Enabling Technologies Strategic Plan

Enabling Technologies
Strategic Plan
2013 - 2016
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Champlain Local Health Integration Network
1900 City Park Drive, Suite 204
Ottawa, Ontario K1J 1A3
Tel:
613.747.6784
Toll-free: 1.866.902.5446
champlain@lhins.on.ca
www.champlainlhin.on.ca
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Table of Contents
Introduction .............................................................................................................................. 5
The Champlain LHIN Strategic Plan ....................................................................................... 6
Enabling Technologies Strategic Goals ................................................................................... 7
Progress on the 2009 eHealth Strategic Plan ......................................................................... 10
Environment ........................................................................................................................... 12
Guidelines .............................................................................................................................. 20
Strategic Goals and Tactics .................................................................................................... 25
Summary - Strategic Goals and Tactics ................................................................................. 37
Index ...................................................................................................................................... 38
Glossary ................................................................................................................................. 39
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Introduction
This Strategic Plan update was established
through a limited consultative process that
included:
•
Presentations by various stakeholders,
including eHealth Ontario, Canada
Health Infoway, OntarioMD, the
Champlain Primary Care Lead, the
Champlain CIO, and the Connecting
Northern and Eastern Ontario (cNEO)
project team, to the Champlain eHealth
Council on the work they have
undertaken.
•
Discussions with, and input from, the
Champlain eHealth Council and
Champlain CIO Committee
•
Input from various Champlain Local
Health Integration Network (LHIN)
staff and, guidance from the senior
management team
•
Input from various local health service
providers (Providers) including the
Champlain CCAC and primary care
physicians
•
Discussions with other LHIN Clusters.
This plan is an update to the Champlain
2009 eHealth Strategic Plan. You will
notice a number of changes when you
compare that plan to this one. The most
obvious change is the title: Champlain
Enabling Technologies Strategic Plan
replaces Champlain eHealth Strategic Plan.
This reflects the new focus on technology
as an enabler of many of the changes
contemplated for the health care system.
In addition, this plan tucks under the
Champlain LHIN Integrated Health Service
Plan 2013-16. As a result, there is a strong
alignment between the strategies of the
Champlain LHIN’s Integrated Health
Service Plan (IHSP) 2013-16 and the
strategic goals of the Champlain Enabling
Technologies Strategic Plan.
As the Champlain LHIN’s focus shifts to
community, Health Links, and primary
care, we shifted the focus of Champlain
Enabling Technologies to include more
work with primary care.
Some changes were minor. The Champlain
Enabling Technologies Strategic Plan
(Plan) confirms and updates the guidelines
established in the previous plan. These
guidelines will:
•
Continue to be followed during the
rollout of the various initiatives
established by the previous plan, and
•
Be used to guide new projects
envisioned as part of the Plan.
Originally, these guidelines were carefully
and thoughtfully established to:
•
Ensure equitable and fair treatment of
all participants
•
Help in the selection of priorities, and
•
Align thinking.
In short, the Plan explains where we will
place our resources and attention and, most
importantly, why. The new Plan is not all
encompassing but it will:
•
Move the enabling technology agenda
forward
•
Support improved quality of care, and
•
Ensure alignment with the LHIN and
provincial visions.
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The Champlain LHIN Strategic Plan
Vision:
Healthy people and healthy communities
supported by a quality, accessible health
system.
Mission:
Building a coordinated, integrated and
accountable health system for people where
and when they need it
Strategies:
•
Build a strong foundation of integrated
primary, home and community care
•
Improve coordination and transitions of
care
•
Increase coordination and integration
of services among hospitals.
These strategies appear to be distinct areas
of work. In fact, they are connected and
interdependent parts of one, integrated
health care system. In alignment with the
LHIN’s strategic plan (Champlain LHIN
Integrated Health Service Plan [IHSP]
2013-16), Enabling Technologies will help
us create, strengthen, and enable an
integrated health care system.
The IHSP sets out a vision and direction to
achieve a person-centred integrated health
care system. The Champlain LHIN sees
improving integration of services as key to
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this. That is why “integrated care”,
coordinated care” and smooth “transitions
of care” are common themes throughout the
IHSP.
An integrated primary, home and
community care sector is essential to
achieving the mission because over 90% of
a typical resident’s interactions with the
health care system occur within the
primary, home, and community care sector.
This IHSP’s tactic to start geographically
based Health Links will move the system
toward the ultimate vision.
In all likelihood, information technology
will enable many of the goals identified in
the IHSP. Geography and institutional
boundaries
can
prevent
important
information in the hands of one health
service provider (Provider) from getting
into the hands of another who is trying to
help support a client in need. The result of
this “information gap” is that the quality of
health care suffers. The old adage that
quality health can only occur when “the
right information is given to the right
person at the right time” remains true.
These three IHSP strategies are a
cornerstone of the Plan (see page 9 for
linkages between the two).
Enabling Technologies Strategic Goals
and sharing information but not to the
degree needed for the type of coordinated
patient care contemplated. The aim is to
reduce this fragmentation. Like the health
care system, the patient record is
fragmented, with different pieces of the
record being held by individual Providers.
The Strategic Goals below form a
framework onto which we align our
projects. In addition, they provide focus
and continuity to the work. The Plan’s
goals are to:
1) Build a regionally shared electronic
health record (EHR), using Ontario’s
defined dataset as its foundation
2) Build an electronic infrastructure that
enables
improved
collaboration,
coordination, and transitions of care
to occur effectively and efficiently
3) Undertake initiatives to enable
coordination and integration of
services among hospitals
4) Undertake initiatives that build a
strong foundation of integrated
primary, home and community care
5) Examine project, program and
services management, operational
funding, and, possibly, governance as
we move the Enabling Technologies
Plan forward.
EHR projects aim to reduce this
fragmentation. EHR projects gather
information from a number of different
providers and allow providers to view the
combined data. The projects underway in
Ontario are significant steps toward
organizing the health data around the
client and eliminating the historical
barriers of geography and institution.
EHR projects are foundational enabling
all parts of the health care system to
operate effectively.
Health care workers and employees of
providers are primarily knowledge
workers. They are at their best when they
can share information. As such, they need
to be able to share best practices, consult
with one another, and help people
securely navigate the health care system.
The Champlain Collaboration Space
initiatives, such as the interagency
referral information system, non-urgent
transportation tool, and shared mental
health screener, move us in the right
direction. This Plan confirms its expanded
use across the community and primary
care sectors, in support of Health Links
and primary care health hubs.
Although greatly improved from what it
was years ago, the health care system
remains fragmented. The players are
becoming accustomed to working together
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In 2009, we set a target of integrating
services in the hospital sector. One
hospital-based
integration
project
exemplifies what is possible: the
Champlain Association of Meditech
Partners (CHAMP).
Today, CHAMP consists of seven
hospitals moving to a shared electronic
patient record and Level 6 on the HIMSS
Analytics electronic patient record scale.
