Sioux Lookout Zone eHealth Strategy eHealth WorkshopFebruary 18-19, 2009

Key Points of Service: Provincial and Territorial Health Systems

Diagram from FNIHB Documentation

• e-Health is the electronic collection and secure sharing of health information so that clinicians can provide the best care, and people can take better care of themselves and their families.

- Definition from Ontario Ministry of Health and Long Term Care

What is eHealth?

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• Ontario Ministry of Health and Long Term Care• Northwest Local Health Integration Network• Canada Health Infoway• Health Canada – First Nations and Inuit Health Branch

What are the funders doing? How do we align with them?

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Ontario’s Health System Vision A health care system that helps keep people healthy, gets them good care when they are sick, and will be there for our children and grandchildren.

Ontario’s e-Health VisionBy 2015, Ontario’s health system is the safest, highest quality, and most sustainable in Canada because people have the right information, at the right time, and in the right place. Ontarians are confident that:▫ They have the right information they need to make decisions about their health

and health care;▫ Providers and clinicians are freed to focus on timely and highest quality care;

and,▫ Government and LHINs ensure an accountable, equitable, effective and

efficient health system.

Aligning with Ontario’s eHealth Strategy

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• The e-Health strategy will track the evidence of realization of five key health system outcomes:▫ Increased access to care based on an expanded Wait Times Information

Strategy.▫ Improved chronic disease management to support Healthy Ontarians in a

Healthy Ontario.▫ Increased efficiency to bend the cost curve.▫ Strengthened public and patient safety and improved quality of services to

increase confidence in the health system.▫ Strengthened health system accountability through population health planning,

evidence-based decision making, and performance management.

MOHLTC Draft eHealth Strategy

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• Ontario Lab Information System (OLIS)▫ Will expand adoption of electronic lab reports

• Drug Program Viewer (DPV) Expansion▫ Will plan expanded access to patient information to other hospital departments

• Diagnostic Imaging (DI/PACS)▫ Will provide funding for all institutions to have access to electronic DI

• Electronic Health Record (eCHN)▫ Will begin to create the base of an electronic health record

• Public Health Information System▫ Will expand public health information which can be communicated electronically

• Continuing Care – e- Referral implementation▫ Will enable electronic referrals between providers

• Client and Provider Registries▫ Will create one profile for each patient and clinician

Current MOHLTC eHealth Projects

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• Ontario Diabetes Registry ▫ Comprehensive tool for diabetes management and self-care▫ Accessible to providers, case managers, patients and their families to support

health promotion, disease prevention and better care ▫ Provides information to health planners, LHINs and system stewards to

enhance system management • EMR / Computers for Physicians

▫ Development of a program to support the funding and distribution of computers to Ontario Physicians

▫ Multiple models to match the different needs of Ontario Physicians ▫ Linked to performance and outcome aligned with other health system priorities

MOHLTC eHealth Strategy Priorities

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• e-Prescribing and Drug Systems ▫ Provides complete drug history and dispensing information ensuring

appropriate prescribing and improved patient safety ▫ Provides drug interaction tools for providers and ensures accurate and

complete information for dispensing• Portals/Integrated Clinical View

▫ Integrates patient information from different clinical systems –Labs, Drugs, Diagnostic Imaging, Public Health

▫ Provides a single access point for to securely view a patient’s clinical results ▫ Builds upon current electronic medical record systems in physician offices and

EHR repositories, including eCHN

MOHLTC eHealth Strategy Priorities Cont’d

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• Develop a regional information and communication technology infrastructure, support, and integration program, including the development of a technology integration framework, architecture and standards

• Enable Smart Systems for Health Agency (SSHA) connectivity • Leverage the provincial EMPI • Increase access to telehealth • Implement a Clinical Provider Portal (Clinical Viewer) • Support the referral processes through e-Referrals • Implement an e-Physician strategy • Continue to develop organizational electronic records and the regional Electronic Health Record • Implement the Pan Northern Ontario PACS Project (PNOPP) • Expand Ontario Drug Benefits (ODB) Plan Viewer access • Develop the Northern Ontario Directory of Services • Develop a Consumer Portal • Align with OLIS

Aligning with Northern LHINs eHealth Office Priorities

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• Creation of an Electronic Health Record that links clinics, hospitals, pharmacies and other points of care.

