LIS’s dictate test nomenclature in use at
HRLMP. No standard nomenclature in place.
QA
Data/Patient Identifiers
Barcoding is done at source.
Connectivity
Interfaces to client sites monitored daily.
Nomenclature/Mapping
Will be done during OLIS implementation
Corrective Actions
Ad hoc process as major issues arise.
Comments on Privacy &
Security
Controlled access to LIS. Network is firewalled.
43
11.7. Hamilton Regional
Laboratory Medicine
Program
How SSHA Fits in the Picture
Hamilton Regional Laboratory Medicine Program (HRLMP)
As of August 2006
No role at this time
How OLIS Fits in the Picture
TBD, As of July 2007, the Meditech LIS will be the sole LIS in use at the
HRLMP. When OLIS is implemented, it will be implemented to the Meditech
LIS.
Critical Success Factors
The HRLMP, a regional academic health sciences laboratory, has a single
administrative structure serving two acute care hospital corporations, a
laboratory reference centre, and several outpatient specimen collection
centres. This single structure is critical in aligning the efforts of the Program
in service, research and academic pursuits.
Another critical factor is the availability and application of technology in
support of data sharing between the HRLMP and its customers.
Vendor support of technology and interfaces facilitate data sharing.
Dedicated LIS and IT staff to support interfaces and data sharing
functionality.
Iterative development of the Medinet interface.
Benefits of This Initiative
Provides service on a regional basis.
Rationalizes the provision of expensive or complex tests.
Eliminates inter-hospital billing for tests.
Contact Info
Christine Probst
Manager, Laboratory Information Systems
Hamilton Regional Laboratory Medicine Program
probst@hhsc.ca
905-521-2100 x77517
44
HRLMP Process Diagram
Electronic
connection
Manual/physical
connection
Clinician
Clinician
Orders/Results
Orders/Results
Hamilton HSC
(Meditech LIS)
Manual
Orders/Results
Same model
is used for all
client sites
St. Joseph’s HC
(McKesson Star LIS)
Specimens
HL7 Interface
Orders/Results
Medinet HL7
Interface
West Lincoln
Memorial Hospital
(Meditech LIS)
HICL
(Proprietary LIS)
Clinician
45
Canadian Medical
Laboratories
11.8. InterHospital Laboratory InterHospital Laboratory Partnership (IHLP)
Partnership
As of August 2006
Lab Reform Region
South West
Description
Regional integration of laboratory services of 6 member organizations
across 11 hospital sites.
Category
Multiple LIS Vendor/Multiple System Integration
Extent of Sharing
4 member sites have fully integrated LIS with main referral lab at Stratford
site of Huron Perth Healthcare Alliance (HPHA). Other member sites and
the community share referred test orders/results and specimens. Pathology
reports are shared with CCO.
Status/Timeframe
Implemented project.
Organizations Involved
InterHospital Laboratory Partnership membership list.
CCO.
Governance Model
Organizations have their own board and CEO
Planning is done by steering committee and input from all parties involved
including IHLP Management, which are all of the CEO’s of the different
Hospitals.
Funding
All tests referred into Stratford are billed based on an IHLP fee-for-service
formula that is approved by all Hospital CEO's yearly.
Data Sharing Model
4 member sites are integrated with Stratford referral lab’s Meditech
database. Listowel site has a Medinet interface for referred orders and
results. Other sites use manual orders and receive faxed results for referred
tests.
Link to Diagram
Click here process diagram.
LIS’s used
Meditech 4.9, Medinet. NPR report (for CCO reports)
HL7 Version
2.3
Network Connectivity
Modem to Modem asynchronous serial connection ( HICL & JBMH )
All connections including the MEDINET INTERFACE use a (comcentric
pipe) which is a private healthcare pipe.
Nomenclature
No nomenclature standards. Once OLIS has been implemented, LOINC will
be used for OLIS transactions.
QA
Nomenclature/Mapping
LIS dictionary audits monthly.
Connectivity
Interfaces are checked on a yearly basis.
Data
Reports are checked on a yearly basis. Calculation verification checks.
Policies on registration, manual order entry, faxing, etc.
Corrective Actions
Centralized Help Desk at the Stratford site, with escalations to application
specialists and LIS coordinator.
46
11.8. InterHospital Laboratory InterHospital Laboratory Partnership (IHLP)
Partnership
As of August 2006
Comments on Privacy &
Security
Controlled access to the Meditech LIS and Medinet. Member organizations
have their own policies on privacy & security. Network is firewalled.
How SSHA Fits in the Picture
TBD
How OLIS Fits in the Picture
TBD
Critical Success Factors
Physician and staff buy in.
Benefits of This Initiative
Improved turnaround times.
Minimized transcription errors.
Improved work flow.
Saved adding staff for volume of work.
Allows staff to move from one site to another with minimal training.