The HIMSS Analytics scale provides an
objective method to evaluate the progress
and impact of electronic patient record
(EPR) systems for acute care delivery
environments. Only four hospitals in
Canada have been certified at Level 6,
none of them is in a shared environment,
so, the CHAMP hospitals will become
leaders in Ontario, perhaps Canada. From
a patient’s perspective, this makes the
group of hospitals seem totally integrated.
home and community care have become a
priority for the Ministry and the LHINs.
Recently,
the
Champlain
LHIN
commissioned a Champlain Community
Sector Alignment study. That project has
set the vision and direction for integration
within the Community Support Services
(CSS) sector and between the sector and
the CCAC. Similarly, Champlain has
moved to establish Health Links and work
with primary care on a new direction for
patient care. The Enabling Technologies
projects identified here will enable the
vision.
Finally, all of the Enabling Technologies
initiatives are complex from a governance
perspective.
Initiatives,
like
the
Diagnostic
Imaging
and
Clinical
Document Repository, are especially
expensive and complex from a
governance, management, and ongoing
funding perspective because they include
multiple providers, funders and LHINs.
Complicating the analysis and decisionmaking is the fact that the cost of these
systems may come to one sector, while
another sector derives the financial and
patient care benefits.
Residents of Ontario have clearly said that
they would prefer to receive services in
the home, whenever possible and
appropriate. The Ministry of Health and
Long-Term Care (Ministry) recognizes
that not only is this good for the resident,
it is good for the health care system.
Services provided at home are an
excellent lower cost alternative to hospital
or institutional care. As a result, primary,
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More than ever, interdependencies among
providers increase the need to evaluate
sustaining
strategies,
governance
structures and establish new ones that suit
the new integrated system. Like EHR
projects, governance is foundational to
organizing the system effectively.
The graphic on the next pages shows the
alignment between the goals of the IHSP
and those of the Enabling Technologies
Plan. In addition, it shows the connection
with the electronic health record and
governance.
Strategic Alignment: IHSP 2013 - 16 and Enabling Technologies Plan
Integrated Health Service Plan Strategies
Build a strong foundation of
integrated primary, home
and community care
Improve coordination and
transitions of care
Increase coordination and
integration of services
among hospitals
Undertake initiatives
that build a strong
foundation of
integrated primary,
home and community
care
Build an electronic
infrastructure that
enables improved
collaboration,
coordination and
transitions of care to
occur effectively and
efficiently
Undertake initiatives to
enable coordination
and integration of
services among
hospitals
•
Build a regionally shared electronic health record, using Ontario's defined dataset as its
foundation
•
Examine project, program and services management, operational funding, and, possibly,
governance as we move the Enabling Technologies Strategic Plan forward.
 Enabling Technologies Strategic Plan Goals 
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Progress on the 2009 eHealth Strategic Plan
Strategy
Progress
We will build a
regionally shared
eHealth record, using
eHealth Ontario’s
dataset as its
foundation.
• eHealth Ontario cancelled the Diabetes Registry in 2012.
• eHealth Ontario completed development of the Ontario Laboratory information
system and is now implementing the service across Ontario.
• eHealth Ontario stopped the Drug Information System project and is reviewing their
strategy.
• The LHINs and hospitals completed the Diagnostic Imaging Repository project in
2012.
• eHealth Ontario continues to plan the portal and HIAL strategy for Ontario.
• Champlain and the South East LHIN completed the development of the Clinical
Document Repository. 16 hospitals, as of Nov 2013, are now contributing
documents to it. Links to physicians EMRs are now being planned.
We will build an
electronic
infrastructure that
allows information
sharing,
collaboration, and
communication to
occur effectively and
efficiently.
• The Collaboration Space, also called LHINWorks, and associated services
established (2009).
• Scheduling of ER time, orphan patients et at Winchester (2009)
• Critical Care Physicians pandemic planning support (2009)
Milestone 1,000 users
• Concurrent disorders screening for mental health and addictions (2010)
• CHEO – regional patient tracking system (2010)
• DRCC support for diabetes management (2010)
• eConsult pilot start (2010 )
• Champlain region -wide non-urgent transportation scheduling support (2011)
• Regional Chiropody referral and booking (2011)
Milestone 2,000 users
• EORLA lab activity reporting for all hospitals (2012)
• LYNC services introduced and federated with Sick Kids Hospital, Cancer Care and
CCACs across Ontario (20,000 users) 2012
Milestone 4,000 users
• EORLA introduction of dashboards and live on-line reporting for all hospitals
• Incident Tracking System introduced (2013)
• Regional retinopathy solution introduced (2013)
Milestone ~6,000 users in 2013
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Strategy
Progress
We will undertake
initiatives to improve
productivity and to
integrate health
services.
• Champlain Association of Meditech Partners (CHAMP) formed (2010).
• Bruyère goes live in the shared environment. (2012)
• Queensway, Carleton Place and Arnprior go live in the shared environment. (2013)
• Montfort Hospital joins the partnership. (2012)
• Glengarry Hospital joins the partnership (2012)
• CSS, LHIN, and CCAC agencies complete review of CSS sector value stream
mapping proposing the creation of a shared client information system service for
the CSS sector. (2010)
• CSS sector forms a project to implement a shared client information system.
(2011)
• 30 agencies ask to join the shared client information system project (2012)
• CSS sector rolls out the InterRAI CHA to all agencies in the sector (2013)
Examine project,
program and
services
management,
operational funding,
and, possibly,
governance as we
move the Enabling
Technologies Plan
forward.
• Project and program governance is introduced into all regional projects (2010)
• The CHAMP participants agree to begin discussions on shared services
governance (2010)
• CSS sector shared service agrees to shared service governance structure (2012)
• Governance and sustainment funding remain an outstanding issue between
eHealth Ontario and the LHINs.
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Environment
4) Champlain LHIN and its IHSP 2013 –
16, representing regional health care
system priorities
Northern &
Eastern Ontario
Cluster
Champlain
LHIN
Canada Health
Infoway
Enabling
Tech
Strategic
Plan
Ministry of
Health &
LongTerm Care
eHealth
Ontario
Over the past four years, the health care and
digital health environments have undergone
significant change. A number of lead
agencies have considered their progress and
established new plans to carry them
forward.
Where possible and appropriate, the Plan
will align with the directions set by those
lead agencies’ strategic plans or stated
direction. This Plan will align with:
1) Canada Health Infoway and its recently
released Opportunities for Action: A
Pan-Canadian Digital Health Strategic
Plan, representing the national
direction
2) Ministry enabling technologies and
health care services strategic priorities,
representing Ontario-wide priorities
3) eHealth Ontario and its eHealth
Blueprint and reference architecture,
representing the existing provincial
eHealth priorities
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5) Directions set by the Northern and
Eastern Ontario (NEO) Cluster.
Aligning with these will keep us focused,
eliminate unnecessary or duplicate effort,
and reduce distractions.
1) Canada Health Infoway
Opportunities for Action: A Pan-Canadian
Digital Health Strategic Plan. Much of
Infoway’s work over the past decade has
concentrated on digital health investments
in EHRs and point-of-care systems or
electronic medical records (EMRs) for
clinicians. Six years ago 22% of Champlain
physicians had EMRs, today over 75% have
them. This provides an excellent foundation
for integrating primary care physicians into
the rest of the health care system. The
Champlain
Enabling
Technologies
Strategic Plan will build on this foundation.
