ehealth Information and Communication Technology Strategic Plan

Transcription

1 ehealth Information and Communication Technology Strategic Plan North East Local Health Integration Network March

2 Acknowledgements The North East Local Health Integration Network (NE LHIN) wishes to acknowledge the contributions of North East Ontario health service providers to the ehealth Information and Communication Technology Strategic Plan. Many organizations and individuals provided input through an on-line survey, discussion groups and individual interviews. Their insights into how information and communication technology can support their services to their clients and patients formed the backbone of the strategies described in this report. The wishes to acknowledge the contributions of: the ehealth Advisory Council: Alice Radley, North Bay Physically Handicapped Adults' Rehabilitation Association (P.H.A.R.A.) Caroline Lidstone-Jones, WHA Moose Factory Dan Hildebrandt, West Parry Sound Health Centre Deborah Potvin-Mask, ehealth, Health Canada, First Nations & Inuit Health Ontario Regional Office Eldon Dutcher, Timmins District Hospital Gaston Roy, NEON / Hôpital régional de Sudbury Regional Hospital Greg Morrow, Muskoka Parry Sound Community Mental Health Service Jacqueline Gauthier, Centre de Santé Communautaire de Sudbury Est / Sudbury East Community Health Centre Jeff Holmes, Algoma Public Health Jeff Weeks, Sault Area Hospital Jennifer Michaud, Ontario Telemedicine Network Joy Galloway, Timmins Family Health Team Judy Sharpe, One Kids Place, North Bay Ken Burns, Hôpital régional de Sudbury Regional Hospital Louis Gravel, Kirkland Lake District Hospital Marc Bouchard, North Bay Regional Health Centre (includes North Bay General Hospital and the Northeast Mental Health Centre), North Bay Margaret Catt, Temiskaming Lodge Michel Raymond, Sudbury East CHC Noelville Mike Labelle, ehealth Ontario Pamela Nolan, Garden River First Nation Wellness Centre Peter Taylor, NE Community Care Access Centre Rob Poulin, Life Labs Terry Moore, Canada Health Infoway Theo Noel de Tilly, FedNor Tamara Shewciw, NE LHIN Laura Boston, NE LHIN Don McGrath, NE LHIN Cindy Adam, NE LHIN; and Healthtech Consultants. This report is dedicated to the health service providers in North East Ontario. Table of Contents March 31, 2011

3 Table of Contents 1. Executive Summary 5 2. Sommaire 7 3. Introduction North East Local Health Integration Network The IHSP Small and Rural Hospital Summit Rural and Northern Care Framework / Plan The Provincial ehealth Strategy Approach to the Refresh of NE LHIN ehealth ICT Strategic Plan Current State Assessment Electronic Medical Record Adoption (EMR-AM) Score Continuing Care Information Management Assessment Tools Adoption Community Support Services Community Mental Health and Addictions ehealth Ontario Gadget Deployments ONE Network Deployments ONE Mail Deployments Drug Profile Viewer Physician ehealth NE LHIN ehealth Projects Current Activities with ehealth Ontario Regional ehealth Foundations and Successes Other Current NE LHIN ehealth Projects NEON Detailed List of ehealth Projects Portal Use in the NE LHIN Existing portals with plans to extend use New portals planned Portals Used Integration Technology Applications Priorities Key Findings from Technology and Infrastructure Readiness Survey Key Findings from Consultation Sessions Priorities Identified from Discussion Groups Key Findings and Conclusions from CEO Interviews Key Findings from the CEO Interviews Priorities Identified from CEO Interviews Current ehealth Project Governance and Accountability Structures and Processes Gap Analysis and Emerging Themes Gap Assessment Opportunities and Recommendations Strategies Vision Table of Contents March 31, 2011

4 6.2 Goals and Guiding Principle Goals Guiding Principles Strategic Directions Alignment of the ehealth ICT Strategies with IHSP Directions Strategic Direction #1 Establish the Electronic Record within Individual Organizations Goals Opportunities Strategic Direction #2 Extend data in the Individual Electronic Health Records to Other Agencies Goals Opportunities Strategic Direction #3 Govern the Development of the Regional interoperable Electronic Health Record (iehr) Effectively Goals Opportunities Strategic Direction #4 Consumer Health Goals Opportunities Implementation and Adoption Project Critical Success Factors Expanding Project Management Capacity Change Management and Communication Planning Priority Project Implementation Plan and Resourcing Decision Making Criteria New Priorities for Development and Investment Appendix A: ehealth Advisory Council Terms of Reference 58 Appendix B: ehealth Advisory Council Membership 62 Appendix C: and Ontario Telemedicine Network Strategic Roadmap 64 Appendix D: Project Descriptions 67 Appendix E: CCIM Overview 73 Appendix F: List of Terms and Acronyms 75 Appendix G: Bibliography 80 Table of Contents March 31, 2011

5 1. Executive Summary The North East Local Health Integration Network (NE LHIN) has updated its existing ehealth Information and Communication Technology Strategic Plan under the leadership of the North East LHIN ehealth Advisory Council (NEEAC). The process was carried out with extensive input from stakeholders through a survey, discussion groups, interviews, review of other surveys and ehealth planning documents. The Council membership is multidisciplinary and ehealth Ontario and Canada Health Infoway (CHI) representatives participated and provided input to the plan. The ehealth ICT strategic planning process takes a system-wide approach to healthcare, with a core principle to maintain a patient centric view. The plan includes non-funded service providers represented on the NEEAC including: Community pharmacists; Nurse practitioners; Children s treatment centres; Community-based physicians; and Public health and other agencies not funded by the LHIN, but who are partners in the circle-of-care. The stakeholders, consulted as part of the planning process, identified electronic generation, sharing and integration of data as their key ehealth priority. Thus the shared electronic client / patient record with appropriate standards, privacy, consent, and security provisions continues to be the key goal of the ehealth ICT strategic plan. A great deal has been accomplished in ehealth by the since it developed its first ICT plan jointly with the North West LHIN and their predecessor organizations. Through its own investments and those made by Canada Health Infoway and the Ontario Ministry of Health and Long Term Care, almost all providers have a basic ehealth infrastructure in place in their organizations and have access to internet technologies. The NEEAC has confirmed the vision for ehealth ICT for the to be one in which: Information and communication technology supports the processes of quality healthcare provision, access to health information (for all Northern Ontarians from anywhere in Ontario), improvement of consumer outcomes, and the most effective use of available resources across Northern Ontario, through collaboration and sharing information amongst providers and with consumers. The NEEAC confirmed that this statement continues to reflect their vision for the future state. They have added the following banner statement to more simply state their intentions: Enabling Access to Quality Healthcare for Northerners through Information and Innovation Four strategic directions have been defined. 1. Strategic Direction #1 Establish the electronic record within individual organizations shareable across the continuum of care. 2. Strategic Direction #2 Extend data in the individual electronic records to other agencies: Page 5 March 2011

6 Increase the ability to share information among electronic records to facilitate communication and information integration; Develop system-wide decision support capability; Use technologies to promote service provider communication for clinical and administrative purposes; and Build on provincial investments. 3. Strategic Direction #3 Govern the development of the regional interoperable Electronic Health Record (iehr) effectively: Develop the technical infrastructure and utilize new technologies to match requirements; Develop the Regional Integration Center concept; Increase project management capacity; and Define ehealth ICT strategic plan accountability. 4. Strategic Direction #4 Consumer Health: Use technologies to respond to consumer needs. ehealth Advisory Council members identified projects under each strategy. Several key priorities were included: Develop the ehealth ICT project accountability and governance framework; Develop the relationship with the Regional Integration Center LHINs; Define an architecture to leverage the assets of the Regional Integration Center; Roll-out specific projects identified under each strategy; Develop a funding strategy for these projects the funding options with ehealth Ontario and CHI will need to be explored in several cases. Several projects will be in the planning stage in Year 1 of the plan, funded through the PMO or other sources. Some projects such as the regional staff scheduling and regional collaboration solution would require significant one-time and ongoing support resources; The timeline for the projects will be largely dictated by available funding, ehealth readiness of the stakeholders, competing priorities, project management and project implementation capacity; and The initial estimate is that approximately $28M is required for the projects under consideration, with an estimated incremental operational cost of $5,530,000. However, these are high-level estimates. Overall, the plan demonstrates the need for increased investment in Information Technology (IT) to move to electronic management of patient information and achieve greater connectivity among health service providers to enable continuity of care. Page 6 March 2011

7 2. Sommaire Le Réseau local d intégration des services de santé (RLISS) du Nord-Est a actualisé son plan stratégique sur la technologie de l information et des communications (TIC) en cybersanté sous la direction du conseil consultatif sur la cybersanté du RLISS du Nord-Est. L actualisation se fonde sur les commentaires exhaustifs des intervenants recueillis par le truchement d un sondage, d entrevues, d un examen d autres sondages et de documents de planification de la cybersanté. Le conseil est un groupe multidisciplinaire regroupant des représentants de Cybersanté Ontario et d Inforoute Santé du Canada qui ont présenté des observations sur le plan. Le processus de planification stratégique de la TIC en cybersanté adopte à l égard des soins de santé une approche systémique fondée sur le maintien d une optique centrée sur le patient. Le plan inclut les fournisseurs de services non financés représentés au sein du conseil consultatif sur la cybersanté du RLISS du Nord-Est, notamment : pharmaciens communautaires; infirmières et infirmiers praticiens; centres de traitement pour les enfants; médecins exerçant dans la collectivité; et bureaux de santé publique et autres organismes non financés par le RLISS, mais qui sont des partenaires du cercle de soins. Les intervenants consultés dans le cadre du processus de planification ont mentionné que la génération, le partage et l intégration électronique des données étaient leur principale priorité sur le plan de la cybersanté. Par conséquent, le dossier médical électronique partagé, doté de dispositions appropriées en matière de normes, de vie privée, de consentement et de sécurité reste l objectif clé du plan stratégique sur la TIC en cybersanté. Le RLISS du Nord-Est a beaucoup de réalisations à son actif dans le secteur de la cybersanté depuis qu il a élaboré son premier plan de TIC de concert avec le RLISS du Nord-Ouest et leurs organismes prédécesseurs. Grâce à ses propres investissements et à ceux d Inforoute Santé du Canada et du ministère de la Santé et des Soins de longue durée de l Ontario, presque tous les fournisseurs ont mis en place une infrastructure de cybersanté de base au sein de leur organisme et ont accès aux technologies Internet. Le conseil consultatif sur la cybersanté du RLISS du Nord-Est a confirmé que la vision de la TIC en cybersanté pour le RLISS du Nord-Est prévoit ce qui suit : La technologie de l information et des communications appuie la prestation de services de santé de qualité, l accès aux renseignements sur la santé (pour tous les résidents du Nord de partout en Ontario), l amélioration des résultats pour les usagers et l optimisation des ressources disponibles dans le Nord de l Ontario grâce à la collaboration et au partage de renseignements entre les fournisseurs et avec les usagers. Le conseil consultatif sur la cybersanté du RLISS du Nord-Est a confirmé que cet énoncé continue de refléter sa vision de l état futur. Il a ajouté l énoncé suivant pour formuler plus simplement ses intentions : Faciliter l accès à des services de santé de qualité pour les gens du Nord par le truchement de l information et de l innovation. Page 7 March 2011

8 Quatre orientations stratégiques ont été définies : 1. Orientation stratégique n o 1 Établir le dossier électronique au sein d organismes individuels partageable dans le continuum de soins. 2. Orientation stratégique n o 2 Communiquer les données des dossiers électroniques individuels aux autres organismes : renforcer la capacité de partager les renseignements contenus dans les dossiers électroniques pour faciliter la communication et l intégration des renseignements; élaborer un système d aide à la décision à l échelle du système de santé; utiliser les technologies pour promouvoir la communication entre les fournisseurs de services à des fins cliniques et administratives; et miser sur les investissements provinciaux. 3. Orientation stratégique n o 3 Diriger efficacement l élaboration du dossier médical électronique interopérable (DMEi) régional : élaborer l infrastructure technique et utiliser de nouvelles technologies répondant aux exigences; élaborer le concept de centre d intégration régional; accroître la capacité de gestion de projet; et définir la responsabilisation dans le cadre du plan stratégique sur la TIC en cybersanté. 4. Orientation stratégique n o 4 Santé des usagers : Utiliser les technologies pour répondre aux besoins des usagers. Les membres du conseil consultatif sur la cybersanté du RLISS du Nord-Est ont cerné des projets découlant de chaque stratégie. Plusieurs priorités clés ont été incluses : élaborer le cadre de responsabilisation et de gouvernance du projet de TIC en cybersanté du RLISS du Nord-Est; renforcer la relation avec les RLISS concernés par le centre d intégration régional; définir une architecture en vue de tirer parti des actifs du centre d intégration régional; mettre en œuvre des projets précis découlant de chaque stratégie; élaborer une stratégie de financement pour ces projets dans plusieurs cas on devra envisager des options de financement avec Cybersanté Ontario et Autoroute Santé du Canada. Plusieurs projets seront à l étape de la planification durant l année 1 du plan et seront financés par le BGP ou d autres sources. Certains projets, notamment celui qui porte sur l établissement des horaires du personnel et la collaboration à l échelle régionale, exigeraient un soutien financier unique et continu important. l échéancier des projets sera en grande partie dicté par le financement disponible, l état de préparation à la cybersanté des intervenants, les priorités concurrentes, la capacité en gestion de projet et en mise en œuvre des projets; et l on estime initialement qu environ 28 millions de dollars seront requis pour les projets envisagés et que le coût opérationnel incrémentiel s élèvera à $. Il s agit cependant d estimations de haut niveau. Globalement, le plan démontre la nécessité d accroître l investissement en technologie de l information (TI) afin d adopter la gestion électronique des renseignements sur les patients et de renforcer la connectivité entre les fournisseurs de services de santé pour faciliter la continuité des soins. Page 8 March 2011

9 3. Introduction The North East Local Health Integration Network (NE LHIN) has updated its existing ehealth Information and Communication Technology (ICT) Strategic Plan under the leadership of the ehealth Advisory Council (NEEAC). The process was carried out with extensive input from stakeholders through a survey, discussion groups, interviews, review of other surveys and ehealth planning documents. The Council membership is multidisciplinary and representatives of ehealth Ontario and Canada Health Infoway participated and provided input to the plan. 3.1 North East Local Health Integration Network The NE LHIN is responsible for planning, integrating and funding healthcare services for just over 570,000 people across an estimated 400,000 square kilometers. The NE LHIN represents more than 40% of the province s land area and 4.5% of the population. Since the 2001 Census, population growth in the NE LHIN region has been less than 1%, in comparison to the provincial growth rate of nearly 8%. Figure 1: Map of the NE LHIN The NE LHIN region has the highest number of French language-speaking communities in the province, with Francophones comprising 24% of the region s population. Aboriginal, First Nation and Métis communities make up 10% of the North East region. The NE LHIN coordinates services among many health service provider organizations and programs that play a critical role in delivery of care: 25 General Hospitals; 1 Regional Cancer Centre; 1 Community Care Access Centre; Page 9 March 2011