Contact Info
Paul Brown
Lab Manager
Huron Perth Healthcare Alliance
Stratford Site
paul.brown@hpha.ca
519-272-8210 x2892#
Participating IHLP Members
•
Alexandra Marine & General Hospital (AM&G)
•
Huron Perth Healthcare Alliance –(Clinton, Seaforth, St. Marys & Stratford Sites) (HPHA)
•
North Wellington Health Care Corporation – (Mt. Forest & Palmerston Sites)
•
Listowel Wingham Hospitals Alliance – (Listowel & Wingham Sites)
•
South Huron Hospital – Exeter
•
Hanover & District Hospital
47
IHLP Process Diagram
Clinician
Electronic
connection
Manual/physical
connection
Sites w. Meditech
LIS*
Listowel
Medinet HL7
Interface
orders/results
Shared Database
HPHA Stratford Site
(STO Meditech LIS and Database)
orders/results
NPR Report
Specimens
Lab Staff
Manual/Faxed
orders/reports
Clinician
(NonMeditech
Site)**
** Exeter, Hanover, Mt. Forest,
Palmerston, Wingham
48
CCO
(PIMS)
Specimens
Specimens
* Alexandra Marine &
General, HPHA Clinton,
Seaforth and St. Mary’s sites
11.9. London Laboratory
Services Group
London Laboratory Services Group (LLSG)
As of August 2006
Lab Reform Region
South West
Description
Centralized repository of patient information with integrated LIS modules
among Thames Valley District hospitals including two reference
laboratories at London Health Sciences Centre (LHSC) and St. Joseph’s
Health Care (SJHC).
Category
Single LIS Vendor/Single System Integration
Extent of Sharing
Full sharing of LIS across sites with referred lab services to reference lab
sites. Pathology reports are shared with CCO. Referred in orders and
results are interfaced directly with Hospitals In Common Laboratory (HICL)
Toronto.
Status/Timeframe
Project implemented for sharing of LHSC/SJHC LIS with Alexandra
Hospital in Ingersoll, Four Counties Health Services in Newbury and
Strathroy Middlesex General Hospital.
Remaining Thames Valley District hospitals’ implementation anticipated for
2006.
Organizations Involved
8 member hospitals of Thames Valley District (see list). CCO. HICL.
Governance Model
Joint Management Committee with representation from each of the Thames
Valley Hospitals. A Memorandum of understanding has been signed by
Thames Valley Hospitals for each of the major IT Projects.
Funding
Phase 1 – Rural & Northern Initiatives provided a $1.3 million grant to
extend the Cerner PathNet LIS to the initial hospitals.
Phase 2 – Funds for remaining integration will come from within the
hospitals global budgets or reserve funding.
Ongoing Support – from within the hospitals global budget.
Data Sharing Model
Currently, orders are handled through an order transcription process
(orders written in the chart and transcribed by a unit clerk or nurse) but
work is underway to introduce Clinical Provider Order Entry. Clinical areas
access a centralized clinical information system, and specimens are routed
accordingly by the system. Results are reported directly into the system.
Link to Diagram
Click here for process diagram.
LIS’s used
Cerner PathNet Millenium System 2003.02
HL7 Version
2.2,2.3
Network Connectivity
Connected via VPN tunnels over Bell’s Core Network
Nomenclature
No nomenclature standards. Cerner PathNet system is capable of
supporting LOINC, ICD-10 and SNOMED. Decisions on nomenclature and
coding standards are pending direction from OLIS and CCO.
QA
Before and after each data conversion data is examined to ensure integrity
of the conversion.
Data/Patient Identifiers
49
11.9. London Laboratory
Services Group
London Laboratory Services Group (LLSG)
As of August 2006
Connectivity
Network devices are tested continually to ensure appropriate transmission
of data. Interfaces have built-in error checking (AC/NAC) to ensure the data
transmission maintains integrity.
Nomenclature/Mapping
For the most part, data mapping tables are not required as part of the
Cerner computer system (since Cerner uses a Central Repository of data
which multiple departments use for storing and accessing data). For data
transferred across interfaces to foreign systems, conversion tables are
used to map data to appropriate data fields in the foreign system. These
tables are used by the Cerner Open Engine interface engine to ensure the
various computer systems receive the appropriate data for their purposes.
Corrective Actions
LHSC has a team of programmers dedicated to supporting IT needs
including interfaces. They work collaboratively with other agencies affected
by the interfaces.
Comments on Privacy &
Security
LIS access is controlled. Network is firewalled. Strict controls on network
access from remote locations using data tokens.
The Privacy Office conducts ongoing audits of access to patient data to
ensure only legitimate access to patient data is respected.
How SSHA Fits in the Picture
TBD
How OLIS Fits in the Picture
TBD
Critical Success Factors
Common vision.
Persistence.
Corporate direction.
Benefits of This Initiative
Easier to manage data and compare productivity indicators.
Ensures standards and procedures are consistently adhered to.
Contact Info
Dr. Robert Lannigan
Clinical Microbiologist
London Health Sciences Centre
robert.lannigan@lhsc.on.ca
519-685-8213
Participating Thames Valley District Hospitals
•
Alexandra Hospital in Ingersoll
•
St. Thomas Elgin General Hospital
•
Four Counties Health Services in Newbury
•
Strathroy Middlesex General Hospital
•
London Health Sciences Centre
•
Tillsonburg District Hospital
•
St. Joseph’s Health Care London
•
Woodstock General Hospital
50
LLSG Process Diagram
Electronic
connection
Manual/physical
connection
Client
Site
Transcribed
Orders
Specimens
Results
Cerner Integrated
Clinical Information
System
Orders/
Results
Specimens
Cerner Open Interface Engine
Reference
Lab
Pathology
Reports
Orders/
Results
CCO
(PIMS)
HICL
(Proprietary LIS)
51
Same model
is used for all
client sites
11.10. Mount Sinai Hospital
Mount Sinai Hospital (MSH)
As of August 2006
Lab Reform Region
Toronto
Description
MSH acts as a reference lab for certain Toronto clients, setting up
electronic interfaces for them, as well as sharing microbiology services with
Toronto Medical Laboratories (TML).