From InfoWay’s perspective, the next
logical step is to accelerate the areas that
will improve the overall patient experience,
because they:
•
Create better transitions through the
system
•
Foster better communication between
patients and providers in all care
settings
•
Provide easier access. Assist Canadians
to have a more convenient healthcare
experience, with reduced wait times, by
using enabling technologies solutions to
better interact with their healthcare
team and navigate the healthcare
system. Technologies may include tools
to
support
patients
renewing
prescriptions, scheduling visits to
physicians, or navigating the health
care system.
Infoway developed the strategic plan in
consultation with more than 500 Canadians,
clinicians, government and healthcare
administrators, national associations and
digital health vendors, who were asked to
identify priorities that health enabling
technologies could best support. Six broad
themes emerged describing healthcare
priorities over the next several years, and
from these themes, five opportunities for
action were developed:
•
Support new models of care. Continue
to expand the deployment and use of
EHR, EMR and other point-of-care
solutions into all care settings to
enable person-centred care and
continuity of care, including, but not
limited to, chronic disease management.
Technologies may include EMR, EHR,
referral
management,
discharge
summaries, care transitions, chronic
disease management, telepathology.
Bring care closer to home. Using
mobile patient monitoring solutions,
coupled with other consumer health
solutions, seniors and other patients
with chronic diseases will be able to
monitor their own health conditions
from their home or within their
community. Technologies may include
Patient monitoring solutions, personal
health records and other consumer
health solutions.
•
Improve patient safety. Accelerate the
deployment of medication management
to reduce preventable medical errors.
This may require the enhancement
and/or replacement of many aging
hospital information systems in
the acute care setting. Technologies
may include electronic prescriptions,
computerized physician order entry,
closed-loop medication management, or
medication reconciliation.
•
Demonstrate the importance of quality
by supporting continuous improvement,
and
•
Create better value by supporting
evidence-based care.
The recently announced plan outlines the
healthcare priorities that digital health
solutions can best support over the coming
years, and identifies key opportunities for
action.
•
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Enable a high-performing health
system. Accelerate the deployment of
analytics solutions to support the
creation of information and evidence
for clinical and administrative decision
making in the quest to create a highperforming health system across
Canada. Technologies include clinical
analytics and evidence development and
use for clinicians, analytics to support
LEAN, population health, research,
planning, operations and evaluation.
With 9,200 primary care physicians
practicing family medicine in Ontario,
almost 1,000 primary care contracts, and a
myriad of payment and funding models,
coordination is a challenge. LHINs are
accountable for Community Health Centres
across the province, and engage other
primary care models through various less
formal means (for example, networks,
councils, and advisories). This complicates
the efforts to coordinate and align the health
care system.
In the next three years, the Plan improves
patient safety with computerized physician
order entry, closed loop medication
management, and medication reconciliation
through elements of the CHAMP project
and initiatives with the small hospitals. The
Infoway Plan will open the way to
initiatives directly involving patients and
their interaction with the health care
system, perhaps later in this plan or in the
next Champlain Enabling Technologies
Strategic Plan.
As a result, primary care remains one of the
largest sectors in the system that lacks
adequate alignment to the rest of the
system’s structures and organizations.
•
2) Ministry: Ontario Action Plan for
Health Care and Health Links
The Ontario Action Plan for Health Care
(Action Plan), released in Jan 2012,
highlights the improvements in the
integration of the health care system at the
provincial level. It recognized the need for
further integration reform in the primary
care sector. The Action Plan indicates that
the LHINs will be more accountable for
primary care planning.
More recently, the Ministry and 14 LHINs
recognized that our system needs to
improve its support for patients with
multiple chronic conditions to transition
well across levels of care.
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The lack of adequate alignment shows itself
in a number of ways:
• Individual solo practices, or small group
practices, work in isolation
• Primary care physicians have limited
formal linkages with the hospital sector
• Primary care physicians have limited or
no formal linkages with community
health organizations (i.e., Community
Care Access Centres)
• Limited
integration
of
health
information, thereby, further isolating
primary care.
In Dec 2012, the Ministry announced the
formation of voluntary Health Links or
patient care networks. They are a new
model of care - at the clinical level - where
all providers in the community, including
primary care, hospitals, and community
care, are charged with coordinating
individual patient care plans for people with
very complex needs. Health Links will be
designed around, and accountable for,
system level metrics established by the
province.
Health Links may look different across
regions, but their formation will be based
on a sound framework with specific
principles, including:
• Person-centred planning with strong
mechanisms in place for the patient
voice to be heard
• Building
on
existing
delivery
organizations and existing best practices
• Joint accountability for attainment of
results
• Common targets and metrics
• Evaluation built into the design.
In the medium term, the LHINs will
identify Health Links ready to proceed
based on specific criteria including the
results of a readiness assessment. Once a
HealthLink is approved, it will be required
to develop a business plan and will be held
accountable to achieve targeted results.
example, all Health Links mentioned the
need to identify the target population they
will be serving on an ongoing basis. This
Plan will address many of those challenges.
3) eHealth Ontario: eHealth Blueprint
and Strategy
Every province in the country has aligned
with the Canada Health Infoway’s
Electronic
Health
Record
Solution
Blueprint. Ontario’s eHealth Blueprint,
developed in 2006, was based on this
national architecture.
The Ontario architecture, included in the
eHealth Ontario Blueprint, provides an
overview of the pieces of the EHR and
principles to guide the development of
Ontario’s eHealth projects. The Blueprint
prepares the ground for the declaration of
information and technology standards.
These
information
and
technology
standards aid information sharing and, as a
result, should be complied with by any
organization wishing to support Ministry or
eHealth Ontario strategies.
There is a significant enabling technologies
challenge facing us with the establishment
of Health Links. So far, all of the Business
Cases highlight the need for information
to support patient and shared case
management, and decision support. As an
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The provincial Drug Information
System Project is presently undergoing
a review by eHealth Ontario and the
Ministry.
•
Below are the components of the EHR and
status of the projects as of the start of fiscal
2013-14:
•
Private and public sector lab test
results: The provincial Ontario Lab
Information System (OLIS) will contain
the laboratory data. At this point, OLIS
contains almost all of the private lab
data. eHealth Ontario and the Ministry
would like to see laboratory data from
hospitals added to the repository before
the end of fiscal 2015-16.
OLIS is available in three Champlain
hospitals. A limited further expansion
across the Champlain LHIN is planned
for fiscal 2013–14.
•
16
Drugs dispensed by retail pharmacies
and hospital pharmacies: The present
Ontario Drug Benefit database with its
Drug Profile Viewer is capable of
providing drug histories on 25% of
residents that account for more than 5060% of drugs dispensed. It has been
available to all of the hospitals in
Ontario for several years.
