LHINs tackle e-Health challenges

Developing e-Health systems across Northern Ontario is a tall order, but the North East and North West Local Health Integration Networks (LHINs) are rising to the challenge.

Tamara Shewciw and Brian Ktytor, chief information officers and e-Health leads for the two LHINs, both came on board last spring to bring the "Northern e-Health vision" to life and align it with the province's fledgling strategy.

A former dean of Confederation College's School of Aviation and director of marketing, communication and external relations at the college, Ktytor brings his senior leadership experience and knowledge of management information systems to the North West LHIN.

Shewciw, a 25-year veteran of Information and Communication Technology (ICT), came from Sault Ste. Marie's Group Health Centre and worked on northern e-Health projects prior to the establishment of the LHINs in March 2006.

"The northern hospitals saw (IT) as an enabler, so they started working together," Shewciw said. "By 2003, they had completed an ICT blueprint for the acute care centres across Northern Ontario."

It was this progressive approach that gave Northern Ontario a head start in developing e-Health systems. In 2006, the two Northern Ontario LHINs embarked on a plan to develop a pan-northern information and communication technology strategy to integrate electronic health-care systems for more than 250 organizations.

In 2007, a tactical plan was developed as a result of extensive consultation with hundreds of individuals throughout the North. It pinpointed 16 priority projects extending to 2012.

"It was an enormous concerted effort at the time and was considered the most comprehensive strategy in e-Health in Ontario," Ktytor said.

Consequently, many of the initiatives within the two LHINs are pan-northern as well as multi-LHIN. Eventually, the projects will "plug into" the province's e-Health system.

A recent pan-northern initiative is the diabetes registry, part of the larger $741 million provincial Diabetes Strategy to prevent, manage and treat the disease. The goal is to enter all Ontario diabetics into an electronic registry that will give them access to electronic information and educational tools to help manage their care. Physicians will have access to the registry to check on patient records, access diagnostic information and send patient alerts.

"Their physician or physician team will have access to more information on their health status in one easy-to-use place," Ktytor said. The portal will allow the care provider to track progress, provide electronic decision support and send alerts or automated communications. "It will also give the diabetes patients a portal to view a lot of those tools and trends on their own, as well as take a more active role in managing their disease."

The Northeast and Northwest LHINs are two of five LHINs piloting the project. The first phase of the initiative, which included an analysis of IT readiness, the establishment of an advisory committee and the selection of pilot sites for the initial testing of the registry has already been completed.

Another project, pending the approval of funding, is a provider portal. It is a multi-LHIN project involving the Champlain, North Simcoe/Muskoka, North East and North West LHINs.

"It is a portal that would allow a provider (physician, specialist, etc.) to go in and have the information they need for that patient in a private, secure fashion," Shewciw said, adding there is a popular misconception that all health-care organizations have access to health records.

"We live in a time when you have access to your banking anywhere in the world. You can withdraw funds, you can book flights online and you can see everything. All of that is electronic. Then we come into the health-care environment and it is not," Shewciw said. "Everyone just assumes it is."

The continuum of health care begins with community health prevention and primary care,  and extends to specialist , acute care, and later in life, complex continuing care. Over this continuum, a variety of health-care providers, including pharmacists, may require access to a patient's health information, which is the intent of the provider portal.

Giving access to all of these providers will reduce overprescription of medications and duplication of health services, resulting in seamless, more efficient care for patients, said Shewciw.

Although it may sound simple, there are many challenges in pulling together assessment and discharge information, case planning notes, prescription medication history, and/or hospital information from the acute-care facility.

"How do you aggregate all that health-care information into one view for your care provider in a way that is completely secure based on who needs to know what, in order to provide the best care possible?" Ktytor asked.

Ultimately, it is about having one view of a patient's information so that as they travel from provider to provider, that information will go with them.

Patient portals will be developed within the diabetes registry to avoid duplication. If successful, it will be converged into one provider/patient portal, Ktytor said.

The adoption of electronic medical records (EMR) by physicians is part of a large Ontario-wide project. Ktytor pointed out that EMRs are stand-alone systems used primarily in hospitals or physician offices, and aren't connected to a broader network. The aim is to have all physician groups, family health teams and clinics adopt EMRs and integrate them with hospital medical records.

Other examples of pan-Northern projects are the Northern Ontario Directory of Services, and the Picture Archiving Communication System (PACS).

The 310ccac.ca web-based directory provides access to health services information across Northern Ontario via Internet or phone.

The PACS project is the delivery of diagnostic imaging services using digital radiology technology and high-speed networks to move diagnostic images between community and regional hospitals. The Timmins and District Hospital NORrad team have been working on this project for several years and continue to implement and connect imaging systems in hospitals across Northern Ontario.

Technology is making a difference in people's lives and it is a valuable tool in a geographical region that extends far beyond the capacity of its human resources.

"We're on a long journey, but it is a very important journey," Shewciw said. "At the end of the day, I want to know that a person can go where they need to go and the information is there and they can get the help they need."


www.nelhin.on.ca
www.northwestlhin.on.ca
www.310ccac.ca