INFORMATION AND COMMUNICATION TECHNOLOGY AND INFORMATION MANAGEMENT

Transcription

1 North East Local Health Integration Network: INTEGRATED HEALTH SERVICE PLAN INFORMATION AND COMMUNICATION TECHNOLOGY AND INFORMATION MANAGEMENT DECEMBER 2006 Sommaire en français inclu. ISBN (PDF)

2 T A B L E O F C O N T E N T S Glossary of Acronyms Executive Summary / Sommaire 1.0 National and Provincial Context... 1 National - Canada Health Infoway... 1 Provincial - Ontario ehealth Strategy North East ICT Planning... 5 Northern Ontario Information and Communication Technology Planning Project (ICT Blueprint) Phase Northern Ontario Information and Communication Technology Planning Project (ICT Blueprint) Phase North East ICT Initiatives...10 Coordination and Integration Ontario North ehealth (ONeHealth) Electronic Health Record...13 Background...13 North East EHR Readiness...15 ICT Blueprint...15 Ontario Hospitals Connected For Care: 2005 EHR Readiness Survey Report for North East Local Health Integration Network...16 NEON Electronic Child Health Network Digital Imaging / Picture Archiving Communications Systems (DI/PACS) Pan-Northern Ontario PACS Project (PNOPP)...21 Timmins Hub / NORrad Telemedicine in the NE LHIN NORTH Network Back Office Services Northern Ontario Hospital Back Office Services (NOHBOS) Information Management Strategy...28 Ontario MOHLTC Information Management Strategy Data Quality in the NE LHIN Data Management Partnerships Issues and Opportunities for the NE LHIN...33 ehealth Information Management North East LHIN: Information and Communication Technology and Information Management

3 GLOSSARY OF ACRONYMS CEO...Chief Executive Officer CHI... Canada Health Infoway CIO... Chief Information Officer DI...Diagnostic Imaging echn... Electronic Children s Health Network EHR...Electronic Health Record EMPI... Enterprise Master Patient Index EMR... Electronic Medical Record EPR... Electronic Patient Record ICT... Information and Communication Technology IM... Information Management NEON... North East Ontario Network NOHBOS... Northern Ontario Hospital Back Office Services NORrad... Northern Ontario Radiology NORTH Network... Northern Ontario Telehealth Network ONeHealth... Ontario North ehealth OTN...Ontario Telemedicine Network PACS...Picture Archiving and Communication System PNOPP... Pan-Northern Ontario PACS Project North East LHIN: Information and Communication Technology and Information Management

4 EXECUTIVE SUMMARY It is readily apparent that planning for, and implementation of, ehealth and information management strategies are significant and growing areas of investment in health systems across the North East, province, nation and globe. The past few years have seen an increasingly high level of adoption of health-related information and communication technologies (ICT) throughout the Northern Ontario health care sector. In many cases, the implementation of new information technology systems also leads to a parallel enhancement, or potential for enhancement, in information management (IM) capacity. The range of benefits is significant to the overall system, individual organizations, staff and patients. These include: helping span the vast geography of the region to better support patient care as close to home as possible; supporting health professionals by providing them with access to the latest technologies where they practice, and using technology to provide continuing education and peer support opportunities; enhancing access to, and use of, scarce specialized health human resources; allowing for increased communication and standardization amongst providers; and creating ICT economies of scale within health sectors and across the health system such as cost sharing on information system development, ICT technical resource sharing, joint ICT purchasing and support arrangements. The potential for ICT to integrate health services and sectors, coupled with the mandate and facilitative role of the LHIN to achieve integration, makes ICT a natural priority for the North East LHIN. Similarly, a comprehensive approach to IM within the region will support sound service planning, management and performance. This report addresses the following questions at a strategic level: What is the ehealth and information management policy context? What planning work has been done to date or is currently being proposed? What is the current status of known ICT/IM initiatives in the region? What have they achieved and what are their future plans? What is the state of readiness in the North East (particularly regarding an electronic health record)? What are the opportunities for LHIN involvement? As with most health care initiatives, ehealth projects have the greatest chance of success within the context of federal and provincial policy and funding requirements if they: enhance patient care services or access to services; are part of a broader regional strategic ehealth plan; use a multi-agency or multi-sectoral partnership approach; have a sound business case; and can be leveraged or used as foundational elements in the creation of an electronic health record. North East LHIN: Information and Communication Technology and Information Management

5 EXECUTIVE SUMMARY The North East has a long and successful track record of ehealth planning and project implementation as is highlighted in the following initiatives: Northern Ontario ICT Blueprint, 2005 (Phase 1 - which focused on hospital, CCAC and regional hospital/program ICT needs and strategies); Ontario North ehealth Steering Committee which was established to implement the ICT Blueprint (and is active in the areas of PACS, EHR and back office initiatives); innovative ehealth and related models such as the North East Ontario Network, Northern Ontario Radiology Program, Northern Ontario Telehealth Network, Northern Ontario Hospital Back Office Services, and participation in the provincial Electronic Children s Health Network. The NE LHIN will build upon work to date by focusing on the following key ICT and information management activities over the next three years. ehealth Planning 1) Support the Northern Ontario ICT Planning Project (ICT Blueprint) Phase 2 to be completed by March ) Complete a third phase of system-wide ICT planning focused priority setting, and tactical and implementation planning to be completed by the end of ) Identify and support high potential ehealth change and innovation initiatives within the LHIN that can be used as models. 5) Support the use of ICT to increase community participation in health planning, and patient participation in their care. Funding 6) Support the development of: systemlevel ICT cost/benefit analysis models; guidelines for provider / LHIN / MOHLTC funding to offset reasonable incremental ICT costs; and incentive structures that are aimed at achieving the NE LHIN ehealth strategy (these items will be particularly applicable in large/regional projects such as PNOPP and NEON for example). Information Management 7) Monitor and support the North East Local Data Management Partnership. 8) Ensure that a strong linkage is established between ICT projects and information management activities. 9) Advocate to ensure that agencies are properly resourced such that accurate MIS/data capture occurs at the agency level. 10) Work to secure access to high quality data at the appropriate level (e.g. raw/record level vs. reports) in a timely manner. Facilitation 3) Engage ICT stakeholders to develop LHINwide ICT standards, requirements for interoperability, and best practices and sharing thereof. North East LHIN: Information and Communication Technology and Information Management

6 EXECUTIVE SUMMARY The specific opportunities that the LHIN has identified for initial action between 2007/2008 and 2009/2010 are: Maintain a leadership role in the Northern Ontario Information and Communication Technology Planning Project (ICT Blueprint) Phase 2. Complete a regional e-health tactical plan with the goal of implementing an electronic medical record across the primary care sector in the NE LHIN. The tactical plan will also address the issues required for enhanced Chronic Disease Prevention and Management outcomes in the following areas: patient self-management; population health monitoring; and access to diagnostics and treatment (wait times). Implement the tactical plan working with ICT stakeholders. This will include the development of LHIN-wide ICT standards, requirements for interoperability and best practices. In collaboration with the ICT stakeholders, support the development of system-level ICT cost/benefit analysis models and guidelines for provider/lhin/mohltc funding to offset reasonable incremental ICT costs. Collaborate with the North East Local Data Management Partnership to: explore the transfer of knowledge from this partnership to other health service sectors in North East Ontario; and develop a linkage between ICT projects and information management activities. North East LHIN: Information and Communication Technology and Information Management