• Establishing an interoperable EHR solution allows clinicians to view and update an integrated patient-centric health record that includes demographic, diagnostic imaging, drug, laboratory, infectious disease, immunization and other relevant health information anywhere, any time.

• Electronic health records will give authorized providers rapid access to their patients' complete, up-to-date health information, including physician visits, hospital stays, diagnostic images and reports, laboratory test results, prescribed drugs and immunizations.

• A network of interoperable electronic health record solutions in Canada — one that links clinics, hospitals, pharmacies and other points of care — will help improve Canadians' access to health services, enhance the quality of care and patient safety, and assist the healthcare system to become more efficient and effective.

• The need for electronic health records is recognized globally as one approach to support the evolution of our modern healthcare system. Canada is no exception. Electronic health records clearly enable the required improvements in access, quality and productivity required to support Canada's Healthcare Renewal agenda.

Aligning with Infoway - Interoperable Electronic Health Record

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• Goal: To provide FN/I with accessible, effective and sustainable quality health services contributing to improved health outcomes for FN/I

• Working Principles:▫ FN/I should have access to the same quality and availability of service as the rest of the

population living in similar geographic areas.▫ FN/I health services focus should be shifted to strengthen prevention of disease and

injury and the promotion of good health.▫ FN/I should receive services in a seamless way through better integration and adaptation

of FPT supported programs and eventual evolution of federal role to that of funder only.▫ FN/I should be supported to have an effective role in the planning and delivery of their

health services.▫ The federal government should gradually evolve out of primary care and direct service

delivery.

Aligning with Health Canada Goals and Principles

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• The current focus of FNIHB’s e-Health Solutions Unit is the selection, development and deployment of health infostructure tools that will contribute to enabling First Nations and Inuit communities to be connected and informed. This developmental stage does not mean that First Nations have remained static with respect to electronic health information applications, as some have moved independently to establish electronic linkages such as access to neighbouring hospitals’ discharge systems.

Aligning with FNIHB’s e-Health Solutions Unit

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Aligning with FNIHB’s eHealth Infostructure Architecture FrameworkHealth Business Areas and Functional Requirements

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eHealth Supporting Components

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Community Health and Primary Health Care Information ServicesCurrent State Vision State• There are virtually no electronic

information management repositories or health information systems in the communities. Physicians have access to Meditech.

• All programs, patient consults and orders are managed manually.

• 5 FNs are part of the Regional PACS Network.

• Menoyawin has Meditech Health Information System.

• The 3 pharmacies in Sioux Lookout have drug information systems. One has a telehealth unit to provide consultations to patients in FN communities.

• Implementation of an integrated Health Information System (HIS) with the following modules:▫ Referral Management

Scheduling, Registration.▫ Lab, diagnostic imaging and Rx

ordering and management.▫ Care planning and chronic

disease management.▫ Patient history management.

• HIS integration with EHR.

EPR Services, EHR Connectivity ServicesCurrent State Vision State• Paper patient charts are retained in Menoyawin in

Sioux Lookout.• Patient charts are also retained on paper in the

community nursing station. • If required, parts of the patient chart may be faxed

(from nursing station or Menoyawin) to specialists in remote locations.

• Patient information may be stored in multiple charts in the nursing station under different names.

• Patients may have paper health records in various physician’s offices in Sioux Lookout

• Patients may retain some personal health records in their homes.

• Patients of the Sioux Lookout Diabetes Program have paper and electronic files in the SLDP Office

• NODIN patients have electronic files in Sioux Lookout

• Implementation of an Electronic Health Record for every community member. Data would include:▫ Medical history, examination and progress

reports of health and illnesses. ▫ Medicine and allergy lists, and

immunization status. ▫ Laboratory test results. ▫ Radiology images and photographs.▫ Medication information, including side-

effects and interactions. ▫ Disease-specific protocols.▫ A record of appointments and other

reminders. ▫ Billing records.

• Implementation of a Patient Portal offering (i) access to the EHR, (ii) the ability to add health information – data from other providers, (iii) chronic disease management, and (iv) education.

Public and Population Health Surveillance ServicesCurrent State Vision State

• Presently, no formal mechanisms are in place that public and population health programming get delivered. ▫ Anishinawbe Health Plan

• Communities fax immunization records to SLFNHA offices in Sioux Lookout. These records are then entered into a FNIHB Health Information System. This is an ad hoc process; compliance is not mandatory.