10 76 Community Support Service Programs; 41 Long-Term Care Homes; 40 Community Mental Health Programs; 10 Problem Gambling Programs; 26 Substance Abuse Programs; 5 Community Health Centres. Additionally, non-lhin funded organizations such as family health teams, health groups, health organizations, health networks, solo physician offices, independent health facilities, nurse practitioners, midwives, pharmacies, children s treatment centres, and public health units play critical roles in the delivery of services. While these health service providers are not under the mandate of the NE LHIN, they have been involved in ehealth Information and Communication Technology (ICT) planning in North East Ontario. The challenges to the long-term sustainability of the health system include: The large geography of the NE LHIN and the rural and remote nature of many communities, which continue to pose challenges for their residents in accessing health services; The demands of the aging population significantly impact services and will continue to grow in the future; Low income levels Socio-Economic Status (SES) is recognized as an important factor that influences the utilization of healthcare services. Research has shown that hospital admission rates in low SES groups is significantly higher; The high prevalence of chronic disease throughout the NE LHIN strains the healthcare system; Advances in technology that create new and cost-effective possibilities for information exchange among providers and users of the health system; and Continued demographic changes, including an aging population. The healthcare landscape in the NE LHIN and across Northern Ontario continues to evolve. Underlying this evolution are several forces and trends, notably, the economic environment and fiscal challenges faced by the major funder of the NE LHIN, the Ontario Ministry of Health and Long Term Care, the NE LHIN and its health service providers. In developing the second Integrated Health Services Plan (IHSP) , the NE LHIN outlined the region s nine healthcare priorities for the next three years. The implementation of these priorities will be approached through innovations in information and communication technologies and electronic processes. The plan emphasizes greater inter-lhin collaboration and joint initiatives, and increasing integration and coordination of health services. The NE LHIN is an early developer of a regional ehealth ICT plan. Along with the North West LHIN, the LHIN developed the first ehealth ICT plan in Ontario which included all the funded and non-funded service providers. The strategy is being refreshed to support the objectives of the IHSP in alignment with the Provincial ehealth strategy and Canada Health Infoway standards. 3.2 The IHSP The NE LHIN is held accountable to deliver an Integrated Health Service Plan to the Minister of Health and Long Term Care every three years. This strategic plan outlines the vision and healthcare priorities reflective of the needs of the North East Ontario population. Page 10 March 2011

11 The NE LHIN IHSP is focused on the long-term sustainability of the North East healthcare system while allowing individuals greater access to quality care. The following NE LHIN priorities are defined for the next three years: 1. Aboriginal / First Nations / Métis Health Services; 2. Addictions and Mental Health Services; 3. Aging at Home; 4. Alternate Level of Care Strategies and Solutions; 5. Diabetes Care; 6. Emergency Department Wait Times; 7. French Language Health Services An Integrated Approach; 8. Health Human Resources; and 9. Optimize Surgical Services. The IHSP acknowledges that Information and Communications Technology (ICT) solutions are key enablers for each of the nine priorities and will be leveraged to support service integration and the delivery of quality care. As with most healthcare initiatives, ICT projects reap the greatest benefit when they: Enhance patient care services or access to services; Are part of a broader regional strategic ICT plan; Use a multi-agency or multi-sector partnership approach; Have a sound business case; and Can be used as foundational elements in the creation of an electronic health record. The IHSP identifies several potential technology solutions, including: Aboriginal / First Nations / Métis Health Services Inclusion of Aboriginal / First Nations / Métis people in electronic medical record implementation; Addiction and Mental Health Services Information Technology and common client assessment tools are used to enhance treatment planning and outcome monitoring in this sector. The Ontario Common Assessment of Need (OCAN) solution is implemented widely in the North East; Diabetes Care Ontario s ehealth Strategy 2009 to 2012 has identified diabetes management as one of its clinical priorities. Four solutions will be developed: The Baseline Diabetes Dataset Initiative will identify Ontarians with diabetes and match them to appropriate care; A Diabetes Registry will electronically monitor adherence to best practices and whether patients receive appropriate interventions; Electronic Medical Record system compatibility with the Diabetes Registry will enable physicians to exchange data; and Laboratory test results will be linked to the Diabetes Registry as a resource for treatment; Emergency Department Wait Times Develop e-referral and resource matching processes to expedite patient referrals out of acute care and divert Emergency Department (ED) visits. A wait time information system to provide detailed information about waits for post-acute care and an ED reporting system to capture information on hospital ER length-of-stay to facilitate performance management; and Health Human Resources Define and implement the functional requirements of a realtime North East Ontario Human Resource Information System. Page 11 March 2011

12 Generally, automation of information management can facilitate processes such as pre-admission screening, discharge planning, service coordination, system-wide case management, and standardizing outcome monitoring mechanisms to assess progress. To achieve the goals of surgical service optimization, electronic systems can be set up for region-wide call schedules, monitoring surgical services performance in the NE LHIN, and implementation of standard integrated pathways for common surgical procedures. The refreshed ehealth ICT strategy is aligned with and supports the realization of the NE LHIN IHSP and the ehealth Ontario strategy. 3.3 Small and Rural Hospital Summit 1 In September 2010, the NE LHIN convened a Small and Rural Hospital Summit to integrate innovative ideas that would address issues facing providers. Several directions were identified regarding technology. These are quoted directly from the Summit report. Support and assist the NE LHIN in the development and implementation of a new Information Technology model. Use technology to its fullest in sharing information to improve service delivery to patients and to share information among providers. Increase the use of telehealth to support nurse practitioners, physician assistants, and registered nurses working in remote areas. 3.4 Rural and Northern Care Framework / Plan 2 The Government of Ontario formed the Rural and Northern Healthcare Panel (the Panel) to define a vision, guiding principles, strategic directions and guidelines to assist the MOHLTC and LHINs to address access to care as one dimension of quality of care in rural, remote, and Northern communities. Panel members included a mix of healthcare providers and administrators, physicians and nurse practitioners, municipal representatives and administrators, Aboriginal health experts, and members of Provincial Parliament, all familiar with the access challenges faced by these communities. In their report, they recommended a Rural and Northern Care Framework / Plan which identifies several technology related recommendations. Adopted by NEEAC in the preparation of the strategic plan, these are quoted below: Across rural, remote and Northern Ontario, opportunities exist to improve the use of technology to enable improved information sharing, establish clinical networks, connect providers and individuals, and support ongoing health professional development. The following recommendation and supporting subrecommendations are proposed by the Panel to improve the use of technology as a tool for improved access to healthcare services in rural, remote and Northern Ontario: Recommendation 12: Enhance provincial information management, clinical and education technology availability (e.g. ehealth, telemedicine, simulation learning), and related health professional networks and incentives to encourage use (Provincial Strategy) Recommendation 12.1: Use should be encouraged and incented both in rural, remote and Northern communities and at the larger referral centres and Academic Health Sciences Centres (AHSC) to ensure effective outreach support is being delivered to rural, remote and Northern Ontario. Recommendation 12.2: Use should be supported for both clinical consultations to help improve access to specialist resources, and for education applications to 1 Summit report provided by the NE LHIN PMO. 2 Rural and Northern Healthcare Framework / Plan. Stage 1 Report. Final Report. Page 12 March 2011

13 improve and maintain core skills of rural, remote and Northern health professionals. Recommendation 12.3: Information and technology connections within local communities, and across local hubs and regional referral centres, should be enabled to improve access and care delivery. 3.5 The Provincial ehealth Strategy ehealth Ontario, the provincial agency responsible for supporting the use of technology in the health system, has developed a provincial ehealth strategy (2009 to 2012). This strategy is intended to create an electronic health record (EHR) for all Ontarians by Pillars of this strategy include: Alignment with the national ehealth strategy as set out by Canada Health Infoway (CHI), including the approved national architecture; An Electronic Health Record that will include patient-specific information pertaining to laboratory tests, imaging results, drug use, immunizations, chronic disease management, hospital discharges, standardized assessments and other information as required and appropriate; and A set of principles to guide the development of ehealth projects in Ontario. The provincial ehealth strategy has three clinical priorities: 1. Diabetes Management; 2. Medication Management; and 3. Wait Times. These clinical priorities are supported by four foundational priorities: 1. Cornerstone information systems; 2. Clinical activity information systems; 3. Technology services; and 4. Enabling practices and talent management. 3.6 Approach to the Refresh of NE LHIN ehealth ICT Strategic Plan The plan was developed using the following approach: Using collected data to assess the status of health service provider information systems; Assess the status of regional, provincial, federal and Aboriginal, First Nation, Métis initiatives; Develop a shared vision and strategic direction for ICT in North Eastern Ontario; Identify specific barriers to, and opportunities for, partnerships and linkages; Identify key decision making criteria for use by health service providers that will support the region s vision; Determine priorities for North Eastern Ontario ICT development and investment; Identify costs, benefits and strategies to implement the priorities; and Identify options and recommendations for ongoing ICT coordination. The overarching framework used to develop the plan is depicted in the diagram below. Page 13 March 2011

14 MoHLTC and Provincial ehealth Objectives Ontario ehealth Strategies NE LHIN Vision, Mission, IHSP EHR & Industry Trends, Standards Infrastructure Foundation NE LHIN ehealth Strategic Plan Figure 2: Framework for Developing the NE LHIN ehealth ICT Strategic Plan The NE LHIN ehealth ICT strategy was developed under the direction of the NEEAC comprised of a broad representation of LHIN leaders. The cornerstone activity in the development of the strategy was a workshop with members of the NEEAC. To prepare for the workshop, a survey of LHIN and non-lhin was conducted, discussion groups were held, and several agency CEOs were interviewed. 106 organizations responded to the survey. 57 service providers participated in the interviews and four hospital CEOs and the CIO of the Community Care Access Centre were interviewed. The findings from these activities, and other available data, were considered at the workshop and formed the basis of the NE LHIN s refreshed ehealth ICT Strategic Plan. The final plan will be available on the NE LHIN s website. Page 14 March 2011

15 4. Current State Assessment A comprehensive current state assessment was conducted as a benchmark or reference document for developing the strategy. The information from the current state assessment was used to inform and identify gaps and possible strategies for consideration in defining the future state by NEEAC. An online Technology and Infrastructure Readiness Survey and eight discussion group sessions were undertaken to assess the changes to the status of health service provider information systems in the NE LHIN. 4.1 Electronic Medical Record Adoption (EMR-AM) Score Ontario has adopted Health Information Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMR-AM). The EMR-AM scores hospitals in the HIMSS Analytics Database on their progress in completing the eight stages to creating a paperless patient record environment. The EMR-AM score for North East Ontario is 1.68 (Ontario average is 2.12); considering all facilities; the combined score for large community hospitals and the teaching hospital is 3.03 (Ontario average is 2.83). 4.2 Continuing Care Information Management Assessment Tools Adoption Through the Continuing Care Information Management (CCIM) initiative, the community sector is adopting standardized assessment tools and back office systems. North East Ontario community sector providers have started to adopt these systems Community Support Services Almost all community support agencies report being in compliance with the Ontario Healthcare Reporting Standards (OHRS). However, there are low adoption rates of the Human Resources Information System (HRIS), Management Information System (MIS), and the Community Health Assessment Tool Community Mental Health and Addictions The majority of community mental health and addictions agencies are in compliance with the OHRS, and are involved in the implementation of HRIS, MIS, OCAN and IAR. 4.3 ehealth Ontario Gadget Deployments ONE Network Deployments The has a total of 370 ONE Network installations spanning continuing care facilities, hospitals, physicians, independent health facilities, community laboratories, Ontario Agency for Health Protection and Promotion connectivity, Ontario Telemedicine Network, and the Group Health Centre in Sault Ste. Marie ONE Mail Deployments The NE LHIN has a total of 5,043 users on ONE Mail, involving 64 organizations. Page 15 March 2011

16 4.3.3 Drug Profile Viewer ehealth ICT Strategic Plan In North East Ontario, 27 emergency departments and 32 other locations have access to the Ontario Drug Profile Viewer, accessing the Ontario Drug Benefit Program. 4.4 Physician ehealth In the NE LHIN, community-based physician EMR implementation has reached 50%. This success is followed by increased requests to mobilize patients clinical information from other sources either accessing and / or integrating with the practice chart. Through consultations conducted by the NE LHIN, physicians indicated that the following are their priorities: Expand Hospital Report solutions across all hospitals across the NE LHIN; Expand Physician Office System Integration with hospital information systems; Expand the eprescribing solution to other FHTs within the NE LHIN. Sending prescriptions from a physician s computer to a pharmacist s computer; Increase access to Telemedicine to facilitate Ontario Telemedicine Network (OTN)-EMR integration to provide physicians broader access to patient data; Provide pharmacists access to EMRs; consolidate their Pharmacy Management Systems (PMS) and EMR into one system, minimize the impact on their workflow; Expand the MedsCheck program; and Continuity of Care Document (CCD) Exchange Suite. Three of these high priority projects are of low complexity, and are likely to deliver high returns in the short term. Therefore, they represent early opportunities to support information exchange between providers: 1. Expand Hospital Report solutions across all hospitals across the NE LHIN; 2. Expand Physician Office System Integration with hospital information systems; and 3. Increase access to Telemedicine to facilitate OTN-EMR integration to provide physicians broader access to patient data. 4.5 NE LHIN ehealth Projects The PMO and service providers are involved in numerous ehealth ICT projects. Such an inventory is a valuable tool to visualize all the projects, to ensure that there is a comprehensive view of all the project commitments, and to prioritize projects to enable the ehealth ICT strategic directions. The projects can be categorized as: involvement in provincial ehealth Ontario projects; Regional ehealth projects; Other ehealth ICT projects that are either in planning stages or involve a subset of the health service provider organizations; North East Ontario Network (NEON) projects, which can be potentially leveraged across the and can be positioned as provincial assets; and A table listing the active projects involving the PMO Current Activities with ehealth Ontario ehealth Ontario Integration Services Multi-LHIN Provider Portal for Community Mental Health and Addictions: Doorways. Page 16 March 2011

17 ehealth Ontario ephysician Regional approach to electronic health record (EHR) and Clinical Management System (CMS) integration. ehealth Ontario Implementation and Adoption (I&A) Change Management and Project Management. Privacy and Security Multi LHIN initiative: Ontario LHINs Privacy Project (OLPP). Integration Services Regional Integration Centers. Communication and Collaboration Tools Regional ehealth Foundations and Successes The projects that have laid the foundation for networking and sharing of information between service providers are briefly listed below. Appendix D contains a partial list of project descriptions. NEON North East Ontario Network: a partnership of 19 hospital corporations with the goal of shared implementation of the full suite of MEDITECH applications. NEON Standards includes 26 hospitals who have adopted NEON standards. NEODIN Northern and Eastern Ontario Diagnostic Imaging Network in Northern Ontario, formerly the PNOP project Pan Northern Ontario PACS extended to Champlain. NEHSA (North East Health Services Alliance) integrated PACS system for seven hospitals in a networked environment connected to NORrad install in Timmins. Allows physicians in the North East to access over 400,000 diagnostic images yearly. NORrad (Northern Radiology) PACS project connecting ten hospitals in a wide area network (WAN) for diagnostic imaging and reports. Directory of Services (DOS) NE and NW LHINs A directory of health care services found on the 310-CCAC website at (211North, Circuit Santé) Shared Network Management involves 29 organizations in the NE and NW LHINs. Ontario Telemedicine Network (OTN) Timmins FHT and OTN project. Group Health Centre with EMRxtra and now PeP e-prescribing. Timmins Hospital and FHT Point to Point Interface Garden River Wellness Centre on an EMR serving Aboriginal, First Nation, and Métis needs. Pan-Northern ICT / ehealth Strategic Plan for acute and community sectors. Algoma Public Health on an EMR H1N1 Canadian success story. ehealth Ontario Network Deploy. Aboriginal, First Nation, Métis connections. MOHLTC Diabetes Strategy Projects with the Diabetes Education Centres and OTN. ehealth Ontario Diabetes Registry getting ready activities. ehealth Ontario ONE Network Connectivity and ONE Mail. Electronic Child Health Network (echn). Electronic Data Resources Service (EDRS) / Wait Time Information System (WTIS) / Critical Care Information System (CCIS) Other Current NE LHIN ehealth Projects Increasing access to TeleHealth Multiple projects to increase adoption of Telemedicine and develop a strategic plan for optimizing use of OTN in the NE LHIN. Page 17 March 2011

