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Strategy Update. 2009 - 2012. Presentation to: Information Technology Association of Canada (ITAC). By Rob Devitt Interim President and CEO. December 2, 2009. Acknowledging recent issues. eHealth Ontario was eager to quickly produce tangible results within its first year.

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Strategy update

Strategy Update

2009 - 2012

Presentation to:

Information Technology Association of Canada (ITAC)

By Rob DevittInterim President and CEO

December 2, 2009


Acknowledging recent issues
Acknowledging recent issues

  • eHealth Ontario was eager to quickly produce tangible results within its first year.

  • Unfortunately, it fell short in meeting taxpayers’ expectations.

  • We will do better to be accountable to taxpayers and ensure their money is spent wisely.

  • We are embracing the recommendations made in the Auditor General’s Report and are developing a strategy to take eHealth from 2012 to 2015.

2


Getting back on track
Getting back on track

  • Restoring stability to the organization

  • Government directives, the provincial Auditor General’s report and appearances before Public Accounts have validated our measures to focus on strengthen our processes and organization for the past six months.

  • Sound business best practices take precedence over schedule.

3


Strengthening the organization
Strengthening the organization

  • Measures taken to improve our business processes:

    • Procurement :

      • Complying with the government’s procurement directive.

      • Re-procuring most consulting arrangements.

      • Focusing on building capacity and capability in-house.

      • Working with Fairness Commissioners in exercising rigorous resource procurement processes.

    • Monitoring discretionary spending closely. 

    • Developed and approved the first Annual Business Plan to elaborate on how we will work towards achieving the commitments made in the strategy.

    • Developed a balanced scorecard to support monitoring and oversight of activities.

    • Developing a new Human Capital Strategy

4


Ehealth strategy commitment clinical priorities
eHealth Strategy Commitment -Clinical Priorities

DiabetesManagement

Monitor patient compliance with evidence-based interventions

Alert physicians when best practices not being followed

Report on care gaps

To Reduce:

Blindness

Heart attacks

Amputations

Renal failure

Deaths

Measure:

% patients receiving best practice care

We remain committed to the eHealth Strategy and its clinical priorities published in March 2009

WaitTimes

  • Enable public reporting and performance management

  • Expedite patient referrals out of acute care where appropriate

  • Divert Emergency Rooms visits to more appropriate community care settings

    To Increase:

    • Focus of Emergency Rooms on urgent patients

    • Access to community services

      Measure:

    • ER length of stay

    • Wait for post acute care

MedicationManagement

  • Enable online prescriptions and medication History

  • Provide decision support for physicians ordering drugs

  • Alert of potential adverse drug events

    To Reduce:

    • Adverse drug events

    • Physician office visits

    • Hospitalizations

    • Deaths

      Measure:

    • % prescriptions ordered online

5


Questions then to doug tessier acting svp for development and implementation

Questions?…then to Doug Tessier, Acting SVP for Development and Implementation

6



Diabetes management
Diabetes Management

In Ontario at least 906,577 people live with diabetes. Each year:

  • 350 of these people will go blind;

  • 1,100 will have a limb amputated;

  • 2,300 will have a heart attack; and

  • 3,200 will die due to complications with the Disease.

    Two main projects to assist with the Diabetes Management

  • Baseline Diabetes Dataset Initiative

    • See next slide

  • Diabetes Registry

    • Request for Proposals issued November 25, 2009

8


Diabetes management provider benefits

Value to practice

Provide baseline dataset to inform the provincial Diabetes Registry and accelerate its adoption

Enables primary care providers to identify patients in their practice who have diabetes

Makes it easier for primary care providers to know when each of their patients last had an A1C test, LDL test and retinal eye exam

Allows primary care providers to compare how their practice performs against peers within their LHIN and across the province

Diabetes management – provider benefits

Patient List & Baseline Care Report

9


BDDI has identified over 900,000 Ontarians with diabetes and measured the baseline diabetes care gap

Total number ofOntarians with diabetes identified:

906,577

Number ofprimary care doctorsfor those patients:

8,966

Next step:

Provide eachprovider with theirDiabetes Patient List and baselineDiabetes Care Report

  • Note:

  • Numbers will change and become more accurate as a result of testing, further analysis and the availability of more up-to-date data

  • Number of primary care doctors does not include some Community Health Centre physicians

  • Number of Ontarians with diabetes may not include First Nations and other Ontarians who receive health coverage from the Government of Canada

10


Medication management
Medication Management measured the baseline diabetes care gap

This year in Ontario, there will be 394,000 preventable adverse drug events resulting in:

  • 240,000 physician office visits;

  • 36,000 hospitalizations; and

  • 4,000 deaths.