• Development of a public and population health strategy and implementation plan.

• Implementation of PANORAMA in the FN communities.▫ As a Point of Service system

supporting communicable disease management line of business.

▫ As an EHR domain repository for immunization-related information.

Decision Support ServicesCurrent State Vision State

• Since virtually all patient data is retained in paper charts, it is difficult to ascertain the efficacy of clinical programs.

• Insufficient tools to facilitate comprehensive, system-wide analysis and decision-making at the community, tribal council, and health zone levels.

• Key Performance Indicators established to measure success of specific programs as well as the health system as a whole.

• Tools and methodologies to:▫ Facilitate program measurement.▫ Health system analysis.▫ Generate periodic and ad hoc

reports.▫ Conduct health system and

population health research on anonymized data, while ensuring OCAP principles.

Registries ServicesCurrent State Vision State

• Most patient information is retained in paper charts.

• FNIHB providers are transient, serving communities locally or from Sioux Lookout.

• There is significant turnover in roles of community health staff.

• Establishment of client registry, listing all community members, with capability to integrate with all health applications (e.g. PANORAMA).

• Establishment of provider registry to maintain a record of all providers who have or are presently serving the community.

Telehealth ServicesCurrent State Vision State

• Nursing stations in 25 remote communities are connected via KOTM facilitating access to consults and education sessions.

• K-Net provides the technological and communications infrastructure to conduct telehealth sessions.

• Many clinical services are provided by partner – Ontario Telemedicine Network.

• A telehomecare pilot project has been initiated

• All FN communities in Ontario are connected via telehealth to each other as well as to clinicians, education content providers and health system administrators.

• There is sufficient bandwidth to be able to conduct multiple telehealth sessions in the community without significantly degrading video and data quality.

• Telehealth is integrated within an eHealth framework so that a remote provider conducting a consult can have immediate access to the patient’s entire EHR.

• Telehomecare extends patient care right beyond the wall of the health care facility right into patients’ homes.

eHealth Stakeholders

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• Patients▫ Owners of personal health information.

• First Nations▫ Owners of the eHealth Strategy and Operations in their communities.

• Providers▫ Delivering health care to patients in FN communities.▫ Custodians of personal health information.

• Sioux Lookout First Nations Health Authority (SLFNHA)▫ Project Lead▫ Providing guidance on the development of the eHealth Vision and Strategic Framework for Sioux Lookout Zone, ensuring

alignment with the Anishinawbe Health Plan.▫ Engaging stakeholders to develop the eHealth Vision and Strategic Framework for Sioux Lookout Zone.

• Education Providers (NOSM)• KO

• KO Telemedicine (KOTM) - Supporting the development and operationalization of eHealth strategy.• K-Net - Providing information technology and communication infostructure and expertise.

• First Nations and Inuit Health Branch, Health Canada (FNIHB)▫ Conducting national strategic action planning for eHealth.

• Ministry of Health and Long Term Care (MOHLTC)▫ Providing provincial strategic action planning for eHealth.

• LHINs• Canada Health Infoway

▫ Providing project funding.

Stakeholders Roles and Responsibilities

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• There are a variety of niche applications and paper charting systems which house patient health information throughout the Sioux Lookout Zone. This data in disparate locations, often unknown, may compromise patient care.

• The SLZ Physicians are reviewing an Electronic Medical Record (EMR) for their practices and patients. ▫ EMR vendor is Practice Solutions – a product which is endorsed by the Ontario

Medical Association. ▫ Discussions need to be held with the physicians to allow nurses and possibly

other clinicians in the zone to use EMR to manage patient records.▫ Physicians are looking for funding source for the EMR solution. Negotiating

EMR funding as part of physician services is recommended.

Findings to Date – Patient Records

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• EMRxtra project in Group Health Family Health Team in Sault Ste. Marie▫ Common EMR for all physicians – vendor is Clinicare▫ Chronic disease management programs – CHF, COPD, Diabetes▫ EMR available to pharmacists to enable better prescription management

• Various Family Health Teams have EMRs, subsidized by funding from the province.• Alberta is only jurisdiction with a provincial Personal Health Record which is available to all

health care providers. Ontario expects all patients to have an EHR by 2016 if funding is provided.