18 Implement a Clinical Provider Portal Related to the Doorways project. The Doorways Project consists of four of Ontario s 14 LHINs who are working together with Ontario s Community Care Information Management (CCIM) leads to establish a provider portal to securely share and access accurate health information electronically. The objective is to conduct a pilot that integrates mental health and addictions data within a portal yielding clinical benefits and lessons learned through system to system integration. ALC Resource Matching & Referral The ALC Resource Matching and Referral project has conducted current state assessments from acute to defined post-acute facilities and will begin to define a future state that will better facilitate patient referrals. Physician Office Integration (POI) The POI project will put into place the infrastructure required to send text based patient reports / results to physicians electronically via their electronic medical record (EMR) system. The intent is to include all participating hospitals in the NE LHIN to collectively send data through a central channel to any physician or nurse practitioner s office and community health centre that is set up to receive the electronic medical records for the POI project. Continue to develop organizational EMRs For the CCAC, LTC, CMH&A, CSS, CHC, Public Health, CTC, Nurse Practitioners, Independent Health Facilities, Physicians, and Pharmacy to deepen the adoption of the MEDITECH EMR suite of applications in the institutional sector. Expand ODB Viewer to others ehealth Ontario targets have been achieved. The would like to expand the use of the viewer to community-based physicians and community sector. Sudbury Regional Health Information Network Provider (HINP) for the CCIM IAR system The Integrated Assessment Record (IAR) is an electronic tool that allows authorized users to view a client / patient s previous assessment information and work in collaboration with other care providers to effectively plan and deliver services. West James Bay Connectivity for PACS Project Connecting five remote hospitals. Manitoulin First Nations EMR Project Implementation of the EMR in the First Nations of Manitoulin Island under the leadership of Giiwednong Health Link initiative (14 First Nation Communities and five Health Centres [Aboriginal Health Access Centres]). Regional ICT infrastructure, support and integration program To include technology integration framework, architecture and standards, and approach to business continuity and disaster recovery. NE LHIN IT Shared Services Organization Governance model identification. Implementation and Adoption The Implementation and Adoption initiative will enable the NE LHIN to achieve readiness in the areas of project management and change management for implementing and adopting ehealth solutions NEON NEON is a partnership of 19 hospital corporations implementing the MEDITECH suite of clinical applications. The partnership represents over 1,500 beds at 22 sites across North East Ontario. NEON is mentioned here due to its success in developing the partnership, standardizing technology processes and choices, and positioning for the roll-out of the full suite of enterprise medical record functionalities. can position NEON s assets (standards, EMPI, project management expertise) as provincial assets. Page 18 March 2011

19 Figure 3: NEON membership in the NE LHIN NEON Clinical Service Deployment Deployed Regionally Deployment Pending Patient Registration Community Wide Scheduling Registration Long-Term Care Oncology Patient Care Management Enterprise Medical Record Order Entry Patient Care Systems Operating Room Management Bedside Medication Verification Imaging and Therapeutic Services Page 19 March 2011

20 Deployed Regionally Imaging and Therapeutic Services Information Technology for Physicians Deployment Pending Physician Care Manager Laboratory Laboratory, Microbiology, Pathology, Blood Bank, Outreach Laboratory Health Information Management Enterprise Patient Index & Medical Records Abstracting Ambulatory Emergency Department Management Pharmacy Pharmacy Figure 4: Status of NEON Clinical Application Deployment NEON Administrative Services Deployment Deployed Regionally Deployment Pending Financials General Ledger Accounts Payable Materials Management Fixed Assets Payroll Budgeting and Forecasting Quality Risk Management Human Resources Information System Business Processes Health Card Validation Concurrent Review Archiving Scanning Electronic Forms Nursing Workload Data Repository Business Intelligence Other Technologies Auto faxing Internet Gateway Firewall Figure 5: Status of NEON Administrative Application Deployment Future Landscape NEON is developing a regional plan for the implementation of advanced clinical systems. Along with the system update of the shared health information system planned in 2011 / 2012, the following development initiatives will be undertaken between 2011 and 2013: Page 20 March 2011

21 Determine archiving needs; Increase ehealth adoption across all corporations; Continue to expand the partnership; and Deliver the new archiving and scanning software Detailed List of ehealth Projects The following table presents the projects that the NE LHIN provides either oversight, support or has initiated to align with provincial ehealth projects. Page 21 March 2011

22 Project Title Description Impact / Outcome Overall Status 1 Alternate Level of Care (ALC) Resource Matching and Referral (RM&R) Project Discharging ALC patients faster from the hospital. A small working group was assembled (four hub hospitals and the NE CCAC) to review the recommendations, conduct an environmental scan of existing RM&R technologies and decide on next steps. 2 Ambulatory Care Proposal. Working with hospital IT staff to develop an ambulatory care proposal that would meet Canada Health Infoway criteria as well as align with ehealth Ontario Strategy. 3 EMR for 14 Aboriginal, First Nation, and Métis communities. 4 Implement a single case management system and common assessment tool for all community health service providers. 5 Diabetes Registry Patients with diabetes and providers share a portal to manage the patient's care. 6 Doorways Project 22 mental health and addiction providers in Supporting Aboriginal, First Nation, and Métis to establish an EMR amongst 14 communities as well as facilitating discussions to promote ehealth connectivity on Reserves. Working with CCIM on the deployment of electronic assessment tools and business systems that include MIS and HRIS implementations for Community Support Services, Mental Health and Addictions, Long-term Care, Community Health Centres, and small hospitals. Work with ehealth Ontario regarding Diabetes Registry reporting. The Champlain, NE, NSM, and NW LHINs are involved in an ehealth Integrated Assessment 1. Faster and appropriate discharge of ALC patients. 2. Improved communication between providers and patients. 3. Building towards a comprehensive HER. 4. Improving access to care (ER/ALC). 1. Upon completion the project will enhance patient care. 2. Building towards a comprehensive EHR by. 3. Improving access to care (ER/ALC). 4. Improving Chronic Disease management. 1. EMR among 14 Aboriginal, First Nation, and Métis communities. 2. Paper based medical record storage, organization, and filing costs will be greatly reduced. 3. Bandwidth will allow access to internet, telehealth, and EMR. 4. Building towards a comprehensive HER. 5. Improving access to care (ER/ALC). 6. Improving Chronic Disease management. 1. Improve coordination of care, client outcomes, less duplication, reporting, and case management efficiencies. 2. Development of implementation and adoption plans. 3. Formalizing partnerships within the region. 4. Building towards a comprehensive EHR. 5. Improving access to care (ER/ALC). 6. Improving Chronic Disease management. 1. Complete the Chronic Disease Management System Report (monthly). 2. Building towards a comprehensive EHR. 3. Improving access to care (ER/ALC). 4. Improving Chronic Disease management. 1. Patient's information will be accessible through a portal between four LHINs and 22 participating organizations In progress In progress In progress In progress In progress In progress Page 22 March 2011

23 Project Title Description Impact / Outcome Overall Status four LHINs share a common electronic assessment tool. 7 ehealth Ontario (SSHA) Circuits Ensuring sectors have the proper bandwidth to operate i.e. internet, ereferrals, videoconferencing, and EMR. 8 Work with provincial ehealth delivery partners to align funding, strategies, and priorities. Record health provider portal known as the Doorways Pilot Project an initiative to improve clinical data available to health service providers and their clients. The NE LHIN is leading the Doorways project. Along with ehealth Ontario, Community Care Information Management, the Sault Area Hospital, Hôpital régional de Sudbury Regional Hospital and Champlain, North Simcoe Muskoka, and North West we have successfully deployed the Doorways/IAR health provider portal. Drawing its data from the Ontario Common Assessment of Needs and the Mental Health Resident Assessment Instrument, Doorways will allow for confidential access to patient information by nurses, doctors, other practitioners employed by community support organizations, hospital emergency rooms and in-patient psychiatric facilities. Working with ehealth Ontario and HSP s as ehealth Ontario right-sizes current circuits. Actively engaged with many ehealth leaders and champions within the province including: CCO, ENITS, EMPI, ERNI, WTIS, I&A representative, Project Management Office Working Group, ehealth Leads Council, OntarioMD, OTN, OACCAC, and others through committee activity. (seven NE, five Champlain, six NSM, and four NW). 2. Development of a Data Sharing Agreement that can be used in other ehealth projects across the province. 3. Building towards a comprehensive EHR. 4. Improving access to care (ER/ALC). 5. Improving Chronic Disease management. 1. Providers will have appropriate bandwidths to run EMRs, diagnostic imaging, internet and other "electronic-based" services. 2. Building towards a comprehensive EHR 3. Improving access to care (ER/ALC). 4. Improving Chronic Disease management. 1. Developing partnerships within the province to facilitate delivery of ehealth projects. 2. Strategize on efficiencies, common provincial implementation and adoption issues, and share best practices. 3. Building towards a comprehensive EHR. 4. Improving access to care (ER/ALC). 5. Improving Chronic Disease management. In progress In progress Page 23 March 2011

24 Project Title Description Impact / Outcome Overall Status 9 Work with regional partners to align funding, strategies, and priorities. Actively engaged ehealth leaders and champions within the region and province including: Northern Ontario School of Medicine, North Eastern Ontario Network, Family Health Team, physician, pharmacist, nurse practitioner, Community Care Access Centre, community health centre, mental health and addictions, long-term care, community support services, independent health facilities, public health, and hospital through committee activity. 1. Developing partnerships within the region (and between sectors) to facilitate delivery of ehealth projects. 2. Identify regional champions to support the implementation and adoption of the diabetes registry and other ehealth initiatives. 3. Building towards a comprehensive EHR. 4. Improving access to care (ER/ALC). 5. Improving Chronic Disease management. In progress 10 Hip and Knee Referral Process establish an electronic referral process between physicians for hip and knee surgery. Working with the NE HKRP SC at an e-referral tool to support the work of a NE Joint Assessment Centre. 1. Development of an electronic referral tool. 2. Building towards a comprehensive EHR. 3. Improving access to care (ER/ALC). 4. Improving Chronic Disease management. In progress 11 Implementation and Adoption Project Align ehealth projects and tools across all sectors so that we can share best practices and resources. Conducting an inventory of HSPs priority projects to look for opportunities to align with existing resources, assets, applications, implementation project management leadership, and resources that exist in the region. 1. Broad consultation with all health service providers through focus groups and surveys and one-on-one consultations. 2. NE LHIN ICT Strategic Plan. 3. Building towards a comprehensive EHR. 4. Improving access to care (ER/ALC). 5. Improving Chronic Disease management. In progress 12 NE Information and Communication Technology (ICT) Shared Services Project. A Steering Committee has been developed to recommend an implementation approach towards the analysis of an ICT Shared Services Organization. This will be accomplished in the best interests of all HSPs while leveraging collective financial and ICT human resource capacities. 1. Economies of scale in capital procurement. 2. Elimination of duplicated effort. 3. Better service, improved quality, and enhanced hours of service. 4. Greater access to specialized skills and infrastructure. 5. Building towards a comprehensive EHR. 6. Improving access to care (ER/ALC). 7. Improving Chronic Disease management. In progress 13 Ontario LHINs Privacy Project (OLPP) ehealth privacy and security policies for all sectors in Ontario. ehealth Ontario is leading a privacy project (via North Simcoe Muskoka LHIN) to address ehealth sharing amongst providers and between LHINs 1. Privacy and security policies and procedures related to ehealth. 2. Building towards a comprehensive EHR. In progress Page 24 March 2011

25 Project Title Description Impact / Outcome Overall Status 14 Ontario Telemedicine Network Education OTN Conference for providers and coordinators in May Ontario Telemedicine Network Expansion Submitting a proposal for expanded telemedicine (more OTN equipment). 16 Ontario Telemedicine Network Expansion Submitting a proposal for Telehomecare (allowing patients with diabetes, COPD, CHF to manage their care from home). 17 NE LHIN / Ontario Telemedicine Network Strategy ("TeleQuest"). Planning is underway with OTN for the Northern Telemedicine Forum which will be held in May, The LHIN is developing a business case and proposal for expansion of telemedicine. The LHIN is developing a business case and proposal for expansion of Telehomecare. Working with OTN to set up a regional plan for telemedicine within the NE LHIN including an 'endof-life' refresh strategy. 18 Pharmacists EMR. Working with pharmacists in the North East to implement an EMR. 1. Formulating partnerships within the region to facilitate delivery of telemedicine. 2. Building towards a comprehensive EHR. 3. Improving access to care (ER/ALC). 4. Improving Chronic Disease management. 1. Patients will have improved access to chronic disease management tools (i.e. Diabetes). 2. Improved health and healthcare. 3. Formulating partnerships within the region to facilitate delivery. 4. Building towards a comprehensive EHR. 5. Improving access to care (ER/ALC). 6. Improving Chronic Disease management. 1. Patients will have improved access to chronic disease management tools (i.e. Diabetes). 2. Improved health and healthcare. 3. Formulating partnerships within the region to facilitate delivery. 4. Building towards a comprehensive EHR. 5. Improving access to care (ER/ALC). 6. Improving Chronic Disease management. 1. Patients will have improved access to care. 2. Improved health and healthcare. 3. Building towards a comprehensive EHR. 4. Improving access to care (ER/ALC). 5. Improving Chronic Disease management. 1. Promoting clinicians and pharmacists to work together. 2. Facilitating the adoption of technology. 3. Improved patient care. 4. Building towards a comprehensive EHR. 5. Improving access to care (ER/ALC). 6. Improving Chronic Disease management. In progress In progress In progress In progress Planned Page 25 March 2011

26 Project Title Description Impact / Outcome Overall Status 19 Physician Office Integration (POI) Project 25 hospitals and physician offices will be able to share patient medical information. Developing a regional approach to allow hospital reports to flow electronically into physician, NP, and CHC electronic medical records. 1. Physicians will receive medical records from all participating NE LHIN hospitals. 2. Paper based medical record storage, organization, and filing costs will be greatly reduced. 3. Shorter turnaround time for the receipt of lab work or any hospital diagnostic imaging or other testing. 4. Building towards a comprehensive EHR. 5. Improving access to care (ER/ALC). 6. Improving Chronic Disease management. In progress 20 Provide support and guidance to HSP's for ehealth projects and act as a liaison between ehealth Ontario and HSPs. 1. Build relationships and trust with health service providers. 2. Engage HSPs and establish communication processes. 3. Focus on support, access, equality, sustainability, integration, and coordination. 1. To align organizational ehealth initiatives to the ehealth Ontario Strategy. 2. Building towards a comprehensive EHR. 3. Improving access to care (ER/ALC). 4. Improving Chronic Disease management. In progress 21 Regional Network Managed Services Project. 29 health service providers share a network managed service. 1. Shared help desk /7 support. 3. Shared procurement. 4. Building towards a comprehensive EHR. 5. Improving access to care (ER/ALC). 6. Improving Chronic Disease management. Completed 22 Registered Nurses Association of Ontario (RNAO) Working with nurses to adopt EMRs and ehealth projects. Working with the RNAO Nurse Peer Leader for the NE to bring ehealth awareness to all nursing communities of practice through a Nurse Peer ehealth Network (NPEN) which will be a venue to provide input into the development of ehealth initiatives and deployment of activities. 1. Formalize partnerships within the region (and between sectors) to facilitate delivery of ehealth projects. 2. Identify regional champions to support the implementation and adoption of the diabetes registry and other ehealth initiatives. 3. Building towards a comprehensive EHR. 4. Improving access to care (ER/ALC). 5. Improving Chronic Disease management. In progress Page 26 March 2011

