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					eHealth Strategy
  A Healthier Tomorrow
    The South West LHIN Webcast Series
The South West LHIN would like to thank you for your
participation in our “A Healthier Tomorrow” webcast

Please stay tuned for future webcasts!

2                                        A Healthier Tomorrow
    Objectives for South West LHIN Webcast Series:

     •   Inform partners of LHIN’s vision, mission, values,
         and health system improvement goals.

     •   Inform partners of how the Priority Action Teams’
         future directions align with the LHIN goals and how
         recently funded projects move us closer to the
         desired state identified by the Priority Action Teams.

     •   Acknowledge contributions of volunteers and
         partners who were actively involved in defining the
         development of the LHIN’s work.

3                                          A Healthier Tomorrow
    Purpose of this Presentation
    •   Provide an overview of the provincial eHealth Strategy

    •   Provide examples of Provincial eHealth initiatives

    •   Provide an introduction to the future South West LHIN eHealth

          Provide examples of how the South West LHIN eHealth
           activities are enabling Priority Action Team recommendations
          Describe the mechanism to guide, lead and provide oversight
           for the projects and initiatives currently underway

    •   Provide examples of South West LHIN eHealth initiatives

4                                                 A Healthier Tomorrow
    eHealth Ontario
    •   In August 2008 Cabinet approved the creation of
        eHealth Ontario to play a lead role in coordinating
        the execution of the eHealth strategy

    •   eHealth Ontario is the single point of accountability
        for eHealth initiatives in the province

    •   Smart Systems for Health (SSHA) and the eHealth
        Program of the Ministry of Health are now eHealth

5                                          A Healthier Tomorrow
    eHealth Ontario: Guiding Principles
    •   eHealth Ontario will focus on enabling clinical
        outcomes (value) for better patient care, not
        technology for its own sake

    •   Early clinical benefits are the key to building and
        sustaining support for the eHealth strategy

    •   The eHealth Strategy will be transparent

    •   Advice from experts with a track record of success
        will be sought

    •   Performance metrics and success indicators will be
        measured and reported publicly

7                                           A Healthier Tomorrow
    eHealth Ontario: Guiding Principles cont’d.
    •   Partnerships will be established to deliver eHealth

    •   Deployment models will vary by product

    •   Wherever possible, legacy systems will be leveraged
        to achieve provincial goals

    •   Clinical content of solutions must be relevant and

    •   Clinicians will be engaged early and often to ensure
        project success
8                                          A Healthier Tomorrow
    Ontario’s eHealth Strategy 2009-2012

    3 Clinical Priorities:

    1) Diabetes Management: To control and manage
       diabetes more effectively in order to reduce
       associated complications and costs

    2) Medication Management: To implement on-line
       management of prescription medications in order to
       minimize preventable adverse drug events

    3) Wait Times: To reduce waits in Ontario emergency
       departments and the incidence of inpatients in acute
       care settings waiting for alternate levels of care

9                                        A Healthier Tomorrow
     Clinical Priority: Diabetes Management
     900,000 Ontarians have Diabetes, and each year:

     •   350 people will go blind

     •   2,300 people will have a heart attack

     •   1,100 will have a limb amputated

     •   3,200 people will die

     •   23,000 people will discover they have this disease

     •   165,000 people will visit an emergency department

10                                          A Healthier Tomorrow
     Clinical Priority: Diabetes Management cont’d.

     •   Baseline Dataset Initiative

     •   Diabetes Registry

     •   EMR interoperability with the Diabetes Registry

     •   OLIS interoperability with the Diabetes Registry

11                                          A Healthier Tomorrow
     Clinical Priority: Medication Management
     There will be 394,000 preventable adverse
     drug events in Ontario this year, resulting in

     •   240,000 physician office visits

     •   36,000 hospitalizations

     •   4,000 deaths

12                                         A Healthier Tomorrow
     Clinical Priority: Medication Management cont’d.
     •   ePrescribing Demonstration Project

     •   Drug Information System (DIR)

