board of directors’ meeting - south west local health...

201 Queens Avenue, Suite 700 London, Ontario N6A 1J1 Tel: 519 672-0445 • Fax: 519 672-6562 Toll-free: 1 866 294-5446 www.southwestlhin.on.ca

Board of Directors’ Meeting Wednesday, December 16, 2010

1:00 p.m. – 4:00 p.m. South West LHIN, Board Room

AGENDA Agenda Item Lead

Decision/ Information

Time Allotted

1. Call to Order – Welcome and Introductions Chair 1:00–1:05 2. Declaration of Conflict of Interest

Chair

3. Approval of Agenda

Chair Decision 1:05-1:10

4. Approval of Minutes Chair Decision 1:10-1:15 4.1

Board of Directors – November 24, 2010

5. Items for Decision/Information 1:15-3:30 5.1

5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11

Appointment of Acting Board Chair Delegation of Signing Authority eHealth Strategy South West CCAC-Revisions to 2009-11 Multi-sector Service Accountability Agreement LHSC-Child and Adolescent Mental Health Transfer of Funding from Community to Hospital Envelope Allocation of Psychiatric Sessional Fee Funding Update on Integration: Choices for Change and Huron Addiction Services Woodstock General Hospital Request to Amend Functional Plan to Accommodate Additional Systemic Therapy (Chemotherapy) Services Health Service Provider 2010-11 Q2 Report Community Sector One-Time Minor Infrastructure Program Behavioural Support System for Older Adults

Chair M Barrett G Lanteigne M Brintnell M Brintnell M Brintnell M Brintnell K Gillis M Brintnell M Brintnell K Gillis

Decision Decision Decision Information Decision Decision Information Decision Information Decision Information

6. Recognition of Departing Board Member

K Blagrave Information

201 Queens Avenue, Suite 700 London, Ontario N6A 1J1 Tel: 519 672-0445 • Fax: 519 672-6562 Toll-free: 1 866 294-5446 www.southwestlhin.on.ca

7. Board and Senior Staff Reports 3:30-3:45 7.1 7.2 7.3

Senior Leadership Report M Barrett, M Brintnell, K Gillis, J White, G Lanteigne Board Chair Report Board Member’s Report

M Barrett Chair

Information

8. Closed Session

9. Date and Location of Next Meetings Board Committee-January 12, 2011, South West LHIN

Chair

10. Adjournment Chair 4:00

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Agenda Item 4.1 South West LHIN

Board of Directors’ Meeting Minutes

Wednesday, November 24, 2010 Wiarton Hospital – Board Room

Present: Kerry Blagrave, Chair (A) Sheryl Feagan, Director Janet McEwen, Director

Ron Bolton, Director Ron Lipsett, Director Linda Stevenson, Director

Staff: Michael Barrett, CEO Kelly Gillis, Senior Director, Planning, Integration, and Community Engagement

Julie White, Director, Communications & Customer Service Rita Casciano, Corporate Coordinator Regrets: Murray Bryant, Director

John Van Bastelaar, Chair (A) 1. Call to Order – Welcome and Introduction

The Acting Chair called the meeting to order at 1:00 p.m. There was quorum and 5 members of the public were in attendance.

2. Declaration of Conflict of Interest There was no declaration of conflict of interest. 3. Approval of Agenda

MOVED BY: Janet McEwen SECONDED BY: Linda Stevenson THAT the Board of Directors’ meeting agenda for November 24, 2010 be approved as submitted with the addition of item 5.8 LHIN high priority provincial projects/activities. No closed session will be required.

.

CARRIED

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4. Acting Secretary MOVED BY: Linda Stevenson SECONED BY: Ron Lipsett

THAT Janet McEwen be appointed as the acting Secretary for the November 24, 2010 Board of Directors’ meeting.

5. Approval of Minutes

5.1 Board of Directors – September 22, 2010 MOVED BY: Janet McEwen SECONDED BY: Ron Bolton THAT the Board of Directors’ meeting minutes from September 22, 2010 be approved as presented.

CARRIED

5.2 Board Committee – October 13, 2010 MOVED BY: Janet McEwen SECONDED BY: Ron Bolton THAT the Board Committee meeting minutes from October 13, 2010 be approved as presented.

5.3 Board of Directors – October 27, 2010 CARRIED

MOVED BY: Ron Lipsett SECONDED BY: Janet McEwen THAT the Board of Directors’ meeting minutes from October 27, 2010 be approved as presented.