    We require solutions to:

  • Create comprehensive medication profiles for Ontarians;

  • Check for allergy interactions;

  • Check for drug-to-drug interactions;

  • Check for drug-to-diagnosis interactions;

  • Allow legible prescriptions for pharmacists to read;

  • Enable accurate dosing of medications; and

  • Improve management of complex therapies.

11


Medication management1
Medication Management measured the baseline diabetes care gap

We will move forward with three solutions:

  • E-Prescribing including a Drug Information System (DIS):

    • ePrescribing demonstration projects

    • Explore options to expand the online medication data as an interim step towards a DIS

    • Expecting to issue the RFQ in Q3 10/11 for a DIS.

    • First physician will ePrescribe using the new system in Q4 11/12.

  • Expanding the Drug Profile Viewer

    • 245 hospital locations (emergency departments and other hospital locations) access Ontario Drug Benefit Data using the Drug Profile Viewer System.

    • Will expand this service to other health care providers such as Family Health Teams.

  • Computerized Physician Order Entry Systems for Systemic Therapy

    • Currently serving 65% of chemotherapy sites.

    • Goal to increase this to 75% by 2011/12

12


Eprescribing demonstration projects
ePrescribing Demonstration projects measured the baseline diabetes care gap

Clinical Impact:

  • Two pilots launched in Sault Ste Marie and Collingwood in the Spring.

  • This pilot enabled prescribers to electronically create, authorize, and transmit prescriptions

  • Enables prescribers to view their patients’ previous dispensing events to better understand patients’ compliance and making informed medication-related decisions

  • Enables pharmacists to receive legible prescriptions and view patients’ medication histories, improving their ability to help patients take their medications appropriately and safely

  • Strengthened relationships between physicians/nurse practitioners and pharmacists

  • Lessons learned will inform the design and implementation of the provincial DIS system.

13


Ehealth ontario portal services
eHealth Ontario Portal Services measured the baseline diabetes care gap

The primary objectives are to:

  • Give clinicians greater access to clinical data such as OLIS and ODB and additional data repositories as they become available;

  • Develop a distribution model that leverages existing health services portals that already provide services to clinicians;

  • Develop portlet based services and contextual framework, standards and processes that enable integration of eHealth services on distribution partners sites; and 

  • We expect to integrate eHealth portlets into the Ontario MD portal and the Ottawa Hospital portal within the short term.

14


Client provider user registry
Client/Provider User Registry measured the baseline diabetes care gap

Identity Access and Privacy Program:

  • We will be moving forward with a Federated Model of Authorization.  Agreements will be in place with Federation ID Provision partners

  • Client Registry, Provider Registry, User Registry leverages the Registered Persons Data Base (RPDB) and Corporate Provider Database (CPDB).

  • We are in discussions with Regulatory Colleges to ensure accurate and updated information at all times. 

  • Consent Directives and Privacy Audit Services will issue an RFP by end of the first quarter of 2010/11.

15


Ontario laboratories information system
Ontario Laboratories Information System measured the baseline diabetes care gap

  • Progress to date:

    • Over 50% of provincial lab test and results are currently being fed into OLIS.

    • Physician adoption targets are still under development.

    • Completed first extract from the OLIS Repository by CCO for tumour staging research project.

    • Integration of OLIS with ConnectingGTA and Ontario Agency for Health Protection and Promotion project underway.

    • OLIS Roadmap RFP to be released within the next two months.

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Physician eHealth measured the baseline diabetes care gap

Funding support for

Equip &

Support

Office Transformation

Technology Management

Enable

Mature Technology

To broaden and

accelerate eHealth participation by Ontario’s physicians for improved clinical outcomes

Offerings

Change Management

Promote Adoption

eHealth Solution Support

Successful First Use

Build Clinical Value

Governance

(e.g. Diabetes Registry,

Decision Support,

Leadership /

ePrescribing)

Accountability

Build BusinessValue

Sustain/

(e.g. Health Card

Evaluation / Evolution

Build Value

Evolve

Validation, eRostering

Governance:

As identified in Ontario’s eHealth Strategy, the Physician eHealth Council, co-chaired by eHealth Ontario and the OMA CEO, provides direction on specific physician strategy initiatives.

