Patient care is improving. The way we work is changing. Thank you to everyone who is taking on additional work to learn our new system delivering improved Patient and Family Centred Care at West Parry Sound Health Centre and with our partner . Thank you generous donors for supporting our delivery of care. THANK YOU TO THE 20 CORE TEAMS DEFINITION OF THE TERM A huge thank you to the 20 core teams, which together have completed “COMPLETING the core build of the health information system (HIS). The core team A CORE BUILD” build members are now involved in testing and reviewing the system. The term refers to when CLINICAL STREAM (8 CORE TEAMS) the build of the HIS Core Team: Clinical Documentation (referred to as ClinDoc) has reached the point Core Team Lead: Julie McEachern - SAH where there is a working system and it is possible Module: Patient Care System (PCS), Bedside Medication Verification (BMV), Management (EDM) to conduct testing with integrated scenarios. Looking at the ONE Core Team: Surgical Services Initiative specifically, the Core Team Lead: Jennifer Ferguson – NBRHC core build represents Module: SUR approximately 80 to 90% of the overall build that will be achieved for Core Team: Health Information management (referred to as HIM) go live. Other remaining Core Team Lead: Tanya James NBRHC components of the system Module: HIM/Abstracting (ABS) / Medical Records Inquiry (MRI) / will continue to be built, up Scanning & Archiving (SCA) to the end of September.

Core Team: Imaging and Therapeutic Services Core Team Lead: Paul Drobny - Timmins District Module: ITS

Core Team: Laboratory Core Team Lead: Rachel Desjardins - NBRHC Module: LAB / Bloodbank (BB)/ Pathology (PTH) / Microbiology (MIC)

Core Team: Patient Access Core Team Lead: Suzie Hanson - SAH Module: Admissions (ADM) / Community Wide Scheduling (CWS)

Core Team: Core Team Lead: Lori Thibodeau - NBRHC Module: Pharmacy (PHA) / Materials Management for Pharmacy (MM. PHA)

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Core Team: Physician Systems TECHNICAL STREAM (6 CORE TEAMS) Core Team Lead: Chantal Gagne - NBRHC Core Team: Data Repository Module: Order Management (OM), Electronic Core Team Lead: Velli Pulkkinen - SAH Medical Record (EMR) and Patient Care Module Module: Data Repository (PCM)

BUSINESS STREAM (6 CORE TEAMS) Core Team: Interoperability Core Team: Business and Clinical Analytics Core Team Lead: Bob Filipowicz - SAH Core Team Lead: Melanie Malette - NBRHC Module: Interoperability / Non MEDITECH Module: BCA Interface (NMI)

Core Team: General Finance Core Team: Medical Information System (referred to as MIS) Core Team Lead: Sara Lingenfelter - NBRHC Core Team Lead: Cathy McQueen- Health Module: General Ledger (GL) and Fixed Sciences North Assets (FA) Module: MIS / Universe (UNV) / Corporate Management Software (CMS) Core Team: HR/Payroll

Core Team Lead: - Sarah McKinlay - SAH Core Team: Reporting Module: HR / Payroll (PP) / Global Internet Core Team Lead: Matthew Scott - SAH Access for Staff (GIAS) Module: Reports / Non Procedural Representation (NPR), for NPR applications / Core Team: Quality and Risk Management Report Designer (RD) for M-AT applications (referred to as QRM)

Core Team Lead: Rhonda Hurley - SAH Core Team: Technical Module: Quality and Risk Management Core Team Lead: Chad Carter - SAH Module: Technical Core Team: Revenue Cycle

Core Team Lead: Brian McKinlay - SAH Core Team: Conversions Module: Revenue Cycle (RCG) Core Team Lead: Andrew Kosar - Health Sciences North Core Team: Supply Chain Module: (no specific module) Core Team Lead: Linda Therien - NBRHC Module: Materials Management (MM) and Accounts Payable (AP)

ONE INITIATIVE NEWSLETTER 3 REGIONAL MILESTONES ACCOMPLISHED TO DATE:

COMPLETED UNDERWAY UNDERWAY 2019

DESIGN PHASE BUILD & TRAINING POST GO LIVE TESTING PHASE GO LIVE

PEOPLE BUILD

ONE Initiative governance Data centre established in Toronto, back-up centre in Montreal structure established. and eHealth connectivity. Approximately 180 people Data sharing agreement among the three WAVE 1 sites has throughout the local sites been signed. have contributed to the ONE Initiative to date. More than 350 regional order sets developed and approved regionally. The order sets are being built into the system and Project Management local review of the sets will soon begin. Office established. It consists of a team Physician usability sessions successfully completed at each of of 17 experts in the three WAVE 1 sites. areas that include, Clinical and business dictionaries are more than 85% completed. HIS implementation, security and privacy, MEDITECH Expanse test environment employed and operational. project management, clinical services, finance, Core build completed. technology, administration Integrated scenario testing started. and communications. Clinical future state work flows documented. Superusers recruited at each site.

TRAINING: Superuser recruitment completed.

POST GO LIVE: Operations and Sustainment committee established; developing post GO LIVE operating team, roles and responsibilities and a cost sharing agreement.

4 ONE INITIATIVE NEWSLETTER EDITION THREE MAY 2019

A LOOK AT THE BUILD, TEST & TRAINING PHASE WE ARE HERE! MARCH APRIL/MAY MAY/JUNE

CORE BUILD INTEGRATED FUTURE STATE COMPLETED SCENARIO WORK FLOWS TESTING VALIDATED COMPLETED

JULY AUGUST OCTOBER

PARALLEL RUNS TRAINING STARTS GO-LIVE GO-LIVE COMPLETED WPSHC SAH AND NBRHC

F2F CLINICAL STEERING COMMITTEE MEETING FEBRUARY 2019. Winter is a logistical challenge for this project. A snowstorm blocked highway access to this meeting in Toronto, for many participants.

ONE INITIATIVE NEWSLETTER 5 BEHIND THE SCENES: A LOOK AT THE ACTIVITIES OF THE PRIVACY AND SECURITY WORKING GROUP

Implementing a privacy and security structure for WAVE 1 hospitals that supports a successful go live in October is essential for the project’s success. This Q&A takes a look at the undertakings of the Privacy and Security Working Group (PSWG), a team of 11 members with the mandate to develop and implement a privacy and security structure for WAVE 1 hospitals that supports a successful go live in October 2019, delivers sustainability and support for WAVE 1 hospitals following go live, and supports a broader regional/ provincial model.

The PSWG has regional representation from North Bay Regional Health Centre (NBRHC), West Parry Sound Health Centre (WPSHC), Sault Area Hospital (SAH), Health Sciences North (HSN) and Timmins and District Hospital (TDH). The team is headed by ONE Privacy and Security Lead Lucas Febbraro, who is based at SAH.

The PSWG is overseen by the ONE Technical Steering Committee and works in partnership with eHealth, the Information Privacy Commissioner of , Meditech, Healthtech Consultants and participating hospitals, to assist ONE Initiative hospitals with meeting shared system privacy and security requirements and compliance.

Privacy and security Q&A

How will patient records change when the facilities and health practitioners responsible for MEDITECH Expanse system goes live at collecting, using and disclosing personal health SAH, WPSHC and NBRHC this October? information on behalf of patients, are referred to The ONE Initiative is about improving quality as Health Information Custodians (HIC). of care and improving the ease of delivering Ontario’s healthcare privacy law (Personal Health that care. The implementation of MEDITECH Information Protection Act, 2004), as well as Expanse at each of the three WAVE 1 sites will other applicable laws, and security and privacy result in a single electronic health information policies and procedures at both a provincial and system based on common standards and built hospital level, mandate that HICs are responsible to meet the specific needs of the north east for ensuring personal health information is held region. The patient record that resides in this securely and confidentially. The privacy and system will be available to all health providers security of all personal health information at at WAVE 1 hospitals involved in the individual’s WAVE 1 hospitals are protected by these laws, care at go live. policies and procedures.