CARRIED

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5.4 Board Committee – November 10, 2010 MOVED BY: Ron Lipsett SECONDED BY: Janet McEwen THAT the Board of Directors’ meeting minutes from November 10, 2010 be approved as presented.

CARRIED

Discussion: The Board discussed how minutes are prepared for the Board’s review. It was agreed that the preparation and presentation of minutes will be discussed at an upcoming Board Committee meeting.

6. Items for Decision/Information 6.1 Huron Perth Health Care Alliance (HPHA) Vision 2013 Kelly Gillis provided an overview of the Board’s role in considering the proposed integration, the review process undertaken by LHIN staff of the HPHA Vision 2013 integration proposal, the review findings, and the recommendations being brought forward for the Board’s consideration. MOVED BY: Janet McEwen SECONDED BY: Linda Stevenson

THAT the South West Local Health Integration Network (LHIN) Board of Directors does not wish to issue an Integration Decision related to the intended integration entitled “Huron Perth Healthcare Alliance (HPHA) - Vision 2013,” for the first two components of the plan that do not relate to changes to Emergency Departments, as proposed in the Notice of Integration submitted to the South West LHIN on October 1, 2010; and THAT the South West Local Health Integration Network (LHIN) Board of Directors requires the HPHA to ensure the completion of the detailed planning necessary to mitigate any risks or potential risks in the implementation of Vision 2013.

CARRIED

Discussion: • Several Board members congratulated the Huron Perth Healthcare Alliance on the

work which was undertaken in the development of the Vision 2013 proposal. Board members also discussed the alignment of the proposal with the strategic directions of both the LHIN Blueprint and Integrated Health Service Plan (IHSP).

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The Board also discussed the risks which were identified in the staff report.The Board also discussed the motion which is required to address an integration proposal from a health service provider. A Board member commented that because of the way the legislation is written, the motion does not reflect the support the Board may have for the proposal.

6.2 Residential Hospice Development Kelly Gillis reviewed the residential hospice development report which was part of the Board package. The Board requested a letter be sent to the Minister expressing concern regarding the funding model for residential hospices. It was noted by staff that there have been ongoing discussions at a provincial level regarding the funding model and the sustainability challenges for residential hospices.

6.3 Board and Board Committee 2011 Meeting Schedule MOVED BY: Linda Stevenson SECONDED BY: Janet McEwen THAT the South West LHIN Board of Directors approves the first three months of the 2011 meeting dates and locations as follows, and that LHIN staff provide a revised list of locations for the remainder of 2011 at an upcoming Board meeting:

CARRIED

6.4 Board Laptop Conversion MOVED BY: Linda Stevenson SECONDED BY: Ron Bolton THAT the South West LHIN Board of Directors migrates to an electronic Board agenda package by January 2010. Board packages will be distributed electronically via email to Board members 5 business days prior to the meeting. Courier packages will no longer be distributed. Paper copies will not be available at the meetings. Board members who wish a paper copy will print the material and provide an expense claim each month for the printing charges. Laptops and internet “sticks” will be provided to Board members as required from the existing equipment inventory.

CARRIED

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6.5 Ombudsman’s Report Michael Barrett reviewed the staff report which was prepared to summarize the actions taken by the South West LHIN in response to the Ombudsman’s report The LHIN Spin. The report highlighted the actions taken by the South West LHIN Board including the amendment of its By-laws to remove “education” from the Board definition, and by adopting the new Communications and Community Engagement Plan, which contains the new guidelines setting out minimum standards for community engagement. The Board inquired as to what communications and community engagement processes are used to reach as many individuals and groups as possible, particularly those who may not have internet access or the physical ability to attending meetings. The Board heard that although the South West LHIN website is a primary resource for information sharing, newsletters are mailed out and media resources are also utilized. The Board also heard that South West LHIN staff spend a considerable amount of time on the telephone speaking directly which people from the LHIN as part of its customer service department.

6.6 Auditor General’s Report Michael Barrett reviewed the staff report provided to the Board on the Auditor General’s Special Report - Consultant Use in Selected Health Organizations, and reviewed with the Board the actions that have been taken by the South West LHIN in response to the report as highlighted in the report. The Board discussed how the recommendation requiring hospitals to report to LHINs on their use of consultants could be incorporated into the new Hospital Service Accountability Agreement (H-SAA) template.

