REACHing for Leading-Edge Patient Care with e-Health

By Dan Germain, VP, CFO and CIO at the Credit Valley Hospital and former e-Health lead for the Mississauga Halton Local Health Integration Network (LHIN.)

In Ontario, very few hospitals can share their disparate Electronic Health Records (EHRs) between providers or with patients/clients. To facilitate sharing of patients’ EHRs among physicians and clinicians, The Credit Valley Hospital (CVH) joined William Osler Health Centre (WOHC) and Halton Healthcare Services (HHS) to establish an electronic clinical portal. Trillium Health Centre (THC) and Headwaters Health Care Centre (HHCC) have also entered into this partnership and will go live in the next few months extending the Rapid Electronic Access to Clinical Health (REACH) EHR initiative to all hospitals within two LHINs serving a catchment area of 1.8 million Ontario residents (about 5% of the total Canadian population). This existing collaboration between six physical hospital sites in the Peel and Halton regions and two LHINs – the Mississauga Halton LHIN (MH LHIN) and the Central West LHIN (CW LHIN) – is unprecedented and a landmark partnership in the Province of Ontario.

The REACH Clinical (EHR) Portal enables all associated sites’ clinicians to have instant access to longitudinal patient health information including but not limited to allergies and alerts, lab and diagnostic test results, diagnostic images and reports, pharmacy data, transcribed notes, scanned images, progress reports, and other important health-related information. A thorough Privacy Impact Assessment was also perforemed to ensure REACH meets all Ontario privacy standards.

At each constituent hospital, patient data is easily accessed today through our secure network solution and consolidated into one customizable, patient-centric view. Based on a federated data-model, patient data remains in its original format on its respective (legacy) vendor IT system, allowing for all systems to be leveraged across multiple domains, rather than replacing them. Additionally, using a federated data-model ensured implementation of the REACH clinical portal was extremely fast and inexpensive especially when compared to other more complex solutions. The partnership between REACH Hospital stakeholders not only enhances patient safety and satisfaction, it provides an intuitive web-based interface that is accessible anywhere.

The REACH portal was created using MEDSEEK in partnership with Agfa HealthCare, both leading providers of enterprise-wide e-Health solutions. This simple portal solution is also vendor-agnostic, so the system is compatible with almost all health information systems, diagnostic imaging vendors, and other suppliers. “Over 160 interfaces are available on a plug-and-play like basis,” says Dan Germain, Vice President, Chief Financial Officer and Chief Information Officer at CVH.

Dr. Paul Philbrook, CVH’s Chief of Family Medicine and Chair of the Central West – Mississauga Halton Community Family Medicine/Public Health Network of Physicians, along with his colleagues, championed the idea of allowing affiliated physicians the opportunity to access their patient records across all local hospital sites. He explains, “The REACH portal is a welcome advancement of access to patient information and integration locally. This will enhance patient care and safety.”

Germain, also former e-Health lead for the Mississauga-Halton LHIN, further explains, “The REACH portal was created for physicians and clinicians to improve patient care and provide real-time access to existing patient records across the region. Although more time is needed to determine the quantifiable benefits of such a solution, it is expected that the REACH Portal will assist in avoiding potential medical errors and offset the possibility that other critical information is inadvertently missed for elective, emergency admissions or outpatient visits. Saving just one life by using this system will pay for itself.”

To date, the REACH EHR portal is getting over 9,000 views per month within the Mississauga-Halton and Central West LHINs---with one-third of those views made by Physicians looking at patient data from other hospitals. Over 1,000,000 outpatient visits and 100,000 discharges per year are now available within the REACH portal at this time. “The clinicians who are accessing patient information via the REACH portal love it,” says Germain. The portal has the ability to consolidate information about a patient/client from other sources (e.g., Community Care Access Centre’s), but currently, the focus is to bring more hospitals on stream and ensure as much clinical data is contained in the portal as needed.

The Mississauga-Halton and Central West LHIN's are fortunate in securing both the commitment of all regional hospitals to join the REACH portal, and also engaging a vendor solution that was both comprehensive and transferrable outside the walls of any specific site. This collaboration between regional hospitals is a stepping stone toward the overall e-Health goals for the province of Ontario, for example, building a standardized methodology to identify each unique patient and then consolidate electronic health care data from a variety of sources (e.g. hospitals, private laboratories, pharmacies, nursing homes.) It should also be noted that Hamilton Health Sciences and the Scarborough Hospital are also using the Medseek portal (distributed by Agfa HealthCare in Canada.) Ottawa-area Montfort Hospital has also signed on, but have not gone live yet. REACH will be ready to plug-and-play into Provincial EHR Initiatives once available.