27 Project Title Description Impact / Outcome Overall Status 23 LHIN Integrated Health Service Plan and ehealth Alignment. Figure 6: Status of ehealth Projects at the NE LHIN 1. Aboriginal, First Nation, Métis health services. 2. Addiction and mental health services. 3. Aging at home. 4. Alternate level of care strategies and solutions. 5. Diabetes care CDM. 6. Emergency department wait times. 7. French-language health services. 8. Health human resources. 9. Optimization of surgical services. 1. Improves upon the delivery of care and access to care within all sectors. 2. Building towards a comprehensive EHR. 3. To align with MOH and ehealth Ontario strategies to transform the health system while maintaining NE priorities. In progress Page 27 March 2011

28 4.6 Portal Use in the NE LHIN The status of clinical portal implementation and use is briefly described in this section of the report. The data was gathered through survey Existing portals with plans to extend use The following HSP sites have plans to extend or upgrade their current portals: 1. Group Health Centre; 2. Hôpital régional Sudbury Regional Hospital (HRSRH); 3. West Parry Sound Health Centre; and 4. Community Care Access Centre New portals planned The following HSP has a plan to add a portal to their ICT offerings: 1. Timmins Family Health Team: This portal is in the early stages of planning Portals Used The following portals are most commonly used by HSPs in the NE: ehealth (five HSPs); Public Health (four HSPs); ONePortal (three HSPs); and OntarioMD (two HSPs) Integration Technology The following is a list of integration technologies in use at participating HSP sites: Mirth Connect; Cloverleaf; OPENLink; ebiz; SharePoint; and Purkinje. Some sites are reporting that they automatically extract information from outside their site, and add the information to their internal data warehouse. Information sources from which data is extracted include: Clinicare (from a different site); CIHI; and CCAC CHRIS information (interface built to HL7 standards). Very few sites are reporting that all client information is captured and stored electronically. Page 28 March 2011

29 The Group Health Centre shares systems and information with Algoma Public Health and the Garden River First Nations Wellness Centre. The Sudbury Regional Hospital shares information, system, and technical resources with a wide variety of HSP sites within the NE LHIN. Business Intelligence tools are widely used and expanding in the NE LHIN. There are some Data Warehouses built around key systems such as MEDITECH and Clinicare Applications The following are ehealth Ontario applications that are most widely used by the surveyed HSPs: Drug Profile Viewer (27 in Emergency Departments; 32 sites beyond ED); Ontario Drug Benefits (seven sites); and ON (46 sites) Priorities The following issues were identified as top priorities for HSP sites responding to the portal survey: French-language and Native; Privacy and security; ehealth strategy; Improving care delivery; Improving care delivery management; Standardizing technology, both internally within their HSP, and across the LHIN; Sharing of information; Information integration, both internal and external to their organization; Access to health information; and Commitment to research. 4.7 Key Findings from Technology and Infrastructure Readiness Survey The Technology and Infrastructure Readiness Survey was circulated and analysis was stratified by sector. Highlights of the findings are presented in this report. A comprehensive analysis of the survey findings is available as a separate report. For the purpose of comparative analysis of the ehealth readiness of HSPs across the region, all organizations were grouped into the following sectors: 1. Community Care Access Centres; 2. Community Health Centres; 3. Community Mental Health and Addictions; 4. Community Support Services; 5. Family Health Teams; 6. Hospitals; 7. Long-term Care; Page 29 March 2011

30 8. Nurse Practitioner's Offices; 9. Other (Physicians, Public Health Units, Children s Treatment Centres, and Independent Health Facilities); and 10. Pharmacies. The figure below provides a breakdown of HSP participation by sector. 13% 3% 9% 4% 4% 9% 19% 14% 15% Community Care Access Centre Community Health Centre Community Mental Health and Addictions Community Support Services Family Health Team Hospital Long-Term Care Nurse Practitioner's Office Pharmacy Other 10% N = 106 Figure 7: Breakdown of Survey Participants by Sector Key Findings HSPs were asked a series of questions related to the current state of shared services at their organizations and whether they were interested in a regional approach to ehealth ICT at their HSP. Hospitals and Community Health Centres reported the highest rate of shared resources with other organizations at 80% and 55% respectively. Community Support Services and HSPs classified as Other had the lowest rates of shared resources with other organizations. On average, 50% of all organizations polled indicated that they share staffing resources with other organizations. ehealth Projects and Initiatives The rate of participation in ehealth projects is moderate with 50% of the HSPs polled indicating that they currently have one or more ehealth Projects that are ongoing or will be started in the near future. Hospitals and Community Health Centres have the highest level of engagement in ehealth projects with 80% of the HSPs in these two sectors indicating that they are currently involved in an ehealth initiative or will be in the near future. Organizations classified as Other have the lowest level of engagement in ehealth initiatives (10%), followed by Community Support Services organizations (31%) and LTC Homes (39%). ICT Inventory and Infrastructure Currently in Place The Information Communications and Technology infrastructure at HSPs across the NE LHIN was evaluated on several criteria including their IT human resources, status of their portal technology, the use of OTN videoconferencing systems, server and data centre infrastructure and disaster recovery protocols that are currently in place in their organizations. The majority of HSPs across all sectors have an aspect of their IT operations outsourced to a third-party provider. Most commonly, HSPs have dedicated IT staff who liaise with a local IT vendor. Page 30 March 2011

31 % of Respondents % of Respondents ehealth ICT Strategic Plan The majority of organizations across all sectors do not have a patient portal in place. Two thirds of all HSPs lack both a patient portal and provider portal. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% No Yes N = 100 Figure 8: Summary of the use of provider portals at HSPs across the NE LHIN. Only 33% of the respondents indicated that their organization uses a provider portal, as indicated by the dashed line. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% No Yes N = 89 Figure 9: Summary of the percentage of respondents who feel a provider portal would be helpful to their organization. Overall, 85% of respondents polled indicated that a provider portal would be helpful to their organization, as indicated by the dashed line. The majority of the HSPs polled have a central server to store their client and office data. Less than half of the survey participants responded to questions related to their organizations data centre or disaster recovery plan. This supports a future ICT plan that places greater importance on providing staff with training on their organization s Information and Communications Technology systems. Page 31 March 2011

32 % of Respondents ehealth ICT Strategic Plan EHR Components Currently in Place Of the various EMR/EHR components in place at HSPs in the NE LHIN, there was an even split between components that were implemented and those that were not. Community Support Services, Community Health Centers and Family Health Teams had the highest number of EHR components implemented, as seen in the chart below. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% No Planned Implemented, but not in use Implemented and in use N = 102 Figure 10: Status of the Components of the EMR / EHR System within each Type of Organization. EMR Components Implemented and in use Status of EMR/EHR Components Implemented, but not in use Planned No Total Patient Demographic / Registration Medical History Patient Disease Registry Patient Education Medication Management Immunization Information Laboratory Test Results Radiology Images Scheduling Electronic Referral Messaging to Other Providers Billing Administrative/Management Reporting Coding Support Document Management Decision Support Figure 11 Status of the Components of the EMR / EHR System within each Type of Organization. On average, across all organizations, approximately ¾ of the organizations have the EMR components in place while 25% do not and 5% plan to. Page 32 March 2011

33 Project Management and Change Management With respect to the Project Management and Change Management initiatives at HSP organizations across the NE LHIN, a significant number of organizations indicated that they engage outside expertise to assist them with Project Management when they embark on a new initiative. To a lesser extent, HSPs indicated that they engage outside expertise for change management. Most organizations do not use formal project management methodologies to complete new initiatives and projects. A very small percentage of organizations employ a Project Manager with a Certified Associate in Project Management (CAPM) or Project Management Professional (PMP) designation (3% and 10% respectively). The following are key findings across all participating organizations with respect to their project management and change management functions: Approximately 60% of the organizations indicated that they engage outside expertise (i.e. consultants) to assist them with Project Management, while 40% of the organizations engage outside expertise to assist them with Change Management when they embark on new initiatives: CHC agencies engage outside expertise more than any other sector for both Project Management and Change Management; Across all sectors, approximately 33% of all organizations indicated that they have a formal project management methodology in place at their organization, while approximately 20% indicated that they have a formal change management methodology in place; With the exception of LTC Homes and Nurse Practitioners Offices, organizations in all other sectors have staff with a designated Project Management (PM) role; Across all sectors, Project Managers and Project Coordinators are the most common PM roles followed by Project Assistants and Senior Project Managers; Approximately 25% of the respondents indicated that they utilize any project management software. The most common PM software used across all organizations is Microsoft Project; and None of the organizations indicated the use of any change management software though ITIL was the most commonly identified change management methodology organizations follow. Privacy and Security Many HSPs have a Privacy Officer, Security Officer, or a dedicated contact person that is responsible for their Privacy and Security issues. Virtually every organization, who responded to the survey, has a privacy and security policy in place. It should be noted that organizations across the NE LHIN have made strides in improving their privacy and security functions over the past three years when this survey was last conducted. The table below summarizes the findings from the 2008 and 2011 ehealth ICT Survey as they pertain to the privacy and security functions across participating organizations within the NE LHIN: Do you have a privacy officer, security officer or other dedicated contact person within your organization? Yes (68%) No (25%) Don t know (7%) Yes (78%) No (22%) Total number of responses: 213 (NE & NW LHIN responses) 96 (NE responses) Do you have a privacy and security policy? Yes (71.5%) No (22.5%) Yes (95%) No (5%) Total number of responses 207 (NE & NW LHIN responses) 102 (NE responses) Page 33 March 2011

34 As shown in the chart above, 10% more organizations reporting having a privacy officer, security officer, or other dedicated contact person within their organization in 2011 compared to Additionally, there has been a 23% increase in the number of organizations that have a privacy and security policy in place in 2011 compared to This indicates that progress has been made in placing privacy and security personnel with each organization and improving the privacy and security related policies currently in place within these organizations. 4.8 Key Findings from Consultation Sessions The key findings from the discussion groups are summarized below, from the perspective of people, processes, and systems / technologies. Perspective Key Findings People More information management (IM) and information technology (IT) staffing needed potential for sharing of resources Processes Standardize reporting across the LHIN and the province Increase sharing by organizations that have successfully implemented best practice processes Systems Integrate information (physician office, other systems) Share technology platforms across HSPs for cost effectiveness and integration of information Populate systems with pre-existing data would make data management, eliminating duplication of effort of data entry and risk of data entry errors Priorities Identified from Discussion Groups Group Identified Priorities Organizational Develop interfaces moving away from paper but appreciate that a lot of faxing still takes place Consolidate servers and systems Enhance the use of EMR LHIN Address funding issues fund or seek funding for ehealth ICT projects Collect data and report at a system level for LHIN-wide dashboards, data analysis, and population health status analysis Advocate for human resource support for systems Develop LHIN based aggregate data of medication use / management 4.9 Key Findings and Conclusions from CEO Interviews Key Findings from the CEO Interviews Perspective Key Findings People Need shared resources Maintain and share intellectual capital Processes Standardize Develop common performance evaluation Systems Integrate Share platforms Increase use of EMR Strategy Move it out of operations and demonstrate big picture thought processes Page 34 March 2011

35 4.9.2 Priorities Identified from CEO Interviews Group Organizational Strategic plan with buy-in Electronic order entry systems Standardization of process Identified Priorities Project resources made available (potential for sharing) HRIS (Human Resource Information Systems) CPOE (Computerized Physician / Provider Order Entry) systems LHIN PMO Office for resource sharing and enhance project delivery Creating the right balance so that the NE LHIN s unique needs get addressed while creating Regional Integration Center-wide relationships and project and investment synergies Partnering in the Regional Integration Center development process, balancing regional needs and those of the other LHINs Working with the NW LHIN to identify and leverage ehealth projects and investments of potential mutual benefit 4.10 Current ehealth Project Governance and Accountability Structures and Processes The PMO reports to the LHIN CIO and ehealth Lead. It is funded by ehealth Ontario to provide project oversight to the numerous ehealth projects in the NE LHIN. Each hub hospital also has a PMO. Where a LHIN-related ehealth project is involved, the LHIN PMO provides project oversight, funding support, and carries out any necessary community engagement. Page 35 March 2011

36 5. Gap Analysis and Emerging Themes NEEAC discussed the range of potential opportunities identified through: An assessment of the data collected on the status of health service provider information systems the survey undertaken as part of the strategic plan refresh process, discussion groups and interviews conducted, existing planning and evaluation documents, and surveys and consultations available from other sources or other NE LHIN projects; An assessment of the status of regional, provincial, federal and Aboriginal, First Nation, and Métis ehealth initiatives; The degree to which the NE LHIN and its health service providers are involved in ehealth initiatives; and The ehealth ICT priorities of those consulted through the survey, interviews, and discussion groups. 5.1 Gap Assessment From an ehealth perspective, though HSPs in some sectors report a high rate of participation in ehealth projects, namely hospitals, CHCs, and FHTs, others have indicated a very low rate of participation. Community Support Service organizations report a 30% rate of participation, LTC homes report a 40% participation rate and within smaller HSPs, (Public Health Units, Children s Treatment Centres, and Independent Health Facilities), only 10% of these organizations indicated that they have any ehealth projects that are ongoing or will be starting in the near future. This discrepancy in ehealth engagement across sectors indicates that HSPs are disproportionately engaged in ehealth across the region. From an IT business perspective, 36% have IT best practice methodology in place to provide a standard for IT and security management. Without standard practices and common IT security methodologies and protocols in place, HSPs are limited in their ability to transmit information amongst one another. From an IT infrastructure perspective, only 10% of the HSPs indicated that they have a patient portal and one third have a provider portal. In comparison, 33% of the HSPs polled would like to see portal technology implemented while 85% would like to see provider technology implemented within their organization. 5.2 Opportunities and Recommendations The NE LHIN has made significant strides towards electronically managing information across all sectors. There is further opportunity for HSPs within the NE LHIN to increase the amount of information that is shared electronically between their organizations. From the discussion groups, the need for increased consolidation and standardization of processes and systems was a recurring recommendation which would lead to increased efficiency and cost savings. Additionally, integration of EMR and physician office shared platforms would be useful and potentially more cost effective than the multi-platform systems currently in place. NEEAC discussed the current state of ehealth ICT in the NE LHIN, the opportunities presented by the successes achieved, investments made, and potential to leverage upcoming investments from Canada Health Infoway (CHI) and ehealth Ontario. The following initiatives were identified: Page 36 March 2011

37 Initiative Shared EHR Governance Sustainability Projects and Description EHR Roll-out of organizational electronic record in all settings. BMV Bedside Medication Verification in the institutional sector. emar Closed loop medication management Electronic Medication Administration Record in the institutional sector (i.e. hospitals and long-term Care), including bed side medication verification. Provider Portal Provider portal for accessing / viewing patient data from other providers serving the patient. Institutional Pharmacy Module roll-out Integration between CCAC, CHRIS and NEON MEDITECH Implementation of GAIN, OCAN MOSAIC (ambulatory deployment) Electronic linkages to tertiary care centres Integration of community information Embracing the EMR-AM score Community pharmacies need patient information Lack of Community Pharmacy EMR Completion of the roll-out of the Pharmacy module at smaller NEON hospitals. Integration between CHRIS and MEDITECH. Assessment tools that can be electronically shared for patients of mental health programs. Deployment of MOSAIC clinical information from Cancer Care Ontario for the regional cancer programs. Exchange of patient information between community support organizations and hospitals. Mobilizing client / patient information among the community sector organizations and with hospitals (e.g. for the purpose of avoiding / planning for crisis situations). Monitoring progress in the adoption of advanced clinical applications. Providing community pharmacies with drug profiles documented in electronic records. Providing pharmacies with EMRs to support their clinical functions and to link their documentation for continuity of care. Shared EHR Setting up accountability and governance framework for regional ehealth and iehr projects. Regional Integration Center s governance Creating a shared vision, ensuring that all providers are in agreement Communication and recognition of NE accomplishments Lack of clarity / communication on projects undertaken Leverage NEON s assets and existing investments Setting up accountability and governance framework for effective working relationships of the North East, North West, Champlain and South East LHINs. To be achieved as part of the governance and accountability work. Branding the NE LHIN accomplishments. Develop a comprehensive ehealth project inventory list for the NE LHIN. Identify assets that can be leveraged and develop tactical plans on a more pervasive deployment. PMO Funding Develop and make further investments in the NE LHIN PMO possible delivery office to support HSPs. Shared service Address ehealth ICT sustainability issues as part of the shared service feasibility study. Packaging the ROI Adopt business case template and full documentation of project costs, benefits, risks, potential funding Page 37 March 2011