7 SOMMAIRE Nul ne saurait douter aujourd hui du fait que la planification et la mise en oeuvre de stratégies de cybersanté et de gestion de l information constituent, de plus en plus, des domaines prioritaires d investissement dans le système de santé, que ce soit dans le Nord-Est, la province, le pays et même le monde entier. Depuis quelques années, l ensemble du secteur des soins de santé du Nord de l Ontario se tourne de plus en plus vers les technologies de l information et de la communication (TIC) spécialisées en santé. Souvent, le recours à de nouveaux systèmes de TIC mène ou peut mener à l amélioration parallèle de la capacité de gestion de l information (GI). Les avantages de cette démarche sont incontestables pour l ensemble du système, y compris les organismes concernés, le personnel et les patients. Mentionnons, entre autres : aider à couvrir le vaste territoire de la région afin d offrir des soins aux patients aussi près que possible de leur domicile; soutenir les professionnels de la santé en leur donnant un accès aux plus récentes technologies sur leur lieu de pratique, et utiliser la technologie afin de fournir un perfectionnement professionnel et offrir des occasions de soutien par les pairs; améliorer l accès et l utilisation des ressources humaines en santé spécialisées dont le nombre est peu élevé; permettre une communication et une standardisation accrues chez les fournisseurs; générer des économies d échelle grâce à la TIC au sein des secteurs de la santé et dans l ensemble du système de santé, telles que le partage des coûts de développement de systèmes d information, le partage des ressources techniques requises par la TIC, et les achats regroupés de TIC et de services de soutien technique. Le potentiel d intégration des secteurs et des services de santé offert par la TIC, jumelé au mandat et au rôle de facilitateur de la RLISS en vue de réussir l intégration, font que la TIC est une priorité qui va de soi pour le RLISS du Nord-Est. De la même façon, une approche intégrée touchant la GI au sein de la région contribuera à appuyer une saine approche de la planification et de la gestion des services, ainsi que du rendement. Le présent rapport aborde les questions suivantes du point de vue stratégique : En quoi consistent les politiques actuelles en matière de cybersanté et de gestion de l information? Quel travail de planification a été accompli ou proposé jusqu à maintenant? Qu en est-il présentement des initiatives connues de TIC/GI dans la région? Qu ontelles produit, et que doit-il en advenir? Quel est l état de préparation du Nord-Est (en ce qui concerne particulièrement les dossiers médicaux électroniques)? À quelles initiatives le RLISS pourrait-il participer? Comme pour la plupart des initiatives en soins de santé, les projets de cybersanté mis en oeuvre dans le cadre de politiques fédérales et provinciales ont le plus de chance de réussir et de respecter les exigences de financement établies si : RLISS du Nord-Est : Technologie de l information et de la communication / Gestion de l information

8 SOMMAIRE ils améliorent les services aux patients et l accès aux services; ils font partie d un plan régional stratégique de cybersanté plus vaste; ils font appel à un partenariat multiorganismes ou multisectoriel; ils font l objet d une analyse de rentabilisation sérieuse; ils peuvent servir de base pour la création d un registre médical électronique. Le Nord-Est est reconnu depuis longtemps comme étant une région propice à la planification et à la mise en oeuvre de projets de cybersanté, comme en font foi les initiatives suivantes : Projet de planification de la TIC dans le Nord de l Ontario, 2005 (phase 1 du projet, axée sur les besoins et les stratégies des hôpitaux, des centres d accès aux soins communautaires et des hôpitaux et programmes régionaux en matière de TIC); formation d un comité directeur de la cybersanté dans le Nord de l Ontario, chargé d appliquer le plan de TIC (et qui s occupe d initiatives concernant le système d archivage et de transmission d images [PACS], les dossiers médicaux électroniques et les systèmes administratifs); modèles novateurs en cybersanté et dans des domaines connexes, comme le Réseau Nord-Est ontarien, le programme de radiologie du Nord de l Ontario, le réseau de télésanté du Nord de l Ontario, les services administratifs destinés aux hôpitaux du Nord de l Ontario et la participation au réseau électronique provincial pour la santé des enfants. Le RLISS du Nord-Est s appuiera sur le travail réalisé jusqu à maintenant en mettant l accent, d ici trois ans, sur les activités de TIC et de gestion de l information clés ci-dessous. Cybersanté Planification 1) Soutenir la phase 2 du Projet de planification de la TIC dans le Nord de l Ontario, qui s achèvera d ici mars ) Mener à bien une troisième phase du projet, qui consistera en l établissement de priorités, la planification tactique et la planification de la mise en oeuvre dans l ensemble du système, d ici la fin de Facilitation 3) Amener les partenaires en TIC à élaborer des normes de TIC dans l ensemble du RLISS, des exigences en matière d interopérabilité et des pratiques exemplaires qui pourront être partagées. 4) Déterminer et appuyer les initiatives de changement et d innovation à fort potentiel en matière de cybersanté et que le RLISS pourrait utiliser comme modèles. 5) Favoriser l utilisation de la TIC afin d accroître l engagement communautaire dans la planification des services de santé et la participation des patients aux soins fournis. RLISS du Nord-Est : Technologie de l information et de la communication / Gestion de l information

9 SOMMAIRE Financement 6) Soutenir l élaboration de modèles d analyse coûts-avantages de la TIC à l échelle du système, de directives de financement pour les fournisseurs, le RLISS et le MSSLD afin de compenser les coûts différentiels raisonnables en TIC, ainsi que d un système d incitatifs conçu pour faciliter l application de la stratégie du RLISS en cybersanté (concerne particulièrement les projets d envergure et régionaux comme le projet de PACS dans tout le Nord de l Ontario et le Réseau Nord- Est ontarien). Gestion de l information 7) Surveiller et appuyer le partenariat local de gestion des données du Nord-Est. 8) Veiller au maintien de liens solides entre les projets de TIC et les activités de GI. 9) Promouvoir l octroi de ressources suffisantes aux organismes concernés de sorte que la saisie des données dans les systèmes de GI se fasse à leur échelle. 10) Assurer l accès à des données de grande qualité au niveau adéquat (p. ex., données brutes/niveau de l enregistrement comparés aux rapports) et en temps opportun. Les activités sur lesquelles le RLISS doit d abord concentrer son attention entre et sont les suivantes. Assurer un rôle de leader dans le cadre de la phase 2 du Projet de planification de la technologie de l information et de la communication dans le Nord de l Ontario. par tout le secteur des soins primaires dans le RLISS du Nord-Est. Ce plan abordera aussi les mesures à prendre pour améliorer les résultats en prévention et en gestion des maladies chroniques, et plus particulièrement dans les domaines suivants : autogestion des patients; surveillance de la santé de la population; accès au diagnostic et aux traitements (temps d attente). Mettre en oeuvre le plan tactique conjointement avec les intervenants en TIC. Il s agit notamment d élaborer des normes de TIC dans l ensemble du RLISS, des exigences en matière d interopérabilité et des pratiques exemplaires. En collaboration avec les intervenants en TIC, contribuer à l élaboration de modèles d analyse coûts-avantages de la TIC à l échelle du système ainsi que de directives de financement pour les fournisseurs, le RLISS et le MSSLD afin de compenser les coûts différentiels raisonnables en TIC. Travailler de pair avec le partenariat local de gestion des données du Nord-Est pour : examiner la possibilité de transférer les connaissances du partenariat à d autres intervenants en santé dans le Nord-Est; établir un lien entre les projets de TIC et les activités de gestion de l information. Établir un plan tactique régional de cybersanté en vue de mettre en oeuvre un registre médical électronique utilisé RLISS du Nord-Est : Technologie de l information et de la communication / Gestion de l information