Category
Multiple LIS Vendor/Multiple System Integration
Extent of Sharing
Full sharing of orders/results and specimens for referred in tests. Full
sharing of microbiology services with TML/University Health Network
(UHN).
MSH shares pathology reports with CCO (not depicted).
Status/Timeframe
Implemented project.
Organizations Involved
MSH, Toronto Rehabilitation Institute, TML/UHN, CCO, Rouge Valley
Health System (RVHS), Baycrest Centre for Geriatric Care, Humber River
Regional Hospital (HRRH), Hospitals In Common Laboratory.
Governance Model
The Laboratory information system (LIS) at Mount Sinai hospital is jointly
administered by the Microbiology department and the PLM department.
Each department has 2 LIS officers committed full-time to the
administration of the LIS. HP, through a contract with Mount Sinai hospital,
supports the infrastructure for all informatics including the LIS.
Funding
Funding for referred-in tests is either based on a contractual agreement or
fee for service. For the shared microbiology service, fee for service invoices
are charged for referred-in tests, while the operating budget is shared 66:34
between UHN and MSH.
Data Sharing Model
LIS connects to different sites via several interface engines
Link to Diagram
Click here for diagram of data sharing model
LIS’s used
Soft Computer Consultants, Inc. (SCC), Meditech.
HL7 Version
HL7 2.3
Network Connectivity
VPN over internet and ISDN lines
Nomenclature
No set nomenclature standards. Will meet OLIS nomenclature standards as
required by project implementation.
QA
Data/Patient Identifiers
In accordance with CAP and OLA standards, data transmissions are
checked for end to end accuracy once a year and with upgrades to LIS
software.
Connectivity
The network is monitored 24X7 by HP. The interface engines are monitored
24X7 by the respective vendors (Cloverleaf and MDI). Interfaces are
checked daily by LIS officers
52
11.10. Mount Sinai Hospital
Mount Sinai Hospital (MSH)
As of August 2006
Nomenclature/Mapping
Mapping is used for only 1 client (HRRH) and we rely on the client to report
any mapping issues.
Corrective Actions
LIS officers are available 24X7 to correct, on an as needed basis, any
issues that may arise.
Comments on Privacy &
Security
MSH LIS modules are accessible only by the use of a user ID/password
combination which is encrypted. User access is controlled internally. Client
organizations follow their own privacy & security policies.
How SSHA Fits in the Picture
n/a
How OLIS Fits in the Picture
Plans to integrate with OLIS TBD.
Critical Success Factors
Establishing standard connectivity processes.
Clear understanding of interface specifications by all parties involved.
The use of interface engines has greatly facilitated interfacing efforts.
Benefits of This Initiative
Less paper, less transcription therefore less data entry work.
Improved accuracy.
Improved turnaround time.
Contact Info
David McPherson
Senior LIS Officer, Pathology & Laboratory Medicine
Mount Sinai Hospital
416-586-4800 ext.1597
dmcpherson@mtsinai.on.ca
53
MSH Process Diagram
Electronic
connection
Clinician
Clinician
Clinician
Manual/physical
connection
Baycrest
(Meditech LIS)
MSH
(Cerner)
HRRH
Specimens
Specimens
Specimens
Orders/Results
Cloverleaf Interface Engine
MSH Main Lab
(SCC)
MSH/TML Micro.
Shared Service Lab
(SCC)
Orders/Results
Micro.
Orders/Results
Orders/Results
E-Gate Interface Engine
Orders/Results
RVHS Custom
Interface
RVHS
(Meditech LIS)
UHN
(MISYS)
Clinician
Clinician
54
Microbiology Specimens
Specimens
Orders/Results
11.11. North Eastern Ontario
Network
North Eastern Ontario Network (NEON)
As of August 2006
Lab Reform Region
North East
Description
Integrated multi-site lab information system
Category
Single LIS Vendor/Single System Integration
Extent of Sharing
Full sharing of laboratory information. Orders/results are also shared on a
referral basis with HICL (not depicted). Information is shared with eCHN
(not depicted). Labs within NEON also act as back-up sites for other NEON
labs.
Status/Timeframe
Implemented project.
Organizations Involved
9 member hospitals in the region (see list).
Governance Model
The governance structure is a joint partnership, with a Steering Committee
comprised of members from each organization. The present voting
mechanism for decision making is one equal weighted vote per member.
Funding
The financial model is a cost-sharing mechanism, based on the cost of
hardware, support, software, etc. The costs are allocated by member site,
according to a bed formula (presently under review). An annual budget is
created and approved through the steering committee.
The initial start up costs for hardware, software and installation (incurred
about 5 years ago) were shared amongst the members using the same bed
allocation formula. Each year a budget is prepared and presented to NEON
Steering for approval. The operational costs, including 16 shared FTE
support staff centered in Sudbury, are also shared using the cost sharing
formula.
Data Sharing Model
Regional information is accomplished through the use of a shared version
of Meditech Client-Server. The main system resides in a single location and
integration of information across all active modules is seen. Through
NEON, smaller organizations were afforded an opportunity to implement
the MEDITECH environment in a cost effective manner.