38 Initiative Collaboration and Capacity Management Productivity Improvement Decision Projects and Description sources, and assets to be leveraged. To be championed and implemented by the PMO. Building capacity Identify leverageable assets and develop tactical plans for deployment of the solutions to other HSPs as appropriate. Address as part of the shared services feasibility study. Ensure leverageable assets are part of the provincial inventory. Increase the PM capability Develop and make further investments in the NE LHIN PMO possible delivery office to support HSPs. Operational funding for sustainability The average percentage of IS to organizational expense is 2.3% among the NE LHIN hospitals versus 2.5% for other LHINs. There is the opportunity to increase these expenditures to make the systems more sustainable. The average for large community hospitals and the teaching hospital is at par (2.2%). (Source: Ontario Hospital Healthcare Information and Management Systems Society Report, 2009) SharePoint A collaboration tool among all service providers to share documents including policies and procedures. Surgical optimization Using electronic tools to manage wait times and access to services. Access to data storage by more organizations Leveraging the NEON Clinical Data Repository (CDR). Resource management Leveraging the CCAC integrated discharge planning project. Operational funds for sustainability Infrastructure / connectivity for CMHA PMO Services / sustainability Shared infrastructure among community sectors Ability to automate with CCACs The average percentage of IS to organizational expense is 2.3% among the hospitals versus 2.5% for other LHINs. There is the opportunity to increase these expenditures to make the systems more sustainable. The average for large community hospitals and the teaching hospital is at par (2.2%). (Source: Ontario Hospital. Healthcare Information and Management Systems Society Report, 2009) Through ehealth Ontario addressing network connectivity and speed issues (e.g. for the West Parry Sound Mental Health Services). Develop and make further investments in the NE LHIN PMO possible delivery office to support HSPs. Leverage NEON and Timmins hub assets to assist the community sector. Address these issues as part of the shared service feasibility study. Continue to roll-out the new Integrated Discharge Planning (IDP) service delivery model. Integrate CHRIS and MEDITECH. Rebranding NEON Leverage NEON and Timmins hub assets to assist all sectors in the roll-out of iehr. Human Resource Information System There is limited automation in this area. Staff Scheduling System There is limited automation in this area. Business Intelligence A LHIN-based decision support and business intelligence structure, process and technology (e.g. Page 38 March 2011

39 Initiative Support Centralized Project Management Projects and Description Hamilton Niagara Haldimand Brant LHIN (HNHB) model and adoption). GAIN / OCAN Targeting 100% adoption of all CCIM assessment tools. PMO Services Develop and make further investments in the NE LHIN PMO. Project delivery projects rather than project oversight Project delivery process Change management and standards Addressing adoption issues in a consistent manner through the NE LHIN PMO. Access to research Decision support at the point of service. Research Consumer Health Adoption Serving Francophones with a French-language EMR Advocating for French-language EMR. Searching for innovative means to address translation issues and make sure that patient information is integrated to ensure continuity of care. Quality of care Carrying our Quality Improvement Projects using electronic tools. Sharing information with patients Regional nursing documentation Sharing information to expedite patients priority needs scheduling, access to test results, prescription renewals. Sharing information with their care providers (e.g. through portals and MyChart type functionality). Sharing information from their personal health record. Addressing adoption issues through the NE LHIN PMO. Ensuring clinical leadership for all clinical system implementation projects. Provider portal Leverage NEON and explore leveraging Champlain LHIN assets. Recognize NE projects provincially and increase assets CCAC/Hospital collaboration (using CCAC work and moving it into the community) Branding the NE LHIN accomplishments. Leverage the IDP project. Clinical leadership Critical success factor for projects. Electronic linkage to tertiary care Figure 12: Potential ehealth ICT Projects in the NE LHIN Exchange of patient information between community support organizations and hospitals. Page 39 March 2011

40 6. Strategies The NEEAC has restated the shared vision and developed refreshed strategic directions for the NE LHIN, consistent with provincial and health industry s ehealth directions and the LHIN IHSP. The following vision, goals, guiding principles, and strategic directions were developed from the findings and conclusions of the survey, discussion groups, CEO interviews and input by representatives from the NE LHIN, Ontario Telemedicine Network, ehealth Ontario and Canada Health Infoway. 6.1 Vision The NEEAC has confirmed the vision for ehealth ICT for the to be one in which: Information and communication technology supports the processes of quality healthcare provision, access to health information (for all Northern Ontarians from anywhere in Ontario), improvement of consumer outcomes, and the most effective use of available resources across Northern Ontario, through collaboration and sharing information amongst providers and with consumers. The NEEAC confirmed that this statement continues to reflect their vision for the future state. They have added the following banner statement to more simply state their intentions: Enabling Access to Quality Healthcare for Northerners through Information and Innovation 6.2 Goals and Guiding Principle To tie the ehealth ICT vision and strategies together, a number of key goals were confirmed. Goals along with the guiding principles presented below provide a filter or decision making framework to develop strategic directions and evaluate any strategic options Goals The vision will be accomplished through the achievement of the following strategic goals: Improve consumer access to health information to support informed decision making and transactions involving the healthcare system (access to test results, appointment scheduling, prescription renewal, etc); Enable information integration and communication among stakeholders and sectors; Improve care delivery; Improve care delivery management; Support information management for evaluation and accountability; Commit to research, education and knowledge transfer; Maximize available funding; and Ensure a planned and coordinated approach to ehealth ICT in North East Ontario Guiding Principles Guiding principles define how health information in North East Ontario will be gathered, managed, and shared. These principles act as guide posts along the path of the strategic directions, Page 40 March 2011

41 assisting all participants to stay focused on the agreed upon plan as they discuss alternatives and / or change priorities to take advantage of funding opportunities. Consumer-centric system Clinical information will be integrated primarily around the circle-of-care, serving communities. The strategies and solutions will have a system-wide focus rather than focus on individual organizations. Delivery of required electronic record (client / medical) content for each sector Solutions will be compatible and interoperable. Solutions will ensure functionality for each sector. Ease of and access to information Provide an integrated view of clinical information at the earliest possible opportunity. Health information will be accessible to service users and service providers, addressing barriers due to language, hearing, and visual impairment. Shared, common, electronic client / patient file with appropriate standards, privacy, consent, security, and provision is the key goal of the ehealth ICT strategic plan. A shared, common database is required to support the electronically-shared, common client / patient file and sharing of information among service providers. Promotion of effective use of health human resources and quality of work life The solutions and approaches must support service providers in their focus on service provision rather than manual information processing. Evolving approach to the achievement of strategies As strategies are implemented, current investment in systems and solutions should be leveraged if they have the appropriate functionality and interoperability. As much as is possible, ehealth ICT solutions should be integrated. To facilitate the achievement of integrated systems, guidance should be provided to individual organizations on the effective selection and implementation of applications. As strategies are implemented, successful projects and investments within Northern Ontario, Ontario, and across the continuum of care should be leveraged. Health information solutions should be standards-based, cost effective and sustainable. There should be an ongoing refresh process for technologies and applications. Standards for information management and data sharing Health information sharing should be guided by agreed upon standards on the form, content and manner of sharing. Standards for privacy, security and consent Health information sharing should be guided by agreed upon standards for privacy, security, and consent, starting with a shared understanding of legislation, professional guidelines, and good practices. Enabling mandatory reporting through the collection of data at the point-of-care Data should be collected once at the point-of-care / service delivery. Data acquired at the point-of-care should then be used as many times as is necessary to meet the mandatory requirements of the various ministries. Alignment with provincial ehealth and NE LHIN IHSP directions Solutions and strategies should be aligned with provincial ehealth strategies and plans and the business objectives of the NE LHIN. Commitment to evaluating the effectiveness of the ehealth ICT Strategies Page 41 March 2011

42 The strategic plan implementation will be evaluated with a view to determine how effectively the plan s vision and strategies are being achieved. 6.3 Strategic Directions In reviewing the gap analysis presented in an earlier section of this report and considering the stakeholder input, vision statement, unfolding technology trends, the significant progress in ehealth being made in the region, four key strategies were determined to guide us to the future state. Through a facilitated process at their workshop, NEEAC grouped all relevant potential projects and priorities under these four overarching strategies. 1. Strategic Direction #1 Establish the electronic record within individual organizations shareable across the continuum of care. 2. Strategic Direction #2 Extend data in the individual electronic records to other agencies: Increase the ability to share information among electronic records to facilitate communication and information integration; Develop system-wide decision support capability; Use technologies to promote service provider communication for clinical and administrative purposes; and Build on provincial investments. 3. Strategic Direction #3 Govern the development of the regional iehr effectively: Develop the technical infrastructure and utilize new technologies to match requirements; Develop the Regional Integration Center concept; Increase project management capacity; and Define ehealth ICT strategic plan accountability. 4. Strategic Direction #4 Consumer Health: Use technologies to respond to consumer needs. The ehealth ICT strategic planning process requires a system-wide approach to healthcare to maintain its core principle of a patient centric view. The plan includes non-funded service providers represented on NEEAC: Children s Treatment Centre; Community pharmacists; Nurse practitioners; Midwives; Community-based primary care and specialist physicians; Public health; and Other agencies not funded by the LHIN, but who are partners in the circle-of-care. 6.4 Alignment of the ehealth ICT Strategies with IHSP Directions These strategies are in direct alignment with the overall LHIN directions. The following chart highlights how the NE LHIN ehealth ICT supports the LHIN directions, as set out in the IHSP. Page 42 March 2011

43 North East Ontario LHIN IHSP Priorities Aboriginal / First Nations / Métis Health Services Addictions and Mental Health Services North East ehealth ICT Strategic Directions Establish Electronic Record within Individual Organizations Sharing and Collaboration - Establish Capability to Share Information Among Electronic Records Governance Consumer Health Use Technologies to Respond to Consumer Needs Aging at Home Alternate Level of Care Strategies and Solutions Diabetes Care Emergency Department Wait Times French Language Health Services An Integrated Approach Health Human Resources Optimize Surgical Services. Figure 13: Alignment of the NE LHIN ehealth ICT Strategic Directions with the NE LHIN IHSP Priorities 6.5 Strategic Direction #1 Establish the Electronic Record 3 within Individual Organizations The focus of this strategy is to advocate for all health service providers to acquire an EMR (appropriately named electronic client / clinical information system to manage service provision) Goals Design for ease of use, access and single sign-on to appropriate information. Build the content of the Electronic Record ensuring that the information is shareable with other applications and systems across the sectors and that information can follow the patient / client / community member. Increase the average NE LHIN and individual organizational EMR-AM score. Support mandatory reporting requirements. Leverage current investments in selecting systems. Provide assistance to smaller sites with expired legacy systems. Provide assistance to smaller sites implementing systems of immediate patient care and patient safety value. Commit to interoperability. Advocate for funding to ensure ongoing support for the applications. 3 There are differences among the health sectors in what the electronic record is called: Hospitals: Electronic Medical Record, Electronic Health Record, Electronic Patient Record; Community Sector: Electronic Resident Record, Electronic Client Record; Patients: Personal Health Record. Page 43 March 2011

44 6.5.2 Opportunities Opportunity A priority project is the implementation of the MEDITECH pharmacy module at smaller hospital sites. Implement Advanced clinical applications via EMR Physician Care for MEDITECH sites, e.g. BMV, emar, Physician Care Manager or equivalent at non-meditech sites, deployment of MOSAIC for oncology programs. Community pharmacy EMR. Nurse practitioner (NP) EMR NP-led clinics, CCAC NPs. Continue with community physician office EMR deployment through OntarioMD. Set implementation targets and monitor setting an annual EMR-AM target for the NE LHIN. Continue the deployment of CCIM assessment tools and solutions. Deploy MOSAIC for oncology programs at hub hospitals (North Bay, West Parry Sound, Sault Ste. Marie, Sudbury, and Timmins) exploring the opportunity of funding ambulatory implementation through the CHI Ambulatory EMR-HIS Connect Program. Create a single MEDITECH system for the NE LHIN hospital providers, expanding from 20 to 25 hospitals. Figure 14: Potential Projects related to Strategic Direction #1 Benefits Implementation of the pharmacy departmental module increases medication safety. Automation of all patient information has many benefits Decreases medication errors and increases patient safety. Increases efficiency of work flow and data quality. Automates secondary use of data. Increases staff satisfaction. Positions for electronic sharing of information with patients. Well-defined, measurable target to measure degree of success in adoption of electronic patient management tools. Automation of the community support sector. Automation of ambulatory oncology care information and interface with hospital information systems. Mobilizing oncology information sharing for continuity of care, especially with primary care physicians, which has been shown to be effective in sustaining positive treatment outcomes. Although still massive, the investments required for implementing and maintaining advanced clinical applications will be minimized with this approach. 6.6 Strategic Direction #2 Extend data in the Individual Electronic Health Records to Other Agencies The focus of this strategy is to advocate for health service providers to mobilize patient / client / community member care information residing in their electronic systems to ensure continuity of care / service for patients / clients / community members Goals Increase the ability to share information among electronic records to facilitate communication and information integration. Build the collaboration tools for sharing of information. Ensure interoperable systems and standards based information sharing. Develop system-wide decision support capability. Use technologies to promote service provider communication. Continue to integrate community-based physician practice EMRs with other EMRs. Advocate for independent nurse practitioner and midwife practice EMRs. Page 44 March 2011

45 Standardize (e.g. Open Order Sets, electronic sharing of standardized assessment tools). Build on provincial investments. Leverage the NEON gadgets registries, clinical data repository. Build on NE LHIN integrative projects: Integrated Discharge Planning (IDP) between CCAC and hospitals; NEON; Doorways portal; NEODIN DI-r; MOSAIC implementation in ambulatory care; and OMNYX (Digital Pathology) between the Timmins hub (Timmins and 13 small community hospitals) and UHN Opportunities Opportunity Exploring the potential to leverage the POI tools for sharing of client profiles among community sector organizations and between the community and hospital sectors. Medication Profile: Sharing medication profiles at all points of referral. Exploring the potential for a quick win project for sharing medication profiles with community pharmacies. Roll-out the / OTN TeleQuest strategic plan expanding use of Telemedicine as planned through multiple projects and guided by the comprehensive strategic plan. Benefits Translating the success achieved with the POI project into the broader community health sector. Integration of patient information for continuity of care. Reducing duplication of testing. Reducing turnaround time of reports and test results. Increased patient, physician, multi-disciplinary team satisfaction. Increasing patient safety through sharing of upto-date information on the medication a patient is taking. Leveraging telemedicine technologies to increase access to care across North East Ontario. Integration of care delivered through Telemedicine with patient information across the continuum of care. Carry-out the surgical optimization project. Using technologies to support projects that increase access to surgical care. Integrate CCAC CHRIS and MEDITECH. Eliminate duplication of patient information entry. Expansion of the use of the Doorways Clinical Portal. Real-time sharing of patient information. Faster referral time. Reduced delays and denials due to incomplete forms. Leveraging a successful project. Expanding for additional services. Implement regional Staff Scheduling System. Promote effective scheduling and management of human resources. Implement regional collaboration tools (e.g. SharePoint). Ability to identify available human resources credentials, skills, and capacity. Can be used for regional knowledge management, sharing of administrative Page 45 March 2011