How will patient records be protected when Through the implementation of physical, the MEDITECH Expanse system goes live at administrative and technical safeguards, SAH, WPSHC and NBRHC this October? consistent with best practices, personal health We all have a duty to protect patient privacy information is secured from unauthorized and that won’t change in the new system. collection, use and disclosure, as well as theft, loss, destruction and damage. In the field of privacy and security, institutions,

6 ONE INITIATIVE NEWSLETTER EDITION THREE MAY 2019

To ensure compliance with these laws, ONE • External data centre through IBM/Cloudwave Initiative hospitals have adopted the principle of privacy and security by design; the safeguards • Annual Service Organization Control include, but are not limited to, implementation Audits (SOC 1 and 2) to ensure compliance of cyber security controls, processes, policies, and standards procedures and resources, software and By integrating the IT systems of hospitals encryption protocols, firewalls, locks and other even more, will the impact of IT viruses be physical access controls, privacy controls and even more significant and wide-spread? oversight, impact assessments, staff training and confidentiality agreements. There are substantial benefits supporting the move toward a shared system. However, there Will the MEDITECH Expanse electronic are inherent risks in shared systems, including health information system being the potential for a more significant and wide- implemented in acute care hospitals spread impact from IT viruses and security across the NE LHIN be secure from viruses breaches. and security breaches? To minimize these risks, several steps are being When the three WAVE 1 hospitals go live in taken, including the development of a true October, the MEDITECH Expanse systems disaster recovery system in which a secondary at these hospitals will be integrated with backup data centre is being established 700 uniform standards, information sharing, and kilometres away from the central data centre at the technical support of world-class managed IBM’s main data centre. The geographic distance service providers. helps protect our systems from events that might The standardization of the privacy and security affect access to a data centre, such as a natural best practices across participating hospitals will disaster. ensure they have robust privacy and security The backup data centre will be for all the WAVE functions. These areas of standardization will 1 Meditech applications, including third party include, for example: applications such as Security Audit Manager, • Two-factor authentication MobiLab, and IPeople Echo.

• Robust security and privacy functionality, In addition to the geographical protection, both including industry standard encryption, data centres conform to strict industry standards ANSI 5010 versions of EDI transactions and and are recognized as Tier 1V centres, the highest supported code sets, and support for of an IT industry rating designation that ranges expanded security requirements and breach from 1 to 4. notification standards

• Greater compliance with eHealth Security Standards and Requirements

ONE INITIATIVE NEWSLETTER 7 How will patients be informed of the collection, use, PRIVACY AND disclosure and safeguards of their personal health SECURITY information in MEDITECH Expanse? WORK GROUP A strategic communication plan is being developed to inform patients about the collection, use, disclosure and safeguards of MEMBERS personal health information, using communication tools such as posters, patient brochures and websites. Lucas Febbraro, SAH, ONE Privacy & Security Lead What regulations govern the privacy and security of hospital Tammy Ryan, SAH, Interim health information systems? Manager Health Records Some of the regulations and resources that assist in governing and Privacy the privacy and security of hospital health information systems include: Chad Carter, SAH, Enterprise Architect • Personal Health Information Protection Act, 2004 (PHIPA);

Melodie Armstrong, NBRHC, • Freedom of Information and Protection of Privacy Act, Coordinator FOI and Privacy 1990 (FIPPA);

Jeremy Hewgill, NBRHC, • Public Hospitals Act, 1990 (PHA); Security Administrator • Organizational policies and procedures; and Dorothy Jenkins, WPSHC, Manager Health Records/ • Data Sharing and Confidentiality Agreements. Admitting & Communications

Denis Lachance, WPSHC, Information Technology Department, Security Administrator

Jim Hanna, WPSHC, Community Relations and Communications Officer

Karen Ann Conlon, TDH, Manager Health Data, Privacy Officer

Stephen Lloyd, HSN, Manager Information Security Top row, left to right: Jeremy Hewgill, NBRHC; Melodie Armstrong, NBRHC; Karen Ann Conlon, Amanda Gray, HSN, Timmins District Hospital; Dorothy Jenkins, WPSHC; Denis Lachance, WPSHC; Jim Hanna, WPSHC. Privacy Analyst Bottom row, left to right: Stephen Lloyd, Health Sciences North; Amanda Gray, Health Sciences North; Chad Carter, SAH; Tammy Ryan, SAH; Lucas Febbraro, SAH.

