Can you say Can you say Collaboration with Collaboration with

Innovation? Strategic Innovation? Strategic Directions for Health Directions for Health

LibrariesLibraries

Rebecca ZakoorRebecca Zakoor

St. Michael’s Hospital, St. Michael’s Hospital, TorontoToronto

Healthcare TrendsHealthcare Trends

• Electronic Health Record –Integration of Electronic Health Record –Integration of resources into the EHR (PRIVACY)resources into the EHR (PRIVACY)

• Programmatic models of healthcare delivery Programmatic models of healthcare delivery • LHIN’s – Local Health Integration NetworksLHIN’s – Local Health Integration Networks• Consortial/provincial licensing-Knowledge Consortial/provincial licensing-Knowledge

OntarioOntario• Patient centric portalsPatient centric portals

Moving to an EHRMoving to an EHR

• In 2005 in Canada, 322 million In 2005 in Canada, 322 million office-based physicians visits-94% office-based physicians visits-94% resulted in handwritten paper resulted in handwritten paper records.records.

• Approx. 2,000 health care Approx. 2,000 health care transactions per minute, many quite transactions per minute, many quite complex, and all requiring complex, and all requiring documentation and information flow.documentation and information flow.

Electronic Health RecordElectronic Health Record

• In November 2002, the Romanow In November 2002, the Romanow Commission issued Commission issued Building on Building on Values:  The Future of Health Care in Values:  The Future of Health Care in CanadaCanada (hereafter “the Romanow (hereafter “the Romanow Report”), emphasizing the importance Report”), emphasizing the importance of electronic health records as “of electronic health records as “one of one of the keys to modernizing Canada’s the keys to modernizing Canada’s health care system and improving health care system and improving access and outcomes for Canadiansaccess and outcomes for Canadians ” ”

Experience as a PatientExperience as a Patient

• Online results for tests while you Online results for tests while you waitwait

• Every physician/healthcare provider Every physician/healthcare provider you see has your history, etc. right you see has your history, etc. right in front of them, in electronic formatin front of them, in electronic format

• Privacy of your records-PHIPA 2004Privacy of your records-PHIPA 2004

Personal Health Information Personal Health Information Protection ActProtection Act

PHIPA Personal Health PHIPA Personal Health Information Protection Act-Information Protection Act-

20042004• Sets out rules that healthcare Sets out rules that healthcare

providers must follow when providers must follow when collecting, using and sharing your collecting, using and sharing your personal health information.personal health information.

• Gives you the right to see your Gives you the right to see your health records and correct any health records and correct any mistakes.mistakes.

EHREHR

• National Electronic Health Record-National Electronic Health Record-Canada Health InfowayCanada Health Infoway

• Smart Systems for Health (SSHA) Smart Systems for Health (SSHA) Ontario Government-e-HealthOntario Government-e-Health

Smart Systems for Smart Systems for HealthHealth

• SSHA’s suite of products and SSHA’s suite of products and services - Ontario Network for e-services - Ontario Network for e-Health (ONE™) - create electronic Health (ONE™) - create electronic connections that improve the flow of connections that improve the flow of patient information between health patient information between health care professionals.care professionals.

Electronic Health Record-Electronic Health Record-Canada Health InfowayCanada Health Infoway

http://www.infoway-inforoute.ca/en/homhttp://www.infoway-inforoute.ca/en/home/home.aspxe/home.aspxElectronic Health Records help improve Electronic Health Records help improve

the the AccessAccess, , QualityQuality and and ProductivityProductivity of Canada's Healthcare System.of Canada's Healthcare System.Infoway invests with public sector Infoway invests with public sector partners Canada-wide to implement partners Canada-wide to implement and reuse compatible health and reuse compatible health information systems to support a safer, information systems to support a safer, more efficient healthcare system more efficient healthcare system

EHR Electronic Health EHR Electronic Health RecordRecord

• EHR Improves AccessEHR Improves Access• Ability to Access Care:Ability to Access Care: Improved wait Improved wait

times and capacity to deliver needed times and capacity to deliver needed services services

• Patient ParticipationPatient Participation: Patient access : Patient access to the electronic health record. to the electronic health record.