Link to Diagram
Click here for the process diagram.
LIS’s used
Meditech Client Server 5.3
HL7 Version
2.3
Network Connectivity
All connectivity runs over Bell/SSH MPLS Network.
Nomenclature
Integrated architecture and a shared data base structure ensure a common
internal nomenclature. Standard nomenclatures are considered, such as
LOINC, but not strictly adhered to within the dictionaries.
QA
Data/Patient Identifiers
All patients in the shared database are assigned a Unique Identifier in the
system. This number remains with the patient and is used system wide.
Connectivity
Data lines are monitored continuously by vendor.
55
11.11. North Eastern Ontario
Network
North Eastern Ontario Network (NEON)
As of August 2006
Nomenclature/Mapping
Dictionary changes can occur at anytime required and the process is to test
the change in the “test” environment prior to live implementation.
Corrective Actions
Sudbury support staff (shared FTE’s) will help address these issues. Each
module has a core team of users, with membership from the various sites,
to help identify and correct problems.
Comments on Privacy &
Security
Security/Confidentiality addressed through policies and recognition of
NEON as being an extended “circle of care”. Access to the LIS is controlled
by username/password access and through staged level of access by job
description.
How SSHA Fits in the Picture
Network connectivity provider.
How OLIS Fits in the Picture
TBD
Critical Success Factors
Strong leadership and vision from the participating organizations.
Clearly defined benefits of integration.
Varied organizations starting points for the membership to account for
different stages of HIS/LIS development. Integrated database for clinicians
was the prime focus.
Benefits of This Initiative
Allowed for the Meditech architecture to be afforded to smaller
organizations. The shared costing model helps to spread out the cost of
implementation and ongoing operational costs.
The interconnectivity of the LIS module allows for reference testing to be
done seamlessly, with on-line batching of reference tests and immediate
distribution of verified results to clinicians, through the EMR.
In addition, labs can act as each other’s back-up in case of production
downtime.
Contact Info
Derek Graham
Diagnostic Imaging
Temiskaming Hospital
dgraham@temiskaming-hospital.com
705-647-1088 x2170
Participating NEON Member Hospitals
•
Hôpital Regional De Sudbury Regional
Hospital
•
Temiskaming Hospital
•
Englehart and District Hospital Inc.
•
Timmins And District Hospital - L’hopital
De Timmins Et Du District
•
Kirkland And District Hospital
•
Northeast Mental Health Centre
•
Services De Sante De Chapleau Health
Services
•
Smooth Rock Falls Hospital Corporation
•
St. Joseph’s General Hospital Elliot Lake
56
NEON Process Diagram
Electronic
connection
Manual/physical
connection
Specimens
Clinician
Orders/results
Specimens
Orders/results
Meditech Database
Orders/results
HICL
Other NEON Site Lab
(as required)
NEON Site Lab
57
Same model
is used for all
client sites
11.12. Northwest Health
Network
Northwest Health Network (NWHN)
As of August 2006
Lab Reform Region
Northwest
Description
Regional integration of IT services under a single system
Category
Single LIS Vendor/Single System Integration
Extent of Sharing
Full sharing of orders/results and specimens which are sent to referral labs
(MDS and Thunder Bay Regional Health Sciences Centre [TBRHSC]).
Status/Timeframe
Shared health information system currently implemented at 7 of 11 NWHN
hospitals. Proposed project to implement shared LIS modules.
Anticipating 2005-06 integration of remaining NWHN hospitals. Anticipating
2006-07 implementation of lab modules.
Organizations Involved
TBRHSC, St. Joseph’s Care Group (SJCG), 9 other referring hospitals (see
list), MDS.
Governance Model
Individual hospital project teams report to a regional IS Project Steering
Committee. Each organization governs its own lab services.
Funding
A portion of each hospital’s global budget funds this project, via a funding
formula. Referred tests are compensated fee-for-service.
Data Sharing Model
MDS is main regional referral lab while some hospitals send certain tests to
TBRHSC. Tests sent by referring hospitals are accompanied by written
orders for manual data entry into testing lab’s LIS. TBRHSC has an
interface with MDS. Results from TBRHSC are entered directly into regional
Meditech HIS. Results from MDS are sent via interface to TBRHSC and
manually faxed to other referring hospitals. TBRHSC and SJCG share IT
services.
Link to Diagram
Click here for process diagram.
LIS’s used
Meditech Client Server. MDS uses their own proprietary system
HL7 Version
2.2
Network Connectivity
Data transmissions use SSHA pipelines.
Nomenclature
n/a
QA
Data/Patient Identifiers
n/a
Connectivity
For MDS interface, data transmissions were tested prior to “go live”.
Testing process included verification of sending and receiving of orders and
results at reference and client labs. Abnormal and critical flagging, profile,
group and reflex test order scenarios were all checked.
Transmission logs are reviewed daily for failed transmissions.
Nomenclature/Mapping
Updates to mapping tables shared on a monthly basis.
58
11.12. Northwest Health
Network
Corrective Actions
Northwest Health Network (NWHN)
As of August 2006
TBRHSC help desk handles first tier support. Additional issues for the MDS
interface may require direct communication (phone and email) between LIS
coordinator, locale MDS office and MDS IT support.
Comments on Privacy &
Security
How SSHA Fits in the Picture
Controlled access to LIS.
