Vancouver Island Health...

Island Health and Vancouver Island Regional Hospital Districts Minutes of Joint Planning Meeting – November 22, 2013

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Island Health and

Vancouver Island Regional Hospital Districts

Regional Joint Planning Meeting Regional District of Nanaimo

6300 Hammond Bay Road, Nanaimo, BC

Minutes of Meeting

In attendance from Island Health Don Hubbard Dr. Brendan Carr Joe Murphy Kim Kerrone Georgina MacDonald Chris Sullivan In attendance from the Regional Hospital Districts Teri Fong, Alberni-Clayoquot Penny Cote, Alberni-Clayoquot Alistair Bryson, Capital Maurice Rachwalski, Capital Mark Keuber, Cowichan Valley Greg Fletcher, Mt. Waddington Dave Rushton, Mt. Waddington Wendy Idema, Nanaimo Paul Thorkelsson, Nanaimo Bruce Jolliffe, Comox-Strathcona Beth Dunlop, Comox-Strathcona Guest Andrea Kiel, Fiscal Negotiator, Ministry of Aboriginal Relations & Reconciliation via teleconference 1. Introductions Joe Murphy welcomed everyone to the meeting and roundtable introductions were made.


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2. Approval of Agenda No changes were made to the agenda. 3. June 14, 2013 Minutes The follow-up items in the Minutes were completed.

4. VIHA Update Dr. Brendan Carr provided opening comments regarding:

• The importance of working with communities on initiatives to improve health; • Island Health reviewing the way we do our work to identify lower cost models that

create better value for health care (e.g. different technologies to reduce need to leave your community to receive health care); and

• Provincial priorities such as primary and mental health care. 5. First Nations Treaties – Funding for RHD’s Andrea Kiel joined the meeting.

Chris Sullivan summarized the discussions from previous meetings including First Nation Treaties and funding for RHDs, RHD membership and RHD taxation (see attached presentation). Alberni Clayoquot participants indicated that the addition of First Nations on their (Regional District) Board was positive and they are working on partnerships for infrastructure.

There was a discussion on the First Nation Health Authority (FNHA). Brendan indicated it is expected the FNHA will focus on primary health care. Andrea added that the FNHA will also focus on non-treaty First Nations as Canada transfers Federal assets to the in-treaty First Nation.

Toni O’Keefe indicated that First Nation representatives are interested in how Island Health interacts with their people. It is more about the relationship at this point, than the facility.

Maurice Rachwalski indicated the Capital Regional Hospital District (CRHD) may consider cost sharing on First Nations facilities.

Chris also discussed a question on whether Federal funding is taken into consideration for cost-sharing on capital projects? In a 2003 Sierra Systems report on Health Authority and RHD cost sharing processes this was identified as a structural issue. The report indicated that:


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In the past there was a direct link between the funds for health capital transferred by federal government on behalf of on-reserve First Nations communities and actual expenditures. At present these funds are contained in the Health and Social Transfer Payment made to the Province, some portion of which flows through the Ministry to the Health Authority, although it would be difficult to follow this trail. Like the Provincial Government contribution to health capital projects, these amounts cannot be traced. As such, they become “nominal” contributions, with a value that equals the value of previous federal contributions. RHDs are concerned that there is no evidence of a “local” contribution being made from federal funds in these areas.”

Follow-up items are:

• A summary of the known information regarding the impact of First Nation treaties and RHDs is to be prepared by Chris Sullivan, Teri Fong and Andrea Kiel.

• This item is to remain a standing agenda item for meeting participants to provide updates as available.

