24 Hospitals, ONE Record: A Study in Collaboration August 10, 2021

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Dr. Derek Garnis s , MD, CCFP(EM), CPHIMSChanta l Gagne, Director , RN, MSN

DISCLAIMER: The views and opinions expressed in this presentation are solely those of the author/presenter and do not necessarily represent any policy or position of HIMSS.

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Welcome

Director of Inpatient and Surgical ServicesNorth Bay Regional Health Centre, Ontario

Chanta l Gagne, RN

CMIO, ED Physician, Sault Saint Marie, Ontario

Dr. Derek Garnis s

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Conflict of Interest

Chantal Gagne has no real or apparent conflicts of interest to report.

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Conflict of Interest

Dr. Derek Garniss, MD, CCFP(EM), CPHIMS

Physician Liaison, Stipend for Product Demonstrations 2020-21 - Meditech

Physician Demonstrator, Non-Paid Speaker - Nuance

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Agenda

1. Overview of the ONE project

2. Standardization achievements

3. Physician advisory committee

4. Next steps for ONE

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Learning Objectives1. Identify the need for the ONE Initiative to serve as a transformational project in Northeastern Ontario that implemented and

shared a single electronic health information system (HIS) across the region’s 24 acute care hospitals

2. Demonstrate how the ONE Initiative developed standardized, evidence-based clinical best practices across two dozen organizations with unique cultures, patient populations, clinical workflows, and governance philosophies

3. Analyze the collaborative model developed which resulted in a cooperative and functional “build team” of over 180 nurses, physicians, allied health professionals, pharmacists, and IT staff who built standardized order sets, nursing and allied health assessments, and medical directives to facilitate care across all specialties

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North Eastern Ontario

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Sault Saint marie

Parry Sound

North Bay

436 KM

460 KM

149 KM

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3 Community Hospitals

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HOSPITAL TECHNOLOGY BEDS STAFF PHYSICIANSWest Parry Sound Health Centre Paper based 70 700 150

Sault Area Hospital EHR Vendor 293 1700 365

North Bay Regional Health Centre EHR Vendor 389 2200 360Same

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Key Drivers for Partnerships

• Founding hospitals were at different stages of upgrading their current HIS systems, pressure to align due to costs

• Ontario HIS Renewal Advisory Panel had put forward recommendations for hospitals within a region to move together in ‘HIS clusters’, leveraging current HIS installs and working in partnership with their respective areas

• The timing was right to take advantage of the opportunity to establish a true “seamless” shared NE hospital electronic health record

• One electronic medical record being the ultimate goal for patients in the North East (NE)

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What is ONE?

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Implement a common health information system (ONE–HIS)

Establish a regional organization to support the systemA clinical initiative to implement a

shared health information system across North Eastern Ontario

One Patient, One Record, One System

Establish cost sharing and decision making frameworks that are equitable for participating hospitals

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The ONE HIS Implementation Phases

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Wave 1• 3 Founding Hos pita ls• Es tablis h ONE HIS• Live s ince October 2019

Wave 2• Trans it ion with 21 addit iona l hos pita ls to ONE

HIS• Add funct iona lity to ONE HIS• Extend to founding hos pita l outpa t ient clinics

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The ONE Journey

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IN SCOPE

• Information Systems

• Financial Systems

• Administrative Systems

• Ancillary Systems

• Clinical Systems

OUT OF SCOPEX

Web Ambulatory Outpatient areas Population Health Oncology Patient and Consumer

Health Portal Case Management Cost Accounting Anesthesia Fetal Heart Monitoring

Standardization

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> 450 Order Sets

30DocumentationTemplates

30 Medical

Directives

50 Clinical

protocols

> 66 Standards

of care

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Subject Matter Experts

Travelled to meet in person

Relied Heavily on Google Suite Tools

Frequent emails & use of Zynx

Networking despite geographical challenges

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• Allergy intake

• Admission and discharge

• Medication reconcilation

• Ressuscitation status documentation

• Problem list implementation

• Front end dictation

Aligned Many Workflows

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This was a clinical project - not an IT project

• Mat/Child

• ED

• Medicine

• ICU

• Surgery

• Anesthesia

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• NICU/PEDS

• Mental Health

• TPN

• Stroke

• Dietician

Multidisciplinary Working Groups

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EMRAM

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The Challenge :

• Three independent hospitals with their own governance structure ( MAC, P&T)• Each hospital has their own ingrained physician practice with established order sets,

medical directives, workflow, and approval processes• Geographical separation of the sites in different cities, with the need for regular

stakeholder engagement• Respecting hospital site autonomy

The Solution :

• Establishment of a robust, well orchestrated Regional Physician Advisory Committee

Physician Advisory Committee

The Challenge : You can’t have change without disruption,… and physicians do not like disruption!

Physician leadership, oversight and engagement = Minimize the disruption

PHYSICIAN ADVISORY COMMITTEE

Dissatisfied Physicians Poor Adoption

Physician SatisfactionEmbrace Adoption

Lack of communication, not involving physicians, Poor EMR Usability, design, and Support.

Engaging Physicians, Effective Communication, and a focus on EMR Usability, training and support.

Credit : ”J-Curve” - David Viney

PAC - Successes• A robust collaboration across multiple hospital sites while respecting individual hospital autonomy

• 3 Founding CMIOs led large scale approvals of content while having to navigate their own

hospital cultures, structures and approval processes

• Internal collegiality among the PAC members that built each others strengths

• Moved all three sites to HIMMS 5 stage

PAC – Lessons Learned

• Regular PAC representation by Nursing, PHA and LAB/DI

• Need for standardized formulary

• Need for a Regional P&T and data governance committee

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Benefits of one

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Evidenced Base Care

The system promotes evidence-

based clinical practices, increased patient safety and offers advanced

clinical tools

1 Seamless Care2 Standardized Care

Northern Ontario represents a huge geographical area

creating a disparity in health care resources to

Northern Ontarians.

A shared system means improvements in

standardized care where patients can expect to

receive the same or similar care throughout North

Eastern Ontario

3The fact that the regional record is shared by all 24 hospitals will facilitate: Faster and safer transfer of

patients between facilities Sharing of patient

information across clinical programs Population health data

collection and analysis

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Our Evolution

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ONE Wave 1 Implementation

Built a new house to be occupied by 3 founding hospitals.

On move-in day there were unfinished items such as walls that needed touch-up paint and several appliances yet to be delivered.

ONE HIS TodayAfter living in the house for a while, the occupants identified changes that were needed such as moving furniture or reorganizing kitchen cupboards.

Over time, more fundamental changes were made such as new furniture or drapes.

ONE HIS- Wave 2 Implementation

Will make structural changes to accommodate additional occupants such as additional bedrooms, upgraded electrical panel, etc. We will ill make changes to existing structure to accommodate needs of larger, collective group of occupants such as changes to kitchen layout, updated appliances, etc.

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Sustainment Model

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▪ This is an operational entity that looks after the support of the system, and the users of the system

▪ Hospitals establish a separate, independent legal entity “New Company” (NewCo) that provides services to hospitals and minimizes perception of bias

▪ NewCo isolates liability away from hospitals/members▪ As in other Healthcare Shared Services Organizations, the structure ensures that sites have

a representative voice by having a Board of Directors made up of member hospital executives and an independent community member▪ Directors have the duty to make decisions in the best interests of NewCo and all

members/stakeholders▪ NewCo Board makes decisions by majority vote

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Thank you!

• Chantalgagne@nbrhconcawwwlinkedin.com/in/chantallise

• garnissd@sah.on.cawww.linkedin.com/in/derek-garniss-252715109

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