10 1.0 NATIONAL AND PROVINCIAL CONTEXT It is essential that health service organizations and the LHIN have an accurate understanding of the ICT context and directions of the broader system in which they must operate both on national and provincial levels. The proper alignment between NE LHIN initiatives and the directions of the main public policy makers/funders (re. ICT) is critical to advancing the state of ICT in the region. National - Canada Health Infoway Canada Health Infoway (CHI) is the primary vehicle for developing and supporting ICT/ electronic health record (EHR) solutions at a national level. Launched in 2001, Infoway and its public sector partners have over 100 projects, either completed or underway, delivering electronic health record solutions to Canadians solutions that bring tangible value to patients, providers and the health care system. Canada Health Infoway Inc. invests with public sector partners across Canada to implement and reuse compatible health information systems that support a safer, more efficient health care system. Infoway is an independent, not-for-profit organization whose members are Canada s 14 federal, provincial and territorial Deputy Ministers of Health. In 2005/2006, Infoway planned to approve an additional $325 million in project investments. By March 31, 2006, it is expected that $646 million 54 percent of Infoway s $1.2 billion of investment capital will have been approved for specific projects. CHI Vision A high quality, sustainable and effective Canadian health care system supported by an infostructure that provides the residents of Canada and their health care providers with timely, appropriate and secure access to the right information when and where they enter into the health care system. Respect for privacy is fundamental to this vision. CHI Mission To foster and accelerate the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan- Canadian basis, with tangible benefits to Canadians. Infoway will build on existing initiatives and pursue collaborative relationships in pursuit of our mission. CHI s Strategic Investor Role Infoway is a strategic investor that works in partnership with health ministries, regional authorities, other health care organizations, and information system vendors to best align Infoway s investments with jurisdictional plans and to leverage existing solutions. Once investment decisions are made, public sector partners lead the development, implementation and use of electronic health record solutions. Infoway provides leadership by establishing a strategic direction for electronic health record implementation in Canada in collaboration with the provinces and territories. Infoway is not a granting agency or a venture capital fund, nor is it a builder, direct implementer or holder of proprietary solutions. Benefits Of Electronic Health Records A network of interoperable electronic health record solutions across Canada linking clinics, hospitals, pharmacies and other points

11 1.0 NATIONAL AND PROVINCIAL CONTEXT of care will help improve Canadians access to health care services, enhance the quality of care, and make the health care system more productive. Access Ability to Access Care: improved wait times and capacity to deliver needed services. Patient Participation: patient access to the electronic health record. Availability: greater access to health care services in the home and community. Quality Safety: fewer medical errors and adverse drug events. Effectiveness: achieving desired health outcomes. Appropriateness: informed prescribing and clinical decision-making. Productivity Efficiency: reduced administrative time and costs. Care Coordination: complete patient information for sharing across the continuum of care. CHI s Business Strategies Share the investment in projects with our public sector partners. Leverage Investment Invest in solutions that can be replicated. Form Strategic Alliances with the Private Sector Implement standards-based commercial solutions that reduce cost and risk. Focus on End-User Acceptance Focus on end-users, early and ongoing, to gain acceptance and adoption. Measure Benefits and Adjust Continually measure benefits achieved against those planned and make the necessary adjustments. Each of Infoway s nine investment programs contributes towards the implementation of comprehensive integrated electronic health record solutions. The investment program strategies and targets are aligned with the electronic health record plans of each of the jurisdictions. The nine programs are: Registries Diagnostic Imaging Systems Drug Information Systems Laboratory Information Systems Interoperable EHR Systems Telehealth Public Health Surveillance Innovation and Adoption Infostructure Target Strategic Investment Programs Focus on the nine areas of investment (see below). Collaborate with Health Ministries and Other Partners Ensure alignment through joint planning with health ministries and other partners. Co-Invest with Public Sector Partners 2 North East LHIN: Information and Communication Technology and Information Management

12 1.0 NATIONAL AND PROVINCIAL CONTEXT Provincial - Ontario ehealth Strategy ehealth is a fundamental component of the Ontario government s transformation agenda. Quite simply, ehealth will be an integral part of all future activity within Ontario s health system. A series of health care system transformation strategies have been developed by the Ministry. While all of these initiatives require ehealth, a number of the transformation strategies actually depend on the ehealth Strategy for completion. ehealth in Ontario means better patient and client care. It will: help provide tools and information to the people of Ontario and health care providers that will help keep people healthier; give health care providers the tools they need to make our health care in Ontario the envy of the world; reduce needless error and duplication; and allow us to use health care dollars where they are most needed. Ontario s current ehealth strategy is undergoing renewal throughout early and mid This renewal will help ehealth better support Ontario s health transformation agenda and allow the benefits of ehealth to make a positive impact on our health system and the people it serves. The goal of renewing the ehealth strategy is support the continued transformation of the health system to achieve better outcomes. Another important aspect of the renewed ehealth strategy is to develop a comprehensive approach to managing information across the health care system. While technology is important to all of this, the emphasis and focus is on finding better ways of delivering health care and managing information. While the means to that end may be technology, computers and technology are not ends in themselves. An effective strategy must have the right balance. Achieving this means addressing the needs of different and complementary aspects of our health care system. The following chart depicts the four categories of benefits the renewed ehealth strategy will deliver. These are: improved population health outcomes; improved health system performance; improved client and patient health outcomes; and improved service delivery efficiency. North East LHIN: Information and Communication Technology and Information Management 3

13 1.0 NATIONAL AND PROVINCIAL CONTEXT Figure 1: Benefits of a Renewed Ontario ehealth Strategy, May North East LHIN: Information and Communication Technology and Information Management

14 2.0 NORTH EAST ICT PLANNING Northern Ontario Information and Communication Technology Planning Project (ICT Blueprint) Phase 1 Phase 1 of the Northern Ontario ICT project started in January 2004 under the leadership of the three Northern District Health Councils (i.e. Algoma Cochrane Manitoulin Sudbury, Northwestern Ontario, and Northern Shores). The process involved working with health service providers from several sectors in Northern Ontario to develop an integrated vision for information and communication technology. This project was the first of its kind in the province. The sectors involved included hospitals, community health centres, community care access centres, regional inpatient mental health hospitals/programs, regional cancer centres, educational providers and current regional ICT initiatives in the North (52 participating agencies). The purpose of Phase 1 of the Northern Ontario ICT Project was three-fold: Assess the current state of ICT in Northern Ontario hospitals, CCACs, regional inpatient mental health programs, regional cancer centres, and current regional ICT initiatives. Identify opportunities to partner and strengthen ICT linkages between Northern health care providers and sectors. Develop a common vision and strategic blueprint for action for ICT in Northern Ontario. The following planning framework was applied that shows the interrelationships between the various components of the broader ICT system. Figure 2: Northern Ontario ICT Planning Model (source: Healthtech) Strategic Business Objectives Operational Efficiency E Business Integrated Health Care PACS Telehealth Point of Care Data Repository Voice Technologies Document Management Wireless Communications Internet / Portal Technology ENABLING TECHNOLOGIES TECHNOLOGY POLICY Electronic Health Record Regional Partnerships IT INFRASTRUCTURE Application Systems Hardware Network Data People Methods & Tools North East LHIN: Information and Communication Technology and Information Management 5