We keep hearing from patients that they want to be more involved in their own health care. "Providing patients with electronic access to their health record and wellness information– that’s our next goal,” says Germain. “We can make our collective vision happen a bit sooner – anything is possible." Now that our disparate Clinical Information can be accessed and leveraged, a REACH Patient Portal is on the horizon. Germain explains that this Patient Portal initiative will be especially beneficial to those managing chronic disease prevention and that it is imperative that that patients have access to their own health records in a secure manner, as well as access to reliable health and wellness information.

Dan Germain is the Vice President, Chief Financial Officer and Chief Information Officer at The Credit Valley Hospital.

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The 2008 ACUMEME eHEALTH AWARD

The ACUMEME e-HEALTH AWARD is given to Canadian Healthcare delivery organization that has successfully extended e-Health application(s) that further our national objective of a comprehensive, interoperable, and transferrable electronic health record (EHR.) The Award promotes and recognizes the exchange of best practices within the field of e-Health.

ACUMEME is pleased to announce the 2008 e-HEALTH AWARD WINNER is the Rapid Electronic Access to Clinical Health Information (REACH) EHR Viewer Initiative in the Province of Ontario’s Local Health Integration Network’s 5 and 6 respectively. Constituent Hospitals include the Credit Valley Hospital, Halton Healthcare Services, and William Osler Health, Headwaters Health, and Trillium Health Centre.

REACH is shaping the future of patient care in Canada. As the first Integrated LHIN’s, REACH extends a seamless (“read-only”) connection to critical patient information aggregated from multiple vendors and multiple sites. For over 1.8 million Canadians residing in LHIN’s 5&6 this ensures their historical patient data is available along the entire continuum of care---regardless of geographical location. Utilizing state of the art clinical portal technology (provided by vendor MEDSEEK,) the REACH platform intuitively weaves together all existing clinical data and services from 11 Hospital sites into one intuitive, unified, patient-centric view at the point of care. When Physicians, hospitals, labs, pharmacies, clinicians, consumers, and researchers are connected through integrated IT systems—healthcare delivery is safer, more efficient, and value-driven.

REACH promises to have a significant effect on patient safety and wasteful duplication, while extending Canadian’s a regional care system where privacy, security, and confidentiality are respected and easily moderated. Congratulations to REACH (and its member constituents) for winning ACUMEME’s 2008 e-HEALTH AWARD.

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Additional information on the REACH EHR Initiative.

Mississauga's William Osler Health Centre goes high-tech with patients' records

The Brampton Guardian | Monday December 24 2007 | PETER CRISCIONE

BRAMPTON - William Osler Health Centre (WOHC) is among three hospital sites in southern Ontario equipped with the ability to share patient data through a new web-based electronic healthcare record (EHR) viewer.

Agfa HealthCare, a leading provider of IT-enabled clinical workflow and diagnostic imaging solutions, unveiled recently new technology (their Clinical Dashboard platform) that allow's users to easily access critical patient information from any personal computer, handheld, or tablet PC with Internet access. For instance, data at WOHC's Etobicoke and Brampton sites can be retrieved and shared with Halton Healthcare Services (Oakville, Milton, Georgetown) and Credit Valley Hospital in Mississauga.

This eHealth portal (EHR Viewer) solution serves the nearly one million residents living in the communities of Brampton, Etobicoke and Georgetown.

"Agfa's proven federated portal model is a 'win-win' situation for hospitals - simple in premise, and deployed at a fraction of the time and cost of competitors, with immediate return on investment," said Dieter Pagani, director of Agfa HealthCare's Enterprise Solutions Group. "These hospitals are truly eHealth leaders in Ontario, and have taken a quantum-leap towards eliminating the traditional barriers associated with sharing data." Company officials say this vendor-agnostic technology promises to fundementally alter the Canadian healthcare landscape.

Agfa HealthCare's eHealth solutions are customized to meet the needs of each hospital and their unique stakeholders, "and built on a complimentary core foundation that is web-based, scalable, extensible and focused on delivering fast return on investment." The new technology ensures all three sites (including Credit Valley Hospital and Halton Health) can securely share all patient records---regardless of IT systems or vendors.

"This makes us trailblazers," said Judy Middleton, Chief Information Officer for WOHC. "If a physician has a patient at Osler, and the patient says 'I've been at Oakville or I've been at Credit Valley', then all the information from their visits will be accessible by the physician. So in terms of expediting treatment and care, you have much more information (at your disposal)."

Middleton said other hospitals in the Central West Local Health Integration Network (LHIN,) of which WOHC is a part of, are taking steps to adopt this innovative technology. In achieving this level of interoperability, William Osler will be able to reduce duplication and errors, while increasing the level of accuracy of information in terms of diagnosis, Middleton said.