Radiology images and notes: These
repositories house X-rays, CT and MRI
images, as well as, images from
other modalities, and associated
radiologist reports. In Champlain, the
implementation included the ingestion
of images into local picture-archive
communications systems, and a small
pilot with primary care physicians. The
repository has been operational for
some time; these latter components are
nearing completion now.
eHealth Ontario will lead the project to
integrate the four repositories’ data
across Ontario. The Champlain LHIN
was heavily involved in this project.
•
Discharge instructions and specialist /
medical notes: The Champlain and
South East LHINs were the first to build
a clinical document repository to house
this type of information. It has been
functioning for two years, and recently
received funding to expand to other
hospitals in the two LHINs and the
primary care physicians’ EMRs.
By the end of November, 16 hospitals
were connected into the Clinical
Document Repository with four more
planned for December of 2013.
The clinical document repository will be
one of the data sources for the EHR.
•
cNEO – Portal and Portal Service:
Over the past two years, eHealth
Ontario has been working with its
delivery partner, The Ottawa Hospital,
Providers and the LHINs to plan for the
establishment of a portal and portal
related services to serve the Champlain,
Southeast, Northeast, and Northwest
LHIN Providers. The planning phase of
this project is nearing completion.
•
Ontario and Standards: Both the
Ministry and eHealth Ontario are
committed to building applications that
are compliant with international data
and interface standards (such as HL7
and DICOM). The Plan commits to
align with these published standards,
wherever possible. This alignment
reduces the cost of building interfaces,
increases the ease of integration, and
ensures that a number of vendors are
capable of providing support to the
vision.
As an example, the Clinical Document
Repository
is
compliant
with
the published Clinical Document
Specification, the EMR Spec 4.1a and
the Discharge Summary Standard.
4) Champlain LHIN IHSP 2013-16
According to the Local Health System
Integration Act, 2006, the LHINs were
established in an environment where
Ontarians and the Ontario government
confirm their commitment to the six
principles of the Canada Health Act. The
Local Health System Integration Act, and
associated regulations, requires all LHINs
to create an IHSP every three years, and to
do so through consultation with local
communities.
17
The Champlain LHIN IHSP 2013-16 builds
on previous IHSP successes and establishes
a solid alignment with the recently
published Ontario Action Plan for Health
Care.
•
More
seniors
are
cared
for
in their communities: The population
in Ontario is aging and living longer,
many with multiple chronic conditions.
This area focuses on ensuring that
Providers know the senior’s care plan
and that they are receiving care in the
most appropriate setting for their needs,
often at home or in the community.
•
More people with complex health
conditions are able to manage their
conditions: These individuals often
need to access services from multiple
providers. This area strengthens the
healthcare system’s ability to ensure
smoother transitions for patients among
providers.
•
More people at end-of-life, families
and caregivers receive palliative care
supports in their setting of choice:
These individuals need to know what to
expect and how to handle changes in
the patient’s condition. They also need
to receive the appropriate support to
live the remainder of their lives in the
setting of their choice.
The IHSP 2013-16 focuses on six Key
Result Areas:
•
•
•
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More people are involved in planning
their health services: This involves
including people as partners in
planning their personal care, and
engaging people in health care system
planning. As the IHSP suggests,
engaged people tend to have better
health outcomes and involving people is
essential to a person-centred, integrated
system.
More people receive quality, evidencebased care: This includes a focus on
access,
whether
managing
and
monitoring wait times for specific
diagnostic procedures, treatments and
services, or increasing the percentage
of the population with access to a
primary care provider. It also involves
a focus on patient safety and quality of
care.
More people with mental health
conditions and addictions have access
to services: This involves addressing the
growing crisis in our society of mental
health and addictions, particularly
among the youth, Aboriginals, and the
Francophone population. It will do this
by focusing on improving the transitions
of care for people from youth to adult
services and strengthening the links
between providers to help people move
from one service to another.
As described on pages 5 through 7 and
shown on page 8, the Champlain
Enabling Technologies Strategic Plan
enables a number of strategies set by
the IHSP.
5) Introduction of the Northern and
Eastern Ontario Cluster
Implementing projects in Ontario is a
complex balance between managing risk
and attaining efficiencies, which often can
come from economies of scale.
As mentioned earlier, project risks increase
with the number of partners, scale of the
project, number of users, and diversity of
needs being satisfied by the project. This
explains why centralized, provincially run
projects are at highest risk. Locally funded,
managed, and scaled projects have the least
risk, but are the most difficult to oversee
centrally.
eHealth Ontario and the Ministry asked the
LHINs to form “clusters” of between four
and six LHINs to provide a balance
between many, low-risk, small projects and
a few, very large, and risky provincial ones.
This request was a result of the successful
implementation of projects like the Clinical
Document Repository, Diagnostic Imaging
Repository, and Integrated Assessment
Record, and the difficulties of moving
forward provincially-scaled projects. This
approach decreases the challenges of
managing many, small, local projects and
linking them together to create a cohesive
whole. Provincial standards, published by
eHealth Ontario, will be adopted by the
clusters to ensure inter-operability between
projects, wherever possible and practical.
The Northern and Eastern Ontario (NEO)
cluster consists of the Southeast,
Champlain, North East, and Northwest
LHINs. The Champlain LHIN is the NEO
cluster lead. There are presently three
clusters in Ontario with similar, but not
identical, approaches to governing clusterbased projects.
An Integration Alignment Council,
consisting of the LHIN CEOs and CIOs,
provides the governance and oversight for
the regional projects. eHealth Ontario,
delivery partners, and others are invited to
the meetings to provide input and advice.
19
Guidelines
The nine guidelines below were developed
in the original Champlain eHealth Strategic
Plan. After review, they will be kept mostly
intact.
As mentioned in the 2009 version, these
guidelines should not change because of
varying business circumstances, altered
short-term goals, the introduction of new
strategies, or any adjustments in senior
management. As also indicated previously,
as long as the strategic goals are alive, the
guidelines will keep us on the right path.
These guidelines represent a philosophy
that will guide decision-making throughout
the life of this strategic plan. The strategic
goals will be achieved if we implement
planned initiatives, and remain open to new
ideas.
Guidelines ensure consistency in our
approach to funding projects, while
allowing us to take advantage of
opportunities that were unforeseen when
the Plan was written.
The guidelines
categories:
align
to
three broad
•
National and provincial direction
•
Champlain LHIN strategic priorities,
and
•
User support and engagement.
20
1) Compliance with national and
provincial direction
•
Projects will abide by eHealth
Ontario’s Blueprint. There is a national
strategy for health care set by the
provincial and federal Ministers of
Health. The Ontario Ministry adopted
the national priorities, and modified
them in response to provincial
conditions. These Ontario priorities, in
turn, are the priorities of the LHINs and
Providers that they fund.
Funding is designed to align with
strategy and direction. Similarly,
Ontario’s eHealth Blueprint aligns with
the national blueprint developed
through a consultation process by
Canada
Health
Infoway.
The
architecture defines the end-state or
final EHR vision for our province.
eHealth Ontario will articulate the
roadmap to that end-state. Alignment is
important to cost-effectively improve
the quality of people’s care.
Although some projects may deviate
from the architecture for pragmatic
reasons, initiatives in the long term
should align with it.