     •   Drug Profile Viewer (DPV)

     •   Systemic Treatment Computer Physician Order Entry

13                                        A Healthier Tomorrow
     Clinical Priority: Wait Times (ER/ALC)
     Emergency room wait times are at an all time high in Ontario

     •   Nearly 50% of emergency room (ER) visits are made by patients
         with non-urgent or less urgent care needs

     •   90% of ER patients are treated within 9.4 hours from
         triage/registration to the time they leave the ER

     •   ER wait times are five times longer for ER patients admitted to
         hospital (~35 hours)

     •   75% of their total ER time is spent waiting for an inpatient bed

     •   A major factor causing long ER wait times is the high number of
         alternative level of care (ALC) patients occupying acute care
         hospital beds

14                                                  A Healthier Tomorrow
     Clinical Priority: Wait Times (ER/ALC) cont’d
     •   eReferral

     •   Emergency Department Reporting System (EDRS)

     •   Wait Times Information System (WTIS)

15                                      A Healthier Tomorrow
Ontario eHealth Strategy

    Diabetes        Medication        Wait Times
   Management      Management

         Cornerstone Information Systems

        Clinical Activity Information Systems

                Technology Services

    Enabling Practices and Talent Management
Each solution group will be delivered using most
appropriate delivery model
         1                    2                      3                  4                    5
  Province-wide         Province-wide           Regional         LHIN, hospital or    LHIN, hospital or
   application;          application;      applications (more     physician office     physician office
    provincial            provincial         than 1 LHIN):         applications;      applications; no
    standards;          standards; not         provincial           provincial           provincial
 managed/hosted        managed/hosted          standards            standards            standards
    by eHealth        by eHealth Ontario
Diabetes Registry     WTIS                 DI/PACS              eReferral Systems    Hospital
Drug Information      EDRS                 HIAL                 Physician EMRs       Information
System                                                                               Systems
                      Telemedicine                              CCAC Systems
Drug Profile Viewer   eCHN
Client Registry       Chronic Disease
Provider Registry     Management and
User Registry         Prevention/
Content Registry
Province-wide DI
Exchange              CCIM
                                                                    A Healthier Tomorrow
     SW LHIN eHealth Vision Statement

       Better Information > Better Care > Better

       To enable measurably better information, better
       care, better health and less travel for all.

18                                      A Healthier Tomorrow
LHIN role in Health IT Infrastructure

     • Will not develop its own IT Department or Services organization or
       significant IT staffing

     • Will act as the Governance body (Standards / Project approval-
       funding / Governance etc.)

     • Has a large vested interest in promoting the adoption/use of standard
       IT infrastructure and enabling innovations

     • Won’t directly support the implementation and technical support
       needs of primary care physicians

19                                                  A Healthier Tomorrow
LHIN role in IT Infrastructure cont’d
     The Challenge:

     • Provide a more reliable IT environment for smaller institutions

     • Drive economies of scale

     Across the SW LHIN;

     • 74 Long-Term Care Homes

     • 2 Community Health Centres (plus 3 under development)

     • 65 Community Support Services

     • 28 Community Mental Health Agencies

     • 14 Addictions Agencies

20                                                  A Healthier Tomorrow
 eHealth Adoption Steering Committee
 •   Members are selected from across the continuum of care and
     geography of the South West LHIN.

 •   Members are systems thinkers, influencers, and leaders.

 •   Comprised of senior representatives from the various sectors in the
     health care system, based on skill set, experiences, geography and
     include a mix of individuals from LHIN Funded Sectors, Partner
     Sectors and Community Partners.

 •   Although a formal communication plan will be developed and
     implemented, all members will be expected to seek input from, and
     relay information to, their respective sectors and local/regional

 •   Additional representatives will be invited to join the Steering
     Committee or attend specific meetings as an expert resource, as
     required. The Steering Committee may establish other sub-groups
     as necessary.