• AvailabilityAvailability: Greater access to : Greater access to healthcare services in the home and healthcare services in the home and communitycommunity

EHR Electronic Health EHR Electronic Health RecordRecord

• EHR Increases QualityEHR Increases Quality • Safety:Safety: Fewer medical errors and Fewer medical errors and

adverse drug events adverse drug events • Effectiveness:Effectiveness: Achieving desired Achieving desired

health outcomes health outcomes • Appropriateness:Appropriateness: Informed Informed

prescribing and clinical decision-prescribing and clinical decision-making making

EHR Electronic Health EHR Electronic Health RecordRecord

• EHR Increases ProductivityEHR Increases Productivity• Efficiency:Efficiency: Reduced administrative Reduced administrative

time and costs time and costs • Care Coordination:Care Coordination: Complete Complete

patient information for sharing patient information for sharing across the continuum of careacross the continuum of care

Electronic Health RecordElectronic Health Record

• Electronic health record for children Electronic health record for children already in place- already in place- http://www.echn.ca/http://www.echn.ca/

• eCHNeCHN's vision is that electronic health 's vision is that electronic health information in Ontario and Canada information in Ontario and Canada should be a universal system that is should be a universal system that is inter-operable, comprehensive, inter-operable, comprehensive, accessible, flexible and available in a accessible, flexible and available in a secure and controlled environment. secure and controlled environment.

Electronic Child Health Electronic Child Health Network- eCHNNetwork- eCHN

• eCHN (electronic Child Health eCHN (electronic Child Health Network) is a non-profit, Network) is a non-profit, government-funded organization government-funded organization dedicated to providing electronic dedicated to providing electronic solutions that permit the sharing of solutions that permit the sharing of healthcare information among healthcare information among authorized healthcare providers.authorized healthcare providers.

Information Provision in Information Provision in HealthcareHealthcare

• Information is core to the Healthcare Information is core to the Healthcare system.system.

• In 2005 in Canada, 60,000 physicians faced In 2005 in Canada, 60,000 physicians faced 1.8 million new medical papers in 20,000 1.8 million new medical papers in 20,000 journals and 300,000 clinical trials.journals and 300,000 clinical trials.

• JIT Delivery/Just in Time/Research/TeachingJIT Delivery/Just in Time/Research/Teaching• Print- being replaced by electronic to some Print- being replaced by electronic to some

degree.degree.• Physical spaces- reduced-virtual collections.Physical spaces- reduced-virtual collections.

Information Provision in Information Provision in HealthcareHealthcare

• Biggest challenge – integrating our Biggest challenge – integrating our Resources/Tools at the Point of CareResources/Tools at the Point of Care

• Handhelds- JIT Delivery-Tablet PC’s, Carts, Handhelds- JIT Delivery-Tablet PC’s, Carts, PDA’s.PDA’s.

• Improving Patient Care-ultimate missionImproving Patient Care-ultimate mission• Strategy must be intertwined with that of Strategy must be intertwined with that of

the healthcare institutionthe healthcare institution• COLLABORATION with all the players – COLLABORATION with all the players –

Information Technology, Research, Information Technology, Research, AdministrationAdministration

Programmatic Models of Programmatic Models of Healthcare DeliveryHealthcare Delivery

• Programmatic structure within larger Programmatic structure within larger health libraries –SMH one of the first.health libraries –SMH one of the first.

• Information specialists need to be Information specialists need to be COLLABORATING and integrated into COLLABORATING and integrated into various programmatic teamsvarious programmatic teams

• VALUE-Research/ TeachingVALUE-Research/ Teaching• Clinical librarians; patient education; Clinical librarians; patient education;

policy developmentpolicy development

Local Health Integration Local Health Integration Networks (LHIN’S)Networks (LHIN’S)

• Created based on the idea that Created based on the idea that people know what kind of health people know what kind of health care services they really need close care services they really need close to home. to home.

• www.lhins.on.ca/english/main/home.www.lhins.on.ca/english/main/home.aspasp

• 14 LHINS14 LHINS

Ministry of Health and Ministry of Health and Long-Term Care-Ontario Long-Term Care-Ontario

LHIN’SLHIN’S• Map out priorities for health system Map out priorities for health system

transformation at the local level in transformation at the local level in Integrated Health Service Plans Integrated Health Service Plans (IHSP’s).(IHSP’s).