6. IHealth (Electronic Health Record) Joe provided a presentation on the advancement of Island Health’s Electronic Health Record (EHR) (see attached presentation). Through the IHealth initiative, we will extend our current facility-based EHR across the continuum of services provided by Island Health, and fully automate the remaining paper-based documentation. The EHR will also connect to the independent primary care systems that have been implemented in GP offices on the Island. Through Island Health’s EHR we will be able to drive the delivery of quality, evidence based care by embedding standards into clinical practice and providing advice to providers at the point that they are making decisions about care and treatment plans. Perhaps most importantly, the IHealth initiative will provide the foundational infrastructure to support improvements in the health of individuals and our population. Personal health records will provide a mechanism for patients to communicate with their providers, and document what’s important for them. The electronic health record will provide us with the data that is necessary to understand the impact of our interventions and to support us in predicting patterns and avoidable outcomes before they happen. The financing plan for this initial project does not include RHDs, although RHD funding may be requested in the future. Equipment purchases and new capital projects, which are cost-shared by RHDs, will be compatible with the I Health plan. Various comments were made including the need to manage expectations and ensure privacy.


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7. Island Health 2018 Strategic Plan Georgina MacDonald provided an update on the development of the strategic plan. During the previous four weeks, 320 sessions were held across Island Health to discuss community priorities and ideas to work differently to improve health and care including partnering with local stakeholders. Next steps are completion of the plan to be brought forward to Island Health Board of Directors at the end of March. Further discussion on the implementation of the plan will be discussed at the next VIHA RHD meeting in the Spring. A handout was provided at the meeting. 8. Community Wellness Information Session Maurice Rachwalski provided an update on the Capital Regional District Community Health and Wellbeing Project. The purpose of this project is to establish the most effective role for the CRD in promoting health and wellbeing of people and communities in the Region. The outcomes of the project can be shared with other RHDs for information. A handout was provided at the meeting. 9. Capital Planning Update Chris provided an update on the capital planning process. There are no changes to the Ministry project approval process or the VIHA process. Island Health has our capital funding targets from the Ministry of Health for the next three years. Island Health is in the midst of its 2014/15 capital prioritization process. As per previous years, the target Is to provide the projects and equipment lists to RHDs by January 31, 2014.

10. Facility Condition Audit As mentioned at the last meeting, the Province’s assessment of facilities is underway by a company named VFA. This is a five year assessment with Royal Jubilee Hospital (RJH) assessed in 2013 and Nanaimo Regional General Hospital to be assessed in 2014.

Follow-up items are: • Provide RHDs with the list of facilities to be assessed and schedule. 11. Future Meeting • Spring 2013


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Attachments: Presentation - VIHA – RHDs Semi-Annual Meeting (November 22, 2013) IHealth (Electronic Health Record) Presentation (November 22, 2013) Island Health 2018 – Draft for Discussion - Planning for the Future Together – Backgrounder (November 2013) CRD Community Health and Wellbeing (CHW) Project Update (November 22, 2013)

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VIHA – RHDs Semi-Annual Meeting November 22, 2013

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First Nations Treaties – Funding for RHDs

• Tla’amin Final Agreement – Describes approach to be used in Treaties

• A Path Forward – Tool Kit, September 2012 – Resource guide to support Treaty First

Nation, regional district and local government collaboration and planning

November 22, 2013

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First Nations Treaties – RHD Membership

• FN lands form part of RHD • FN represented by the RD director • If no RD director, then an elected

member of FN government to sit as RHD director

November 22, 2013

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First Nations Treaties – RHD Taxation

• Indian Act does not apply after Treaty • Property tax exemption (general rule)

– Residents – phased out over 12 years – Commercial – no exemption – Government – exemption remains

November 22, 2013

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Federal funding

• Federal funding for on-reserve populations? • 2003 Sierra Systems Review

– There was a direct link between funds transferred – At present there is no break down – As such, they become “nominal” contributions

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Capital Planning Update

No changes to: • Ministry project approval process • VIHA process

November 22, 2013

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VIHA Process Update

• 2014/15 project prioritization is underway

• January 31 target for RHD submissions

November 22, 2013

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Facility Condition Audit

• Five year rolling assessment • Royal Jubilee Hospital assessed in

Spring/Summer – results not yet final • Nanaimo Regional General Hospital will

be assessed in 2014/15

November 22, 2013

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The Advancement of Island Health’s Electronic Health Record (EHR)

One Plan One Person

for care and health

One Record

November 22, 2013 J. Murphy, Vice President, Operations and Support

The Need for Automation and Integration of Records

• Fragmented - paper-based health records are created and stored by provider, in different formats, in separate locations

• Inaccessible - paper is available in one location at a time, and is often not accessible (or even known to exist)

• Inefficient –care providers spend a significant amount of time ‘searching’ for relevant information

• Error-prone - the quality of manual documentation is not validated and there is no feedback provided to care givers

The Inherent Limitations of Paper-based Health Records

…errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them.”