6.7 Year-End Forecast of Operational Budget – 2010/11 The Board reviewed the Year-End Forecast for the Operational Budget – the Board was informed that although the Ministry of Health and Long-Term Care has provided reassurance that the funding will be coming in this fiscal year, the LHIN is still waiting for confirmation of the revenue associated with eHealth $600,000 and the Critical Care physician lead of $75,000. The Board was informed that several budget lines are forecasted to have a surplus amount, and it was recommended that these surplus amounts be used to address LHIN priorities. Board members asked several questions for clarification. The Board was also informed that additional revenue associated with the SPIRE project was not shown in this forecast, but would be included in future reports to the Board. MOVED BY: Linda Stevenson SECONDED BY: Janet McEwen That the South West LHIN Board of Directors authorizes the movement of up to $360,000 from surplus amounts in the operational budget to the “Consulting Services” budget line.

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CARRIED

The Board took a break at 3:30 pm The Board returned from break at 3:40 pm 6.8 LHIN High Priority Provincial Projects/Activities The Board was provided with an overview of the high priority provincial projects that have been agreed to by the LHIN CEOs. These projects are intended to provide a provincial focus for all 14 LHINs, and have been developed in close consultation with senior representatives from the Ministry of Health and Long-Term Care. Each priority project has a project charter and a LHIN CEO lead.

7. Board and Senior Staff Reports

7.1 Senior Leadership Report No questions were received from the Board.

7.2 Board Chair Report Kerry Blagrave reported that the Community Nominations Committee has met and shortlisted a number of potential candidates for the Board member positions who will be intervewed on December 10 and 15, 2010.The Board Chair position has not yet been appointed.

7.3 Board Members’ Report • Linda Stevenson attended the Minister’s announcement at the Stratford Hospital regarding

new MRI. • Ron Lipsett attended the hospice palliative care workshop in Grey Bruce on November 8,

2010 and the HOPE Grey Bruce Mental Health and Addictions 25-year celebration. • Janet McEwen attended the hospice palliative care workshop in Middlesex on November

17, 2010, the Minister’s grand opening of peopleCare Oakcrossing long-term care home location in London on October 29, 2010, and the Dale Brain Injury Services grand opening of a new building on November 12, 2010.

• Ron Bolton represented the South West LHIN Board at the Ontario Hospital Association HealthAchieve conference in Toronto, and provided a welcome from the South West LHIN at the Huron Perth Provider Table workshop called What Keeps You Awake at Night on November 17, 2010.

8. Closed Session No closed session was held.

9. Date and Location of Next Meeting

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Board of Directors - December 8, 2010, South West LHIN Office, London. Note: There is no Board Committee meeting in December.

10. Adjournment The meeting was adjourned by Ron Bolton at 3:43 p.m.

CARRIED

APPROVED: ______________________________

KERRY BLAGRAVE , CHAIR (A) SOUTH WEST LHIN

Date: ________________________

_____________________________

Janet McEwen, SECRETARY (A) SOUTH WEST LHIN

Date: ________________________

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Report to the Board of Directors Appointment of an Acting Board Chair

Meeting Date:

December 16, 2010

Submitted By:

John Van Bastelaar, Board Chair (A)

Submitted To:

Board of Directors Board Committee

Purpose:

Information Only Decision

Suggested Motion THAT the South West LHIN Board Committee opens the floor to nominations for Acting Board Chair effective January 4, 2011. Background At the June 9, 2010 Board of Director meeting the board passed the motion that the South West LHIN Board Committee appoint John Van Bastelaar as Acting Board Chair commencing June 17, 2010. The permanent Board Chair position is appointed by the Lieutenant Governor in Council. Interviews for the Board Chair are in progress through the Minister’s office. As of yet no appointment has been received. John’s term ends on January 4, 2011, therefore it is necessary for the South West LHIN Board of Directors to appoint a new Acting Board Chair. Under legislation the South West LHIN Board can only appoint an acting chair. It was recognized that the new Acting Board Chair will assume the position to fill the role; however, time commitment and responsibilities will be limited until that position is filled by the Ministry on a permanent basis.

