Meeting Date: March 01, 2012 Action: Topic Decision ClinicalConnect Base Funding Allocation Purpose: To provide the Waterloo Wellington Local Health Integration Network s Board of Directors with the information necessary to approve the recommendation of a base funding allocation for the WWLHIN wide integrated electronic health record platform, known as ClinicalConnect. Recommendation: That the Board of Directors to approve the allocation of $530,000.00 in annual base funding, to maintain a WWLHIN wide integrated electronic health record platform. And That the Board of Directors approve allocation of the 2012/13 fiscal year s funding to the HEALTHeCONNECTIONS Project of the WWCCAC as an interim funding recipient pending the outcome of the WWLHIN shared services discussions. Background ClinicalConnect is a legacy of the HEALTHeCONNECTIONS Project (HEC). The project funded the implementation of the integrated electronic health records platform for purposes of sharing electronic health information and service records from hospitals and the WWCCAC to the Family Health Teams in scope of the project. At the time of implementation, ClinicalConnect was WEB portal system in use at Hamilton Health Sciences (HHS) and continues to be managed and maintained by HHS resources. HEALTHeCONNECTIONS was the spark that enabled ClinicalConnect to expand to the rest of the HNHB LHIN. See the attached appendix for ClinicalConnect background and context. ClinicalConnect s underlying software is supplied by MEDSEEK. ClinicalConnect was integrated with the core patient records systems at the Wellington Health Information Network (WHIN GGH, GMCH, NWHC WHIN is hosted at GGH), SMGH and the client services system hosted at the OACCAC for WWCCAC service records in 2010.
The integration of ClinicalConnect with the McKesson system at GRH posed significant integration challenges which resulted in GRH data not being included during the Canada Health Infoway portion of the HeC project. HeC funded a proof of concept that was successfully completed early in 2011. GRH committed to move forward the proof of concept to production in late 2011. The confirmed integration completion date for GRH is spring 2012 The implementation of ClinicalConnect committed the WWLHIN health system to annual maintenance cost of CAD $530,000. The maintenance costs are comprised of the MEDSEEK software maintenance fees and Hamilton Health Sciences costs to provide a user registration service and technology maintenance and support. While ClinicalConnect is the first generation of an integrated electronic health record (iehr) system for Waterloo Wellington, it is expected that the iehr will evolve in coming years. It is intended that this funding be permanently allocated to iehr platform(s) for the Waterloo Wellington Local Health Integration Network service providers as they evolve. Cost Risks Connecting South West Ontario (cswo) is working on a iehr solution for SWO. The impact to ClinicalConnect and/or iehr related costs are unknown. ClinicalConnect expanded rapidly; HHS is in the process of quantifying hosting costs based on the current scale of deployment. Additional data sources integrated into the platform will increase MEDSEEK maintenance costs examples of potential additional data sources are: Ontario Lab Information System (OLIS), Diagnostic Imaging Repository (DI-r). Additions to the platform will be managed under separate projects and managed accordingly. GRH s maintenance costs are included in the $530K base funding request. Next Steps: Share Services discussions are underway within the LHIN, The iehr is a shared service and is a candidate to be included in the shared service provider or organization s portfolio should it develop. LHIN staff will work to determine suitable out years funding recipient(s) in a way that provides for flexibility to move the base funding as necessary. A brief demo of the TEST ClinicalConnect system will be provided at the Board Meeting Attachments ClinicalConnect Background to Base Funding ClinicalConnect Base Funding Q&A
Care Coordination in Action Improving Quality
The Journey to ClinicalConnect We know: No matter where patients are, their health information must be accessible Health systems need to exchange information Better communication with regional care providers is vital
About ClinicalConnect Secure provider portal or "Virtual Electronic Health Record Aggregates essential electronic patient care data from multiple hospitals and systems (eg: Hospitals, CCAC, Oncology) Provides Physicians and Healthcare Providers real time, anytime & anywhere access to their patients electronically stored records via the internet.
Planning, collaboration 2005-2011 1. Procurement to buy a solution a MedSeek 2. Development a multidisciplinary physician group, nursing, education etc 3. ClinicalConnect across Hamilton Health Sciences 4. Data viewable to community providers 5. Electronic Download to community providers EMRs 6. LHIN-wide privacy agreements 7. Expansion to WW & HNHB LHIN
ClinicalConnect Today 28 hospitals + oncology care services 2 Community Care Access Centres 2,500+ care providers 2 million patients 2 LHINs HNHB LHIN and WWLHIN
ClinicalConnect Today Providers gather comprehensive data in seconds Web or mobile in real-time, anytime, anywhere Electronic delivery of labs results and reports to family physicians Electronic Medical Record systems High patient care value proposition due to breadth of accessible data
Sharing information across continuum of care Common tool a consistent information a improves patient care Knowledge and Communications Platform integration (e.g. McMaster Plus, Registered Nursing Association of Ontario Best Practices)
Sharing information across continuum of care cont d Future access point to advance provincial information systems (e.g. Diagnostic Imaging Repository, Ontario Lab Information System, Diabetes Registry) Positioned to advance: patient portal, secure messaging, e-referrals
Privacy, security top priorities Participants must: Comply with the Personal Health Information Protection Act (PHIPA) Be in the circle of care Organizations must: Have privacy, security policies, controls, procedures, training programs ClinicalConnect: Is governed by a multi-lhin Privacy Committee Is securely encrypted Follows industry standards
Integrating Patients Across Multiple Hospitals and LHINs
Integrated Data Including Oncology Aggregated Clinical Data Oncology Reports are integrated with other reports (discharge summaries, operative reports, consults etc).