•
All projects will abide by Ministry
procurement policies. The Ministry,
eHealth Ontario, LHIN's, and Providers
are required to abide by these various
policies. Initiatives funded by these
parties will abide by the same rules.
•
All regional projects will be subject to
a Privacy Impact Assessment. Any
project funded by Canada Health
Infoway is required to undergo a
stringent Privacy Impact Assessment.
eHealth Ontario has moved in the same
direction. Anywhere information is
being shared; best information sharing
practices must be available. Privacy
Impact Assessments help make this
happen.
The Assessment ensures that the
integrated solution, including the people
involved in using the tool, is compliant
with Ontario privacy best practices and
privacy legislation. Ontarians want to
know that their personal health
information is being protected; their
trust in their Provider depends on it.
•
Regional initiatives will comply with
the Local Health System Integration
Act, 2006. Most of the projects
contemplated by the Plan have a
solution that requires a shared services
or integrated structure to maintain. As
an example, the Champlain Alliance of
Meditech Partners (CHAMP) project
involves the formation of a governance
structure involving seven hospitals,
signed contracts and an exchange of
money.
The Local Health System Integration
Act, 2006 provides a notification and
approval framework under which this
can happen. According to the
legislation, anytime more than one
Provider is involved in service
integration, the LHINs must be notified
of their intent. We expect further
Voluntary and Facilitated Integrations
to occur in the coming years.
Failure to meet this standard jeopardizes
peoples’ trust, increases the probability
that a privacy breach will occur, and,
most certainly, will result in a funding
holdback.
21
2) Alignment with Champlain LHIN
strategic priorities
•
3) Alignment with user support and
engagement
Initiatives that support the Champlain
IHSP will be funded as a priority. The
IHSP sets the priorities for the LHIN,
and ensures alignment with provincial
priorities.
At its core, the IHSP focuses on
building a person-centred, integrated,
and sustainable local health care
system.
Although this guideline is not exclusive,
the Plan recognizes that communitybased enabling technologies initiatives
focused on the Key Result Areas
highlighted in the plan
Initiatives that focus on achieving IHSP
strategies will be considered higher
priority than those that do not.
•
Alignment with Champlain’s published
standards and compliance with service
accountability agreements. From time
to time, the Champlain LHIN may
publish standards and ask that all
Providers work by those standards.
Although Providers may not be required
to abide by the published standards, we
commit that all enabling technologies
initiatives will comply with the relevant
ones.
Accountability
agreements
are
contracts. As such, all Providers are
required to comply with them.
Similarly, any enabling technologies
initiatives involving those Providers
must comply with those accountability
agreements.
22
•
Projects will have wide support from
users. The quality of health care
provided is at its best when Providers
cooperate and work together toward
common goals. Additionally, we know
that the implementation and adoption of
enabling technologies services goes
more smoothly and with a higher degree
of success when those Providers are
intimately involved in the selection of
the systems that they will use or will be
impacted by.
The Local Health System Integration
Act, 2006 recognizes the importance of
stakeholder engagement. It requires that
all Providers consult with stakeholders
before making major changes to
services.
Transparency
and
stakeholder
engagement are principles that will be
used to guide the work of all enabling
technologies initiatives, and provide a
foundation for support and increased
success rates on projects. Although
wide support from Providers is
required, unanimity is not.
•
Initiatives will provide measurable
benefit to the majority of participants.
The Plan will result in projects that
make the overall health care system
more effective and/or more efficient.
First, we will look for initiatives that
focus on improving the IHSP target
populations’ health status, their
experience with the health care system,
or the performance of the system as it
relates to the interactions with the target
populations. Second, we will look for
initiatives that contain administrative or
other costs.
However, these projects will not affect
everyone in the same way. Projects will
benefit some providers more positively
than others. This is a reality of our
diverse health care system and the type
of projects that we will undertake in the
coming years as the health care
system matures.
Individuals’ personal circumstances
influence how they perceive the relative
merits of certain benefits, too. The Plan
assumes that Providers will not
necessarily perceive projects as
equally beneficial to all participants.
Nevertheless, it is important that we
commit to win-win outcomes, wherever
and whenever we can.
•
Initiatives
will
present
a
realistic opportunity for measurable
implementation
success.
Before
embarking on any enabling technology
project, it is important to be sensitive to
the probability of success.
Consultants, the press, and researchers
are quick to point out that large-scale
enabling technology projects have a
high failure rate, as high as 75%.
Enterprise Resource Planning projects
(ERP) are particularly prone to failure.
In 2001, the Conference Board survey
of 117 companies found that 40% of the
ERP projects failed to achieve their
business case within a year of going
live. The same survey found that ERP
implementation costs were typically
25% over budget and ongoing costs
were typically underestimated by an
average 20%.
Similarly, health care is littered with
large-scale projects that were late,
significantly over budget, or failed to
produce the results envisioned at the
beginning.
23
Below are some principles that improve
the chances of success in health care:
24
•
The benefits of the implementation
must justify the cost, time, and
resources spent doing the work.
•
The project risks must be captured,
defined, and understood. Risk
management
and
change
management are keys to success for
large-scale and complex health care
projects.
•
The ongoing funding needs of the
project should be thought through
before starting.
•
Wherever possible applications
should be purchased, not developed.
Many vendors exist in the health
landscape and they have products
that are financially supported by a
multitude of customers. Except for
unusual circumstances, it is more
cost effective to buy than build.
Providers should not be software
developers.
•
An architectural and standards
review should be completed on a
project. This helps reduce project
risks by aligning the project work
with tested best practices.
•
Starting with pilots and small-scale
projects can be a lower risk and
lower cost, way to learn what is
needed before tackling large-scale
projects.
•
Project management best practices
and project methodologies can turn
an average project manager into an
excellent project manager and
significantly reduce the risks on
projects.
Strategic Goals and Tactics
This section gives a detailed description of
each strategic goal, and the tactics to
achieve it. The descriptions help the reader
understand
the
Champlain
LHIN
environment into which projects must fit.
Strategic Goal 1:
Build a regionally shared EHR using
Ontario’s defined datasets as its
foundation.
According to Ontario’s existing eHealth
Blueprint, the EHR consists of domain
repositories:
•
Drug histories
•
Laboratory test results,
•
Images and radiologist reports
•
Immunization history
•
Discharge instructions and specialist
notes, and
•
Shared health profiles, which include
basic information on chronic diseases.
Much has changed since that list was
developed.
The percentage of physicians in the
Champlain LHIN with EMRs has grown
from 22% in 2007 to approximately 77%
today. This change has altered the healthcare technology landscape and caused the
players to rethink components of the
provincial strategy. As an example, all
physician EMR Systems have chronic
disease management features. This could
make externally provided chronic disease
management systems redundant, for them.
In addition, physicians and other authorized
health care providers with electronic
clinical management systems (Community
Health Centres and Family Health Teams
included) have emphatically stated that they
do not want to log on to multiple systems to
look at their client's health record.
Integration has become the new focus.
Clinicians want to log on to their own EMR
and practice management system and see
all the relevant information on the client.
