Redesigning Care through Digital Health Implementation Lessons Learned from Ontario Hospitals Acknowledgements The Ontario Hospital Association (OHA) would like to thank all the member hospitals and provincial partners who contributed to this resource. Individual contributing authors are noted at the end of each story. The OHA also acknowledges the ongoing and valuable work of all health care professionals who embrace change as hospitals innovate to improve care delivery and patient experiences. Disclaimer This publication is a collection of hospital submissions The Ontario Hospital Association (OHA) assumes no showcasing digital health implementation initiatives responsibility or liability for any harm, damage or other across the province. It has been created for general losses, direct or indirect, resulting from any reliance on information purposes only and implementation the use or the misuse of any information contained in suggestions should be adapted to the circumstances of this resource. Facts, figures and resources mentioned each hospital. Hospitals should seek their own legal and/ throughout the document have not been validated by or professional advice and opinion when developing the OHA. For details on sources of information, readers their organization’s approach and plans for digital health are encouraged to contact the hospital directly using the implementation. contact information cited in each submission. I Introduction Digital technologies have, and will continue to, These factors point to what may be the key ingredient in dramatically change the delivery of care in Ontario’s achieving impactful implementation of new technology, hospitals and health care organizations. However, namely, collaboration. Involving stakeholders and end technological innovations are not solutions in users in meaningful opportunities for feedback and themselves, but offer a powerful opportunity to redesign dialogue is clearly critical for developing impactful the way care is delivered and leverage existing resources, solutions to address challenges in health care delivery streamline processes, and modernize care. Hospitals and patient and provider experiences. Within the across the province are actively working with local and collection, some stories feature work on large-scale provincial partners to jointly identify opportunities to digital health architecture or data and analytics. utilize technology to enable more seamless, high-quality Others focus on connecting care within and across patient care. provider organizations. Many detail patient experience improvements or virtual care. Although every story is This publication is a collection of stories showcasing unique, each one is a testament to the great work being successful digital health implementation in Ontario done in Ontario hospitals. hospitals. Each story is focused around a key challenge, an explanation of the process taken to address it, and The OHA hopes this collection will act as a catalyst a reflection on the impact of the work in question. in spreading innovative ideas to those seeking digital Hospitals have also shared valuable insight into the strategies for improving care delivery and patient lessons learned in the achievement of their goals. experiences in their own organizations and heath care communities. In gathering these examples of technological adoption, contributing authors were asked to choose from a predetermined set of success factors1 which they considered most relevant to the successful completion of their initiative. Factors most often selected were (in descending order): involving stakeholders, involving end users, project leadership, workflow redesign, and feedback and dialogue. 1 Adapted from: B. Kucukyazici et al. Best practices for implementing electronic health records and information systems in Health Information Systems: Concepts, Methodologies, Tools, and Applications. 2009 II Table of Contents Acknowledgements I Disclaimer I Introduction II CONNECTING CARE Enabling Integrated Care and Mitigating Hallway Medicine through Transitions, Discharge Planning Pathways and iPlan 1 Increasing Access to Specialized Care: The Ontario eConsult Program 5 Modernizing Health Care Communications 9 Using Smartphones to Improve Patient Care 12 DATA & ANALYTICS Command Centre: Large-Scale Technology to Support Patient Care, Efficiency and High Reliability 15 Our Journey to Quality Metrics 19 EMR EVOLUTION Electronic Health Record Optimization – Transformation Project 23 From Paper to Pixels: How Niagara Health Avoids Costs for Distributing Paper Reports to Community-Based Clinicians 29 One Tube One Label – Specimen Collection 33 Ontario Lab Information System Direct Integration to Hospital Information System 36 Single Encounter Workflow Project 39 PATIENT EXPERIENCE Empowering Patients Using Integrated Bedside Terminals 42 MySMH Pilot Project 45 Reducing the Burden of Opioid Use Disorder 48 Two Peppers: Humanoid Robots that Help Patients and Families Cope with Psychological Stress 51 VIRTUAL CARE Helping Bridge Gaps in Access to Care 54 How a Progressive Hospital System Is Expanding Care Outside its Walls 57 Putting the Heart into Heart Failure Care – Medly Program 60 III CONNECTING CARE Enabling Integrated Care and Mitigating Hallway Medicine through Transitions, Discharge Planning Pathways and iPlan Humber River Hospital Our Challenge Our Process Humber River Hospital (HRH), along with many In March 2016, the Central Local Health Integration hospitals in Ontario, is under enormous pressure Network (LHIN) formed an ALC Collaborative with to provide care to a growing and aging population. Central LHIN Hospitals, Central LHIN Home and Hospitals in Ontario regularly operate over 100% Community Care, and the Central LHIN to provide capacity; this negatively affects patients as there are focused, collective resources across the continuum for fewer hospital beds available for care and may result in the benefit of patients. hallway medicine. The biggest contributor to capacity challenges is that many patients who do not require The ALC Collaborative leveraged the Cancer Care the intensity of resources/services provided in an Ontario (CCO) Provincial ALC Leading Practices acute care hospital – designated Alternate Level of User Guide and developed clinical workflows to meet Care (ALC) – are waiting to transition to care in more identified strategies outlined in the Discharge Planning appropriate settings. Pathway. Over the course of a year, the Guide was used to identify gaps and opportunities in hospital processes, The majority of ALC patients waiting in hospital are through a current-state analysis conducted at each frail, elderly, and at risk of deconditioning, nosocomial hospital site. infections and iatrogenic injury, affecting their future health status. Efficient and timely transitions for these Qualitative data were obtained from staff through patients to appropriate care settings minimizes risks and surveys and engagement sessions, and from patients allows for better care and outcomes. Patients designated through patient experience surveys and feedback ALC are influenced by both hospital process and system communicated to discharge coordinators. ALC metrics capacity challenges: were collected and compiled from the CCO Wait- Times Information System (WTIS). The current analysis • Hospital process can be defined as how efficient revealed variation in discharge planning practices within the hospital is in transitioning patients to their next and across organizations. There were no standardized level of care and how effective they are at connecting processes which often resulted in miscommunication patients to their most appropriate care setting. with patients and families, late engagement, avoidable delays in discharge planning, and lack of a team • System challenges are a result of misaligned services, approach. This was echoed in qualitative data, and where available services in the community are not evident in quantitative ALC metrics. accessible in a timely manner. During the summer of 2016, the ALC Collaborative To address these barriers, hospital processes must prioritized opportunities for improvement and formed be optimized, and system challenges identified and two subgroups to work on a standardized substitute made visible to regional authorities to allow for better decision-maker (SDM) and escalation process. Subgroups alignment of community resources on a continued basis. were comprised of representatives from each hospital site, Home and Community Care, and the Central 1 Enabling Integrated Care and Mitigating Hallway Medicine through Transitions, Discharge Planning Pathways and iPlan LHIN. It included planners, unit managers, patient flow Additionally, HRH in collaboration with Central LHIN managers, discharge coordinators, ethics and program Hospitals, Central LHIN Home and Community Care directors. An iterative and collaborative approach to and the Central LHIN, developed iPlan, a new and development was used to ensure all stakeholders affected innovative application that was implemented across five by newly devised processes were included in solution hospitals and home and community care in a phased development. approach. iPlan automates the Discharge Planning Pathway to support: Our Solution • Day-to-day operations; The goal was to create efficient and effective processes • Corporate quality improvement; and at the hospital level in partnership with community • System-level decision making. agencies by leveraging leading practices in