15 2.0 NORTH EAST ICT PLANNING The regional strategic business objectives of the participating organizations serve as the primary mechanism in identifying the technology needs of Northern Ontario. An appreciation of the essential business issues is critical in understanding the future needs of the organizations and in identifying how technology might facilitate meeting those needs. Enabling Technologies Traditionally, technology has been seen as a mechanism to achieve operational efficiency and effectiveness. However, technologies have become increasingly important in facilitating new and innovative approaches for accomplishing strategic objectives and improving business capability. Electronic health records, wireless communications, internet-based applications such as portal technologies, voice and imaging systems are examples of enabling technologies which are being applied in healthcare settings. Technology Infrastructure The technology infrastructure serves as the foundation for the enabling technologies and for operational effectiveness. Northern Ontario health service providers technology infrastructure consists of its applications, hardware, network, data, methods and tools, and human resources. The ICT plan assesses the capability, strengths, and limitations of this infrastructure. Issues such as the application portfolio s capability to support both the current and future service demands of the region, the capacity of the hardware and network to support computing demands, the potential to share data, and the ability of staff to assimilate and apply rapidly changing technologies are some of the factors to be considered. Technology Policy The technology policy serves as the decision-making framework that defines the characteristics of the desired state of the technology infrastructure and as the direction for acquisition and development. For example, a technology policy may include important elements such as characteristics as open systems compliance, use of flexible user interfaces, migration to a client/server architecture, a commitment to a core systems vendor, etc. The first step in the development of the integrated Northern Ontario ICT plan was the development of a comprehensive inventory of the current state of technology across the North. Through surveys and interviews, baseline data was collected to expose the level of ICT deployment, network architecture, key system vendors, status of Picture Archiving Communication Systems (PACS) and use of telemedicine at all 52 participating agencies. Some findings include the following: Participating organizations have made significant investments in their current ICT systems. A wide variety of basic administrative (e.g. patient registration and health records) and core financial systems are in use. However, the least utilized applications are in the domain of enhanced clinical applications such as physician and clinician order entry, electronic medical record (EMR), clinical documentation, case and operating room management. In terms of readiness to implement a regional electronic health record (EHR), North Eastern Ontario health care providers are in three groups: the Group Health Centre in Sault Ste. Marie stands 6 North East LHIN: Information and Communication Technology and Information Management

16 2.0 NORTH EAST ICT PLANNING alone as a totally paperless environment; those with recent and/or upcoming investments in applications that position them well for the eventual implementation of the EHR (e.g. NEON, North Bay General); and those who need to make investments in new core systems that will position them for participation in the regional EHRs. The shortage of physicians, from primary care to specialists, is a key change driver in the North. The effective deployment of ICT, including remote technologies, has already demonstrated its value in making more effective use of existing resources. The creation of the Northern Ontario School of Medicine will also require that state-of-the-art ICT be in place to enable the distributed learning model that is being implemented, and will be a contributing factor to encourage physicians, trained in the North, to stay in the North. A significant impetus for change and the stated goal of all new hospital redevelopment projects in the North East (e.g. North Bay, Sault Ste. Marie and Sudbury) is the development of a paperless service delivery environment. The inventory results allowed for the identification of opportunities to partner and strengthen ICT linkages across the North. Twelve core strategies evolved out of these findings, thus forming the foundation of a multi-sectoral plan for implementing ICT in the North based on the following vision: Information and communication technology supports the processes of quality healthcare provision, access to health information and the most effective use of available resources across Northern Ontario, through collaboration and sharing of information amongst providers. The vision will be accomplished, through collaboration and sharing of information among health service providers, by a system that has the following characteristics: A common integrated direction for ICT among health service provider networks across Northern Ontario. Flexibility to meet changing health needs of residents of Northern Ontario. Enables integration of care delivery. Incrementally builds on existing investments and infrastructures developed through the commitment of three levels of Government (regional, provincial, federal). Enables and fortifies patient quality care and ensures equity that is based on best practice within the health services sector. Provides technical tools and enhancements to processes to effectively deliver health services within appropriate standards and outcome measures. Broadens technology enhancements and development across a wider range of health services. Leverages technologies to support business processes and operations. Promotes learning and professional development. Enables partnership development and greater collaboration across Northern Ontario Health Networks. North East LHIN: Information and Communication Technology and Information Management 7

17 2.0 NORTH EAST ICT PLANNING Enables exchange of patient information with referral centres, networks, and centres in Southern Ontario and Winnipeg. The Blueprint contains design and development principles for the applications that will support the twelve core strategies with high level capital and operational cost assumptions. The core strategies are as follows: 1) Build the Northern Electronic Health Record (that supports patient referral patterns and leverages current investments). 2) Build the content of the organizational EMR across all sectors. 3) Address requirements of integrated services. 4) Integrate the diagnostic components/ PACS. 5) Invest in technology for the regional EHR across the continuum of care. 6) Support work effectiveness. 7) Leverage web-based technologies. 8) Implement decision support and business systems. 9) Respond to consumer needs. 10) Support research and education. 11) Build the infrastructure. 12) Optimize available funding. The project was successful in many ways. The Northern ICT Blueprint provides a foundation for the data, methods, and tools required by the participating agencies to achieve the overall vision. The Blueprint articulates distinct directions for technology, and links these back to provincial directions. The plan is also visionary in that it describes the strategies that will be needed to integrate clinical and administrative data across the two LHINs in Northern Ontario. The end result will be improved patient care. Northern Ontario Information and Communication Technology Planning Project (ICT Blueprint) Phase 2 The analysis described above was limited to seven sectors, given the project s original timeframe and available resources. As Phase 1 has been completed, the ONeHealth Steering Committee and two Northern Ontario LHINs are in a position to expand the ICT Blueprint to cover other sectors. Additional planning will benefit the larger health care system by expanding the number of agencies that can integrate into the common vision, thereby enhancing the usefulness of the Blueprint. The following six additional sectors will be the primary scope of Phase 2 (this represents over 200 agencies): community mental health and addiction services (approx. 85 agencies) long-term care facilities (approx. 65 facilities) public health units (7) independent health facilities providing laboratory and diagnostic imaging services (42) children s treatment centres (5) medical practitioners primary care group practices (including minimally: the 28 approved Family Health Teams as of April 2006; and existing FHGs, FHNs and RNPGAs) fee-for-service GPs * specialists * 8 North East LHIN: Information and Communication Technology and Information Management

18 2.0 NORTH EAST ICT PLANNING Additionally, a secondary focus will look at: The ICT linkage between pharmacies, the Ontario Drug Benefit Program and the broader health system. * The ICT needs and integration requirements of community support service providers both within the CCAC service framework and broader health system. * Options, opportunities, and requirements to build patient selfmanagement tools into the Regional ICT system. * These areas will be studied by contacting/interviewing/ surveying a representative sample of each of the respective broader groups in the North. The nine month project will begin in June 2006 and be completed by March Key components of the work will involve merging the work of the two phases into an overall NE LHIN system plan, and developing systemwide coordination/governance options for the future. North East LHIN: Information and Communication Technology and Information Management 9

19 3.0 NORTH EAST ICT INITIATIVES The North East is fortunate to have a significant number of current initiatives aimed at applying information and communication technology solutions to provide better and more accessible services to the region s residents. Given the level of hospital-related ICT planning completed to date (i.e. ICT Blueprint Phase 1) and the magnitude of hospital expenditures on ICT relative to other sectors, much of the focus of this section will be on hospital focused projects. This situation will change as further ICT planning occurs related to the community sector (i.e. ICT Blueprint Phase 2) and existing initiatives reach a point where successful expansion of scope is possible. Although there are many examples of organizations individually, or in small groups, implementing innovative ICT solutions, the projects described in this section were selected for discussion because: They cross a significant number of organizations (typically hospitals) within a sector; and/or There is significant potential for the projects to evolve to a point where they cross sectors and involve an array of providers within a limited geographic area (e.g. district) or across the region. Please note that there is a relationship between a number of the projects but for the purpose of providing a description of the various initiatives, they are presented separately on the following pages. From a planning perspective, all of the projects link back to the ICT Blueprint as either the initiatives: arose from the Blueprint (i.e. ONeHealth); or they are important partners in the realization of the Blueprint s vision and core strategies. By topic, the following projects are reviewed: Coordination and Integration Ontario North ehealth (ONeHealth) Electronic Health Record North East LHIN EHR Readiness North East Ontario Network (NEON) Electronic Child Health Network (echn) Digital Imaging / Picture Archiving and Communication System (PACS) Pan-Northern Ontario PACS Project (PNOPP) Northern Ontario Radiology (NORrad) Telemedicine NORTH Network Back Office Services Northern Ontario Hospital Back Office Services (NOHBOS) Ontario North ehealth (ONeHealth) In mid-2005, an organizational structure was developed to guide the implementation of the ICT Blueprint. An incorporated organization already existed in the Northwest (i.e. the Northwest Health Network) that was overseeing the development of the ICT plans for its member organizations. A corresponding Northeast ICT Network organization was developed to oversee projects of common interest to both regions. With the establishment of the LHINs, the two ICT Network structures representing their respective LHIN areas were connected by the ONeHealth ICT Steering Committee that is currently overseeing the Northern Ontario ICT 10 North East LHIN: Information and Communication Technology and Information Management

