Previous page: Health care goes horizontal
Cost or investment?
Funding is a central issue. More money would give LHINs more wiggle room to help fulfil their e-health integration mandates, says Anderson. "The Ministry will say, there they go again. But the reality is it doesn't have to be a lot," he says, pointing to the successful wait-times program as an example.
In response to citizen pressure, extra funding was provided to help hospitals perform more high-priority procedures within defined timeframes. But to achieve that clinical outcome, a comprehensive information system was developed to support it. "They didn't say, let's put in a measuring system; they said, let's reduce wait-times."
The lesson learned is that a small percentage of overall funding can be very useful as incentive for systemic IT improvements, says Anderson. "If you look at the actual amount of money the wait-times program controls around doing more cancer procedures, for example, it's actually a fraction of the overall budget for cancer treatment in Ontario."
There are other areas where a similar approach can help build the information bridges needed to connect islands of information, he says. Projections of diabetes, for example, are making headlines. With an increasingly aging population, about 10 per cent of Ontarians will be diagnosed with the disease by 2010.
"IT will be the investment required to support diabetes management. We don't need all of the money for all of the databases required for that - many are already constructed," he says.
To understand patterns of the disease, a first step is building a population health model aggregating information from all sources: from hospitals to clinics to nursing homes.
But organizations struggling to meet their own IT needs will have a tough time coming up with funds to support broader integration projects. IT budgets in the health care sector are already at bare-bone levels, about half what is typically allocated in other industry sectors, says Martineau.
So extra funding would be useful in getting cash-strapped organizations onside, adds Anderson. "Then we could go to organizations with those diabetes databases and say, 'We're not asking you to cough up the dough yourself; we've got a bit here to move on the diabetes management agenda.'"
Martineau agrees funding levels and models are a major issue. "The biggest challenge the LHINs face from an IT perspective is dollars: inadequate funds to move on the e-health agenda," he says.
Other provinces fund IT projects separately from administrative budgets. Ontario alone lumps these together, he says. "You need to spend more money on IT today to get savings down the road.
"But hospitals get their knuckles rapped if they spend too much on administration. There's a lot of discussion going on at the Ministry to say, no, we should break out the IT budget so we can analyze it separately."
Many such funding and strategic issues are pending before government for decision, says Adalsteinn Brown, Assistant Deputy Minister with Ontario's Health Ministry.
Eliasoph says: "The Ministry's view has always been, 'We're in the health care business, not the IT business.' But that's an archaic view: if you're in the health care business, then you're in the IT business."
Joining the islands
The government's position is clear. "We want to see systems oriented to patient needs, so it means the systems that support the care people receive in different settings must be able to talk to each other," says Brown, adding the Ministry isn't concerned how systems are knitted together so long as this end-goal is achieved.
Many integration projects on the table predate LHIN restructuring, so there is tremendous goodwill to get on with the job, says Martineau.
With it comes a major behavioural change. Learning to work in teams across organizations to fulfil system-wide goals is the biggest challenge in the IT community, says Sam Marafioti, CIO at Sunnybrook Health Sciences Centre in the Toronto Central LHIN.
Different LHINs are at different starting points on the road to integration, as are different organizations within them. Most hospitals have advanced IT systems, but community care access centres have virtually no infrastructure. Many LHINs need basic plumbing and wiring such as secure e-mail and health information management networks to achieve a minimum level of interoperability within their own regions.
On top of intra-LHIN integration, there are many cross-LHIN dependencies to be considered in strategic planning. Toronto Central LHIN receives patients for specialized care from across the province at the Hospital for Sick Children and other downtown hospitals. Beyond Ontario, it also contains some of the biggest teaching hospitals in Canada.
One of the top priorities is building a common e-referral system, says Marafioti. Still largely handled by paper and fax, this project will define and digitize the patient information that needs to be transmitted and moved around as one organization refers a patient to another for tests, secondary follow-up care, and so on.
"This will really help people understand wait-times and moving patients based on priority. A referral will either get you immediate attention or get you on a waiting list," he says.
System integration will need to be done within the context of privacy and security legislation.
"We know how to secure information within our local systems, but how to secure it when it's moving around dynamically among many partners is very new to all of us," he says.
Dealing with the tension between local and regional priorities is another major challenge for the IT community, says Anderson. Organizations have their internal strategies to fulfil, but with limited resources.
"These are all committed to moving your organization forward, and now you have to parse off some resources to go over and build an interface," he says.
These projects are rarely as easy as they sound, as IT folks often run into data quality issues and other time-consuming problems, Anderson adds.
This may delay local projects that clinical staff want to launch. "Then you must tell someone local, 'I can't put in your departmental system because I have to shift my resources over to this regional priority,' which may or may not have great value back to my organization," he says.
Continued: Work in progress
Related content:
Health integration calls for more collaboration
Provincial health care blocks clamour for credibility
Leveraging analytics to maximize e-health records
State of the union: Health care regions across Canada
Regional networks offer wider access to information
Infoway upbeat on EHR progress
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