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HELPFUL RESOURCES ABOUT ELECTRONIC MEDICAL RECORDS AND PATIENT CARE BENEFITS

The Health Information and Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMRAM)

Have you wondered how your hospital’s use of electronic medical records (EMRs) compares to other hospitals? A helpful resource is the HIMSS EMRAM, which uses methodology and algorithms to score hospitals throughout the world on their electronic medical records capabilities. Using eight stages, the model measures the adoption and utilization of electronic medical record (EMR) functions.

HIMSS CUMULATIVE CAPABILITIES STAGE

• Complete Electronic Medical Record • External HIE; Data Analytics, Governance, Disaster Recovery, 7 Privacy And Security

• Technology Enabled Medication, Blood Products, And Human Milk Administration; Risk Reporting; Full CDS 6 Wave 1 Hospitals • Physician Documentation Using Structured Templates after go live. • Intrusion/Device Protection 5

• Computerized Physician Order Entry (CPOE) with Clinical Decision Support (CDS) • Nursing & Allied Health Documentation (90%) 4 • Basic Business Continuity

• Nursing & Allied Health Documentation (50%) • e-Medication Administration Record (eMAR) 3 NBRHC, SAH, • Role-Based Security and WPSHC, currently.

• Clinical Data Repository • Internal Interoperability 2 • Basic Security

• Ancillaries - Lab, Pharmacy, and Radiology / Cardiology Information Systems; PACS; Digital Non-DICOM Image Management 1

• All Three Ancillaries Not Installed 0

ONE INITIATIVE NEWSLETTER 9 HIMSS is a global, cause-based, not-for-profit organization focused on better health through information and technology. According to the website, it has more than 70,000 members. The organization leads efforts to optimize health engagements and care outcomes using information and technology. The headquarters are in Chicago and it has additional offices in the United States, Europe and Asia.

PATIENT CARE BENEFITS OF EMRs The HIMSS website has case studies of the clinical benefits of moving to HIMSS Stage 6 and 7. These accounts are from hospitals throughout the world, including Ontario hospitals, such as North York General Hospital, Ontario Shores and MacKenzie Health.

The following is a summary of the clinical benefits North York General Hospital (NYGH) has experienced in the meeting HIMSS Stage 6 requirements, by NYGH CMIO Jeremy Theal, an ad hoc guest of the ONE Physician Advisory Council.

• 100% clinician adoption, with over 80% of clinicians satisfied or very satisfied, with the system, immediately after go live.

• Medication reconciliation improved from 8% to >85% of our medical patient population, over four years since go live.

• Medication turnaround time for STAT antibiotics improved by 83% (from 291 minutes to 50 minutes), immediately after go live.

• Over 11,000 potential medication errors averted (patient mismatch averted through Closed- Loop Medication Scanning), over five years since go live.

• Appropriate prophylaxis against venous thromboembolism increased from 50% of inpatients to >97% of inpatients, with a corresponding 39% reduction in venous thromboembolism, over five years since go live.

• Order set usage on patient admission to hospital increase from 36.5% (paper) to >97% (Computerized Provider Order Entry), even though not mandatory, one year after go live, compared to before go live.

• Mortality from pneumonia and COPD exacerbation was reduced by 45% using CPOE vs paper orders, and by 56% using Computerized Provider Order Entry with a correctly-matched evidence-based order set, one year after go live, compared to before go live.

10 ONE INITIATIVE NEWSLETTER EDITION THREE MAY 2019

MEDICAL USERS SOFTWARE EXCHANGE (MUSE) Looking to learn and share your knowledge and experience about MEDITECH? You may find the Medical Users Software Exchange (MUSE), a community of MEDITECH users and related professionals, a helpful network to join.

The MUSE website describes this community as the leading source of networking and education for professionals using MEDITECH.

Membership benefits are listed as:

• Member-to-Member Knowledge Sharing

• Educational Conferences and Networking

• Virtual Training and Shared Learning

• Local Inspiration and Support

For more info about MUSE and how to become a member, visit museweb.org

MEDITECH BLOG The MEDTECH blog is a source of information about healthcare IT for health professionals around the world. Several posts are typically added each month.