Therefore, these systems must be able to
interface with provincial clinical datasets.
The provincial architecture includes
publishing of standards such as EMR Spec
4.1a, which allows clinical management
systems to upload data from the provincial
data repositories and present that data in a
format that is familiar to physicians.
Finally, since the previous Champlain
eHealth Strategic Plan was published in
2009, most EMR vendors are becoming
compliant with the provincial interface
standards. This opens the opportunity to
integrate data directly into them.
25
The hospital sector in the Champlain region
is complex and evolving, too. A number of
institutions have their own electronic
patient records. More hospitals are planning
to purchase them as part of their hospital
information system. Hospital clinical staff
does not want to log onto multiple systems
to see their patients’ electronic health
information.
The EHR Strategy in Ontario is evolving.
Strategic Goal 1 Tactics
Where appropriate, tactics requiring
funding are flagged as Planned (unfunded),
Partially Funded, or Funded.
We will:
1) Work with the Eastern Ontario
Regional Lab Agency to ensure that
Champlain LHIN hospitals will
contribute to the Ontario Laboratory
Information System by 2015. Funded
2) Work collaboratively with the cNEO
project team to evolve the portal
strategy in the Northern and Eastern
Ontario Cluster. Funded
3) Work with the South East LHIN to
complete the clinical document
repository and integrate the documents
into the EMRs of physicians across the
two LHINs. Partially Funded
26
4) Explore expansion of the clinical
document repository to include regular
client update reports and discharge
reports produced by community nursing
partners and CCAC case managers.
Planned
5) Work with the mental health and
addictions service providers to identify
what enabling technologies changes
they need. Planned
6) Build a system that will support the
regional Champlain Hospice Palliative
Care Program, and the referral of
clients to this service. Partially Funded
7) Explore the value of a patient portal in
Champlain. Planned
Strategic Goal 2:
Build an electronic infrastructure
that enables improved collaboration,
coordination and transitions of care to
occur effectively and efficiently.
•
Every activity undertaken in health care
requires a document or form to initiate
the service and a method to track and
respond to those documents. There are
many forms!
Health care workers are primarily
knowledge workers. As such, they need to
be able to share information with each
other, to consult with one another, and to
help their clients or patients navigate the
health care system. Moreover, this
collaboration cannot be constrained by
technology. As an example, a telephone is
not a good collaboration tool for physicians
and specialists because their schedules are
tightly controlled, and do not allow for
interruptions.
•
Health care workers want systems that
are customized for their specific needs,
and adjust to their changing practices.
Collaboration requires a fluid and highly
flexible environment. Social networking
and collaboration tools on the Internet are
examples
of
this
highly
flexible
environment; however, existing web
services cannot be used for clinical
collaboration because of the perception of
insufficient
security
and
privacy.
Additionally, there are issues with the
existing health care landscape that make
collaboration a challenging and inefficient
activity, such as:
•
The Champlain LHIN Collaboration Space,
also called LHINWorks, built in 2009
provides a solution that addresses these
issues. It was designed for collaboration
between external organizations and
individuals, and the platform provides a
secure and scalable environment.
The existence of such an environment is a
tremendous step forward in facilitating
collaboration among health care providers
in and beyond the region, and has enhanced
productivity in a number of areas.
Hospitals and community organizations
are separate enterprises with internal
systems and tools that do not lend
themselves to collaboration with
external organizations or individuals.
27
There are currently running a large number
of initiatives leveraging the Champlain
Collaboration Space to address existing and
anticipated needs in our region. Examples
include:
•
Web-enabled dashboards and reporting
tools that are used by the Eastern
Ontario Regional Lab Agency to track
their laboratory activity at each of the
LHIN hospitals.
•
Repositories used by project staff to
share documentation and best practices
related to project management,
•
An access point for physicians to
coordinate their on-call schedules,
resource room booking, and contact
lists with one another.
•
An infrastructure that allows CCAC and
community support services agencies to
manage referrals for Adult Day
Services.
•
An electronic form to help physicians
screen and refer clients for specialized
services and aid in their transition in
care.
After three years, the Collaboration Space
has grown. Staff in most, if not all,
LHIN-funded Providers are now using it.
Furthermore, the usage continues to grow,
as new ideas come forward. From a small
service serving 23 physicians, the user base
has grown to 6,000 users (Nov. 2013)
within and outside the Champlain LHIN.
Almost two years ago, the Champlain
LHIN added online instant messenger and
sharing service. Through a cooperative
effort with other organizations, the
Champlain service provides access to over
20,000 people across Ontario including
Sick Kids, Cancer Care Ontario, CCAC
Staff and other LHINs’ employees.
Strategic Goal 2 Tactics
Where appropriate, tactics requiring
funding are flagged as Planned (unfunded),
Partially Funded, or Funded.
We will:
1) Facilitate regular interaction among
key organizations in the LHIN to
dialogue, share ideas, create and share
tools
using
the
Champlain
Collaboration Space. This will drive
benefits for all participants, and attract
new participants.
2) Define, plan, and implement new
initiatives using a focused and limited
scope at the outset, an agile approach,
to allow for tangible quick results with
low cost.
28
3) Establish and participate in forums to
share ideas with other LHINs, LHIN
Shared Service Office, and other
Ministry Providers to maximize the
collaboration benefits and establish
standards.
4) Leverage existing assets in the region
and province and by driving
“federation”, thus providing a seamless
environment
across
multiple
organizations / regions. Planned
5) Work with the Champlain CCAC to
expand the LHIN Collaboration Space
and integrate it more fully into the
CCAC’s Client Health Related
Information System (CHRIS) and the
CSS sector’s shared client information
system as a mechanism for referral of
clients to and from the CSS sector.
Planned
6) Continue to expand the Champlain
Collaboration Space to improve
efficiency concerning communication
with, and referrals to, specialists.
Partially Funded
collaboration spaces, enabling multiLHIN collaboration. Planned
8) Establish a working relationship with
Champlain Health Links, and help them
gain information they need to diagnose
and treat patients, transition them from
one provider to another within and
among Health Links, and collaborate
with one another.
9) Explore using the Collaboration Space
as a patient portal. Partially Planned
7) Seek opportunities to “federate” service
with other LHINs as they build their
Strategic Goal 3:
Undertake initiatives to enable
coordination and integration of
services among hospitals
A myriad of options are available to
improve the way enabling technology and
information services are managed in the
Champlain LHIN. From simple joint
procurement of software and hardware to
more complex restructuring of enabling
technologies operations, these initiatives
benefit the healthcare system the most
when they improve the patient experience
with the system. Like EHR Projects, these
projects can be complex.
and participated in the project. In fact, this
project extends to the Northeast and
Northwest LHINs, where there are 40 more
hospitals.
As example, Queensway Carleton Hospital
provides services to the smaller Carleton
District Memorial Hospital, and most
recently Arnprior Regional Health.
Fortunately, Champlain LHIN Providers are
willing to work together. The most recent
example of this is the Diagnostic Imaging
Repository project, now under way. All 20
hospitals in our LHIN were involved with
29
Outsourcing projects have the potential to
reduce one-time and ongoing costs of
software upgrades and system management.