• British Columbia has pioneered systems for pharmacists to share drug information. Ontario is developing a provincial drug information system.

• Nova Scotia is building a system to give doctors and health-care providers access to patient records through a Web portal.

• BC Intertribal Health Authority has launched a $4.5M comprehensive eHealth project including 51 telehealth sites, regional EMR and full range of clinical services integrated with the province.

Findings to Date – eHealth Leaders

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• Review state of health records and clinical information applications in Sioux Lookout area which would include: Menoyawin, Nursing Stations, SLFNHA, Physician Groups, Public Health, Dental Program and Tribal Council Health Directors.

• Conduct a cursory review of eHealth projects in Ontario and Aboriginal communities across Canada and assess adaptability to SL area. Review the top 3 and document how they could be adapted.

• Identify high-level clinical applications and EHR requirements for the SL area in the context of the Anishinawbe Health Plan.

• Develop the value proposition for eHealth in the SL area to substantiate further analysis of opportunities afforded by eHealth.

• Meet by phone with community Health Directors, SLFNHA, FNIHB, MOHLTC, KOTM, K-Net and other clinical partners – physician groups, nursing groups - to solicit input for proposal.

• Establish project governance, communication strategy and project plan – timeline, budget, resources, deliverables – to develop the eHealth Strategy for the SL area.

Development of eHealth Strategy Proposal

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• Activities Meetings held with FNIHB and LHIN representatives in Balmertown and stakeholders

in Sioux Lookout. Meetings held with community members, leaders and clinicians in Sachigo Lake and

Keewaywin and Health Directors from Sandy Lake and Wunnumin Lake. Meetings held with Menoyawin, SLFNHA, NODIN, SLZ Physicians, Sioux Lookout

Diabetes Program, Sioux Lookout Zone Nursing Staff, MOHLTC Public Health Staff, EMS Staff, Pharmacist, Hugh Allen Clinic.

Researching top eHealth projects in Ontario and Aboriginal communities across Canada.

Conducting SLZ eHealth strategy planning meetings with key regional/provincial/federal stakeholders

Report to be developed.

• Deliverable▫ Proposal to develop an eHealth strategy for the Sioux Lookout area.

Project Plan

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• Establish eHealth Steering Committee including clinicians from all programs serving the SLZ.

• Conduct workshop(s) to engage community and other health providers and solicit input and commitment for the eHealth Strategy.

• Develop an Electronic Health Record framework ensuring all health data sources are incorporated.

• Develop a client registry, ensuring compliance with AFN and Health Canada framework.

• Implement EMR in Sioux Lookout Zone▫ Ensure nurses have access to application.▫ eReporting for health statistics.▫ Determine appropriate application for managing health records generated by community

health staff.

Interim Recommendations

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• Collaborate with the LHIN to leverage local and provincial eHealth initiatives.▫ Diabetes registry (participate in pilot project focussed on Aboriginal communities)▫ eHealth Portal – OLIS, DI/PACS, DPV▫ eReferral▫ Directory of services

• Collaborate with Health Canada FNIHB on eHealth initiatives.▫ Connectivity▫ Telehealth▫ PANORAMA▫ Program Reporting

• Develop provider portal for community health staff, including education content.

Interim Recommendations

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• Continue discussions with Northern Ontario eHealth Office, Ontario eHealth Agency, and FNIHB eHealth Office to collaborate on development of eHealth strategy.

• Develop a detailed eHealth Strategic Framework and Road Map.▫ Establish e-Health governance and leadership. ▫ Detail the eHealth supporting components applicable to the Sioux Lookout Zone.▫ Prioritize the supporting components to be developed and implemented.▫ Address change management issues.▫ Obtain approval for eHealth Strategic Framework and Road Map.

• Concurrent with the strategic planning activities noted above, there are some quick wins can be achieved by the following:▫ Establishment of a client registry for each community. [Aligned with AFN client registry project].▫ Implementation of electronic medical record (EMR) application. [Aligned with OntarioMD].▫ Establishment of diabetes and other chronic disease management programs/applications.

[Aligned with MOHLTC diabetes registry project].

Next Steps

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Janet Gordon, SLFNHA Director of Clinical Services (Project Lead)janet.gordon@nodin.on.ca

(807) 737-6101

Donna Williams, KOTM Program Managerdonnawilliams@knet.ca(800) 387-3740 x1303

Project Sponsors

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