Agenda Item 5.1

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Report to the Board of Directors Delegation of Signing Authority

Meeting Date:

December 16, 2010

Submitted By:

Michael Barrett, CEO Lisa Johnson, Manager of Corporate Services

Submitted To:


Purpose:


Suggested Motion THAT the South West LHIN Board of Directors approves the revised Delegation of Signing Authority for the new Acting Board Chair (note: as approved under item 5.2-Selection of Acting Board Chair, at the December 8, 2010, Board of Directors meeting). The signing authority for both commitment and spending is a maximum threshold of $100,000 up to $999,000 as per level 2; and THAT the South West LHIN Board of Directors approves the General Banking Resolution to approve that the new Acting Board Chair is added as an authorized signing officer. Background With a new Acting Board Chair to be appointed at the December 8th meeting, it is also necessary for the Board to ensure that the new Acting Board Chair has the proper signing authority. This motion does not change the signing authority thresholds; rather it simply ensures the new Acting Board Chair is given the appropriate approvals for signing. Next Steps A revised Delegation of Signing Authority will be signed when a permanent Board Chair is recruited.

Agenda Item 5.2

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Report to the Board of Directors eHealth Strategic Plan

Meeting Date:

December 16, 2010

Submitted By:

Glenn Lanteigne, Chief Information Officer and eHealth Lead

Submitted To:


Purpose:


Suggested Motion THAT the South West LHIN Board of Directors approves the eHealth Strategic Plan dated November, 2010. Purpose The South West LHIN has been without a formal eHealth Strategy. There has been an extensive process of evaluation and engagement to create the eHealth Strategic Plan that will provide guidance to the LHIN moving forward with respect to eHealth. The Strategic Plan is designed to act as a key enabler of the IHSP and the Blueprint to meet local requirements while also being in alignment with the Provincial eHealth Strategy. Overall, the eHealth Strategic Plan is intended to provide a vision for eHealth, as well as provide guiding principles and a framework for project evaluation. The eHealth Strategic priorities in which key projects must fall are defined as follows:

1. Capacity Management, Coordination and Collaboration 2. Quality and Process Improvement 3. Shared Electronic Health Record 4. Decision Support 5. Consumer Health

Agenda Item 5.3

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Background The approach to the creation of the eHealth strategy was to build on the Current State Assessment conducted by Healthtech and then use that assessment in the development of the Strategy under the direction of the South West LHIN eHealth Office, its eHealth Adoption Steering Committee, comprising a broad representation of LHIN leaders. In developing the eHealth strategy, an extensive cross section of stakeholders were engaged, leveraging existing structures, including the area provider tables, the Health System Leadership Council, numerous LHIN committees such as the CEO Forum, as well as constituents and key players, eHealth project leads, Information Management/Information Technology leadership, physician groups, as well as a broad range of external stakeholders and other LHINs. Considerable and in-depth information was collected and compiled by various data collection means of health service providers across the LHIN geography. To harness, leverage and optimize the benefits of technology, the South West LHIN has developed an eHealth strategy that will ensure the Blueprint and IHSP and is aligned with the Provincial eHealth strategy and Canada Health Infoway standards.

South West LHIN

eHealth Strategic Plan November, 2010

Agenda Item 5.3b

Today (Current State)

ll things considered, it had been a good month for Edith. After all, her hypertension seemed to be in check, her meds were stabilized and her diabetes was under control. Moreover, she felt as though her energy levels were to the point where she was able to get through most days without needing a mid-afternoon nap, something that had become a mainstay over the past several months. Not bad for a 78-year old widowed grandmother of two.

When she left the house that morning, she was confident that her visit to her family physician would be quick and uneventful. Of course, that had not been the case almost a year ago; looking back, Edith would shake her head in wonderment about how things worked or, more often than not, how they didn’t.

The biggest question was why it took so long to figure out what was wrong with her and what to do about it. She had several visits to her family physician, the cardiologist, the cardiac surgeon and the hospital outpatient clinic, not to mention several calls with Telehealth Ontario, two visits to the Emergency Department and an overnight stay in hospital for a series of tests and assessments by the heart team. She had several blood tests, a fluoroscopy test, a CT scan and others she couldn’t even remember. And, of course, for visits to the specialists, she had to travel from her home in Seaforth to London. There was even a time where she was transferred from the hospital in Seaforth to London Health Sciences Centre for a consult and further tests.

Edith could only chuckle at the mere thought that there was something called the health care system. It seemed to Edith that very few of the many moving parts of the ‘system’ worked together, shared information or was truly working as a team. The hospital, where she expected some semblance of order, also had its challenges. Edith wondered why she even needed to be in the hospital and why things took so long when she was there.