21                                              A Healthier Tomorrow
 South West LHIN Implementation Model (draft)
           System Level Goals                 South West LHIN Board
              Healthier Community
              Equitable Access
              Quality
              Sustainability                  South West LHIN CEO                    Health Professionals
              Integration                           and Staff                        Advisory Committee

 P       Health System            Best Level of Care
AT                                                          CDPM Steering              eHealth Adoption
        Design Steering           & Quality Steering
                                                             Committee                Steering Committee
          Committee                  Committee
C                                                                                                      OneMail
M                                                                           Diabetes Registry
M                                                                                                    North South
E                                                                                                   Cerner Project
O                                                                                     eHealth Project
                     LHIN-Project Management Office
N                         Coordination/Tracking/Reporting                            Management Office

                                                                      A Healthier Tomorrow
     eHealth Adoption Steering Committee Mandate

     1)   eHealth Initiatives: Provincial

     2)   eHealth Initiatives: South West LHIN

23                                       A Healthier Tomorrow
     eHealth Initiatives: Provincial – Early Adopter

      Diabetes Registry (SW LHIN: Early Adopter)

      An initial deliverable of the eHealth Strategy is a
      Diabetes Registry in support of the government’s
      Diabetes Strategy and commitment to Chronic
      Disease Prevention and Management. The Registry
      will serve as a tool to help people with diabetes and
      their care givers manage the disease better.

24                                         A Healthier Tomorrow
     Diabetes Registry cont’d.

     •   Manage the disease by monitoring whether patients
         receive evidence based interventions

     •   Electronically monitor adherence to best practices
         for patients with diabetes and provide alerts to
         physicians when best practices are not being

     •   Measure baseline level of care and report on care

25                                         A Healthier Tomorrow
     Diabetes Registry Preliminary Timelines

     •   Request for Proposal (RFP) released (Q2 2009/10)

     •   Limited release working prototype in use (Q4

     •   Begin Diabetes Registry deployment to 14 LHINs
         (Q4 2010/11)

26                                        A Healthier Tomorrow
The Ontario Diabetes Strategy is enabled by the
Diabetes Registry

          Diabetes                      Diabetes                      eHealth
          Strategy                      Registry                      Strategy
     Improves health outcomes for     Provides comprehensive      Ensures IT enables
     Ontarians living with diabetes   tools for effective,        improved patient access
     and reduced health care          best-practice diabetes      and care for more
     costs through health             care                        effective use of
     promotion and disease                                        healthcare resources
     prevention programs, self-
     care management and
     access to specialized
     resources and health care

27                                                             A Healthier Tomorrow
     eHealth Initiatives: Provincial – Early Adopter
     The Provider View (SW LHIN: Early Adopter)

     The Diabetes implementation is part of the early
     stage that will bring together an individual’s health
     information from various clinical systems and
     provide a secure single access point for up-to-date
     information such as lab test results, drug history and
     diagnostic imaging reports.

28                                         A Healthier Tomorrow
     eHealth Initiatives: Provincial

     LHIN 1-2 Diagnostic Image Repository (SWO
     DI-r) and the LHIN 3-4 Diagnostic Image
     Repository (DI-r)

     Provides access to images from any hospital in
     South West Ontario (LHIN 1, 2, 3 4) allowing for
     region-wide consultation.

29                                      A Healthier Tomorrow
Diagnostic Imaging Repository (DI-r)
                                              Grey Bruce
 SWO Regional MAP                                             Kodak Carestream PACS
 (LHIN 3/4 not shown)                South                    Cerner HIS/RIS

                                                     Listowel & Wingham
                  Bluewater/Sarnia                       Philips I-Site PACS
                     Agfa PACS                         Medisolutions HIS/RIS
                  Meditech HIS/RIS

  Chatham Kent
  GE Centricity
McKesson HIS/RIS                                                   Repository

                                             TVHPP/Huron Perth Region
  Windsor Region
  McKesson PACS                              GE Centricity
Quadris & McKesson
                                             Cerner & Meditech HIS/RIS
     eHealth Initiatives: Provincial
     Emergency Neurosurgery Image Transfer System (ENITS)