46 Opportunity Benefits documents such as policies and procedures. Implement a regional Decision Support solution. Ability to automate organizational and regional reporting. Integrate information exchange between systems, e.g. MEDITECH and CIMS. Figure 15: Potential Projects related to Strategic Direction #2 Automate sharing patient information for continuity of care. 6.7 Strategic Direction #3 Govern the Development of the Regional interoperable Electronic Health Record (iehr) Effectively Goals Develop the technical infrastructure and utilize new technologies to match requirements. Develop the Regional Integration Center concept. Create project management and delivery capacity, in addition to the current project oversight capacity of the NE LHIN PMO to enable the delivery of large regional projects (e.g. RM&R, ereferral, and managing surgical wait times). Design and implement ehealth ICT strategic plan accountability, including further development of NEEAC role and accountability Opportunities Opportunity Develop iehr governance and accountability framework for the NE LHIN. Develop the Regional Integration Center relationship. Benefits Project and enterprise program management accountability. Comprehensive program portfolio view of all regional projects. Create a shared vision, ensuring that all providers are in agreement. Alignment of ehealth projects across the Regional Integration Center North West, North East, Champlain and South East LHINs. Develop project management and delivery. Increase the regional capacity in project management Develop a NE LHIN ehealth ICT communications plan accomplishments, clarity about projects, etc. Ensure adoption of methodologies is consistent with Project Management Institute evidenceinformed practices. Raise skills levels and capacity. Acquire project management software to monitor the portfolio of regional projects. Ongoing identification, prioritization of project in response to mandatory requirements and funding opportunities. Ensuring that the North East Ontario accomplishments are recognized by funders and policy makers. Shared Service. Address ehealth ICT sustainability issues as part of the shared service feasibility study. Identify leverageable assets and develop tactical plans on a more pervasive deployment. Ensure leverageable assets are part of the provincial inventory. Page 46 March 2011

47 Opportunity Improve business case development (e.g. developing the ROI considering all factors, costs, and benefits). Make the case for hospitals to increase their operational budget for ehealth ICT to match their peer group average. Figure 16: Potential Projects related to Strategic Direction #3 Benefits Leverage NEON and Timmins hub assets to assist the community sector. Address these issues as part of the shared service feasibility study. Leverage NEON and Timmins hub assets to assist all sectors in the roll-out of iehr. Ensuring that all project costs, benefits and risks have been identified and documented; and demonstrate to project sponsors and potential funders. Ensuring sustainable funding to support ongoing operational costs of applications. 6.8 Strategic Direction #4 Consumer Health The focus of this strategy is using electronic tools as part of a larger NE LHIN goal of engagement of the consumer in preventing and managing their chronic diseases. This can happen by providing access to information and teaching skills in behaviour change Goals Provide consumers self-service tools to manage their transactions with the healthcare system, e.g. receiving test results, scheduling and medication renewals. Equip consumers with the tools and capacity to participate actively and share in decisions affecting their health. Ensure that consumers have timely access to information to manage their care, health and relationships with their service providers Opportunities Opportunity Develop a consumer ehealth strategy for the NE LHIN, including consideration for: Consumer ehealth Understanding the patient / client / family view of opportunities presented by electronic collaboration tools and web-based technologies; Patient Collaboration Tools Assessment of solutions that support patient / client / community member engagement in self-care, including leveraging provincial projects (e.g. Diabetes Registry), Telehomecare, and local projects (e.g. Directory of Services 310 CCAC); and Patient Portal Assess existing patient portal projects across other LHINs to leverage opportunities to provide patients access to their own healthcare / service record. Figure 17: Potential Projects related to Strategic Direction #4 Benefits Developing strategies for rolling-out patient selfmanagement; better access to healthcare system; and personal health records Page 47 March 2011

48 7. Implementation and Adoption In this section of the ehealth ICT strategic plan, project implementation and adoption critical success factors are identified, the key aspects of effective project governance and management are described and a conceptual framework for change management is presented. 7.1 Project Critical Success Factors ehealth projects tend to be complex, involving multiple stakeholders. Critical success factors include: User input Extensive user input from physicians, clinicians, and managers; Consensus building Consensus-building among the multi-stakeholder groups involved in projects, coupled with effective change management strategies; Workflow transformation Implementation of the iehr/emrs may require workflow changes or complete transformation. Assessments of workflow and practice needs must be part of an EMR change management program; Due diligence Dialogue with service providers to understand their issues to determine project leadership, and the most appropriate change management program, identifying gaps, future requirements, and technology adoption issues; Development of robust business cases Documenting costs; Optimize user adoption and uptake Ability to plan and deliver ehealth ICT change management programs that optimize user adoption and uptake; Front line clinical experience Project staff that have worked on the front lines and have a track record of using ehealth ICT in transformation of care at the point of care; Project management Using evidence informed project management practices (e.g. Project Management Book of Knowledge and Ontario Public Sector Enterprise Program Management Tools); Proven approach Proven approach to implementation evaluation and impact analysis of information technology projects in healthcare; Ongoing support Change management is a key success factor in driving both uptake and optimal utilization of EMRs. Provider change management programs must be ongoing to realize the full benefits of EMR adoption on healthcare outcomes; Clinician Involvement Leadership and involvement is critical in both design of the system and championing for its deployment; Value management Establishing the value of having the EMRs based on analysis of the end user needs and environments and how well the vendor solution supports those needs as well as process to achieve, measure, and maintain that value. Answering the question, What is in it for me? ; and Support and communication Tailored to the individual practice environment and mechanism to receive and respond to feedback. 7.2 Expanding Project Management Capacity The NE LHIN PMO is mandated and funded to provide an oversight role and tracks ehealth projects across the NE LHIN. The NE LHIN needs to increase its capacity to manage LHIN-wide projects (i.e. develop project delivery capacity). There are several ways this could be accomplished: establish a LHIN project delivery office under the auspices of the NE LHIN, establish a separate project delivery PMO or Page 48 March 2011

49 consider these functions under a shared service structure (currently under exploration in the NE LHIN). Expanding the project delivery capacity: Develop consensus on the role of a project delivery focussed NE LHIN project management office function; Develop the accountability and governance framework for the Project Delivery Office; Establish project delivery roles and responsibilities; Ensure that the Project Delivery Office is resourced to match its role; Determine how the Project Delivery Office fits within other PMOs in the region and the NE LHIN PMO; and Establish and maintain an inventory of current projects. Implementing evidence-based project management for all LHIN level projects: Establish project governance and accountability; Implement a PMO toolkit (e.g. business case and project gating); Ensure that the approach includes effective project management, change management, communication and governance; and Develop the project gating process and a transparent decision making process. Advocating for evidence-informed information technology management standards: It would be part of the PMO role to advocate for implementation of evidence-informed IT practices. Developing the project delivery governance structure and processes: Defining the accountability for project delivery; Deciding which organizational entity the Project Delivery Office joins (i.e. NE LHIN, independent, or part of a NE Shared Service Organization [SSO]); and Redefining and or enhancing the role the NEEAC, in the context of above discussions and decisions (e.g. providing advice on project prioritization). 7.3 Change Management and Communication Planning 4 Large-scale change only occurs when a significant number of people support and choose it. This is why the development and implementation of a comprehensive change management strategy is critical to the success and adoption of complex change initiatives in healthcare organizations. The benefits of such a strategy are many; however, there are four worth highlighting. A well designed and implemented change management strategy can: 1. Increase the speed by which change is adopted into the team / organization; 2. Improve the overall level of participation and ultimate utilization of the change (e.g. processes, tools, systems, and re-organization); 3. Increase employee performance in the new environment; achieving expected performance levels; and 4 Comments based on PROCI change management methodology. Page 49 March 2011

50 4. Contribute to an overall positive culture of change and enhance an organization s change reputation. In support of the above-mentioned benefits, a multi-faceted approach needs to be taken to change management methodology. This approach consists of three phases of change management activities, anchored by two foundational underpinnings, and continually supported by ongoing communication, education and training. Change Management Pillars At its core, change management methodology is guided by two pillars: stakeholder engagement and building capacity. By building on these two concepts, organizations can implement complex, wide-ranging change that is both immediately successful and sustainable in the long term. And building capacity among end users refers to information, knowledge, and skills that will positively contribute to change efforts. Three Phases of Change Planning for Change The initial phase of the change management methodology, Planning for Change, is perhaps the most crucial of all three phases. It is at this time that a number of assessments are completed and information is collected to determine the overall change management strategy. More specifically, this phase involves: Sizing the Change (scope of change, departments / units / organizations impacted, number of employees impacted, type of change(s), and complexity of change); Assessing the Organization / Organizational Readiness (value system, capacity for change, leadership culture, change history, change reputation); Identifying the Change Management Team (team members, structure, governance, skill assessment, training, role clarity); Leadership Readiness (identification of sponsor and key stakeholders, sponsor assessment, role clarity, coaching); and Clarity of Rationale (clear understanding and articulation of the urgency / opportunity driving the change to inform communication and coaching efforts). Implementing Change Implementing change is the second phase of a well-rounded change management methodology. It is during this phase that customized, detailed, and actionable change management plans are designed based on the information gathered during Phase 1, and on the implementation work of the project team. Examples of plans that may be required include: Communication Plan (typical components include identification of audiences, key messages, timing, delivery methods, senders, and frequency); Sponsor / Leadership Coaching Plan (based on readiness assessments completed during phase one; defines how sponsors / leaders will be supported to understand the role of change sponsor / leader, communicate change, manage change with their employees, identify and manage resistance to change, and reinforce change in new environment); and Training Plan (based on the outcome of a needs assessment and gap analysis: determines what positions require what skills and knowledge during and / or after the change; detailed training requirements by position / level, delivery channel, timeline, and trainer). Page 50 March 2011

51 Sustaining Change The final phase of an evidence-informed change management methodology is that of Sustaining Change. All too often, once a change has been implemented, our attention turns to the next priority or task at hand. It is during this time that we revert back to familiar and comfortable ways. For that reason, it is important to remain focused on reinforcing new changes after their initial implementation. Examples of activities to sustain change include: Compliance Auditing (engaging with stakeholders to collect feedback on uptake of new changes; supporting managers in auditing for compliance); Ongoing Resistance Management (identification of pockets of resistance and underlying causes, action plans and leadership coaching to resolve); Lessons Learned (debriefing activities to identify what change management activities worked well, what did not work, and how to enhance future change management success); and Celebrating Success. Communication and Education and Training Although communication, training and education have been addressed in the above sections, it is important to stress that none of these elements are one-time events or activities. All are continuously occurring throughout the entire change process. Change management is about the people side of change as they transition from current state to future state. Page 51 March 2011

52 8. Priority Project Implementation Plan and Resourcing ehealth ICT Strategic Plan 8.1 Decision Making Criteria There are numerous opportunities facing the NE LHIN in the development of its digital ehealth ICT environment for the delivery of health services. These numerous projects will need to be filtered through agreed upon criteria. Building on the decision framework proposed previously, NEEAC discussed the following as key influencers of the project selection decisions: Affordability of the project, including availability of ongoing operational funding; Whether the project is net new, optimization, infrastructure, or a foundational dependency ; Impact (e.g. improve patient care; positively impacting the workflow of a large number of providers; leveraging large institutional assets to support smaller agencies, thus increasing the ROI of existing investments; and helping avoid higher cost levels of care); and High priority item of IHSP and other key strategies. 8.2 New Priorities for Development and Investment At the NEEAC workshop, members identified projects under each strategy. Several key priorities were included: Development of the LHIN project accountability and governance framework; Development of the LHIN project delivery capacity; Development of the relationship with the Regional Integration Center LHINs; Defining an architecture that would leverage all the assets of the Regional Integration Center; Roll-out specific projects identified under each strategy; Develop a funding strategy for these projects the funding options with ehealth Ontario and CHI will need to be explored in several cases. Several projects would be in the planning stage in Year 1 of the plan, funded through the PMO or other sources. Some projects such as the regional staff scheduling and regional collaboration solution would require significant one-time and ongoing support resources; The timeline for the projects will be largely dictated by available funding, ehealth readiness of the stakeholders, competing priorities, project management and project implementation capacity; and The initial estimate is that about $28.1M is required for the projects under consideration, with an estimated incremental operational cost of $5,530,000. However, these are highlevel estimates only. Page 52 March 2011

53 Year 1 Year 2 Year 3 Year 4 Year 5 + Patients Hospitals Community Support Sector Long-term Care Community-based Practitioners 6. Community Pharmacists ehealth ICT Strategic Plan Who Benefits? One-time cost or costing assumption Ongoing costs 5. or costing assumption Sponsor and Lead Strategic Direction #1 Establish the electronic record within individual organization 1. Set EMR-AM score targets for the NE LHIN for the next five years; support with accountability agreements, vendor strategies, leverage Regional Integration Center assets Part of PMO costs Part of PMO costs NEEAC ehealth Lead 2. Implement the MEDITECH Pharmacy module at the smaller hospitals (i.e. Englehart, Smooth Rock Falls, Sturgeon Falls, and Wawa) $200,000 $40,000 NEON CIO 3. EMR for community-based practitioners Complete deployment of community-based physician EMRs ehealth Ontario ehealth Ontario Regional Physician Lead Seek funding for community pharmacist EMRs TBD TBD NEEAC OPA member Seek funding for Nurse Practitioner EMR NEEAC NP member Seek funding for Aboriginal EMR TBD TBD NEEAC Abor/FN/Métis Members 4. Implement advanced clinical applications via EMR Physician Care for MEDITECH sites or equivalent at non-meditech sites, i.e. $20,000,000 to $30,000,000 $4,000,000 to $6,000,000 NEON or hub CIO ED documentation BMV, emar NEON or hub CIO CPOE, Physician Care Manager or equivalent at non- MEDITECH sites NEON or hub CIO 5. Deploy CCIM common assessment systems and back office systems in the community sector Costs covered by CCIM and Costs covered by CCIM and NEEAC CSS member 5 Annual ongoing operating costs estimated at 20% of one-time investment. 6 Community based primary care physicians, community-based specialists, nurse practitioners, midwives. Page 53 March 2011

54 Year 1 Year 2 Year 3 Year 4 Year 5 + Patients Hospitals Community Support Sector Long-term Care Community-based Practitioners 6. Community Pharmacists ehealth ICT Strategic Plan Who Benefits? One-time cost or costing assumption Ongoing costs 5. or costing assumption Sponsor and Lead organizations organizations Business leads from individual organizations 6. Deploy MOSAIC for oncology programs at hub hospitals (North Bay, West Parry Sound, Sault Ste. Marie, Sudbury, Timmins) - exploring the opportunity of funding ambulatory implementation through the CHI Ambulatory EMR-HIS Connect Program $300,000 $60,000 Regional Oncology Program Executive 7. Single instance of MEDITECH for NE LHIN hospitals (at time of MEDITECH 6.0 upgrade for the NE LHIN) for the Magic and Client Server platforms Explore funding through CHI Innovation (expediting regional CPOE) Strategic Direction #2 Extend data in the individual electronic records to other agencies TBD 7 TBD North Bay CIO 8. Continue Physician Office Integration ehealth Ontario ehealth Ontario SRHRS IT 9. Implement regional HR/Scheduling Management System $4,700,800 $940,160 Timmins hub CIO 10. Develop regional collaboration tools (e.g. SharePoint) $1,000,000 $200,000 LHIN Senior Director, Integration 11. Implement regional Decision Support tool $1,000,000 $200,000 LHIN Senior Director, Accountability 12. Integrate data from CHRIS to MEDITECH Electronic transfer of key CHRIS data to MEDITECH (or equivalent from non-meditech hospitals) $50,000 $10,000 NE CCAC CIO 7 Sault Area Hospital, North Bay and Mattawa are already licensed but require resources and costs for conversion, consulting and staff training costs. Would need to buy licenses for WAHA and West Parry Sound. MEDITECH 6.0 upgrade would not cost anything for the current NEON hospitals. MEDITECH costs would be incurred for the North Bay conversion from Magic to 6.0. Page 54 March 2011