Institute of Medicine. To Err is Human: Building a Safer Health System, November, 1999 “

Geographic Reach of Island Health’s Current Electronic Health Record

North Island (January 2008)

Centre Island (October 2008)

Port Hardy Port McNeill

Port Alice Alert Bay

Campbell River

Gold River Courtney/Comox

Tofino

Port Alberni Parksville

Nanaimo

Duncan

Saltspring

Victoria

South Island (2000 – 2002)

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Island Health’s single, integrated EHR is currently used at over 50 Locations

Denominational Affiliate – St. Joseph’s Hospital (October 2011)

Current EHR Content and Functionality

• Orders, Results, Documentation – Lab Results – Diagnostic Imaging Reports – Transcribed Documents – Structured Emergency,

Mental Health and Medical/Surgical Documentation

• Medication Profiles – Inpatient, Community (PharmaNet)

• Provider Communication Tools

• Limited Electronic Capture of

Vital Signs

EHR Access, Use, and Volumes

• EHR Access – 1,600 physicians and 13,000 clinical staff

have active EHR accounts – Wireless access is implemented across all

major hospital facilities – Over 10,000 computer devices on Island

Health’s secure network, including 510 mobile carts

• EHR Use – Over 3,000 unique daily users – Average daily peak of 2500 concurrent users

• EHR Volumes – Over 68,000 transactions/day, including:

• 2,700 medical imaging test orders, 4,000 medication orders, and 24,000 lab orders

– Over 4,200 new encounters/day

450

2,500

2005 2006 2007 2008 2009 2010 2011 2012 2013

Concurrent Use of the EHR (average daily peak)

The Value of a One Person, One Record EHR

A Patient’s Journey for Cancer Care in North Island

General Practitioner

Pt. McNeill Outpatient Laboratory

Pt. McNeill Hospital Inpatient Treatment and

Diagnostic Services

Virtual Consult with Oncall Specialist - VGH

Virtual Treatment Review by Oncologist

and Team Campbell River Outpatient Chemotherapy

Physician Orders Physician Reports

Multidisciplinary

Graphic Monitoring

Laboratory Reports

Diagnostic Reports

Medication Records

Miscellaneous

Cerner PowerChart Pt Demographics

Transcribed Reports Triage Documents

Lab Results Imaging Results Medication List

MH Clinical Profiles

Paper Electronic

Paper/Electronic Acute Care Record*

Current EHR Environment – the Hybrid Paper/Electronic Chart

* Chart Content Proportions Estimated for Illustration

Paper/Electronic Cross Continuum Record

Current EHR Environment – the Hybrid Paper/Electronic Chart

Acute Care

Residential Care

Home Care

Specialist Offices

GP Office

Provincial Registries

/Other

One Person

Island Health’s Electronic Health Record – The Road Ahead

1999 EHR system selected for Capital Health Region through RFP process

2002 VIHA established as one of six Regional Health Authorities

2006 VIHA Board approves strategy to establish a single, integrated Regional EHR

2008 One person, one record EHR in place across all acute and residential sites

2011 New capabilities introduced in RJH Patient Care Centre

2013 Strategy to extend EHR across the full continuum of care approved - IHealth

HOSPITAL BASED CROSS CONTINUUM/PERSON FOCUSED SECTOR SPECIFIC/PROFESSION FOCUSED

The IHealth Initiative

• Leverage the current One Person, One Record solution across the continuum of services provided by Island Health to fully automate the health record and enable intelligent EHR functionality. Connect to private primary care offices and other providers to complete the patient story.