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[Original Article]

William Osler Health Centre’s Clinical Portal (EHR Viewer) Sets Connectivity Standard in Ontario

This article reprinted with permission from Medseek's eHealth Success Stories

In 2005, the Ontario Ministry of Health and Long-Term Care required William Osler Health Centre to transfer one of its hospitals to the Mississauga-Halton Local Health Integration Network (LHIN). Osler Health needed to provide physicians with real-time access to clinical information so that the continuity of care would not be disrupted during the transfer period and beyond. The most cost-effective and least complex solution was to build and deploy a clinical portal, and Osler turned to MEDSEEK due to the company’s reputation for reliability and service. Osler’s trust in MEDSEEK was extended when it rolled out their Rapid Electronic Access to Clinical Health information (R.E.A.C.H.) eHealth Portal in 2006.

The REACH eHealth Portal (EHR Viewer) has been extremely well received by physicians, in large part because the health system made sure to enlist their assistance and support from the start.

"From a quality perspective, more clinicians are using it and it is allowing them to access all the information they need to make patient care decisions faster, which ultimately affect clinical outcomes for the better," - Elizabeth Nemeth, RN, BScN, MN, project manager of the REACH and MD-Net portals

“A CIO can develop the vision, but if he or she doesn’t have physician and clinician champions along the way that vision is all for naught,” said Judy Middleton, chief information officer at Osler. “It’s really important to involve key individuals and end-users. They will let you know whether you are heading in the right direction and whether the information you’re providing is useful and meaningful to them. At the end of the day that’s what’s important.”

Although the divestiture provided the immediate spark that led Osler to launch a portal, the health system, one of the largest in Ontario, had been considering using a portal as a strategic tool to improve patient care and foster closer ties with physicians, patients, consumers and employees.

"It was part of the overall vision of the organization to provide access anywhere anytime to patient information over the Web,” Middleton said. “The master plan was already there and the Ministry of Health provided the impetus for us to make it happen sooner rather than later.”

Portals Improve Data Flow and Clinical Outcomes
Since its debut, REACH has been so successful that it led Osler to expand access in October 2007 to all nurses and allied health personnel. “From a quality perspective, more clinicians are using it and it is allowing them to access all the information they need to make patient care decisions faster, which ultimately affect clinical outcomes for the better,” said Elizabeth Nemeth, RN, BScN, MN, project manager of the R.E.A.C.H. and MD-Net portals at William Osler.

Due to its strategic nature and clinical impact, R.E.A.C.H. was expanded to the Peel and Halton regions, and just this past fall William Osler Health Centre welcomed clinicians at Credit Valley Hospital to the REACH portal. The successful collaboration between six physical hospital sites means all of their clinical stakeholders have instant access to patient health information stored electronically at any of the hospitals---regardless of legacy vendor platform.

"It was part of the overall vision of the organization to provide access anywhere anytime to patient information over the Web," - Judy Middleton, chief information officer at William Osler

The R.E.A.C.H. eHealth portal network provided federated access to over 90,000 inpatient stays and 1,050,000 outpatient visits for the fiscal year ended March 31, 2007. Patient stays and visits from all hospitals are consolidated into one, intuitive Web portal.

The REACH initiative (EHR "Viewer" based on Canada Health Infoway's designation) allows authorized users secure access to longitudinal patients information via a secure web-browser, whether inside and outside of the native hospital environment. This means records are both transferable and comprehensive. As patients move between regional facilities for different diagnostic tests and procedures, data like lab and diagnostic test results, images, transcriptions and progress reports written at one hospital can be viewed immediately by a physician treating the patient, on a subsequent visit, at any of the associated REACH facilities.

William Osler Health also plans to extend regional stakeholders a patient portal in the near future. While the organization’s Web site currently only extends minimal patient self-services (e.g.online bill payment,) the planned patient portal will offer patient stakeholders a richer menu of services such as online access to laboratory and test results, online appointment scheduling, and much more. Creating this portal, however, is particularly challenging because William Osler serves one of the most ethnically diverse populations in Canada.

“We are proceeding carefully because we want to be culturally sensitive and make sure that we do this right,” Middleton stated. “With each portal, we try to create a similar look and feel so the portals don’t look very different from each other but still meet the unique needs of the various end-users.”

"William Osler’s positive experience with REACH has also attracted the attention of the Province of Ontario's Ministry of Health. The Ministry is weighing whether other local health integration networks (LHIN's) in the Province should use it as a model for electronically exchanging information within their individual organization", Middleton said.

[Original article]