17


Physician ehealth
Physician eHealth measured the baseline diabetes care gap

Initial Priorities:

Establish the physician eHealth governance model, roles and responsibilities for implementing this strategy and ongoing management

Develop a network connectivity strategy for physicians ✔

Explore opportunities with LHINs to promote physician participation and demonstrate value

Develop new funding programs and template agreements to achieve targets for physician participation ✔

Develop accountability agreements for service delivery and program management ✔

Consult with stakeholders to develop support options

Develop change management strategies ✔

Moving Forward:

eHealth Ontario has established a Physician eHealth Program to manage delivery of the Physician eHealth strategy

18


E health data sharing patterns
e-Health Data Sharing Patterns measured the baseline diabetes care gap

1. Local data within a single enterprise

2. Point-to-Point / Multi-point sharing across enterprises

3. Systems-Wide sharing amongst authorized stakeholders

Sharing in e-Health can be distilled to three data sharing patterns. The Reference Architecture provides support for each of these patterns.

Data, information and knowledge is held and owned by stakeholders / organisations and managed by individual (local) applications within a single enterprise. Sharing is limited to localized or remote access through the use of local applications and networks. All of the participating Stakeholders are explicitly known and trusted by the shared systems . Resources are accessed natively using these shared systems and their supplied interfaces and access is not intermediated by e-Health Services.This approach is common place and represents the vast majority of the existing investment in e-Health solutions across the broader health sector. Each of these systems represents one of the multitudes of “islands of information” that exist across the health system.

CMS

e.g. Physician CMS

Sharing occurs on a point-to-point or a point-to-multi-point basis amongst named stakeholders. The trust model is explicit in that the sharing stakeholder explicitly knows and must trust all of the named intended recipients. Point-to-point interactions (e.g. referrals, electronic mail, billing / payment etc) share a number of common characteristics:

The sharing of resources is deliberate and is initiated by a stakeholder.

The recipient(s) of the information are specifically identified by the sender.

The sharing of information typically is triggered by an event in which all parties have a shared interest (a referral/consultation, responding to a request etc.) and typically relates to integrating a business process across organizational boundaries (B2B).

Hospital

CCAC

Service

Provider

Discharge Summary

Service

Order

Physician

Specialist

Referral

Note

e.g. e-Referral

Sharing occurs on a point-to-multi point basis; however, subsequent uses of the shared information will happen at a different point in time from its sharing. The trust model is transitive in that the sharer of information may or may not know the eventual users of the shared information and the sharer must implicitly trust the mechanism used to share and those trusted by that mechanism.

The sharing of resources is deliberate and is initiated by a stakeholder.

Subsequent uses of the shared information will happen without the involvement of the creator of the shared resource and the creator of the resource may or may not know the stakeholder accessing it.

The sharing of the resource typically is triggered by a local event wherein a new resource is created or an existing resource has changed and needs to be updated.

Physician

Specialist

Ordering /

Results

Ordering /

Results

EHR

Lab

Domain

Public

Health

Unit

Results

Results

Lab

e.g. Sharing Lab

Information


Electronic health record architecture
Electronic Health Record Architecture measured the baseline diabetes care gap

Ontario’s Electronic Health Record is logical concept that encompasses elements of the Infrastructure, Privacy & Security, Shared Resources, e-Health Services and Stakeholder Interfaces components of the e-Health Architecture. It enables a longitudinal (life-long) health record for Health Care Recipients to be used by Providers and Clinicians in the delivery of care.

Ontario’s Electronic Health Record is an aggregation of components from the Ontario e-Health Blueprint. The principles and rules described within the e-Health Blueprint provide the foundation for Ontario’s Electronic Health Record. Over time it is anticipated that additional classes of shared resources and related e-Health Services will be added to the architecture supporting an evolutionary approach to providing a longitudinal (life long) record for individuals receiving health services in Ontario.


Pending procurements
Pending Procurements measured the baseline diabetes care gap

  • RFP for Diabetes Registry issued November 2009.

  • RFP for OLIS Roadmap within the next two months.

  • RFP Integration Services (discussed next presentation)

  • RFP for Consent Directives and Privacy Audit Services by the end of first quarter of 2010/11

  • RFQ for Drug Information System in third quarter of 2010/11

    (estimated timelines, subject to various approvals)

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Questions

Questions? measured the baseline diabetes care gap

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