• Drive the delivery of quality, evidence-based Care by embedding standards into clinical practice and providing meaningful advice to care providers

• Maintain and improve individual and population Health through person-health records, ongoing screening and monitoring, early intervention as required, active coordination of care activities, and monitoring of compliance/efficacy

One Plan One Person

for care and health

One Record

Excellent care for everyone, everywhere, everytime.

Island Health 2018planning for transformational change

viha.cavancouver

authority

The Vancouver Island Health Authority (Island Health) is one of six health jurisdictions in British

Columbia, providing health care and support services to more than 760,000 people on Vancouver Island, the islands in the Salish Sea and the Johnstone Strait, and mainland communities north of Powell River.

We are one of the largest employers on Vancouver Island, with more than 18,000 staff, 1,900 physician partners, and an army of volunteers. Their commitment – along with the dedicated support of our foundations and auxiliaries – enables us to deliver a broad range of health services, including: public health services, primary health care, home and community care, mental health and addictions services, acute care in hospitals, and much more across a huge, geographically diverse region. Beyond the scope of health care, Island Health is an important contributor to the local economy of the communities we serve, with our annual budget of about $2 billion.

As we begin to plan for the future, now is the time to reflect together about the challenges we face, the opportunities at hand, and the changes we need to make. This document describes some of the opportunities and challenges we feel are important. We would like to know what you envision for the future of our health care system, whether or not you agree with our ideas, whether there are other ideas you think should be considered, and how you believe we might achieve them. At the end of this document, you will find a link to a brief survey. We invite you to take a moment to provide your feedback about these emerging themes and ideas.

Planning for an organization as large and complex as Island Health is an

exciting challenge – one that must extend far beyond goal setting. We need a shared vision of the future that moves our hearts and minds. Over the past two years, Island Health’s staff, physicians and leaders have worked together to renew our vision and core values so they inspire our actions, guide our decisions and set the foundation for our new future. Our Vision:

Excellent care for everyone, everywhere, every time.

Our Core Values: Courage: to do the right thing, to change, innovate and grow.

Aspire: to the highest degree of quality and safety.

Respect: to value each individual and bring trust to every relationship.

Empathy: to give the kind of care we would want for our loved ones.

Planning for Change

C A R E

Island Health 2018

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Island Health employs over

18,000 staff and has more

than 1,900 physician partners

Island Health 2018

Opportunities

1 World Health Organization, 20112 BC Vital Statistics, 2011

A Healthy Population In A Desirable Location

At 82 years, Canadians have the fourth highest life expectancy in the world1 – and BC has the highest life expectancy in Canada. Health in BC has been improving for 20 years; age-adjusted death rates have declined by almost 35%, and infant mortality has dropped more than 50%.2 Because Vancouver Island is a particularly desirable location to live, it has become a retirement destination. The region – with its 3,400 km of coastline, mountains, old growth forests and mild year-round weather – tends to attract a vibrant, active population with a love of the outdoors and a generally healthy lifestyle.

Great People And A Great Place To Work

Island Health’s staff, physicians, volunteers and leaders are highly skilled and committed to provide excellent care in countless ways every day. We attract and retain great people so we can provide quality health care services.

Island Health has been one of Canada’s top 100 employers for the past four years. As an organization we value those who work for, and with us, and are committed to continue providing and improving our safe, high quality workplaces. We have made significant investments to support the staff, physicians and volunteers who provide care and services. One of our goals in this effort has been to create a workforce that reflects the populations we serve.

2

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Opportunities

Strong Partnerships

Over the past few years, Island Health has focused on establishing strong relationships and critical collaborations that help improve care. These valued partners include the Ministry of Health, local municipalities and Regional Hospital Districts, Aboriginal organizations, foundations, auxiliaries, Divisions of Family Practice, Collaborative Services Committees, Community Health Networks and many others.