Why was it that everywhere she went, she was asked the same questions over and over again, and no one seemed to have all the information they needed from others to help make decisions and determine next steps? It seemed to her that there were unnecessary tests repeated because the information was not available – why did her family doctor perform the same tests as the cardiologist and the hospital clinic? Why did it take six weeks for the cardiologist to schedule an appointment with the cardiac surgeon, and then wait another two months to see the surgeon – couldn’t all this have been coordinated at one time?

And, of course, during this time, one of her ER visits, to the Stratford General Hospital, occurred. Would it have happened if her visit to the surgeon been arranged in a timely manner? What was really perplexing to Edith was that, no matter which hospital she visited, they all kept separate information about her; it seemed that there was no communication among them.

The things that seemed to be going well include the fact that most of her diagnostic imaging results were being stored centrally and could be accessed from anywhere and that there was an on line resource that her daughter could access to help navigate the system, called thehealthline.ca. In addition, her doctor’s electronic medical system was getting some of her hospital reports.

While Edith understood that her family physician coordinated her overall care, she sensed that once the matter was in the hands of the cardiologist, that a(nother) new point of coordination materialized, and that there was little coordination between her family doctor and the cardiologist. And what about her home care and Telehealth records? After all, her family doctor, as well as her home care nurse, were managing a variety of health care issues., yet this information was not readily available to each other or others, and certainly not the hospitals – the ones in Seaforth, Stratford and London. She shook her head, wondering how, despite itself, the health system actually managed to function.

A

November 2010

Table of Contents Today (Current State) ___________________________________________________________________________ 2

The Context ___________________________________________________________________________________ 1 Context.......................................................................................................................................................................1 The South West LHIN Blueprint and IHSP ..................................................................................................................3 The Provincial eHealth Strategy .................................................................................................................................4 Approach to the development of the strategic plan ..................................................................................................6

The South West LHIN eHealth Strategy _____________________________________________________________ 7 Introduction ...............................................................................................................................................................7 eHealth Vision, Guiding Principles and Evaluation Framework .................................................................................7 Strategy Development Methodology .........................................................................................................................8 Current State Assessment ..........................................................................................................................................8 eHealth Projects .......................................................................................................................................................10 Current State SWOT Analysis by Sector ...................................................................................................................13 eHealth Adoption .....................................................................................................................................................18

Future State __________________________________________________________________________________ 21 Strategies and Supporting Goals ..............................................................................................................................22 1. Capacity Management, Coordination and Collaboration .....................................................................................22 2. Quality and Process Improvement .......................................................................................................................24 3. Shared Electronic Health Record..........................................................................................................................25 4. Decision Support ..................................................................................................................................................27 5. Consumer Health .................................................................................................................................................28

Alignment ___________________________________________________________________________________ 29 Alignment between Current State Themes/Opportunities and Strategies ..............................................................29 Alignment of Strategies and Themes/Opportunities with Stakeholder Benefits .....................................................30 Moving Forward – Strategic Priorities......................................................................................................................31

Tomorrow (future state) ________________________________________________________________________ 35

List of Acronyms ______________________________________________________________________________ 36

Appendix 1 - Emerging Current State Themes / Opportunities __________________________________________ 37

South West LHIN eHealth Strategic Plan

November 2010 1

The Context Context

The South West LHIN health system serves approximately 944,852 residents across 8 counties spanning 21,865 square kilometers.

For planning purposes, these counties have been segmented into three geographic clusters:

North: Bruce and 95% of Grey Counties;

Central: Huron and Perth Counties; and

South: Middlesex, Oxford, Elgin, and 12% of Norfolk Counties.

A map of the LHIN showing the hospital referral activities is presented at the end of this section.

Approximately 70% of the South West LHIN population resides in the southern cluster, with London and Middlesex County having the greatest proportion of visible minority residents and residents with a non-official language mother tongue. The population distribution has naturally resulted in a concentration of specialized health services in the south.

While today’s health system is caring for its current population, emerging challenges may threaten its sustainability in the future.

The large geography of the LHIN and the rural nature of some South West LHIN communities continue to pose challenges for their residents in accessing health services.

The growing unemployment rate may have an adverse effect on select populations, increasing the need for mental health and addiction and other types of services beyond the current capacity.

The demands of an aging population significantly impact services and will continue to grow in the future.