Aggregated Clinical Data from Multiple Sources Across the LHIN
CCAC Data with Hospital Data Provides a 360 degree patient view CHRIS patient information includes CCAC client demographics, personal & medical contacts, placement and services details, patient s in-home CCAC services and long-term care placement.
Mobile Anytime, Anywhere Access iphone Sample Shown (also available via Blackberry, Android, ipad, Tablets etc )
Improving patient care ClinicalConnect means: Less time tracking down records No duplicate tests Fewer medical errors since information is electronic Less exposure to diagnostic imaging radiation
Improving patient care (cont d) ClinicalConnect means: Reduced waiting time More health care can be delivered close to home (eg: avoid patient transfers) Patients are more involved in their care CCAC and Oncology data combined Better patient transition across the continuum of care Prepares providers for future ehealth services
ClinicalConnect reduces repeat tests ClinicalConnect is a godsend. In the past we had essentially no access to patient info from other hospitals so it often took many days after admission to get a complete picture of the patient s history. This often resulted in repeat tests, miscommunication, and delayed care. Now, with the click of a mouse I can be instantly looking at consult notes, discharge summaries, radiology reports and lab data from previous hospital visits all across the LHINs. Remarkable Dr. Rob Lloyd, Pediatric Intensivist, Hamilton Health Sciences
Improve treatment and discharge planning ClinicalConnect helps to determine collateral clinical information for patients with acquired brain injury. This provides a better context for treatment and discharge planning. Mari O Brien MSW., RSW, Clinical Social Worker, St. Joseph Healthcare System
ClinicalConnect improves care and saves time Being able to access my patients medical information in seconds rather than days, means that I can make timely care decisions, saving time for both me and my patients. ClinicalConnect keeps me in the loop and helps me provide better continuity of care. Dr. Barbara Teal, Family Physician, Hamilton
Faster diagnosis and treatment with ClinicalConnect A recent patient visit in Niagara showed blood work with unstable Angina but no heart attack. The cardiologist immediately made the decision to proceed with intervention without waiting for hard copy documentation from the referring physician since it was taking too long. ClinicalConnect had all the information needed to proceed. Corinne Tartaglia, R.N., MScN, Heart Investigation Unit (HIU) - Triage Coordinator
A Family Physician s Perspective With ClinicalConnect, I am able to look up a patient s hospital information from my office, read their test results, read their discharge plan, and review their medications. When they came to my office, I have a complete picture of what happened in hospital and am able to develop a care plan right away. This reduces the need for repeat appointments, improving the quality and efficiency of care for my patients. Dr. Mohammed Alarakhia, Family Physician. 21
A Pharmacist s Perspective Sometimes the medication list for a patient arrives without the discharge summary. Using Clinical Connect, I am able to view the discharge summary to get a more complete picture of what was prescribed and why. This is important information, easily obtained and it s why I like ClinicalConnect. It s great to find the information I need without having to spend time calling hospitals. - Robin, Family Health Team Pharmacist 22
A Specialist s Perspective Traditionally, the first visit with a patient would be about information gathering. Now, I am able to look up the patient s information before our first visit. With ClinicalConnect, what would have been a multi-visit, multi-step process, can now be accomplished in one appointment. Having the whole picture of a patient s health also helps me to better triage their care needs. Dr. Pandey, Cardiologist 23
Futures Expanded Adoption... Evolve process changes Integration of Grand River Hospital Mature Cross LHIN Collaboration / Support and Shared Services / Governance / Advisory Single Sign on / Patient Context Launch Hospital Systems Integration with the Diagnostic Imaging Repository Integration with Provincial Systems such as Diabetes Registry, Ontario Lab Information System (OLIS) Leverage provider portal integration for Patient Portal Upload data (cumulative profile) from community physician Leverage IDS / Integrated Decision Support
Innovation Example: Integration with ClinicalConnect Provide intelligent Patient Profile to front-line Profile created from IDS historical data containing Counts Analytical measures Predictive measures Scoring e.g. LACE score Provides valuable complementary information to physicians at the point of care Provides valuable insight on patient susceptibility at the time of discharge (eg. Likelihood of readmission within 30 days) 25
Example Patient Profile In CC 26
For more details, elearning and other resources info.clinicalconnect.ca