55 Year 1 Year 2 Year 3 Year 4 Year 5 + Patients Hospitals Community Support Sector Long-term Care Community-based Practitioners 6. Community Pharmacists ehealth ICT Strategic Plan Who Benefits? One-time cost or costing assumption Ongoing costs 5. or costing assumption Sponsor and Lead Electronic transfer of a referral from MEDITECH (or equivalent from non-meditech hospitals) to CHRIS NE CCAC CIO 13. Leverage POI for sharing of client profiles among community sector organizations and with the hospitals $100,000 for planning NEEAC CTC member. 14. ALC RM&R Provincial Regional Integration Center approach to implementation ehealth Ontario ehealth Ontario LHIN ehealth Lead 15. Formulate a quick-win project for sharing MedsCheck profiles between community pharmacies and physician office EMRs $100,000 for planning NEEAC OPA member 16. Continue with Doorways ehealth Ontario ehealth Ontario PMO 17. Leveraging local assets, expanding for additional services and increase ability to share information: Doorways, NEON, MEDITECH, HIMP, Registries, NEON CDR, Portal, etc. 18. Surgical optimization project ehealth enablers for Surgical Optimization project NE HKRP TBD TBD ehealth Lead $40,000 $8,000 SRHRS IT NE Call Schedule TBD TBD ehealth Lead 19. Roll-out of the NE LHIN/OTN TeleQuest strategic plan Telemedicine Expansion TBD TBD OTN Regional Director Telehomecare Roll-out TBD TBD ehealth Lead 20. Continue NEODIN CHI, ehealth CHI, ehealth NEODIN Lead 21. NEODIN integrating diagnostic images from IHFs into the regional repository for viewing through all EMRs TBD TBD NEODIN Lead 22. Develop Regional Integration Center relationship - cneo TBD TBD ehealth Lead Page 55 March 2011

56 Year 1 Year 2 Year 3 Year 4 Year 5 + Patients Hospitals Community Support Sector Long-term Care Community-based Practitioners 6. Community Pharmacists ehealth ICT Strategic Plan Who Benefits? One-time cost or costing assumption Ongoing costs 5. or costing assumption Sponsor and Lead Strategic Direction #3 Govern the Development of the Regional interoperable Electronic Health Record (iehr) Effectively 23. ehealth governance and accountability for the NE LHIN Develop iehr governance and accountability framework for NE LHIN 24. Enhance NE LHIN project delivery functions Develop NE LHIN Project Delivery Office for project management and delivery Part of PMO LHIN CIO $100,000 $20,000 LHIN PMO Continue to carry-out ehealth ICT project identification and planning Request as part of project funding Request as part of project funding 25. Develop NE ehealth ICT communication plan accomplishments, clarity about projects, etc. Part of PMO LHIN CIO 26. Shared Services Part of PMO LHIN CIO 27. Funding Improving business case development (e.g. stating the ROI comprehensively) $100,000 LHIN CIO Making the case for hospitals to increase their operational budget for ICT Strategic Direction #4 Consumer Health Part of PMO NEON CIO 28. Develop a consumer ehealth strategy for the NE LHIN $250,000 LHIN CIO Total Figure 18: NE LHIN ehealth ICT 5 Year Roadmap and Strategic Priorities Timeline $28,100,000 to 38,100,000 $5,530,000 to $7,530,000 Page 56 March 2011

57 Appendix A: ehealth Advisory Council Terms of Reference Page 57 March 2011

58 Appendix A: ehealth Advisory Council Terms of Reference ehealth ICT Strategic Plan North East Local Health Integration Network (NE LHIN) ehealth Advisory Council Terms of Reference V December 16, 2009 PURPOSE The ehealth Advisory Council is an important component in ensuring the overall success of the provincial ehealth Strategy in the North East. The ehealth Advisory Council will provide a system-level perspective to the NE LHIN on information and communication technology (ICT) and ehealth needs, priorities and initiatives within the North East. The role of the ehealth Advisory Council is to provide advice to the NE LHIN on the implementation of the Northern Ontario ICT Blueprint, within the broader context of the NE LHIN s Integrated Health Service Plan (IHSP). Continuing the relationship with the North West LHIN and its Advisory Council (through the joint pan-northern ONeHealth structure) and building links to the NE LHIN s Health System CEO Round Tables will be important factors to the success of the ehealth Strategy in the region. ROLES AND RESPONSIBILITIES 1. Provide ehealth expertise and knowledge to the broader health system. 2. Provide leadership and strategic guidance in moving forward with ehealth as aligned with ongoing provincial priority projects, the NE LHIN IHSP and the Northern ICT Blueprint. 3. Guide the planning, implementation and management of the Northern Ontario ICT Blueprint, including a shared Electronic Health Record (EHR) and Picture Archiving and Communication System (PACS) for healthcare service providers in the North East. 4. Champion ehealth initiatives at North East regional, provincial, and national levels. 5. Promote linkages, and address communication and coordination issues along the continuum of health services related to information systems, EHR, PACS and other Blueprint initiatives. 6. Provide support to other NE LHIN planning initiatives as appropriate and requested (e.g. Chronic Disease Prevention and Management). 7. Pursue funding opportunities and leverage existing investments to support the Northern ICT Blueprint vision. 8. Provide advice to the NE LHIN on the allocation or reallocation of resources as appropriate to achieve the ehealth Strategy. 9. Act as a communication point to share project information within their respective organizations and sectors. Page 58 March 2011

59 ACCOUNTABILITY AND REPORTING ehealth ICT Strategic Plan Council members are accountable to the broader health system. The Council will have an accountability mechanism in the form of an evaluation that the group will conduct annually to assess: Outcomes based on an agreed upon work plan; and Adequacy of the established terms of reference. The Council will report to the NE LHIN CEO through the LHIN s CIO and ehealth Lead. MEMBERSHIP The Council will be comprised of no more than 22 voting members and will consist of one representative from each of the following NE LHIN funded sectors: Hospitals CCAC Long-Term Care Homes Community Support Services Community Mental Health and Addiction Community Health Centres Additional members will be selected at the discretion of the Council (not limited to LHIN funded sectors). All seven planning areas within NE LHIN must be represented on the Council, along with Francophone and Aboriginal, First Nation, Métis representation. As noted previously, the Council is a system-level platform comprised of the various sectors of the health services continuum. Members are not participating on behalf of their own individual organizations. The involvement of agencies and sectors beyond those that comprise the Council membership will occur through the processes that are employed to undertake the Council s work (e.g. surveys, sub-committees). Members will be appointed for a two or three-year term with a proportional rotation being established to ensure continuity of the group. The Council Chairperson will be the ehealth Lead for the. NE LHIN staff will participate as ex-officio non-voting members. QUORUM A simple majority of members shall constitute a quorum. Meetings may be held in person, or via electronic connections that allow two-way involvement of all participants. Page 59 March 2011

60 DECISION-MAKING ehealth ICT Strategic Plan Decisions will be based upon a reached consensus. If a consensus is not possible, the chairperson may call a vote. A simple majority favorable vote of those members in attendance will be needed to resolve or approve any issues requiring a vote. MEETING FREQUENCY The Council will meet a minimum of four times per year. CONFIDENTIALITY Members will respect the privacy of Council participants and agree not to disclose information or views expressed by individuals during meeting. Deliberations should remain confidential until there is a general agreement and consensus to make them public. In addition, all Council members must agree to not disclose any other confidential information or documentation. All materials produced by the Council will remain property of the. Page 60 March 2011

61 Appendix B: ehealth Advisory Council Membership Page 61 March 2011

62 Appendix B: ehealth Advisory Council Membership ehealth ICT Strategic Plan Name NE LHIN ehealth Advisory Council (NEEAC) Membership List Organization 1 Alice Radley North Bay Physically Handicapped Adults' Rehabilitation Association (P.H.A.R.A.) 2 Caroline Lidstone-Jones WHA Moose Factory 3 Dan Hildebrandt West Parry Sound Health Centre 4 Deborah Potvin-Mask ehealth, Health Canada, First Nations & Inuit Health Ontario Regional Office 5 Eldon Dutcher Timmins District Hospital 6 Gaston Roy NEON / Hôpital régional de Sudbury Regional Hospital 7 Greg Morrow Muskoka Parry Sound Community Mental Health Service 8 Jacqueline Gauthier Centre de Santé Communautaire de Sudbury Est / Sudbury East CHC 9 Jeff Holmes Algoma Public Health 10 Jeff Weeks Sault Area Hospital 11 Jennifer Michaud Ontario Telemedicine Network 12 Joy Galloway Timmins FHT 13 Judy Sharpe One Kids Place, North bay 14 Ken Burns Hôpital régional de Sudbury Regional Hospital 15 Louis Gravel Kirkland Lake District Hospital 16 Marc Bouchard North Bay Regional Health Centre (includes North Bay General Hospital and the Northeast Mental Health Centre), North Bay 17 Margaret Catt Temiskaming Lodge 18 Michel Raymond Sudbury East CHC Noelville 19 Mike Labelle ehealth Ontario 20 Pamela Nolan Garden River First Nation Wellness Centre 21 Peter Taylor NE Community Care Access Centre 22 Rob Poulin Life Labs 23 Terry Moore Canada Health Infoway 24 Theo Noel de Tilly FedNor 25 Tamara Shewciw NE LHIN 26 Laura Boston NE LHIN 27 Don McGrath NE LHIN 28 Cindy Adam NE LHIN Page 62 March 2011

63 Appendix C: and Ontario Telemedicine Network Strategic Roadmap: TeleQuest 2011 Page 63 March 2011

64 Appendix C: and Ontario Telemedicine Network Strategic Roadmap OTN Areas of Concentration Network Sites & Systems Patient Consultations - Consultants Patient consultations Referrers Patient Case Conferencing Mental Health & Addictions Current Alignment / Activity Leverage LHIN funding and support to members with EOS systems. HRSRH: Telemedicine used strategically by 100% of clinical programs. Significant alignment with Oncology, Supportive Care Oncology, Acquired Brain Injury, e- ICU, Pre-Hospital Care Program, Eating Disorders Program, Cardiac Rehabilitation, Community MH, and Crisis Intervention. Northeast Specialized Geriatric Services: Geriatric assessments provided by Dr. Clarke to region. Northeast Mental Health Centre: Regional Early Intervention Program, Regional Aboriginal, and Senior's Mental Health. 13 FHTs are OTN members and actively involved in TM. Community of Practice Forum developed for FHTs. HRSRH: Supportive Care Oncology, Acquired Brain Injury. Cochrane Temiskaming CMHA: Assertive Community Treatment Teams. Northeast Mental Health Program: Assertive Community Treatment Teams. Northeast Mental Health Centre: Full telemedicine integration by Regional Early Intervention Program, Regional Aboriginal, Senior's Mental Health, and CREU. HRSRH Community Mental Health Programs: Satellite support to sites in NE LHIN OTN Strategic Roadmap NE TeleQuest 2011 Future Strategies Opportunities Assist members with procurement and swapping. Support long-term ever-green planning engaging senior decision makers at member sites. HRSRH: Nephrology, Complex Care Diabetes, e-trauma, Pediatric Centre of Excellence, Community Mental Health, Mental Health Crisis Support, and Orthopedics. North Bay General (Pre-Admission Clinic, Stroke Rehab Assessments, and Nipissing Diabetes Centre). Sault Area Hospital (Pre-Admission Clinic, Nephrology Program, Algoma District Oncology Program, MH and Addictions). Northeast Joint Assessment Clinic: Pre and post consultations to region. Northeast Mental Health Centre: Pre-transfer consultations, discharge planning, family visits (to support regional beds). Populate provider portal with NE Consultants. Store Forward Dermatology and Plastic Surgery. Expand OTN point of presence to White River, Whitney, NP Led Clinics, and new FHTs. Target regional programs at HRSRH, TaDH, NBGH, and SAH. Northeast Mental Health Centre: Collaboration between two campuses, pretransfer and discharge planning. Follow up with referrers when consultant refuses TM referral. Target therapeutic areas of Mental Health, Nephrology, Oncology, Acquired Brain Injury, and Rehabilitation. Services to Algoma District from psychiatric providers at SAH to district. ACT teams Assertive Community Treatment (patient Promote provider portal once launched. Target Assertive Community Treatment Teams across LHIN. HRSRH: Crisis Mental Health services to Manitoulin- Sudbury district. HRSRH: Office- Based solution for NE LHIN Areas of Concentration Infrastructure Surgical Optimization Health Human Resources Surgical Optimization Health Human Resources Health Human Resources Mental Health and Addictions Mental Health and Addictions Health Human Resources ED/ALC Page 64 March 2011

65 OTN Areas of Concentration Distance Education Current Customers Current Alignment / Activity Espanola, Elliot Lake, and Manitoulin Island Eating Disorders regional service delivery. Methadone Maintenance Treatment provided to region by Drs. Shapiro and Dressler. Support to NOSM and participant sites (collaboration with NOSM to support their distributed learning model). Pre-Hospital Care Program (for advanced care paramedics). Sault College RPN shortage in Northern Ontario learning by video. LHIN Presentation at CEO Summit. NEEAC membership. Collaboration with CIO, Tamara Shewciw. Primary Care 13 FHTs are OTN members and actively involved in TM. Community of Practice Forum developed for FHTs. Timmins FHT participation and leadership in Telehomecare. Long-term Care Northeast Specialized Geriatric Services, Dr. Clarke. Seven NE LTC homes implemented with ongoing clinical program development. Implementation of LTC Community of Practice. NE LHIN OTN Strategic Roadmap NE TeleQuest 2011 Co-delivery of education to nurses across LHIN 13 with RNAO best practice lead for ehealth. Regional Diabetes Steering Committee membership. Transition equipment from loaned to granted. TM for ED visit prevention for LTC residents; discharge planning. Future Strategies Opportunities case conferencing). Store Forward Mental Health. Northern Diabetes Health Network. Quarterly LHIN Update newsletter distribution. Implement new FHTs and NP Led Nurse Practitioner clinics in NE. psychiatrists. Implementation of Web-Conferencing solution for members. Northern Telemedicine Forum Telehomecare Expansion for Diabetes. NE LHIN Areas of Concentration Health Human Resources Telemedicine OTN CDM Diabetes COPD CHF ED/ALC Telehomecare. ED/ALC Aging at Home FLO Collaborative LEGEND Completed Active Pending Page 65 March 2011