Advances In Technology

Quickly evolving technology has enabled us to dramatically change the way we provide care. Increasing electronic literacy and the use of devices such as smart-phones gives constant access to information on the Internet and makes it possible for ideas and information to spread almost instantaneously. Island Health is shifting to a fully integrated Electronic Health Record, which will transform the way we manage information, improving communication between care providers, and increasing access and safety by providing a single comprehensive health record wherever a patient is receiving services.

The development of “smart” telehome devices will help many people monitor their chronic diseases and vital signs at home, contributing to more effective and efficient primary health care and helping people stay healthy in their own homes much longer.

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A Population That Is...

Growing • Island Health’s population of 765,849 is expected to grow 5-6% by 20183.

Changing • Our population in general is aging and birth rates are decreasing, but some regions have younger populations and are growing. • The population of the Western Communities, from Sooke to Colwood, will grow by more than 10% by 2018 - the highest growth on Vancouver Island3. • Other populations are actually expected to decrease in size – for example, Vancouver Island West, which has the greatest decline, is expected to shrink by 3.5%3. • Youth aged 0-14 make up 29% of the Aboriginal population compared to 14% for the non-Aboriginal population4.

Aging • The proportion of elderly people with higher needs for health care is on the rise. • In the next 20 years, Island Health’s population over age 75 is expected to grow from 9% of the population to 15% – twice the growth rate of the overall population3.

Health Challenges

3 BC Stats – PEOPLE 20124 Census 2006

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Health Challenges

An Uneven Distribution of Health

Overall, our population is relatively healthy, but there are significant differences across geographic areas with the poorest health in the North Island, West Coast and Cowichan Valley. Aboriginal people, people living in rural and remote communities and socially marginalized people generally have poorer health and face greater barriers to accessing health care.

Aboriginal Health5/6 • Life expectancy for First Nations peoples is nearly six years shorter than for other Island Health residents. • Premature mortality for First Nations peoples is more than twice as high as for other residents, with alcohol (5 times higher) and substance use (2 times higher) among the leading causes. • Premature death from chronic disease such as circulatory system diseases (2 times higher) and respiratory system diseases (2.5 times higher), and death from medically treatable diseases (2 times higher) is more likely for First Nations peoples than for other Island Health residents.

Rural/Remote Communities • Overall, life expectancy for Vancouver Island residents is high, at 81.5 years, but is much lower in some communities such as Vancouver Island North (76 years) and Alberni (78 years). • In these communities, external causes of death (including things like accidental poisonings, suicide and motor vehicle accidents) and alcohol and drug-related mortality rates are 1.5 to 2 times higher than BC.

Socially Marginalized Populations • There are over 1,500 homeless people in the Greater Victoria region alone7, and pockets of homeless people in other regions across the island. Many face complex conditions such as HIV or Hepatitis C, mental illness and substance use challenges • An estimated 25-50% of homeless people suffer from a mental health disorder and more than 90% suffer from at least one chronic physical health problem8.

5 Provincial Health Officer’s Report: Pathways to Health and Healing, 20076 Data represents only Status Indian populations7 Coalition to End Homelessness8 Mental Health Commission of Canada, 2012

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Health Challenges

A Rising Challenge of Chronic Disease

While Vancouver Islanders are more physically active and have better eating habits than people in the rest of Canada, not everything we do is healthy. Unhealthy behaviours and social determinants that impact health, such as poverty and the high cost of housing, contribute to a rising burden of chronic disease9.

• 21% of North Island residents smoke, compared to 18% on the rest of the Island and 17% in BC. • 18% of South Island residents report heavy drinking, against 15% on the rest of the Island and 16% in BC. • Over 50% of Central and North Islanders are overweight or obese, against 45% in the South Island and BC. • Chronic conditions like asthma, diabetes, and hypertension have been on the rise for 10 years — over 40% of our population has at least one chronic condition; 8.5% have three or more conditions10.

Youth Mental Health and Wellbeing

The transition from childhood to adulthood is especially difficult for young people with mental health issues. If we can focus our efforts earlier in a child’s life we may be able to build resilience and decrease the risk and impact of mental illness and substance use problems later in life.