• Part of each LHIN’s IHSP is an e-Part of each LHIN’s IHSP is an e-Health strategy that supports/enables Health strategy that supports/enables health service providers in ensuring health service providers in ensuring clients receive safe, high quality, clients receive safe, high quality, effective and efficient health services.effective and efficient health services.

What’s e-Health?What’s e-Health?

• Ontario Hospital Association definition:Ontario Hospital Association definition:“…“…a consumer or client centred model of a consumer or client centred model of

health care where stakeholders collaborate health care where stakeholders collaborate utilizing Information and Communications utilizing Information and Communications Technology, including Internet Technologies, Technology, including Internet Technologies, to manage health, arrange, deliver and to manage health, arrange, deliver and account for care, and manage the health account for care, and manage the health care system”care system”

E-Health helps everyone in health care work E-Health helps everyone in health care work together better for benefit of all those who together better for benefit of all those who participate in the system, including participate in the system, including consumers, providers and organizations.consumers, providers and organizations.

LHIN’s and Health LHIN’s and Health LibrariesLibraries

• Examination of health library Examination of health library services and consideration of new services and consideration of new methods for delivery of resources methods for delivery of resources and provision of library/research and provision of library/research services province-wideservices province-wide

Health Sciences Health Sciences Information Consortium of Information Consortium of

Toronto ( HSICT)Toronto ( HSICT)• Successful model of collaboration for 17 years!Successful model of collaboration for 17 years!

Emulated elsewhere.Emulated elsewhere.• 30 Teaching and Community Hospitals and 30 Teaching and Community Hospitals and

Healthcare InstitutionsHealthcare Institutions• Achieving cost savings, facilitating Achieving cost savings, facilitating

professional development, and providing professional development, and providing valuable instructional programs-not just valuable instructional programs-not just licensing!licensing!

• COLLABORATIVE collection development.COLLABORATIVE collection development.• Union List journals/SIRSI developmentUnion List journals/SIRSI development

Health Sciences Health Sciences Information Consortium of Information Consortium of

Toronto ( HSICT)Toronto ( HSICT)• Strategic Issues Subcommittee has Strategic Issues Subcommittee has

established, in consultation with the established, in consultation with the Consortium membership and Board, a set of Consortium membership and Board, a set of guiding principles that are essential to any guiding principles that are essential to any discussion of a new model for health library discussion of a new model for health library service in the province of Ontario.service in the province of Ontario.

• Consortial/Provincial licensing-Consortial/Provincial licensing-COLLABORATIONCOLLABORATION

• Recommendations to be made to the LHIN’s.Recommendations to be made to the LHIN’s.• HSICT is GTA centric/straddles LHIN HSICT is GTA centric/straddles LHIN

boundariesboundaries

Model for Information Model for Information services for health services for health

professionals in Ontarioprofessionals in Ontario• Comprehensive svc delivery-access, Comprehensive svc delivery-access,

training, reference, research-support training, reference, research-support quality patient care, research and quality patient care, research and teachingteaching

• *Scope-needs of medical/allied health *Scope-needs of medical/allied health professionals who don’t have cross appt’s professionals who don’t have cross appt’s to universities, other institutional to universities, other institutional affiliations, or other means of accessaffiliations, or other means of access

• Specialized collections-ie: pediatrics, Specialized collections-ie: pediatrics, mental health, geriatrics, rehabilitation, mental health, geriatrics, rehabilitation, oncology, etc.oncology, etc.

Model for Information Model for Information services for health services for health

professionals in Ontarioprofessionals in Ontario• Professional expertise-onsite reference, Professional expertise-onsite reference,

orientation, training and supportorientation, training and support• Hospital accreditation-Lib/inf services Hospital accreditation-Lib/inf services

must support Canadian Council on must support Canadian Council on Health Services Accreditation standards.Health Services Accreditation standards.

• Local needs and priorities/LHIN’sLocal needs and priorities/LHIN’s• Licensing funded by MOHLTC would Licensing funded by MOHLTC would

free up funds within institutions (change free up funds within institutions (change in gov’t?)in gov’t?)