66 Appendix D: Project Descriptions Page 66 March 2011

67 Appendix D: Project Descriptions NE LHIN Background Information to Projects Challenges such as large geography, lack of physicians including specialists, higher mortality, higher morbidity and an aging population and low population density, has forced the North to find innovative ways of delivering care. ehealth has been instrumental in providing excellence in health services in this challenging environment. Our successes to date have made the North leaders in the use of ehealth technology. NEON: The Northern Ontario Eastern Network is a partnership of 19 hospital corporations in North Eastern Ontario sharing single financial and clinical information systems for over ten years. NEON Standards Project: NEON led a regional standards project with 26 hospitals, including all hospitals in the NE LHIN not just NEON hospitals. This was to ensure that NEON could support all 26 hospitals in the future and fulfill its integrated patient record strategy. PACS: NorRad: The Northern Radiology Project includes 23 sites in North Eastern Ontario that share a common PACS vendor integrated with its own EMPI, initiative. There are two Hub sites within NorRad where the Radiologist reads images for the Hub and the Spoke sites. NEHSA: the North East Health Services Alliance includes seven sites that share a common PACS vendor. PNOPP: The Pan Northern Ontario PACS Project (includes NorRad and NEHSA) provides an archive that will support more than 40 hospitals, primary care sites, and many first nation sites. Supported by Canada Health Infoway (CHI) and the Ministry of Health and Long Term Care, the project includes all hospitals in LHIN 13 and LHIN 14 plus and IHFs that are interested in participating. This project has now extended to include the Champlain LHIN and the project is now called NEODIN, Northern and Eastern Ontario Diagnostic Imaging Network. DOS: The Directory of Services (DOS) was a regional initiative aimed at integrating various regional healthcare directories into one easily accessible portal, including services provided in Aboriginal and French languages. This directory is now part of 310-CCAC. Source: Welcome to NE LHIN Page 67 March 2011

68 NE LHIN Background Information to Projects Cont d GHC: The Group Health Centre with its multi-disciplinary team of physicians and allied health professional provides the most comprehensive seamless outcome-based primary care in all of Canada. The use of Electronic Medical Record at GHC has enabled effective longitudinal management of chronic disease through the GHC s Health Promotion Initiatives program. This program optimizes patient care outcomes through the promotion, support, education and implementation of evidence-based medicine. EMRxtra: GHC has advanced the management of chronic disease with the enhanced sharing of clinical information between community, physicians, pharmacists, and patients through and initiative with Canada Health Infoway and the Ontario Pharmacists Association. The EMRxtra Project has extended the circle of care for physicians, pharmacists and patients to better coordinate the provision of care and exchange clinical information. Telemedicine: Telemedicine is the delivery of health-related services and information using telecommunications technologies. Ontario Telemedicine Network (OTN) has made Ontario the most sophisticated and extensive telemedicine environment in Canada. Northern Ontario represents 34% of that Ontario environment. ICT Blueprint: The Information and Communication Technology blueprint was developed as a plan for integration and technology in the North. The North established this plan to ensure that investments in Health IT would converge in an integrated system. Phase 1 of this plan included the acute care sector in Northwest and Northeast and was established before the introduction of the LHINs. Phase 2 and 3 completed the blueprint by including all non-acute health providers representing over 450 community agencies. Our vision is that ICT supports the processes of healthcare provision, access to health information and the most effective use of available resources across Northern Ontario, through collaboration and sharing information amongst all providers. Physician Adoption of EMR: Excellent examples of change management adoption and existing champions of EMR, the North East in general, as per the Ontario MD tally dated August 31, 2008, 40% of eligible Primary Care Physicians were funded for IT/EMRs. Page 68 March 2011

69 NE LHIN Background Information to Projects Cont d Northern Ontario ehealth Privacy and Security Policies: The development of legal and ethical Pan Northern privacy and security policies to support the sharing of clinical data that all healthcare providers can confidently and easily use, understand and access in order to develop and / or expand their ehealth initiatives internally, across health sectors and / or the North. Execution of Northern Ontario ehealth Communication Plan: Focus of plan is: Build awareness of the establishment, role an awareness of the ehealth Office; Build awareness of the ehealth ICT activities to be carried out by the ehealth Office and how the project is progressing; Build excitement about the Northern Ontario ehealth initiatives to all stakeholders, particularly funding sources; Influence health service providers to gain a greater understanding of the ehealth Office and how it benefits their client services; Ensure continuity and consistency of information and projects relating ehealth across the North; and Position Northern ehealth as an enabler that is capable of improving access to the quality of health services. Shared Network Management: With the withdrawal of OTN network management, 51 sites in Northern Ontario have been affected. Working with OTN, SSHA, and the two LHIN s a plan for interim network management services was create and with funding from SSHA was executed. A business case to create long-term network management for the north is being worked on ICT Planning Survey Report: Conducted a comprehensive survey to create an inventory of Northern Ontario ICT which includes current technology infrastructure, level of project management resources, current ehealth project and level of privacy policies and practices. 235 complete responses were collected and data was sent to the GIS group at innovation Centre for analysis and GIS mapping. Page 69 March 2011

70 NE LHIN Background Information to Projects Cont d Technical Advisory Group (TAG): The Technical Advisory Group is a group of technical experts from across the north. The group includes members from five hub hospitals, two CCACs, SSHA, OTN, CHI, and MOH. Five projects and project charters have been started by this group, dealing with Communication, Collaboration, Information Sharing, Regional Operational Network Support, Standardization (Network), Business Continuity (IT Operations), and SSHA Network Deployment. ehealth Ontario (SSHA) Network Deployment: TAG identified the SSHA network deploy project as one of their highest priority projects, working with ehealth Ontario. A prioritization tool was developed and is used to priorities connections across Northern Ontario. This is a complex tool that takes into consideration First Nations sites, rural First Nation sites, LHIN and Provincial ehealth priorities. Doorways Project consists of four of Ontario s fourteen LHINs who are working together with Ontario s Community Care Information Management (CCIM) leads to establish a provider portal to securely share and access accurate health information electronically. The objective is to conduct a pilot that integrate mental health and addiction data within a portal yielding clinical benefits and lessons learned through a system to system integration. ALC Resource Matching and Referral project has conducted current state assessments from acute to defined post-acute facilities and will begin a future state that will better facilitate patient referrals. Implementation and Adoption initiative will enable the NE LHIN to achieve readiness in the areas of governance, project management and change management for implementation and adoption ehealth solutions. The Ontario LHINs Privacy Project will draw on the input from all 14 LHINs and promote a standardized approach when dealing with privacy, allowing for improved discussion and planning between health service providers and LHINs. Page 70 March 2011

71 NE LHIN Background Information to Projects Cont d The Physician Office Integration (PIO) Project will put in place the infrastructure required to send text based patient reports / results to physicians electronically via their Electronic Medical Record (EMR) system. The intent is to include all participating hospitals in the to collectively send their data through one channel to any physician s office that is set up to receive the electronic medical records for the Physician Office integration project. ehealth Ontario Diabetes Registry: The NE LHIN was identified as an early adopter of the provincial rollout of the provincial ehealth Strategy for high risk populations. OTN Telehomecare Project: the Timmins FHT was one of the eight FHTs selected by the Ontario Telemedicine Network (OTN) to participate in a four-month Telehomecare pilot to monitor patients with congestive heart failure (CHF) and congestive obstructive pulmonary disease (COPD). Garden River Wellness Centre: By working with Group Health Centre, this aboriginal health centre has moved to electronic records that encompass the needs of aboriginal health service providers. MoHLTC Diabetes Strategy The strategy includes an online registry that will enable better self-care by giving patients access to information and education tools that empower them to manage their disease. the registry will also give healthcare providers the ability to easily check patient records, access diagnostic information and send patient alerts. e-physician Timmins District Hospital and the Timmins Family Health Team (FHT) partnered to implement an electronic interface between the hospital HIS and the health team electronic medical record. eprescribing Pilot Project The Group Health Centre (GHC) is one of only two sites which participates in the groundbreaking eprescribing pilot project being hosted by MOHLTC and eho. The project is aligned with the Medication Management priority of the ehealth Strategy (on-line management of prescription medications). Page 71 March 2011

72 Appendix E: CCIM Overview Page 72 March 2011

73 Appendix E: CCIM Overview Page 73 March 2011

74 Appendix F: List of Terms and Acronyms Page 74 March 2011

75 Appendix F: List of Terms and Acronyms Acronym ALC ALC IS ASP BMV BI CAP CAPM CCAC CCD CCIM CCIS CCO CDPM CDPMIS CDPSMIS CDR CDS CHC CHI CHIS CIHI CIMS cmar CMG CMHA CMH&A CML CMS CNIB CPOE CPSO CRaNHR CSS CTC DART DATIS DOS DPV DR DSL DSS Term Alternate Level of Care Alternate Level of Care Information System Application Service Provider Bedside Medication Verification Business Intelligence Community Assessment Program Certified Associate in Project Management Community Care Access Centre Continuity of Care Document Community Care Information Management Critical Care Information System Cancer Care Ontario Chronic Disease Prevention and Management Chronic Disease Prevention and Management Information System Chronic Disease Patient Self-Management Information System Clinical Data Repository Common Data Set Community Health Centre Canada Health Infoway Consolidated Health Information Service Canadian Institute for Health Information Clinical Information Management System Computerized Medication Administration Record Case Mix Group Canadian Mental Health Association Community Mental Health and Addictions Canadian Medical Laboratories Clinical Management System Canadian National Institute for the Blind Computerized Physician / Provider Order Entry College of Physicians and Surgeons of Ontario Centre for Rural and Northern Health Research Community Support Services Children s Treatment Centre Drug and Alcohol Registry of Treatment Drug and Alcohol Treatment Information System Directory of Services Drug Profile Viewer Diabetes Registry Digital Subscriber Lines Decision Support System Page 75 March 2011

76 Acronym echn EDI EDRS EHR cmar emar EMPI EMR EMR-AM ENITS EPR ER / ED ERNI FedNOR FFS FHG FHN FHO FHT FTE GAIN GHC GHL HIAL HICL HIMSS HINP HIS HR HRIS HSP I&A IAR ICT IHSP iphis ISCIS IS/IT IVR LAN LHIN LIS LOS LTCH MCSS Term Electronic Child Health Network Electronic Data Interchange Emergency Department Reporting System Electronic Health Record Computerized Medication Administration Record Electronic Medical Administration Record Enterprise Master Patient Index Electronic Medical Record Electronic Medical Record Adoption Model Emergency Neurosurgery Image Transfer System Electronic Patient Record Emergency Room / Department Emergency Room National Ambulatory Care Reporting System Initiative Federal Economic Development Initiative for Northern Ontario Fee-for-Service Family Health Group Family Health Network Family Health Organization Family Health Team Full Time Equivalent Global Appraisal of Individual Need (for substance abuse) Group Health Centre (Sault Ste. Marie) Giiwednong Health Link Health Information Access Layer Hospitals In-Common Laboratory Health Information Management Systems Society Health Information Network Provider Health / Hospital Information System Human Resources Human Resources Information System Health Service Provider Implementation and Adoption Integrated Assessment Record Information and Communication Technology Integrated Health Service Plan Public Health Information System Integrated Services for Children Information System/Information Technology Integrated Voice Recognition Local Area Network Local Health Integration Network Laboratory Information System Length of Stay Long-term Care Home Ministry of Community and Social Services Page 76 March 2011

77 Acronym MCYS MDS MH MICs Group of Hospitals MIS MOHTLC MPI NACRS NDHN NEEAC NEHSA NEODIN NEON NOMEC NOMP NORrad NORTH Network NOSM NP NSM LHIN NW LHIN OACCAC OCAN ODBP OLIS OHA OHIP OHISC OHN OMA OTN PACS PDA PHIPA PHR PHU PIMS PMO / EPMO PMP PMS PNOPP POC POI PSR RAI Term Ministry of Children s and Youth Services Minimum Data Set Mental Health Matheson Iroquois Falls Cochrane Group of Hospitals Management Information System Ministry of Health and Long Term Care Master Patient Index National Ambulatory Care Reporting System Northern Diabetes Health Network ehealth Advisory Council North East Health Services Alliance North and East Ontario Diagnostic Imaging Network North East Ontario Network Northwest Ontario Medical Education Program Northern Ontario Medical Program Northern Ontario Digital Radiology Northern Ontario Remote Telecommunications Health Network Northern Ontario School of Medicine Nurse Practitioner North Simcoe Muskoka Local Health Integration Network North West Local Health Integration Network Ontario Association of Community Health Centres Ontario Common Assessment of Need Ontario Drug Benefit Plan Ontario Laboratories Information System Ontario Hospital Association Ontario Health Insurance Plan Ontario Health Informatics Standards Council Ontario Health Number Ontario Medical Association Ontario Telemedicine Network Picture Archiving and Communication System Personal Digital Assistant Personal Health Information Protection Act Personal Health Record Public Health Unit Pathology Management Information System Project Management Office / Enterprise Program Management Office Project Management Professional Practice Management System Pan Northern Ontario PACS Project Point of Care Physician Office Integration Psycho-social Rehabilitation Resident Assessment Tool Page 77 March 2011

78 Acronym RIIFSSSO RIS RM&R RNAO ROI SAN SE LHIN SSHA SSS Tertiary care VLE VoIP VPN WAN WSIB WTIS Term Regroupement des intervenantes et intervenante francophone en santé et en service sociaux de l Ontario Radiology Information Management Resource Matching and Referral Registered Nursing Association of Ontario Return on Investment Storage Area Network South East Local Health Integration Smart Systems for Health (now part of ehealth Ontario) Staff Scheduling System Highly acute and specialized services provided in large community and academic hospitals Virtual Learning Environment Voice Integrated Over Internet Provider Virtual Private Network Wide Area Network Workplace Safety and Insurance Board Wait Time Information System Page 78 March 2011

79 Appendix G: Bibliography Page 79 March 2011

80 Appendix G: Bibliography Community Care Information Management Assessment Project Overview. CCIM Assessment Project Forum. January CCIM. Community Mental Health and Addictions (CMH&A) Sector in the Business Systems and CAP. March Community Support Services Common Assessment Project (CSS CAP) Technology Checklist. CCIM. January Community Support Services Sector in the Business Systems and CAP. March 17, Doorways Survey. Doorways Current State of Portal Technologies Doorways Survey Summary. Doorways Current State of Portal Technologies. ehealth Ontario. Customer & Ontario Telemedicine Network Strategies Roadmap NE Telequest ehealth Ontario. Delivering Electronic Healthcare to Ontarians. Strategic Direction. February ehealth Ontario. Service and Deployment Monthly LHIN Report. North East & North West. February Maloney, S. Canada Health Infoway. Infoway Clinical Innovation. February 15, Ministry of Health and Long Term Care. Rural and Northern Healthcare Framework / Plan. Stage 1 Report. North East CCAC. Integrated Discharge Planning (IDP) Information Management. Vision 2011 (Between CCAC and Hospital). Presented to NEEAC January Current ehealth and ICT Projects.. March 23, Current State of Portal Technologies.. January Integrated Health Service Plan (IHSP) Integrating Innovative Ideas: Small Rural Hospital Summit. September 23-24, Sault Ste. Marie. Summary of the Summit Proceedings. October 28, Physician Office Integration (POI) Project Charter. Page 80 March 2011

81 fo Minute. Healthcare Update. More Primary Care Options for People in Northeastern Ontario. NE LHIN Welcomes Three Nurse Practitioner-Led Clinics and Six New Family Health Teams.. Physician Office Integration Proposal. Submitted to ehealth Ontario. September 18, Physician Office Integration Project Plan. September and North West LHIN. Joint Physician Office Integration Proposal to ehealth Ontario. September Physician ehealth Discussion. October 3, Sudbury Regional Hospital. Meeting Results Summary. Shewciw, T. Welcome to North Eastern Ontario ehealth. January Sylvestre, L. Canada Health Infoway. EMR and Integration. Ambulatory EMR and HIS Connect. Page 81 March 2011

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