     •   On June 2, 2008, the Neuro Action Team, on behalf of the
         Neurosurgery Expert Panel, approved using the electronic
         solution (ENITS) for transferring, storing, and accessing neuro
         images which will be sent to a separate shared PACS at LHSC
         from CTs across the province

     •   The ENITS Shared PACS (ESP) project will provide an interim
         solution to improve patient access to care in the case of
         urgent head trauma. This is meant to be a short to mid term
         solution until full access to Provincial DIr is available (i.e.
         SWO DIr)

31                                              A Healthier Tomorrow
                                                  Tele -Neurosurgery
                                               Expert Consult Workflow

                                                                               3b Tele-consultation

                                  2a   Consultation request

                 1      Images
                                                   Shared PACS   CRITICALL   2c      Confirmation

                                  2b   Image Transfer            3a   Image Review
          ( or PACS )


32                                                                            A Healthier Tomorrow
     eHealth Initiatives: Provincial
     Ontario Lab Information System (OLIS)

     •   Is a single provincial system that allows all laboratory
         information within Ontario to be exchanged
         electronically between health care providers
         (practitioners, hospitals, community laboratories)

     •   OLIS is an early step in moving the health system away
         from paper-based to electronic records.

     •   Grey Bruce Health Services was one of the Foundation
         Adaptors for OLIS and has been sending results into the
         OLIS database since 2007.

33                                            A Healthier Tomorrow
     eHealth Initiatives: Provincial
     ONE® Mail and ONE® Network

     ONEMail: E-mail that allows health care
     professionals to send patient information quickly,
     confidently and securely between registered users.

     ONENetwork: ONE Network Access allows health
     care providers to confidently and securely share
     information over a high-speed network built for
     health care.

34                                      A Healthier Tomorrow
 The Ontario Telemedicine Network
 Available Virtually Everywhere
     What is OTN?
     •   Independent & not-for-profit organization, funded by the Province of
     •   Direct Transfer Payment Agent of the Ministry of Health
     •   Programs and services are delivered by over 2000 HCP in over 640 sites
         across the province via 1230 videoconferencing systems
     What is Telemedicine?
     •   Delivery of clinical care by HCPs to patients via videoconferencing systems

     •   Delivery of education/best practices to HCP and students via video and the

     •   For more information go to or call 1-866-454-OTN1 (6861)

      SW LHIN Telemedicine Growth YTD
                                                    Telemedicine Examples in the SW
18000                                              • Rehab Intake Assessments and
                                        17, 346    • Discharge Planning (Huron/Perth)
                                                   • Mental Health – ACT Team
                                                       Support; Specialty Psychiatry
12000                                                  Clinics; Tele Crisis (Form 1
10000                                                  Avoidance)
                          10, 637           FY 07-08
 8000                                              • Acquired Brain Injury – Survivor
                                            FY 08-09 and Family Education Series
                                                   • Telehome Care – Chronic Disease
 4000                                                  Management (COPD and CHF)
 2000                                              • Dementia Care Network
    0                                              • New employee Orientation Sessions
        Clinical   Ed   Admin   Total
                                                   • Mental Health – Lunch and Learns,
                                                   • Grand Rounds

     eHealth Initiatives: Provincial
     The Physician IT Program is managed by
     OntarioMD and includes:

      • A selection of approved Clinical Management
        Systems (CMS)

      • A Transition Support Program designed to help
        physicians acquire and use information

      • A Primary Care IT Funding Plan

37                                       A Healthier Tomorrow
     eHealth Adoption Steering Committee Mandate

 1)      eHealth Initiatives: Provincial

 2)     eHealth Initiatives: South West LHIN

38                                 A Healthier Tomorrow
     eHealth Initiatives: South West LHIN
     Results from Electronic Patient Record (EPR) to
     Physician Electronic Medical Records (EMR)
     •   Grey Bruce Health Services is sending electronic
         results from their Cerner HIS to 89 physician
         practice EMR’s