How OLIS Fits in the Picture
TBD
Critical Success Factors
Agreement on a single LIS platform.
Network connectivity provider.
Organizational buy in.
Development of a global funding formula
Benefits of This Initiative
Regional access to patient lab data.
More efficient use of lab services.
Contact Info
Bev Junnila
Technical Director - Laboratory Services
Thunder Bay Regional Health Sciences Centre
junnilab@tbh.net
807-684-6000
Participating NWHN Hospitals
•
Nipigon District Memorial Hospital
•
The McCausland Hospital
•
Geraldton District Hospital
•
Manitouwadge General Hospital
•
Wilson Memorial General Hospital
•
Atikokan General Hospital
•
Red Lake Margaret Cochenour Memorial Hospital
•
Dryden District General Hospital
•
Sioux Lookout Meno-Ya-Win Health Centre
59
NWHN Process Diagram
Electronic
connection
Manual/physical
connection
Clinician
Faxed Results
Client Site
(Meditech Client)
Faxed Orders
MDS Lab
Staff
Specimens
Specimens
Orders/Results
Regional Meditech
Database
MDS
(Proprietary LIS)
Orders/Results
Custom
Interface
Orders/Results
Thunder Bay
RHSC
(Shared
Meditech LIS)
St. Joseph’s
Care Group
(Shared
Meditech LIS)
Clinician
Clinician
Specimens
60
Typical model
for NWHN sites
with
implemented
regional
Meditech
11.13. Pathology Information
Management System
Pathology Information Management System (PIMS)
As of August 2006
Lab Reform Region
All
Description
Electronic identification and transmission of cancer case pathology reports
from labs to Cancer Care Ontario (CCO).
Category
Province-wide Data Repository
Extent of Sharing
Full sharing of complete cancer pathology reports from hospital to CCO.
Status/Timeframe
Implemented project.
PIMS roll-out took place from 2003-2005 with the main project completion
in April 2005; MDS Labs was added in July 2006.
Organizations Involved
45 provincial labs (representing 90% of the provincial pathology reports) –
majority hospital labs (see attached list of members). Other hospitals still
submitting but on disk or via fax
Governance Model
Project is a CCO initiative.
Funding
Following the CCO Information Management Strategy, MOHLTC funding
under DTRACC (Data Tracking, Referral and Analysis of Capacity for
Cancer Care)
Data Sharing Model
Pathology reports are filtered by locally installed client software for cancer
cases, and then shared via unidirectional interface with CCO. Some
implementations provide a central filter where the reports are sub-divided at
CCO.
Link to Diagram
For Generic PIMS Architecture Diagram click here.
LIS’s used
Each site runs its own LIS, which may have a separate vendor for its
pathology module. Those interfaced with PIMS include Eclipsys LabVision,
Meditech Client Server, Meditech, Meditech Magic, SCC SoftLab, Cerner
Classic, Cerner-CoPath, McKesson HBOC STAR, MISYS-CoPath and
Intellipath.
HL7 Version
Ranges from 2.1 to 4.9 (majority approx. 2.6)
Network Connectivity
SSHA or via encrypted public internet (VPN).
Nomenclature
n/a – this project did not address this issue
QA
QA performed by CCO Coders as they review reports submitted.
Data/Patient Identifiers
61
11.13. Pathology Information
Management System
Pathology Information Management System (PIMS)
As of August 2006
Connectivity
No automated central monitoring utility for PIMS sites in use at this time;
CCO IT Operations Analyst runs a Crystal Reports inquiry daily to see
which hospitals/labs have transmitted reports for the previous day, and to
check the volume of reports. When a hospital stops transmitting reports for
several days or has a significant reduction in the regular volume of reports
over several days, the IT Ops Analyst contacts the hospital/lab to
investigate the issue and resolve it if possible. If the issue cannot be
resolved, the primary support vendor is contacted (see Corrective Actions).
Nomenclature/Mapping
n/a
Corrective Actions
If significant problems are encountered with the transmissions from a
hospital/lab, the IT Ops Analyst will investigate and subsequently involve
the primary PIMS vendor (Artificial Intelligence in Medicine – AIM) if
required for correcting any major problems found.
Comments on Privacy &
Security
Cancer Act governs CCO’s access to this data for maintaining the Ontario
Cancer Registry. Compliant with PHIPA.
How SSHA Fits in the Picture
SSHA is the network infrastructure provider
How OLIS Fits in the Picture
Ultimately, OLIS will provide the service required by CCO as it will create
and house a repository of all cancer pathology reports which CCO can
access. However, this is a long-term plan and not likely to materialize in the
next few years.
Critical Success Factors
Ability of technology to filter cancer from non-cancer reports.
Understanding and Commitment of local pathology information
management teams.
MOHLTC support.
Project Management Methodology and Rigorous application.
Benefits of This Initiative
Substantial improvements in overall data quality.
Unprecedented capability for automated cancer surveillance.
Enables of rapid enrolment of patients in to research studies.
Significant cost reductions achieved.
Traceability of disclosures for hospitals.