Outsource arrangements allow small
community providers to utilize enabling
technologies they may not normally be able
to afford or to support because of human
resource or financial constraints.
Shared Services refers to the provision of
(a) service(s) by one organization, for the
benefit of other organizations, where the
cost and staffing of the service provision is
shared. The Eastern Ontario Regional
Laboratory Association is an example of a
sophisticated, large-scale, shared services
organization. The business model includes
the development of a separate corporation
with the Board of Directors made up of the
partners.
Of course, shared services strategies need
not be big and complex, nor need they
involve the creation of a new legal entity
and Board of Directors. A number of LHIN
providers have organized their services to
help one another provide a service to
clients. In most cases, a simple Service
Level Agreement (SLA) is sufficient. The
IHSP contemplates a number of models
including the often talked about “Hub and
Spoke Service Model.”
The top three cited reasons for
implementing a shared service model are:
1) To improve operating efficiency. This
occurs because the model naturally
lends itself to economies of scale in
operations. Efficiency comes through
the reduction of administration costs
and the reduction in duplicated
services.
30
2) Management teams of the contributing
organizations are freed to focus on their
core businesses, without the daily
distraction of managing the specific
“back office” service.
3) The nature of the new, shared service
organization. Each Provider has limited
resources to take on large-scale
strategic initiatives, whereas the new
shared-service organization has size in
its favour. The larger shared service
organization may be able to use and
afford technologies that are more
sophisticated. Additionally, the larger
organization may be able to provide
support 24 hours per days 7 days per
week.
Previously,
the
smaller
organizations may have been able to
provide no, or limited after-hours,
support. This is certainly true of most
LHIN-funded Providers.
The most common services provided
through a shared services model include
“back office” functions: human resources,
payroll, procurement, and financial support
services. Some people add laundry and food
services to this list.
Additionally, a shared services strategy can
support clinical work more directly such as
laboratory, diagnostic imaging technology,
central intake, and some parts of
information technology.
The Plan proposes an incremental approach
to the evolution of shared services. For
example, rather than migrating all servers to
a centralized data centre as part of a single
large-scale project, this plan reduces the
number of computer rooms and data centres
over time, and builds the data centre
management skills along the way.
Applications and hardware are moved to
where they can be best supported, not
necessarily one data centre. This
incremental approach has the advantage of
deriving benefits incrementally while
building consensus, and is less risky.
The
CHAMP
project,
mentioned
previously, is a good example of a
measured approach to reducing the number
of data centres and computer rooms. Most
importantly, when
the project is
complete, the institutions will have a
single, shared, fully integrated hospital
information system, including clinical and
administrative systems and EHR.
Additionally, each site will keep its
preferred solution vendor, derive some
economic benefit, and migrate to the latest
version of the software. There is consensus
among participants that this is a good
initiative. Regionally, we will benefit by the
size reduction of some computer rooms,
and may be able to eliminate one or more.
This Plan incorporates the belief that
enabling technologies services will
continue to find ways to reduce costs and
standardize, while moving to a shared
services model.
Strategic Goal 3 Tactics
patient referrals from acute care to
other acute sites, rehabilitation,
complex continuing care, home care
and long-term care homes. Partially
Funded
Where appropriate, tactics requiring
funding are flagged as Planned (unfunded),
Partially Funded, or Funded.
In the hospital sector, we will work with
1)
Champlain Meditech hospitals to
build on their successful model by
seeking out new ideas for improving
productivity and improving services to
patients and each other. Planned
2)
The provincial delivery partner and
other LHINs in our cluster to
standardize forms and work flows for
3)
Small and rural hospitals to explore
ways to share information with each
other and other Providers in their
catchment area. Partially Funded
4)
Hospitals in the Champlain LHIN to
establish a central intake service for
MRI and CT. Planned
31
Strategic Goal 4:
Undertake initiatives that build a
strong foundation of integrated
primary, home, and community care
As the Champlain IHSP 2013-16 states, “A
health care system built upon a strong,
integrated foundation of primary, home,
and community care promotes better health,
makes better use of resources and improves
the person’s experience with care.” This
strategic goal will help enable that vision.
Primary care physicians and nurse
practitioners assess patients’ medical needs,
help manage their care, and coordinate any
care triggered by them. The CCAC is part
of that circle of care. CCAC assess the
patients’ non-medical care needs and
coordinates the non-medical and medical
supports for them in the home or
community setting. The planning for
primary care services is intended to
transition to the LHINs in Ontario. As a
result, the LHIN’s initial focus will be
public engagement, establishing integrated
health networks, and implementation of
programs that identify people with complex
conditions, requiring coordinated care.
Information sharing is central to the success
of these initiatives. Primary care physicians
have told us that they and other Providers
need access to their data.
32
The majority of physicians do not have the
data management skills in-house to utilize
the data they have about their patients for
decision-making. Finally, the EMRs used in
Ontario do not use a common coding
system, so the data cannot be readily
analysed and compared.
Similarly, physicians have said that data
coming to them is not as useful as it could
be. For example, hospital emergency
records are a summary of what happened at
the hospital, but do not give advice on what
the primary care physicians should do next.
Coordination of care is not possible merely
with the data provided. Sometimes the
documents are unreadable and not timely
enough.
Primary care physicians provide services in
long-term care and retirement homes,
where there is often no or limited
information systems support for them.
Furthermore, the information that moves
with the patient to the hospital from longterm care is not as helpful as it should be.
Clearly, we have to work on the quality and
timeliness of information moving to and
from primary care offices.
Some work is already underway.
eConsultation, a service that allows
physicians in the community to ask clinical
questions of specialists without the patient
acting as a go between, implemented on a
limited basis two years ago, is expanding
this year with an objective to making it
available to all physicians in the LHIN. An
eReferral pilot is underway. Within a year,
we will have a plan for full rollout across a
LHIN.
As mentioned previously, the Ministry
announced the formation of voluntary
Health Links. They are a new model of care
- at the clinical level - where all providers
in the community, including primary care,
CCAC, hospitals, and community support
service agencies, are charged with
coordinating individual patient care plans
for people with complex needs. Health
Links will be designed around, and
accountable for, system level metrics.
Strategic Goal 4 – Tactics
Where appropriate, tactics requiring
funding are flagged as Planned (unfunded),
Partially Funded, or Funded.
4) Complete implementation of the
Regional Non-Urgent Transportation
project. Partially Funded
We will:
5) Work with the Ministry, eHealth
Ontario, and physicians to build access
to linked hospital and CCAC data for
performance monitoring purposes.
Planned
1) Strengthen the link between the CCAC,
the hospitals, and primary care. This
may be accomplished via such projects
as a CCAC Emergency Department
Notification System or the CCAC /
Primary Care Information Exchange.
Both will be explored. Planned
2) Work with the project team to migrate
the majority of CSS Providers to a
shared service model incorporating a
standardized client information system.