• 1 in 5 Canadians will develop a mental illness by the time they are 25. • People between the ages of 10 and 19 represent about 10% of Island Health’s population, but account for about 14% of mental health visits to the emergency department.

9 2009/10 Canadian Community Health Survey10 Ministry of Health Chronic Disease Registry, 2008/09

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System Challenges

An Aging and Changing Workforce

Like Island Health’s population, our workforce is also aging and changing. This, and an increasingly specialized workforce, makes it more important than ever that we manage our human resources effectively as we plan for our future as an organization.

Replacing an Aging Workforce • Almost 30% of Island Health’s workforce is 55 years old or older. • As these people retire, declining birth rates and increasing global competition for labour will make recruiting and keeping skilled employees more difficult.

Adapting to Increased Specialization • Medical education and training has become increasingly specialized over the past few decades. • This makes it difficult to find people to take on more generalist roles that are particularly needed in smaller and more isolated communities.

Recruiting and Engaging with Physicians • Attracting and retaining physicians, especially in rural and remote settings is an ongoing challenge. • We must build strong partnerships with physician colleagues and ensure that their communities support them well.

Embracing Evolving Values • Representing both an opportunity and a challenge, younger people working in health care have new perspectives about work-life balance, flexible working arrangements and life-long learning opportunities.

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System Challenges

Keeping Healthcare Sustainable

Growth in health care spending consistently out-paces growth in revenues. As a country, we spend about 12% of our Gross Domestic Product (GDP) on health care – which could rise to 20% by 204011.

• BC spends about 42% of its budget on health care12. If we stay on our current path, that could increase to over 60% by 2030. When we spend so much on direct health care there is less available for other significant contributors to health, such as: health promotion, education, housing and social development. • We know that tackling the social determinants of health (things like poverty, housing and employment) can help keep Canadians healthy, yet the health system continues to stretch itself thin managing the day-to-day consequences of unhealthy physical and social environments. If this continues, we will spend more and more on a narrowing range of expensive services, and have less for other vital societal functions.

Making the Most of Evolving Technology

Rapid technological advances push organizations like ours to evolve quickly and present new opportunities to improve patient care. Island Health’s shift to a single Electronic Health Record and the adoption of home-based monitoring and communication technologies offers tremendous opportunities for improving care, but brings significant challenges as we change the way care providers work with each other and with patients and families.

11 Parliamentary Budget Officer, Fiscal Sustainability Report 2010 12 CIHI, 2010-11

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Preparing for the Future

The question is no longer, “Should we change,” but rather, “HOW will we change?” That is why we want to hear from you at this early stage of planning. We want to know about the

challenges and opportunities you think are important so that, together, we can build a health system that allows us to achieve and sustain our vision long into the future: Excellent care for everyone, everywhere, every time.

Island Health 2018: Emerging Themes We want to describe what Island Health will look like in 2018. These themes are emerging:

Healthy Islanders

Building and reinforcing community partnerships that help to create health, and working to improve health for our most vulnerable populations.

“Wow Culture”

Creating vibrant communities of staff, physicians, patients and clients, engaging visionary leaders who inspire excellence and generating an environment that instills passion about making a difference.

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Preparing for the Future

Excellence Every Time

Providing care that is driven by patient and client needs, evidence and best practice, and promoting relentless pursuit of learning, research and improvement.

We Are Better Together

Supporting the establishment and growth of integrated teams providing great care, realizing the courage to do the right thing – to change, innovate and grow, and fostering an environment where partners are valued.

With You All the Way

Providing health services with patients and clients as “partners in care”, with a commitment to a lifetime of care in a manner that promotes safety of clients, patients and staff at all times.

Innovation and Better Value

Building a system that ensures resources are always put to best use, to ensure services remain effective and efficient.

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authority

Island Health 2018

June 2013

We would like to hear your thoughts about the opportunities and challenges we are facing, and about the emerging themes

for the future direction of Island Health.

Please help by taking a moment to complete a short survey at:

viha.fluidsurveys.com/s/SP-survey

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