20 3.0 NORTH EAST ICT INITIATIVES Blueprint implementation (moving towards a regional electronic health record). Figure 3: ONeHealth Steering Committee Governance Structure, May 2006 EHR Work Effectiveness And Administrative Systems Technology and infrastructure Diagnostic Services Information Integration Northwest ICT Network ONeHealth Steering Committee * DI/PACS ICT Blueprint Implementation Other Projects, e.g., NOHBOS Northeast ICT Network EHR Work Effectiveness And Administrative Systems Technology and infrastructure Diagnostic Services Information Integration The role of the Steering Committee will be as follows: Coordinate and guide Northern ICT strategies; Establish appropriate linkages to Winnipeg, LHIN 12 and Southern Ontario; and Undertake/lead joint pan-northern initiatives. Mission The mission of the ONeHealth Steering Committee is to build on existing investments to provide partner organizations with coordinated and interoperable information systems, building toward an integrated information system - as outlined in the Northern Ontario ICT Blueprint - that supports the provision of care within Northern Ontario. Reporting Relationship The ONeHealth Steering Committee will report to the Northern Ontario Hospital CEOs group through reports to regional committees or networks and through summary reports to CEOs in the North. The ONeHealth Steering Committee will also provide an advisory role to LHIN 13 and LHIN 14 CEOs. North East LHIN: Information and Communication Technology and Information Management 11

21 3.0 NORTH EAST ICT INITIATIVES Functions The primary functions of the ONeHealth Steering Committee are to: oversee the implementation of the Northern Ontario ICT Blueprint through the implementation activities of the Northeast and Northwest ICT networks and through specific task groups established to implement specific pan-northern strategies identified in the Blueprint; guide the planning, implementation and management of the Northern Ontario ICT Blueprint, including a shared EHR and PACS for health care service providers in the North, in conjunction with planning and implementation work done by the North West and North East subgroups; be the champion for ICT initiatives in Northern Ontario and actively promote initiatives at regional, provincial and national levels; promote linkages with community-based health care providers and organizations, tertiary care centers, and other referral sources related to IS, EHR, PACS and other ICT Blueprint initiatives; and oversee the completion of Phase 2 of the Northern Ontario ICT Blueprint with the objective of expanding it to the non-acute care health sectors. Membership The committee is composed of up to eighteen members plus one chairperson. Membership is established to ensure various health care groups are represented while keeping an even split between North Eastern and North Western Ontario. Committee composition will have a desired target of 50% for hospital representation based on the following: all five Class C hospitals in Northern Ontario each have one representative; at least one primary care representative; at least one Community Care Access Centre (CCAC) representative; at least one member representing Aboriginal Interests; at least one member from a community hospital; at least one member representing mental health; and other members representing sectors such as public health, long-term care, physicians and cancer services. ONeHealth has completed, and is pursuing, a number of projects as follows: Completed Work/Projects: Pan-Northern Ontario PACS Project (PNOPP) An Infoway proposal was submitted and approved for the detailed planning of a regional PACS strategy (approximately a $1 million project). The planning phase was completed in April Development of a marketing logo and identification with a key message of being a patient centered information system development. 12 North East LHIN: Information and Communication Technology and Information Management

22 3.0 NORTH EAST ICT INITIATIVES Current Projects: Pan-Northern Ontario PACS Project (PNOPP) (described in more detail in a following section) - Memorandum of understanding and letter of intent for the operations of the regional PACS system prepared. The documents have been brought forward to the five individual level C hospitals (hubs) involved for approval. Detailed model development and planning has been completed with the support of a Canada Health Infoway grant. Funding has now been requested for implementation of the regional PACS model which should go to the Infoway Board in mid The proposed overall investment in the region is nearly $75 million over 5 years and funding sources beyond Infoway will be required for implementation. A governance transition plan for the group will be required to become an incorporated entity once Phase 2 of PNOPP has been approved. This will help support the long-term operations of PNOPP, in conjunction with NOHBOS initiative. Sponsoring, in collaboration with the two Northern LHINs, the second phase of the Northern ICT planning project which is to involve the community-based health sectors. Negotiating with Meditech to change the model for licensing of software from: Provider-based (not patient centric) i.e. beds in hospital, beds in LTC facilities, number of physicians in a primary care group, etc. to Regional licensing based on population that supports: a patient-centric approach, Canadian and international directions; and 1 patient = 1 record. Northern Ontario Hospital Back Office Services (NOHBOS) ONeHealth continues work with all Northern Hospitals in the NOHBOS project to collaboratively examine the feasibility of sharing and leveraging resources, people and information to improve efficiency and reduce operating costs of back office services. ONeHealth will be in a better position to identify possible shared projects with NOHBOS once it has completed its business case and implementation analysis. Electronic Health Record Background An electronic health record (EHR) is defined by Canada Health Infoway as follows: An electronic health record provides each individual in Canada with a secure and private lifetime record of his or her key health history and care within the health system. The record is available electronically to authorized healthcare providers and individuals anywhere, anytime, in support of highquality care. North East LHIN: Information and Communication Technology and Information Management 13

23 3.0 NORTH EAST ICT INITIATIVES Generally, it is agreed that the EHR needs to contain the following pieces of information (Canada Health Infoway, EHR Standards Analysis, March 31, 2004): Client demographic and identification information. Health history and clinical summary information. Problem lists and diagnoses. Diagnostic information (values and interpretation). Medication information (past and present). Care plan and decision support information. Treatment information. Consent information. Vital signs and alerts. Provider identification information. Clinical document for chronic diseases. Existence/encounter information. Immunization information. Primary care and community care information. Quality and safety information. The guiding principles of the Electronic Health Record Solution (EHRS) are (Electronic Health Record Solutions Blueprint Version 2, Canada Health Infoway, March 2006): Patient Centric making patient/person clinical data available to authorized caregivers for the purpose of caring for them. Mass Customized Views of All Clinical Data EHR must be able to provide customized views of data aligned with each requestor s needs and purpose. Value Added for the Provider support mission critical activities of each organization. Timely and Accurate Information to be viewed as an authoritative and reliable source of clinical information; sustaining care with timely, complete and accurate information. Think, Build and Act at All Levels (local, regional, national) support providers across the continuum of care in the local and regional jurisdictions. Interoperable and Integrated among different jurisdictions, provider types and provider delivery settings. Standards-Based. Replicable Solution (patterns, components) solutions to be reusable. Leverage Legacy Systems and Solutions. Design for a Phased Rollout with Near Term Results. Scalable. Extensible to Support Future Growth. Cost-Effective. Secure and Private. Allow for Innovation and Competition. Comprehensive. Use of an EHR This descriptor of primary or secondary use of the electronic health record is intended to distinguish between the different purposes for accessing the EHR. The perspective driving this definition is that of the end user and the work processes carried on by such users. The qualifier of primary versus secondary uses refers to the data coming from an EHR and the way in which the data contained in the EHR contributes directly to the functioning of work processes involved in the provision of care to a patient. Primary Use of the EHR refers to usage of the EHR data to directly contribute to the provision of care for a patient/client for a given 14 North East LHIN: Information and Communication Technology and Information Management