Some of the articles feature Canadian case studies. For example, on March 12, 2019, Alicia Stevens, R.Ph.T., Pharmacy Informatics Coordinator, Regional Pharmacy Services at Huron Perth Healthcare Alliance and Alexandra Marine & General Hospital in Southwestern Ontario posted the story, “Five hospitals, two organizations, and one eMAR come together to improve patient safety.”

Interested readers can subscribe to the blog to automatically receive new postings, using the subscription feature on the right-hand column of the blog. MEDITECH BLOG MARCH 2019.

ONE INITIATIVE NEWSLETTER 11 WOW… INTEGRATED SCENARIO TESTING THANK YOU DONORS With the core build now completed, integrated scenario testing is starting at each of the WAVE 1 sites. The focus of this phase is testing Thanks to West Parry the future state workflows the teams have created and integration Sound Health Centre between modules. Foundation donors who supported last summer’s To conduct this stage of testing, sixteen scenarios have been Moose FM Radio-athon, developed with the input of the Core Teams and their Healthtech this WOW (Workstation on consultants, and ultimately finalized and signed-off by the Core Team Wheels) was purchased Leads. Each patient scenario will be tested within the new electronic for use in the WPSHC ED. health information system. It is part of the hardware being familiarized prior The testing scenarios will take virtual patients from emergency to go-live with ONE. ED department admission to discharge, and some scenarios will require nurses Jordan Patten and Mary Lynn Lee show off transition to inpatient processes. Peripheral components of the build their WOW along with will also be tested, including bar code scanners, armband printers, ED Clinical Leader Cara regular printers, and scanners. Rankin. An example of how the modules need to communicate between each other is when a physician orders a lab test from the Order Management Module: Lab and Nursing Modules should both receive the pending order notice.

Test scripts are used to guide testers step-by-step through a patient scenario in which data has to pass through multiple modules. The scenarios will also be evaluated on privacy and security.

Testing the future state workflows allow the sites to determine where the future workflows they have developed do not work in their environment, so these areas can be adjusted before the workflow signoff at the end of June.

WPSHC FEBRUARY 2019

Left to Right: Mary Lynn Lee, ED Nurse; Jordan Patten, ED Nurse; Cara Rankin, ED Clinical Leader.

12 ONE INITIATIVE NEWSLETTER EDITION THREE MAY 2019

INTEGRATED SCENARIO TESTING AT SAH APRIL 2019

INTEGRATED SCENARIO TESTING AT SAH APRIL 2019

INTEGRATED SCENARIO TESTING AT SAH APRIL 2019

ONE INITIATIVE NEWSLETTER 13 ABOUT THE 24 NE ONTARIO WAVE 1 hospitals THE ONE ACUTE CARE HOSPITALS WAVE 2 INITIATIVE IN THE ONE INITIATIVE hospitals This monthly regional newsletter shares some of the many project accomplishments of the ONE Initiative with hospitals in the North East Local Health Integration Network (NE LHIN), to help you get to know the NE ONTARIO people behind this transformational work. Readers with questions, requests for more information, or submissions for future articles, are welcome to contact the ONE Initiative Communications Lead, at christina.marshall@ necare.ca

Articles in this regional newsletter may be copied by hospitals participating in the ONE Initiative, with or without, acknowledging the ONE Initiative regional newsletter.

ONE INITIATIVE ACTIVITIES FROM APRIL TO JUNE

APRIL: Online orientation for WAVE 1 superusers APRIL 16 TO 18: Integrated scenario testing at SAH APRIL 30 TO MAY 2: Integrated scenario testing at WPSHC MAY 7: Superuser Bootcamp Day 1 at WPSHC MAY 7 TO 9: Integrated scenario testing at NBRHC MAY 21 AND MAY 23 Superuser Bootcamp Day 1 at NBRHC JUNE 5, 6, 7 Superuser Bootcamp Day 1 at SAH JUNE 10 TO 12 Closed parallel testing JUNE 17 TO JUNE 28 Open parallel testing * (some superusers will be participating)