Contact Info
Andrea MacLean
Pathology Project Manager
Cancer Care Ontario
andrea.maclean@cancercare.on.ca
416-217-1391
Pat Mason
Pathology Project Consultant
Cancer Care Ontario
patrick.mason@cancercare.on.ca
416-971-9800 X3309
62
Participating PIMS Labs (as of August 2006)
•
Brantford General Hospital
•
Grand River Hospital Corporation
•
Kingston Hospitals Laboratories Services
•
London Health Sciences Centre
•
Joseph Brant Memorial Hospital
•
Thunder Bay Regional
•
Toronto East General
•
Hamilton Health Sciences Corporation
•
North York General
•
Humber River Regional
•
Mount Sinai
•
University Health Network
•
St. Joseph’s Toronto
•
Trillium Health Sciences
•
St. Michael’s Hospital
•
Halton Healthcare Services Corporation
•
St. Joseph’s London
•
Lakeridge Health Corporation - Oshawa
•
Queensway Carleton
•
Sunnybrook Health Sciences Centre
•
Stratford General Hospital
•
Rouge Valley Health System
•
Peterborough Regional Health Centre
•
Grey Bruce Health Services
•
Royal Victoria
•
Quinte HCC
•
Cambridge Memorial
•
William Osler
•
St. Mary’s
•
Ottawa Civic
•
Guelph General Hospital
•
Ottawa Hospital
•
St. Joseph’s Hamilton
•
Sudbury Regional Hospital Corporation
•
Southlake Regional
•
Scarborough Hospital
•
York Central Hospital
•
Niagara Health System
•
Credit Valley
•
Bluewater Health - Sarnia
•
North Bay General
•
Gamma Dynacare
•
Timmins and District Memorial
•
MDS Labs
•
Markham Stouffville
63
Generic PIMS Architecture Diagram (local filter)
Hospital Pathology
Lab
(Pathology LIS)
Pathology Reports
Autocode Filter
Application
PIMS
IP Network
TransMed EDI
TransMed EDI
64
11.14. Sunnybrook Health
Sciences Centre
Sunnybrook Health Sciences Centre (SHSC)
As of September 2005
Lab Reform Region
Toronto
Description
SHSC’s hospital laboratory acts as a referral lab for clients in the North
East Regional Group.
Category
Multiple LIS Vendor/Multiple System Integration
Extent of Sharing
Full sharing of orders/results and specimens for referred in tests. Sharing
of pathology reports with CCO.
Status/Time frame
Implemented project, with ongoing plans to increase scope
Currently transitioning connectivity to use SSHA network. Planning to link
with North York General Hospital, Southlake Regional Health Centre and
Hospitals In Common Laboratory – target completion Spring 2006. Planning
integration of blood bank transfusion system with UHN – anticipated over
2006-07.
Organizations Involved
SWCHSC, York Central Hospital, Markham Stouffville Hospital, North York
General Hospital and Southlake Regional Health Centre. SWCHSC refers
some tests to Gamma Dynacare and vice-versa.
Governance Model
Cooperative initiative. Participants meet on a regular basis to discuss
services, issues, strategy and planning.
Funding
Each site pays their own vendor and connectivity costs (connectivity will
transition to SSHA). Model based on fee for service. Each member is
responsible for their portion of the cost.
Data Sharing Model
SHSC’s LIS connects directly to external partners.
Link to Diagram
Click here for process diagram.
LIS’s used
MISYS v5.3.3.2.5 and CoPath v2.3b. Meditech, MISYS and HBO
McKesson at client sites. Proprietary LIS’s at HICL and Gamma Dynacare.
HL7 Version
2.1, 2.3, depending on vendor system
Network Connectivity
SSHA, VPN, ISDN Link, Dial Up
Nomenclature
Each Institution have their own unique mapping requirements, typically
vendor negotiated
QA
Data/Patient Identifiers
Once monthly perform random data checks.
Connectivity
Interface is monitored regularly. Dispatching endpoints are responsible for
checking message dispatch.
Nomenclature/Mapping
Systems are stable, verification is done only when mapping enhancements
are required.
Corrective Actions
In the event of a service interruption one of the endpoints will notify the
other. Also QA is performed monthly to validate data.
65
11.14. Sunnybrook Health
Sciences Centre
Sunnybrook Health Sciences Centre (SHSC)
As of September 2005
Comments on Privacy &
Security
Network is firewalled and access to the LIS is controlled; only LIS staff have
external access
How SSHA Fits in the Picture
SSHA will be the network connectivity provider in future integrations
How OLIS Fits in the Picture
TBD
Critical Success Factors
Meditech (Vendor to Vendor) LIS to LIS agreement to standardized
transaction formats to support each vendor’s requirements.
HBO/McKesson was unable to accommodate micro’s discreet components.
They simply populate with text.
Benefits of This Initiative
Reduce resource effort.
Improved turnaround times.
Standardized Test Dictionary.
Less human intervention.
Reduction in transcription across systems.
Contact Info
Murray Kaufman
Consultant
Sunnybrook Health Sciences Centre
murray.kaufman@sunnybrook.ca
416-480-6100 x3192
66
SHSC Process Diagram
Electronic
connection
Clinician
Manual/physical
connection
Sunnybrook
Electronic Patient
Record System
(OACIS/Dinmar)
Orders/results
Enterprise Interface Engine
(EBIZ-SYBASE)
Sunnybrook LIS
(CoPath/MISYS)
Microbiology orders
(text dump)
Orders/results
HL7 Interface
Client Hospital
(HBO McKesson)
Client Hospital
(Meditech or MISYS)
CCO
(PIMS)
67
HICL
(Proprietary LIS)
Gamma Dynacare
(Proprietary LIS)
Specimens
Specimens
Pathology Reports
11.15. Toronto Medical
Laboratories
Toronto Medical Laboratories (TML)
As of July 2005
Lab Reform Region
Toronto
Description
Joint venture between a hospital lab and a private lab that provides lab
services to client hospitals
Category
Multiple LIS Vendor/Multiple System Integration
Extent of Sharing
TML works in partnership with other hospitals to provide laboratory services
to University Health Network (UHN) hospitals. TML also provides full lab
services to the Ajax-Pickering and Centenary Sites for the Rouge Valley
Health System (RVHS), which includes interfaced orders and results.