24 3.0 NORTH EAST ICT INITIATIVES encounter or episode. In most provinces today, primary uses are conducted under some form of implied consent with or without notification. In general, we recognize the following categories as representing uses that would be considered as primary: 1) Health services provision. 2) Patient-focused outcome analysis where names are required. Secondary Use of the EHR refers to usage of the EHR data for activities that are not directly related to the care of a specific patient/client for a given encounter or episode. In most provinces today, secondary uses of the data are done via anonymized data and require some form of consent. Secondary uses may also pertain to identifiable data and, in that case, always require explicit consent from the patient/client. In general, we recognize the following categories as representing uses that would be considered as secondary: 1) Governance and health service delivery administration. 2) Program management conducted by programs and health authorities. 3) Education e.g. teaching hospitals, etc. where education is bundled with care provision, it is considered care first and foremost, not education. 4) Insurance. 5) Research. 6) Public health surveillance. North East EHR Readiness ICT Blueprint Per the ICT Blueprint of January 2005, readiness to implement the electronic medical record (EMR)/electronic health record (EHR) in the North East varies by health care providers in three groups: the Group Health Centre in Sault Ste. Marie that stands alone as a totally paperless environment; those organizations whose recent and/or upcoming investments in applications positions them well for the eventual implementation of EHR; and those organizations that need to make investments in new core systems that will position them for the EHR. The larger centres have systems, or are implementing systems, that are already building up to the EHR (NEON, North Bay). The core applications of patient management and diagnostic information are in place and online results viewing is available. Additionally, NORrad has facilitated the implementation of PACS at many hospital sites in North East Ontario. There are several major implementation projects that will be undertaken prior to full EHR. The following is a brief list of applications that build up to the EMR locally and subsequently an EHR regionally. Online pharmacy information system and automation automated drug profiles and medication administration records. Information management systems for surgery and emergency. Clinical decision support. Electronic clinical documentation for nursing and allied health both inpatient and outpatient. Order entry (non physician and physician). Documentation (non physician and physician). System for positive patient identification, using bar-coding technology (e.g. patient arm band, specimens, medication, blood and blood products). Document scanning. Access to images (e.g. ECGs, etc.). Physician enhanced viewing. MPI (master patient index). North East LHIN: Information and Communication Technology and Information Management 15

25 3.0 NORTH EAST ICT INITIATIVES Ontario Hospitals Connected For Care: 2005 EHR Readiness Survey Report for North East Local Health Integration Network To assess Ontario hospitals preparedness to engage in the provincial ehealth strategy, the Ontario Hospital Association (OHA) and the Ontario Hospital ehealth Council undertook the Ontario Hospitals Connected for Care: 2005 EHR Readiness Survey to measure organizations capability and use of Electronic Health Record solutions. The EHR Readiness survey had three survey domains in which performance indicators were defined as follows: 1) Level of electronic patient record (EPR) functional capability and use domain. Patient registration, records management and directory services indicator. Results reporting indicator. Order entry indicator. Clinical documentation indicator. Information infrastructure indicator. 2) Level of EPR organizational and human capacity domain. EHR leadership and planning indicator. EHR skills complement indicator. EHR priorities indicator. Barriers to implementation indicator. 3) Level of regional/inter-organizational EHR readiness domain. Inter-organizational data sharing indicator. Inter-organizational Enterprise Master Patient Index (EMPI) indicator. Interoperability with an EHR indicator. Regional governance indicator. Results are shown as the gap between the hospital s actual score and the maximum potential score, normalized to 100. The capability gap represents the amount of improvement that an organization needs to make in its EHR capability in order to attain a fully functioning EHR. The use gap represents the opportunity for improvement within an organization in order to fully use its EHR. Three key system level results are presented by LHIN in the following figures. They are: Interoperability Capability with EHR or Other EPR Interoperability Use with EHR or Other EPR Regional Governance Capability Definition: INTEROPERABILITY WITH AN EHR OR OTHER EPR This indicator measures the gap in interoperability between organizations. Some organizations share by providing access to a shared document repository while others share by maintaining a registry of available documents and allowing organizations to retrieve documents upon request. Functions in this indicator include the capability to: send laboratory results, diagnostic imaging reports, and other clinical documents to a shared repository for retrieval by clinicians associated with another organization; participate in a document registry that allows clinicians associated with another organization to retrieve documents from the EPR on demand; and provide secure for sharing clinical information 16 North East LHIN: Information and Communication Technology and Information Management

26 3.0 NORTH EAST ICT INITIATIVES Hospitals in the NE LHIN show a greater interoperability capability and use than the province as a whole, and rank in the top 3 or 4 LHINs in Ontario for these indicators. Figure 4: Hospital EHR/EPR Interoperability Capability by LHIN, 2005 Definition: REGIONAL GOVERNANCE This indicator measures the gap in regional governance associated with the EHR strategy. Functions in this indicator include having: a CIO or senior executive with EHR responsibility; a steering committee with EHR responsibility; a strategic EHR plan; a strategic EHR plan encompassing all organizations in its respective LHIN. The NE LHIN is at the provincial average with respect to regional governance capability. With the recent introduction of the LHIN ehealth lead, the establishment of ONeHealth and the completion of the second phase of regional ICT planning in early 2007 (that will result in a plan for the entire health system), the North East is demonstrating significant progress towards regional ICT coordination/governance. Figure 5: Hospital EHR/EPR Interoperability Use by LHIN, 2005 Figure 6: Hospital Regional ehealth Governance by LHIN, 2005 The OHA and the Ontario Hospital ehealth Council will be launching the 2006 version of its ehealth Readiness Survey in May The results will help identify requirements and opportunities to promote efficiencies and reduce redundancies in the establishment of a provincial ehealth strategy. North East LHIN: Information and Communication Technology and Information Management 17

27 3.0 NORTH EAST ICT INITIATIVES NEON North Eastern Ontario Network (NEON) is a consortium comprised of seven hospitals (Services de santé de Chapleau Health Services, Englehart and District Hospital, Kirkland and District Hospital, Smooth Rock Falls Hospital, Hôpital Régional de Sudbury Regional Hospital, Temiskaming Hospital, and Timmins and District Hospital) and the North East Mental Health Centre (NEMHC). The member organizations have implemented the Meditech System (clinical and financial software modules). NEON is managed by a Steering Committee with representation from all partners. Each hospital has one vote and there are shared service agreements in place. Figure 7: Current NEON Members, May 2006 To achieve this objective, NEON is targeting two major strategies: 1) Meditech standardization; and 2) implementation of advanced clinical applications. ( Advanced clinical applications include: patient care system, physician order entry, emergency room, oncology, scanning functionality and forms that print on demand.) Two new hospital partners have recently been added to the NEON consortium Elliot Lake and Wawa. Elliot Lake is presently implementing intermediate clinical applications (laboratory and diagnostic imaging modules), after completing implementation of preliminary applications (central patient index, health records, financial applications, etc.). Wawa is implementing a comprehensive, turnkey solution to address its information management needs. Smooth Rock Falls H Timmins H Chapleau H Kirkland Lake H H Englehart HNew Liskeard The Sault Area Hospital (SAH) is currently considering joining the NEON partnership as one option in its system upgrade process. Due to the status of NEON and Meditech s licensing structure, if the SAH selects Meditech, it will have to implement it independently initially and then look at a subsequent alliance with NEON. Sudbury H H North East Mental Health NEON is positioning ICT as an enabler of integration and regionalization, following the lead of regionalization processes in Alberta and Nova Scotia, in developing systems to create a unified electronic medical record. Meditech, the prime vendor to NEON, is involved in province-wide ICT initiatives in both of these jurisdictions. In terms of connections with sectors of the health system beyond general hospitals, Meditech modules are being applied to 250 inpatient beds associated with mental health services (NEMHC). There is currently no linkage established with long-term care facilities, CCACs or community services, although some of the NEON partner hospitals do allow select access to system information and resources to clinical employees from other agencies who are involved in the patient s circle of care. 18 North East LHIN: Information and Communication Technology and Information Management