     •   The Thames Valley Hospital Planning Partnership is
         now starting a project to leverage the success in
         Grey Bruce

     •   Huron Perth Healthcare Alliance is planning
         integration pilots with Family Health Teams

39                                         A Healthier Tomorrow
     eHealth Initiatives: South West LHIN
     Common Desktop & Infrastructure (CDI)
     •   As eHealth initiatives are identified and implemented it
         will be critical for health service providers to have
         adequate and compatible computer hardware and
         software. This will help expedite the implementation
     •   CDI will help identify the needs across the LHIN and
         create strategies to better position health service
     •   A current state hardware & software inventory of all
         Health Service Providers within the SW LHIN is currently

40                                             A Healthier Tomorrow
     eHealth Initiatives: South West LHIN
     Common Order Sets

     •   Develop multi-disciplinary orders sets for the right medical
         intervention for the right patient context
             Reduces errors, reduces costs, best practice evidence

     •   Grey Bruce Health Services has been working with Open
         Source Order Sets (OSOS)

     •   In the south a project team has been reviewing OSOS and
         Zynx to leverage the evidence based research library to
         facilitate clinician use of current literature to support their
         order set development and maintenance

     •   Huron Perth region also received LHIN funding and are
         planning their approach to move forward.

41                                                     A Healthier Tomorrow
     eHealth Initiatives: South West LHIN
     North South Connectivity Project

     The North South Connectivity Project is the first
     phase of a larger implementation that will eventually
     create a platform for the development of the
     electronic health care record incorporating
     community and primary health care services. The
     1st phase will connect the hospitals in the North
     (GBHS) and South (Thames Valley,
     Exeter,Wingham/Listowel) to provide access to
     patient clinical data.

42                                       A Healthier Tomorrow
Connecting Thames Valley + and GBHS
     eHealth Initiatives: South West LHIN

     •   A web portal that provides access to health services
         information and much more
     •   Began as innovative partnership between CCAC,
         health unit, hospitals – grew to cover the South
     •   Developed eight years ago, now attracts more than
         1.5 million visits per year
     •   Accurate, up to date, credible
     •   Trusted source of truth

44                                          A Healthier Tomorrow Service Information & Location Maps
     Electronic Health Record (EHR)

46                                    A Healthier Tomorrow
Electronic Health Record
Grey Bruce Information Network
 •   Wait Time Information System (WTIS)- expansion to include “all surgeries”
 •   Diagnostic Imaging Repository (DI-r) – currently sending all new images to
     the London archive and beginning the migration of previous images
 •   Electronic Child Health Network (eCHN) – working on migration of results
 •   Critical Care Information System (CCIS) - live at all the rural hospitals
 •   Ontario Laboratory Information System (OLIS) - GBHS is live. All mapping
     for SBGHC and Hanover Hospital is competed. Currently working on the
     CR120 privacy trigger.
 •   Pediatric Wait List - built and awaiting go live date next month
 •   CCAC Integration - work continuing to move forward
 •   Nursing Documentation - all hospitals will be live except for Owen Sound
     by June 2009
 •   Open Source Order Sets (OSOS)- continues to be built into Cerner

48                                                      A Healthier Tomorrow
 Huron Perth Healthcare Alliance and Alexandra
 Marine and General Hospital
 •   WTIS expansion
 •   OLIS – Entering the project
 •   Physician Office integration – working with Huron Perth Family Health
     Teams to integration patient results from Meditech to office EMR’s
 •   Expansion of Electronic Health Record at all sites
 •   Network Single Sign-on with Proximity card technology
 •   Electronic interface from Patient Monitors to Meditech
 •   Emergency Department Tracker Board – full featured tracking system for
     the ER. Untargeted into HIS – going Live late 2009
 •   Wireless rollout for Nursing Point-of-Care Handhelds – May 2009
 •   Voice-over-IP phone systems – Live Oct 2008

