Regionalization creates organisms from isolated cells
Back in the 1970s, U.S. Secretary of State Henry Kissinger, frustrated with the baffling multiplicity of people to consult, grumbled: "When I want to speak to Europe, who do I call?"
A similar state of affairs prevailed in Ontario's health care sector until recently. Organized in sectoral silos, there was no central entity concerned with common interests. "It wasn't clear who to call, so everyone would be called," says Hy Eliasoph, CEO of the Central LHIN (Local Health Integration Network) in northern Toronto. "Things got replicated over and over."
Moving forward on e-health initiatives across the continuum of health care providers was difficult in this scenario. Decisions made in isolation created fragmented IT environments lacking interoperability, says Eliasoph. As a consequence, Ontario lags other provinces in developing a unified health care system.
"Looking across Canada, there is a high correlation between regional integration and IT systems integration," says Michael Martineau, e-health practice leader at Branham Group Inc., an Ottawa-based IT research consultancy.
Shifting from a vertical to a horizontal regional model is a major change for Ontario. Now over two years into reorganization along regional lines, the 14 fledgling LHINs must learn to speak with one voice and their systems must talk to one another. Their impact is being felt in many areas and will continue to grow as they integrate disjointed parts into a provincial system.
Financial teething pains
A milestone was reached this month when the 14 LHINs assumed responsibility for funding health care organizations within their regions. Recognizing the province can't continue to micro-manage this enormous area, the Ontario Ministry of Health and Long-Term Care transferred about $21 billion of the $35.4 billion operation into LHIN hands.
"Just from a financial accountability perspective, this is a huge undertaking," says Eliasoph, adding that LHINs have been putting financial systems in place for this area of responsibility. These evolving organizations will play a larger strategic role in the future. "Any additional funding that hospitals or other organizations may want will be directed to us."
But there isn't much discretionary funding, at least for this first fiscal year, says Matthew Anderson, e-health lead for the Toronto Central LHIN and CIO of the University Health Network. "All that money is already spoken for," he says.
Agreements were signed with the Ministry last October, specifying the services expected for the funding. "For the most part, it means maintaining last year's volumes of transplants, cardiac procedures and so on, plus or minus a few things - so we'll be dealing with the deltas."
All administrative funding is in that pot, including money for IT projects which are not funded separately by the Ministry. In the past, if hospitals wanted to implement a system, they had to find the money themselves, says Eliasoph. This independent approach to systems development has created the cacophony of systems in Ontario, he says.
"Over time, we're thinking of a different funding model for hospitals and other organizations. IT funding will come with strings attached, which will be this: you can't just do whatever you think is right for your organization - there's a broader health system to consider."
Ultimately, LHINs are political vehicles to influence their organizations to operate with a more regional rather than local focus, since they have no delivery responsibilities themselves, says Anderson.
LHINs do have the authority to shift money around within their regions based on the priorities of the whole: to close or consolidate health care organizations, start joint programs and so on. But extra funding has not been provided for integration projects, he says.
Continued: Joining the islands
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