28 3.0 NORTH EAST ICT INITIATIVES There is increasing automation of physicians offices supported by grant funding currently offered through the MOHLTC (Ontario MD). However, the physicians office information management software, offered by Meditech, is not on the list of products supported by Ministry grant funding. Consequently, specific efforts to further integrate ICT between medical offices and NEON hospitals are not occurring at this time. The major challenge facing the NEON group, at present, is the requirement from Meditech relating to significantly greater standardization as a result of exceeding a 1,000 bed total limit under the license. This is a significant initiative for the partnership requiring a virtual rebuild of the entire system. It is scheduled for implementation by November NEON has requested funding from FedNor to undertake standardization but specifics concerning funding support have not been finalized. Electronic Child Health Network A noteworthy project that has built bridges among service providers is the Electronic Child Health Network (echn). Arising out of an in initiative at Hospital for Sick Children, echn s Health Information Network (HiNet) is an operational Enterprise Master Patient/ Person Index (EMPI) and an Electronic Health Record (EHR) in use at 25 member sites and approximately 100 physician offices in Ontario. The echn solution is based on a central repository that assembles consented paediatric patient data to form a longitudinal electronic medical record. HiNet encompasses various tools, e.g. medical entities dictionary tools which echn uses to build an enterprise dictionary of laboratory test orders, panels, sub-panels and reference ranges. HiNet accepts standard HL7 data feeds (ADT, e-reports, radiology reports and images as well as laboratory reports and test results), which are all monitored for data integrity/quality against a set of standards for a particular site. Almost all of the Northern Ontario hospitals are either members of echn or are planning to be as resources allow. When restricted by a lack of implementation resources, organizations can initially elect to simply view data available through the echn portal, e.g. the Manitoulin/Sudbury CCAC. As of August 2005, echn members from the NE LHIN area include: Sudbury Regional Hospital North Bay General Hospital Chapleau Health Services Sault Area Hospital North East Mental Health Care West Nipissing General Hospital Smooth Rock Falls Hospital Mattawa General Hospital Englehart and District Hospital Kirkland and District Hospital Sensenbrenner Hospital Temiskaming Hospital Timmins and District Hospital Thessalon Hospital Group Health Centre Sault Ste. Marie Manitoulin-Sudbury CCAC Near North CCAC Algoma CCAC Cochrane District CCAC Timiskaming CCAC West Parry Sound CCAC and the following two specialty children s centres: Bloorview MacMillan Children s Centre The Hospital for Sick Children North East LHIN: Information and Communication Technology and Information Management 19

29 3.0 NORTH EAST ICT INITIATIVES Clinical records from patients who have given consent have been stored on HiNet since July 1, Health care professionals affiliated with member institutions have had operational access to patient information on HiNet since October 31, Digital Imaging / Picture Archiving Communications Systems (DI/PACS) The introduction of PACS, combined with computerized and/or digital radiography in the health care environment, is enabling the development of the film-less organization. PACS offers distribution of images throughout the organization with the assistance of the appropriate network infrastructure. Viewing of images is accomplished with the assistance of diagnostic and clinical workstations, and web-enabled applications. A PACS environment offers many benefits to the clinicians such as the manipulation of the image to maximize image quality and diagnosis, viewing of the same examination at multiple locations, and the ability to have the Figure 8: Current State of PACS in Northern Ontario, May 2006 Lake of the Woods District Hospital Kenora Red Lake Margaret Cochenour Memorial Hospital Riverside Health Care Facilities Dryden Regional Health Centre Kenora Atikokan General Hospital Population Served: 30,500 Exam Volume: 41,076 Number of Beds: 96 PACS Status: AGFA Implimented Thunder Bay Hub Sioux Lookout Meno-Ya-Win Health Centre Thunder Bay Regional Hospital Thunder Bay Nipigon District Memorial Hospital Sault Ste Marie Hub Population Served: 119,500 Exam Volume: 80,716 Number of Beds: 297 PACS Status: AGFA Planned Geraldton District Hospital The McCausland Hospital Manitouwadge General Hospital Group Health Centre Sault Area Hospital - Plummer Memorial Wilson Memorial General Hospital Sault Area Hospital - Richard's Landing Site Sault Area Hospital - Thessalon Site Notre Dame Hospital Hornepayne Community Center Lady Dunn Hospital Sault Sainte Marie General Hospital Sault Ste. Marie Attawapiskat Population Served: 238,500 Fort Albany Exam Volume: 223,032 Number of Beds: 1,027 Timmins Hub PACS Status: Philips Implimented Population Served: 84,000 Exam Volume: 141,306 Number of Beds: 606 PACS Status: AGFA Implimented Chapleau Health Services Sen Sen Brenner General Hospital Blind River District Health Centre Timmins St. Joseph's General Hospital Elliott Lake Espanola General Hospital Manitoulin Health Centre - Mindemoya Site James Bay General Hospital Smooth Rock Falls Hospital Lady Minto Hospital Anson General Hospital Timmins and District Hospital Sudbury Regional Hospital - Laurentian Site Wee Nee Bayko General Hospital Bingham Memorial Hospital Kirkland and District Hospital Hôpital Général de Nipissing Ouest Englehart and District Hospital Temiskaming Hospital North Bay Hub Population Served: 185,000 Exam Volume: 123,919 Number of Beds: 345 PACS Status: Philips planned North Bay General Hospital - Scollard Site Sudbury Regional Hospital - Memorial Site Sudbury Regional Hospital - St. Joseph's Health Centre Site North Bay General Hospital - Maclaren Site Mattawa General Hospital Sudbury North West Parry Sound Bay Manitoulin Health Centre Health Centre - Little Current Sudbury Hub Population Served: 312,000 Exam Volume: 183,217 West Parry Sound Number of Beds: 705 PACS Status: Siemens PACS Status: AGFA Implimented Note: West Nipissing General Hospital is part of Sudbury hub, and the Temiskaming Hospital is technologically part of the Sudbury hub. 20 North East LHIN: Information and Communication Technology and Information Management

30 3.0 NORTH EAST ICT INITIATIVES image at any location, at any time. Numerous successes have been achieved in Northern Ontario in the development of common regional PACS platforms and the collaborative management of medical images across the enormous geographic expanse. A critical success factor for the realization of an even broader vision of image management throughout all of Northern Ontario will be to leverage these successes towards a shared new model that supports regional patient referral patterns and is aligned with the movement towards a Northern Ontario Electronic Health Record. A PACS model must effectively facilitate the delivery of electronic images both within the north and to other hospitals in Southern Ontario. The marriage of the image, diagnostic interpretation, and other pertinent information required to provide patient care, and its accessibility are components of the Northern Ontario PACS strategy (ICT Blueprint, 2005). The development of the regional PACS model noted above has been moved forward through ONeHealth and its Pan-Northern Ontario PACS Project (PNOPP). The precursor to regional PACS discussions can be traced back to the Northern Ontario Radiology (NORrad) Program that has operated for a number of years in the Cochrane District and is labelled as the Timmins hub in Figure 8. Pan-Northern Ontario PACS Project (PNOPP) Initiated in August 2005 as a project of ONeHealth, the objectives of the Pan-Northern Ontario PACS Project (PNOPP) are: to create a film-less DI/PACS environment for Northern Ontario; to use technology for the purpose of maximizing the use of limited resources (transfer pictures not people); to establish a deep archive that will meet current and future storage needs; and to maximize current funding opportunities. The project has 3 phases: Phase 0 - Conceptual Planning Phase 1 - Detailed Planning Phase 2 - Implementation Canada Health Infoway has provided funding support to undertake and complete Phases 0 and 1. The required deliverables included the identification of the current state, the identification of the future state, and a gap analysis of DI/PACS in Northern Ontario. CHI has also required the development of a shared DI governance model supported by a memorandum of understanding, the design of DI repository architecture to support a filmless state and the creation of a migration plan which outlines the steps required to achieve a Northern Ontario shared DI repository. The Project is currently awaiting CHI approval of the planning work to date and funding for the detailed implementation planning. The following figure illustrates the PNOPP concept. Although a number of hubs are, or will be, using different PACS vendors, PNOPP will enable information sharing within/ between the hubs, and a level of redundancy and data storage that would not be possible on an individual hospital or hub basis. North East LHIN: Information and Communication Technology and Information Management 21