Microbiology services are provided to Baycrest Centre and are shared with
Mt. Sinai Hospital (MSH).
Status/Timeframe
Implemented project with plans to expand client list.
Proposed projects for 2005-06 include interfaces with Sunnybrook
Transfusion Medicine, Trillium Gift of Life Network and Hospitals in
Common Laboratory.
Organizations Involved
TML, UHN, MSH, RVHS, Baycrest, MDS
Governance Model
The relationship is between TML and its clients as a contractual
arrangement for a purchase of services. Services are provided to the
clients. Governance decisions are made by TML.
Funding
TML bills a portion of the start up costs at inception, and then the remainder
of the cost of contract is handled on a multi-year basis, with allowances
made for increased or decreased payments based on volume thresholds.
Data Sharing Model
TML’s 5 LISs currently connected operate separately and conduct all crosscommunications through the E-Gate. The interface engine (E-Gate) is
software developed by the Courtyard Group that sits on its own server that
formats, logs and makes adjustments in all message that pass between the
different LIS. MSH orders on Cerner are transmitted through MSH’s
Cloverleaf interface gate connection directly into SoftMic.
Link to Diagram
Click here for diagram of current interfaces to TML.
LIS’s used
MISYS, Meditech, ULTRA and I-Net [GE Healthcare], CoPath [Cerner],
Softmic [SCC], Hemocare [Mediware]
HL7 Version
HL7 2.1-2.3 (depending on the system and interfaces)
Network Connectivity
Baycrest’s connection uses the SSHA pipeline. For Bridgepoint (a client
hospital that does not use an HIS) the SSHA connection is used to
generate reports directly to their printers on their internal network.
Other connections are run on VPN connections over the internet or on
ISDN lines.
68
11.15. Toronto Medical
Laboratories
Toronto Medical Laboratories (TML)
As of July 2005
Nomenclature
SNOMED; generally nomenclature is a cross-reference table mapping
between individual lab systems.
QA
Data/Patient Identifiers
Institution medical record number or OHIP number gets transmitted through
the whole process. An institution key is assigned to data in the E-Gate and
that number is readable by all the different systems. A single barcode is
maintained throughout process, except for specimens processed by
Meditech LIS. A separate barcode is attached at the TML site for
Pathology, Microbiology and Transfusion Medicine specimens.
Connectivity
Periodic checks of data integrity.
Nomenclature/Mapping
Verified as changes require.
Corrective Actions
When isolated incidents occur, error logs are checked and the error is
corrected after it is reported.
Comments on Privacy &
Security
Access to LIS’s is controlled within TML. Clients follow their own privacy &
security policies.
How SSHA Fits in the Picture
Network connectivity provider for certain clients.
How OLIS Fits in the Picture
Plans to integrate with OLIS TBD.
Critical Success Factors
Standardization of certain aspects of systems involved. The ability to avoid
over-labeling created restrictions on the system (every system needs to be
identified uniquely). Standardization also meant a large amount of field to
field mapping and cross-referencing test names.
Physical logistics of moving specimens from client sites to the laboratory
site.
Implementing data connections (a dedicated T1 line to RVHS, a VPN set up
with MDS, etc.)
A key to success was TML’s ability to generate cost savings for clients by
capitalizing on its capacity (reducing TML’s own cost per test in the
process). This provided the business case for clients to use this service.
Benefits of This Initiative
80% of TML’s work comes through interfaces. The information exchange is
vital to the continued success of TML.
Order entry and results reporting is conducted in a timely manner.
Extensive data mining is possible using the databases of the individual lab
systems and, for UHN, indirectly through their MYSIS HIS.
The interface model is a selling point for future partnerships by allowing for
reduced front end workload without the need for over-labeling.
Contact Info
Peter Woo
Manager, Information Systems, Toronto Medical Laboratories
Peter.Woo@uhn.on.ca
416-340-4800 x2518
69
TML Process Diagram
Electronic
connection
Clinician
Clinician
Clinician
Clinician
Manual/physical
connection
UHN
(MISYS HIS)
Rouge Valley HS
Ajax-Pickering Site
(Meditech LIS)
Rouge Valley HS
Centenary Site
(Meditech LIS)
Baycrest
(Meditech LIS)
Orders/Results
Orders/Results
E-Gate Interface Engine
(Courtyard Group)
Orders/Results
Orders/Results
TML General Lab
(ULTRA)
TML Pathology
(CoPath)
MSH/TML Shared
Services
Microbiology Lab
(SoftMic)
TML Transfusion
Med
(Hemacare)
70
Specimens
Specimens
RVHS Custom
Interface
11.16. Trillium Health Centre
Trillium Health Centre (Trillium)
As of August 2006
Lab Reform Region
Central West
Description
Fully integrated multi-site hospital laboratory.