ClinicalConnect Base Funding Q&A The Finance and Audit Committee of the Board asks questions during the F&A deliberations on this matter. The following Q&A reflects the type and nature of the questions asked, and the answers given at the time. Q What percentage of the population of the Waterloo Wellington LHIN would have personal health information / health records available in ClinicalConnect? A Today, patient records are available from Cambridge Memorial Hospital, Guelph General Hospital, Groves Memorial Community Hospital, North Wellington Health Care hospitals and the Waterloo Wellington CCAC in the portal. The ClinicalConnect portal combines the data from connected underlying information systems into a consolidated view of a person s record. However there is no mechanism to count a unique patient across all the underlying information systems. Therefore, arriving at a percentage is difficult and affected by the following: Several of the underlying information systems have historical information dating back to the late 1980 s. It is therefore expected that people represented in the underlying systems may or may not live in the LHIN. A person may receive health care services from one or all of these service providers, that person may appear in each of the underlying information systems. Many people in our LHIN have never needed services from these providers and therefore will not appear in the underlying systems. Today, the underlying hospital information systems contribute the following unique people records to ClinicalConnect: Cambridge Memorial Hospital 340,000 Groves Memorial Community Hospital 218,000 Guelph General Hospital 418,000 NWHC Louise Marshal Hospital 83,000 NWHC Palmerston District Hospital 78,000 St. Mary s General Hospital 569,000 The total above is 1,706,000 people records. As a conservative estimate, factoring out variances indicated above, it is likely that between 400,000 and 600,000 residents of WWLHIN could have records available through the portal. Assuming that there are about 750,000 residents in the WWLHIN, between 55% and 80% of WWLHIN residents have records potentially available through the portal. As a note: ClinicalConnect has sophisticated person matching software that consolidates a person s records from across all the underlying information systems. As a fun fact, assuming that on average number of times a person might receive services from one of the facilities above to be let say 3. The total number of individual service occurrence records would be over 5,110,000. Given that HNHB and WW residents are combined in the system. It is very conceivable that over 15,000,000 unique service records and easily over 80,000,000 individual tests, reports and prescription are available through ClinicalConnect. Clinicalconnect Base Funding Q&A 1 of 3
This long winded explanation is offered to illustrate the need for solutions like ClinicalConnect. ClinicalConnect is able to consolidate a person s records from multiple systems and display the multiple service occurrences and associated tests transparently for the user of the system. Q What if a person does not what their information displayed in the portal? A A person provides consent to share personal health information at the time of service and that consent decision is recorded in the service provider s information system. ClinicalConnect only displays information that the service provider s information system provides for sharing. Q - Is all the information collected in the hospital? A No, the hospitals have other records systems that are not currently connected to ClinicalConnect. In addition, some records are paper based that, for obvious reasons, are not in ClinicalConnect. Q Why is patient information not available from Grand River Hospital? A Grand River Hospital s information system is different from that of the other hospitals. A proof of concept is complete to manage the technology issues, GRH is moving forward with implementing the integration services to provide patient records from their McKesson Information System. Q- When will Grand River Hospital data be available in ClinicalConnect? A Grand River Hospital expects to have the first data appearing in ClinicalConnect by Spring 2012. No ETA is given for project completion at this time. Q - How many care providers are enrolled to use ClinicalConnect? A 600 clinical persons are enrolled to use ClinicalConnect at this time. ehealth Ontario has recently provided funding to WWLHIN to expand the use of ClinicalConnect. The Centre for Family Medicine will lead the project which will expand enrollment to over 2000 at the conclusion of the project. Q- What measures are in place to ensure annual maintenance costs do not increase? A ClinicalConnect is a hosted service of Hamilton Health Sciences (HHS). HHS maintains the technology and software maintenance agreements with the software manufacturer. HHS provides the service at pass through or at cost to participants in the portal. It is expected that cost increases will occur overtime. When increases occur, they will have to be managed at the time by the participants. It is important to note that HHS manages the ClinicalConnect service for all of HNHB and WW LHIN participants. Cost containment is aggressively managed by all participants and HHS. Q- Does the base funding of $530,000 include ongoing growth? A Yes - There is no cost to grow the number clinical persons using the system, and No Additional data sources will demand additional maintenance costs. Clinicalconnect Base Funding Q&A 2 of 3
Q- Where would additional funding come from when adding information systems (i.e. St. Joseph s, Homewood)? A Capital funding for growth could come from a variety of sources. At this time no funding has been identified to complete these integrations. Q- How confident is the WWLHIN in providing the WWCCAC with continued funding for the HEALTHeCONNECTIONS Project? A Very, The WWCCAC continues to deliver the level and depth of service needed for HEALTHeCONNECTIONS. Clinicalconnect Base Funding Q&A 3 of 3