49                                                        A Healthier Tomorrow
Thames Valley Hospital Planning Partnership
 •   Wait Time Information System (WTIS)- expansion to include “all surgeries”
 •   WTIS ER/ALC – Early Adoptor
 •   Diagnostic Imaging Repository (DI-r) – interoperability of DI-repository
     with all LHIN 1, 2. 3, 4 hospitals
 •   Emergency Neurosurgery Image Transfer System (ENITS)
 •   Electronic Child Health Network (eCHN)
 •   Critical Care Information System (CCIS)
 •   Ontario Laboratory Information System (OLIS)
 •   Order Sets/Western Ontario Health Knowledge Network (WOHKN)
 •   Cancer Care Ontario (CCO) Synoptic Reporting
 •   Electronic Patient Record (EPR) Platform Expansion – Wingham/Listowel
 •   Shared Service established
50                                                    A Healthier Tomorrow
     South West CCAC
• GBHS eReferral – Oncology, shared databases.
• Service Desk – new features to allow for a more “user friendly” experience.
• Service Capacity Reporting System (SCRS) III – adding a multi change feature.
• .ASP - .NET Conversion – converting all old .asp pages to .net will help standardization
• Occurrence Reporting Tracking System (ORTS) III – Integrated with Health Partner Gateway
• eCAFE- offline eReferral
• Intake & Referral II - additional functionality
• Portals - Board, HAL.
• Survey - New question types, summary page, ability to complete at later date.
• Client Health Related Information System (CHRIS), Health Partner Gateway & ONE MAIL –
  Rolling out of CHRIS.
• & Client Management TRAVEL AGENT – CM at Client’s home.
• Standardize Workflows & Frameworks – Shutting down old Intranets.
• WOHKN Network – Training Management.
     Priority Action Teams (PATs)
     The PAT’s worked on the Action Plans identified for each of the
     following Integration Priorities:

      • Strengthening and Improving Primary Health Care (PHC)

      • Chronic Disease Prevention and Management (CDPM)

      • Building Linkages Across the Continuum for all Seniors and
        Adults with Complex Needs

      • Accessing the Right Services, in the Right Place, at the Right
        Time, by the Right Provider

      • Utilization & Access PAT to ensure an integrated approach to hip
        and knee total joint replacements across the LHIN

      • Health Human Resources (HHR) Advisory Group

52                                                A Healthier Tomorrow
Priority Action Team’s Recommendations
Foster communication across the continuum of       • Diabetes Registry
care, Electronic Medical Records that include      • Diagnostic Imaging Repository
reminders for monitoring and follow up, health
information accessible across many providers       • Electronic Patient Record
Improved and equitable access to health            • Wait Time Information System
services                                           • Ontario Telemedicine Network
Registry of services for patients and providers    •
                                                   • Connex (for Mental Health and Additions)
Establish common data and communication            • Provincial solutions/standards
standards                                          • IT Physician Project
Web-based portal for info for providers            • Common Order Sets
(evidence-based, protocols)                        •
Empower patients to manage their own care;         • Diabetes Registry (will eventually expand to
                                                   cover other chronic diseases)
patient portal to help manage and navigate their
     Key Messages
     •   eHealth is about enabling people to work together

     •   eHealth is about improving the flow of patient
         information, NOT about technology

     •   Provincial and regional (LHIN) eHealth strategies
         must support secure movement of patient/client

     •   Focus must be on the person and their information
         and integration of patient care

54                                        A Healthier Tomorrow

     Your feedback is valuable to us.
     Please take a few moments to complete
     our short Online Survey about this
     Just go to the South West LHIN website
     homepage, and click on the link to the

55                                      A Healthier Tomorrow

Dial: 1-866-507-1212 and ask
for “South West Local Health
Integration Network”
Please note: If you have
questions after the webcast, feel
free to email questions in to
A full Q&A document will be
posted on our website at the end
of the webcast series.

56                                  A Healthier Tomorrow
     Thank you for joining us!

57                     A Healthier Tomorrow

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