Partially Funded
3) Work with the CCAC and CSS
Providers to better integrate services
and communications between and
amongst them e.g. Inter-agency referral
and shared care plans. Planned
6) Work with primary care to advocate for
the establishment of standard coding
techniques within EMRs.
7) Establish a Collaboration Space site
tuned to the needs of Primary Care. As
an example, some physicians are using
the Collaboration Space for schedule
management, consults, CME credit
courses, and access to Diagnostic
Images and Reports. Planned
8) Establish a Collaboration Space site
tuned to the needs of Health Links.
Planned
33
9) Work with primary care to advocate for
opening primary care EMR databases
in support of effective decision-making.
10) Work with the LHIN and Ministry to
ensure that the primary care networks
and Health Links obtain appropriate
data analysis support. Planned
11) Work with hospitals and primary care
to standardize the content of Emergency
Department discharge summaries to
make them more relevant to primary
care. Planned
12) Work with Health Links and Primary
Care Networks to ensure that data for
planning and evaluation is available to
them, i.e. a data warehouse containing
linked patient data. Planned
34
13) Work with primary care to advocate for
the expansion of the Ontario Drug
Benefits and Ontario Lab data viewing
to include primary care physicians.
14) Work with primary care to improve the
information available to them when they
serve clients in long-term care facilities
and retirement homes. Planned
15) Work with the Long Term Care
organizations to uncover opportunities
to share information with other parts of
the health care and health services
planning community. Planned
Strategic Goal 5:
Examine project, program and
services management, operational
funding, and, possibly, governance as
we move the Enabling Technologies
Plan forward.
The government recognized the need for
overall provincial enabling technologies
governance by establishing eHealth
Ontario, which was given the mandate to:
•
Develop a single, provincial enabling
technologies strategy,
•
Align all publicly funded enabling
technologies initiatives by being a
single point of accountability; and
•
Encompass all provincially funded
health care system initiatives that are or
could be province-wide in scope.
Similarly, the government established the
LHINs through the Local Health Systems
Integration Act, 2006. This legislation gives
the LHINs a mandate to integrate services
within a geographic area. Often, service
integration is enabled through IT, resulting
in some overlap of mandate between
eHealth Ontario and the LHINs.
All projects guided by the LHINs, clusters,
and eHealth Ontario span multiple
Providers.
The need to address project, program, and
service management is evident:
•
Who will ultimately be responsible for
the management and maintenance of
initiatives spanning multiple Providers?
•
Who determines whether new features,
functions, or upgrades occur on these
new systems?
•
Who pays for the ongoing costs
associated with these large-scale
applications?
•
What processes will be established and
put in place to allow new participants to
join?
This Plan, like the IHSP, describes a
number of regional initiatives that have
begun or will begin over the planning time
horizon. The most complex initiatives
include the Ministry (or eHealth Ontario),
the LHIN or LHINs, and, often, numerous
Providers.
All of the initiatives are complex to
undertake and maintain, once complete.
These complexities increase the need to
evaluate the ongoing management, and
funding and governance structures and
establish new ones where appropriate.
35
Strategic Goal 5 - Tactics
Where appropriate, tactics requiring
funding are flagged as Planned (unfunded),
Partially Funded, or Funded.
We will
1) Work with the CHAMP participants to
develop a governance and management
structure that will guide the ongoing
support and growth of the shared
service. Funded
2) Work with the CCAC and CSS
Providers to develop a governance and
management structure that will guide
the ongoing support and growth of the
community-based
shared
service.
Funded
36
3) Work with the other LHINs within this
cluster and eHealth Ontario to establish
suitable governance and funding
models for the projects implemented
within the cNEO project. Planned
4) Where appropriate, establish new
project,
program
or
enabling
technologies
services
structures
amongst Providers to support the
successful implementation and ongoing
support for the Plan.
5) Examine the Collaboration Space’s
path forward, and develop a long-term
governance and support strategy.
Planned
Summary - Strategic Goals and Representative Tactics
Legend
Teal:
Green:
Yellow:
Red:
Enabling Technologies Strategies
Tactics underway
Tactics conceptualized; awaiting funding or resources
Tactics not yet started.
37
Index
C
F
Champlain Collaboration Space
7, 28, 29
Client Health Related Information System
(CHRIS)
29
Clinical Document Repository
8, 16, 19, 26
cNEO
26
consumer health solutions.
13
D
Diagnostic Imaging
8, 19, 29
DICOM
17
Drug Profile Viewer
16
Federate
29
H
Health Links
HL7
5
17
I
Inter-operability
19
L
LEAN
14
LHINWorks
27
O
E
eHealth Ontario Blueprint
15
Electronic health record (EHR)
Electronic medical records (EMRs)
Electronic patient record (EPR)
EMR Spec 4.1a
7
12
8
25
Enabling Technologies
1, 5, 7, 8, 9, 11, 35
Enabling Technologies:
7
Enterprise Resource Planning
23
Online instant messenger
28
P
Personal health records
13
Privacy Impact Assessment
21
S
Service Level Agreement (SLA)
30
T
Telepathology
13
38
Glossary
C
F
Champlain Collaboration Space: suite of
technologies used to enable information
sharing (aka LHINWorks)
Federate: term used to describe the virtual
merging of two disparate systems for the
purpose of sharing information
Client Health Related Information System
(CHRIS): system used by the CCACs to
coordinate their clients' services
H
Clinical DocumentRrepository (CDR):
system used to store and share clinical
documents eg dermatogolist notes
cNEO: eHealth Ontario project situated in
Northern and Eastern Ontario
Consumer Health Solutions: software
systems used by patients to manage their own
health information
D
Diagnostic Imaging: techniques used to create
images of the human body for clinical purposes
Health Link: loose organization of health
service providers in a small geographic region.
Health Level 7 (HL7): non-profit organization
established to set technology standards in the
healthcare sector
I
Inter-operability: the ability of two systems to
exchange information.
Online Instant Messenger : electronic tool
used to enable the exchange of live messages
between invidivuals.
L
DICOM: standards unsed to handle, move, or
store images used in medicine
LEAN: The quality management approached
whose focus is the elimination of waste
Drug Profile Viewer: software used by
clinicans to see dispensed drugs covered by the
Ontario Drug Benefit Program
LHINWorks: internet address of the
Champlain Collaboration Space
(www.LHINWorks.on.ca).
E
P
eHealth Ontario Blueprint: document which
describes the Electronic Health Record
technologies
Personal Health Records: the patient
controlled form of an elertonic health record.
Electronic Health Record (EHR): systematic
collection of patients' eletronic information
Electronic Medical Records (EMRs) :
electronic patient information manged by
physicians in their opffices
Electronic Patient Record (EPR): electronic
patient information managed by hospitals
EMR Spec 4.1a : standard established by
OntarioMD to ensure the interoperability of
physician systems
Enabling Technologies: new term
encompassing information technology and
information systems in health care
Privacy Impact Assessment : review which
examins information sharing from the
persepective of the patient
S
Service Level Agreement (SLA): contract
establishing agreed-upon response times for
problem resolution
T
Telepathology: enabling of diagnosis,
education and research at a distance with a
focus on lab specimens
39
40