31 3.0 NORTH EAST ICT INITIATIVES Figure 9: PNOPP Conceptual Architecture, May 2006 Kenora AGFA 21 Spokes Thunder Bay Spoke Cache 6 Spokes Spoke Cache Spoke Cache 8 Spokes Sudbury Timmins AGFA 17 Spokes Spoke Cache Philips HL7 Sault Ste Marie Agfa - planned AGFA Spoke Cache North Bay 4 Spokes PACS Application Redundancy Op PACS DBMS Redundancy for Business Continuity PHILIPS OP PACS DBMS REPLICATION Thunder Bay Mirror Replication of Database Structure (Oracle, SQL) Privacy DBMS Redundancy Integration Layer Sudbury Primary AGFA OP PACS DBMS REPLICATION Siemens SIEMENS OP PACS DBMS REPLICATION Parry Sound DICOM Philips - planned Access/ Retrieval/ Transmission of Images Archives Thunder Bay DI I EMPI HL7 Sudbury Live DICOM HL7 DICOM Stage Mirror Live DICOM HL7 DICOM Stage Teleradiology LHIN 14 Data Centre Live LHIN 13 Data Centre Live Prov. EHR Services Data Centre Redundancy Data Redundancy DI Viewer - DI Image Viewer - DI Text Reports Teleradiology Timmins Hub / NORrad Nine hospitals, led by the Timmins and District Hospital, have installed state-of-the-art digital imaging technology. The project delivers diagnostic imaging services to 100,000 people living across 150,000 square miles in Ontario s most north eastern region extending up to James Bay. The following are the hospital partners: Kirkland and District Hospital; Notre Dame Hospital, Hearst; Sensenbrenner Hospital, Kapuskasing; Smooth Rock Falls Hospital; MICs Group of Health Services (Bingham Memorial Hospital, Matheson; Anson General Hospital, Iroquois Falls; Lady Minto Hospital, Cochrane); Weenebayko General Hospital, Moose Factory. 22 North East LHIN: Information and Communication Technology and Information Management

32 3.0 NORTH EAST ICT INITIATIVES Thus, NORrad s scope ranges from James Bay Coast nursing stations in the north to Englehart in the south (only Kashechewan is outstanding and this implementation is in progress). Figure 10: NORrad Sites, May 2006 Moose Factory H Kapuskasing Cochrane Hearst H H Smooth Rock Falls H H Iroquois Falls H HMatheson HKirkland Lake Timmins H H Englehart Espanola Blind River Sudbury H H H HLittle Mindemoya H Current Under NORrad, local area networks are used to carry diagnostic images and reports between referring physicians, radiologists and emergency staff within each hospital. A high-speed, fibre-optic wide area network connects the nine independent hospitals in a strategic alliance, facilitating image analysis and consultation among medical professionals. The NORrad technology also permits the integration of diagnostic image data with electronic patient records. As the first and longest fully functioning hub in the North East, NORrad has much experience to share as PACS is adopted across the region. NORrad continues to develop as highlighted by its recent accomplishments and planned initiatives as follows: Implementing digital mammography in four sites in 2006/2007 including: Timmins, Hearst, Kapuskasing and Kirkland Lake. This technology has already been implemented in Moose Factory. The equipment cost is $250K to $500K per site depending on technology. The Timmins hub is linked to the Sudbury hub for the purpose of sharing images. There is a shared central patient index at all participating hospitals: together, this includes 24 hospital sites. the technology chosen has been approved in Ontario (i.e. Initiate) and is already in use in some Southern Ontario communities. Moving forward with implementing web-based applications for managing cardiology data (i.e. the results of ECGs and holter monitor exams). Currently investigating the implementation of an EMR portal (instead of using Meditech s EMR). Telemedicine in the NE LHIN NORTH Network Note: The new Ontario Telemedicine Network (OTN) was recently formed through the amalgamation of the three large telemedicine programs in the province (including NORTH Network). Nonetheless, given NORTH Network s history and applicability in the North East, and it is a widely known brand in the Region, it will be reviewed as the separate entity that it was up to June Since 1998, Northern Ontario Telehealth Network s (NORTH Network) telemedicine North East LHIN: Information and Communication Technology and Information Management 23

33 3.0 NORTH EAST ICT INITIATIVES program has allowed patients to consult with medical specialists and allied health professionals across more than 80 different disciplines in regional or tertiary care centres across Ontario without leaving their home communities. NORTH Network now includes over 225 telemedicine-equipped sites in more than 120 communities across the province. Using videoconferencing technology and electronic diagnostic equipment such as otoscopes, digital stethoscopes and patient exam cameras for close-up examinations, patients can be assessed just as if they were in the health professional s office. X- rays and other diagnostic tests can also be viewed during consultations and a Telehealth coordinator helps to facilitate the entire consultation. Telemedicine is particularly effective for follow-up appointments, triage decisions, pre-admission work-ups and initial consultations in many specialties. In addition to supporting access to clinical care, NORTH Network supports continuing professional development and continuing medical education activities, with up to 3,000 people participating in more than 275 educational sessions a month. NORTH Network is a program of Sunnybrook and Women s College Health Sciences Centre in Toronto. The Network has more than 115 Ontario members, including academic health sciences centres, community hospitals, psychiatric hospitals, clinics, nursing stations, long-term care homes, community care access centres, public health units and educational facilities. Funding comes primarily through the Ontario Ministry of Health and Long-Term Care although the Network has received growth funding from more than 90 organizations. NORTH Network s membership model is based on a philosophy of collaborative partnership and open communication. Members are encouraged and supported in their efforts to develop Telehealth initiatives in their organization and are invited to guide and validate NORTH Network s initiatives. In this way, members are assured that their needs and expectations are addressed. In addition, the number and variety of members provides a rich environment within which common objectives are identified and advanced. NORTH Network s provision of comprehensive, effective and efficient support to its various partners is achieved through the centralized management of all technology (such as the network itself, videoconferencing activity, bridging and procurement) and core business processes (such as referral management, scheduling and help desk supports). Centralizing these business and infrastructure functions allows the regional leadership to focus on developing appropriate telemedicine programs and assume responsibility for clinical and educational operations. NORTH Network s emphasis on the regional development of Telemedicine programs further supports a natural alignment with the evolving LHIN structure in Ontario. By ensuring common practices and minimum standards, the quality of clinical and educational sessions is ensured for all NORTH Network member participants. Business Strategy NORTH Network s vision is of a seamless, integrated, comprehensive Telemedicine network across all segments of the health 24 North East LHIN: Information and Communication Technology and Information Management

34 3.0 NORTH EAST ICT INITIATIVES sector that brings health care to any patient, anywhere, anytime and enhances opportunities for continuing professional development for physicians and allied health care providers as well as providing improved access to educational opportunities in communities across Ontario. NORTH Network invests significant resources to facilitate and support a change management program so that regionally specific objectives are effectively realized. Key features of the change management strategy to encourage physicians and other health professionals to incorporate Telemedicine into their practices include: local leadership at every site; enhanced regional communication; referral management; adapted strategies for First Nations communities; maintenance of existing referral patterns; comprehensive training; and turnkey technology support. Figure 11: Telemedicine-Enabled Communities Partnering with NORTH Network North East LHIN: Information and Communication Technology and Information Management 25