Ontario Health Library Ontario Health Library Service ModelService Model

• Structure?Structure?• Funding model/business caseFunding model/business case

Members with full library servicesMembers with full library services

Partner members who contract for Partner members who contract for library serviceslibrary services

Governance? University controlled Governance? University controlled (NO)-not by one(NO)-not by one

Consortial/Provincial Consortial/Provincial Licensing-University Licensing-University

Centric ModelsCentric ModelsHealth Sciences Information Health Sciences Information

Consortium, TorontoConsortium, Toronto

McGill University-difference-same McGill University-difference-same network backbone shared by hospitals.network backbone shared by hospitals.

Hamilton-McMasterHamilton-McMaster

University Managed University Managed ModelsModels

University of Manitoba-No remote accessUniversity of Manitoba-No remote access

Queen’s University- fee for service-closed Queen’s University- fee for service-closed local hospital librarieslocal hospital libraries

University of Alberta and University of University of Alberta and University of Calgary-Health Knowledge Network – Calgary-Health Knowledge Network – HKN-hospitals, organizations, individuals HKN-hospitals, organizations, individuals can buy memberships.can buy memberships.

COAHL Consortium of Academic Health COAHL Consortium of Academic Health Libraries – cooperative of six medical Libraries – cooperative of six medical schoolsschools

Regional and Provincial Regional and Provincial ModelsModels

e-HLbc- 2006- Electronic Health Library of BC-e-HLbc- 2006- Electronic Health Library of BC-Health authorities, post secondary instit’s, Health authorities, post secondary instit’s,

provincial ministries, Coll of Physicians and provincial ministries, Coll of Physicians and Surgeons…Surgeons…

Saskatchewan Health Information Resources Saskatchewan Health Information Resources PartnershipPartnership

NOVL-Northern Ontario Virtual Library-Northern NOVL-Northern Ontario Virtual Library-Northern Ont. School of MedicineOnt. School of Medicine

Knowledge Ontario!Knowledge Ontario!Public Health Div-OMHLTCPublic Health Div-OMHLTCProvince of Quebec-4 geographic regions/one per Province of Quebec-4 geographic regions/one per

medical school-RUISmedical school-RUIS

Other InitiativesOther Initiatives

• Ontario MD – province’s physicians- Ontario MD – province’s physicians- Ontario Medical Association.Ontario Medical Association.

• Nurse One- Canadian Nurses Nurse One- Canadian Nurses Association PortalAssociation Portal

June 2006June 2006• Canadian Health Libraries Association Canadian Health Libraries Association

(National Network of Libraries for (National Network of Libraries for Health)-possibility of linking health Health)-possibility of linking health libraries nationally.libraries nationally.

Provincial/consortial Provincial/consortial licensinglicensing

• $$$ being spent that is duplicated – $$$ being spent that is duplicated – duplicate access ie: physicians, duplicate access ie: physicians, nursesnurses

• Number of initiatives-need to bring Number of initiatives-need to bring them all together common direction.them all together common direction.

• Smaller libraries/remote libraries.Smaller libraries/remote libraries.

Patient Centric PortalsPatient Centric Portals

• Web based personal health Web based personal health application that can integrate with a application that can integrate with a patient’s electronic health record, patient’s electronic health record, supporting the patient in supporting the patient in management of his/her own health management of his/her own health carecare

Patient Centric PortalsPatient Centric Portals

• Chronic Kidney Disease Patient Portal Chronic Kidney Disease Patient Portal initiative -December 2006-online tool for initiative -December 2006-online tool for Ontarians with chronic kidney disease – Ontarians with chronic kidney disease – management of their own care-management of their own care-operational by March 2008operational by March 2008

• Grand River Hosp, Hamilton HS, Grand River Hosp, Hamilton HS, University Health Network and Canada University Health Network and Canada Health Infoway.Health Infoway.

• Better adherence to care plans.Better adherence to care plans.• Secure login processSecure login process

Strategic Future for Health Strategic Future for Health LibrariesLibraries

• EHR Integration- Point of Care Tools EHR Integration- Point of Care Tools and presenceand presence

• Continuation of Programmatic Models-Continuation of Programmatic Models-Integration into health teamsIntegration into health teams

• LHIN’s – Local Health Integration LHIN’s – Local Health Integration Networks-Models for delivery of Networks-Models for delivery of information servicesinformation services

• Consortial/provincial licensing-increaseConsortial/provincial licensing-increase• Patient portals/access/patient educationPatient portals/access/patient education

Questions?Questions?