Category
Single Vendor/Single LIS Integration
Extent of Sharing
In house testing has fully integrated data exchange. Referred out tests
follow a manual process.
Status/Timeframe
Implemented project. Planned OLIS integration.
Organizations Involved
Trillium Health Centre (Mississauga and Queensway sites). CCO (not
depicted). OLIS (planned).
Governance Model
All sites are governed under one corporation.
Funding
Lab services are funded by one corporation. Information systems are
funded under yearly contracts, with ongoing operational costs for fixes,
interfaces and upgrades.
Data Sharing Model
Full sharing of lab services between campuses.
Manual orders and results process for referred out tests.
Planned unidirectional feed to OLIS data repository. Planned integration
between OLIS Viewer and Meditech LIS.
Link to Diagram
Click here to view process diagram.
LIS’s used
Meditech 4.9, upgrading to 5.5 in Sept. 2006.
HL7 Version
Not available
Network Connectivity
SSHA pipeline
Nomenclature
LOINC for OLIS, ICD-10 for Health records.
QA
Data/Patient Identifiers
Barcoding being examined prior to implementation of physician order entry.
Connectivity
Functionality is tested daily by staff using the equipment.
Nomenclature/Mapping
Mapping tables being created and reviewed for OLIS, Eclipsys Sunrise
Clinical Manager and Meditech. Semi-automated updating of table values in
Meditech. Change control forms ensure sign off from all parties when
changes are made.
Corrective Actions
Test suites are in place to define action on defect tracking and review of
interface engine error logs. Meditech support and defect tracking system
available to address issues.
Comments on Privacy &
Security
How SSHA Fits in the Picture
Controlled access to LIS, network firewalled.
Network connectivity provider.
71
11.16. Trillium Health Centre
Trillium Health Centre (Trillium)
As of August 2006
How OLIS Fits in the Picture
Trillium is an OLIS foundation adopter. Once implemented, clinicians can
access historical results from the OLIS data repository via historical lookups
from the Meditech LIS.
Critical Success Factors
Participation in OLIS foundation adopter program.
Funding.
Organizational buy in.
Benefits of This Initiative
Integration with OLIS for historical lookups will bring the following expected
benefits:
Contact Info
•
Reduce unnecessary duplicate laboratory testing
•
Provide timely access to patients’ laboratory records
•
Provide access to decision support and “best practices” information
•
Provide better data for policy analysis and business planning
•
Provide pseudonymous planning and management data
•
Provide access to research and analysis tools
Andre Bottis
Project Support Consultant, Information Technology
Trillium Health Centre
abottis@thc.on.ca
905-848-7580 x5725
72
Trillium Process Diagram
Electronic
connection
Manual/physical
connection
Clinician
OLIS Orders &
Results
Orders/results
Orders/results
Specimens
OLIS Database
Meditech Database
Historical Lookups
Orders/results
OLIS Viewer
Mississauga Site Lab
Queensway Site Lab
73
11.17. William Osler Health
Centre
William Osler Health Centre (WOHC)
As of August 2006
Lab Reform Region
Central West
Description
Internal information exchange using a single health information system
(Meditech) across multiple campuses.
Category
Single LIS Vendor/Single System Integration
Extent of Sharing
Full sharing of lab services between campuses.
Status/Timeframe
Implemented project.
Organizations Involved
WOHC consists of two hospital sites at Etobicoke, Peel Memorial and
shares services with Georgetown Hospital.
Governance Model
All sites are governed under one corporation.
Funding
Lab services are funded by one corporation.
Data Sharing Model
Full sharing of lab services between campuses.
Bi-directional exchange with HICL.
Sharing of pathology reports with CCO (not depicted)
Link to Diagram
Click here to view process diagram
LIS’s used
Meditech version 4.9. HICL uses a proprietary LIS.
HL7 Version
2.3
Network Connectivity
SSHA/VPN/Fibre
Nomenclature
ICD 10
QA
Data/Patient Identifiers
Bar-coding of all specimens except pathology.
Connectivity
Internal monitoring
Nomenclature/Mapping
Edits from one party are communicated with other – on going process.
Dictionary edits in Meditech take effect immediately after fully tested. They
are automatically incorporated or copied to new updates or releases
Corrective Actions
IT initiates a Help Desk ticket immediately upon notification of a
malfunction. This ticket is electronically updated as staff work to rectify the
problem. The electronic ticket is closed once the problem has been
resolved.
Comments on Privacy &
Security
LIS is password protected and access controlled. Regular audits are
conducted on firewall logs.
How SSHA Fits in the Picture
Network connectivity provider
How OLIS Fits in the Picture
TBD
74
11.17. William Osler Health
Centre
William Osler Health Centre (WOHC)
As of August 2006
Critical Success Factors
Bar-coding.
Funding.
Benefits of This Initiative
Reduction in transcription errors.
Broader availability of information.
Real time access to information.
Reduction in clerical time
Contact Info
Debbie Cock
William Osler Health Centre
debbie_cock@oslerhc.org
416-747-3400 x.32024
WOHC Process Diagram
Electronic
connection
Manual/physical
connection
Specimens
Clinician
Orders/results
Specimens
Orders/results
Meditech Database
Orders/results
HICL
Peel Memorial Site
Lab
Etobicoke Site Lab
75
Georgetown Site Lab