The high prevalence of chronic disease throughout the South West LHIN may contribute to increased hospitalizations if managed inappropriately.

The South West LHIN population receives services from an array of LHIN and non-LHIN funded organizations across the community, long-term care, and acute health sectors. Residents rely on these organizations for a variety of needs including home/social support, episodic, chronic, and long-term care. The following LHIN-funded organizations play a critical role in delivering services to its residents:

19 public hospitals operating 33 sites and 1 private hospital;

75 community support services;

4 community health centres (plus 1 under development);

28 mental health agencies;10 agencies providing addictions services;75 long-term care homes; and

1 Community Care Access Centre (South West Community Care Access Centre).


November 2010 2

In addition, non-LHIN funded organizations such as family health teams, family health organizations, family health networks, solo-physician offices and public health units, play a critical role in the delivery of services. While these providers are not under the LHIN’s mandate, they play a significant role and have thus been captured in the South West LHIN’s Health System Blueprint – Vision 2022.

The health care landscape in the South West LHIN and across Ontario continues to evolve. Underlying this evolution are several forces and trends, notably:

The political and economic environment and fiscal challenges faced by the Ministry of Health and Long-Term Care, LHINs and health service providers;

The maturing of LHINs, including cycle of the Integrated Health Service Plans, greater inter-LHIN collaboration and joint initiatives, and increasing integration and coordination of health services;

Advances in technology that create new and cost effective possibilities for information exchange among providers and with users of the health system; and

Continued demographic changes, including continued population growth, aging and multi-cultural diversity.

In developing the second IHSP (2010 – 2013) and the Health System Blueprint – Vision 2022, the LHIN has set out a long term vision and roadmap to guide the planning coordination and funding of health services, as well as a near term tactical plan to focus on specific populations. To enable the achievement of the vision and plan, it is clearly recognized that information and clinical technology is a key enabler.

To harness, leverage and optimize the benefits of technology, the South West LHIN has developed an eHealth strategy that will enable the Blueprint and IHSP and is aligned with the Provincial eHealth strategy and Canada Health Infoway standards.

Figure 1: South West LHIN


November 2010 3

The South West LHIN Blueprint and IHSP

The South West LHIN Blueprint is an overarching and guiding framework for the realization of the LHIN’s vision of “A health care system that helps people stay healthy, delivers good care to them when they get sick and will be there for their children and grandchildren”. Toward this end, the Blueprint is intended to support planning, coordination, integration and funding of activities by and under the auspices of the LHIN and beyond. The focus of the Blueprint is built on an Integrated Health System of Care, built on two integrated service delivery approaches:

Population-based integrated health services; and

Centrally coordinated resource capacity.

The Blueprint also sets the context and parameters within which the current and future iterations of the LHIN Integrated Health Service Plan (IHSP) are developed. The current IHSP (2010 – 2013) features two strategic directions including:

1. Enhancing capacity and integration of primary, specialized and community-based care, with a focus on the following populations:

a. Seniors and adults with complex needs

b. People living with mental health and addictions challenges, and

c. People living with or at risk of chronic disease(s).

2. Enhancing access and sustainability of hospital-based treatment and care related to:

a. Emergency services; and b. Medicine, surgical and critical care

services.

Information and clinical technology (eHealth) is a key enabler of the Integrated Health System of Care described in the Blueprint. Specifically, the Blueprint identifies several potential technology solutions, including:

a centrally accessed repository of all South West LHIN health services;

a clinical information repository available to all health providers, as appropriate;

a clinical information repository, connected to a personal health portal;

an integrated care coordination system to enable electronic appointment referrals and bookings for patients/clients;

telemedicine and telehealth services; and

information systems to coordinate capacity management within acute care services.

The eHealth strategy is intended to align with and support the realization of the Blueprint as a key enabler. A thorough review and assessment of the Blueprint was undertaken using an eHealth lens to ensure that this eHealth strategy was developed in the context of enabling the Blueprint. Specific eHealth tactics were developed to support the IHSP 2010 – 2013.

Services provided close to homeDelivery of high volume/ low complexity services to broader populationCollaboration across local traditional and non-traditional providersEmphasis on an individual’s self-health management

Service delivery by geographic clustering of moderate volume/ complexity services focused on targeted populationsSeamless referral relationships with local and LHIN providers

Delivery of low volume/highly complex services to manage specialized populationsSupport multi-community and local providers with accessibility to specialized servicesMay serve as a broader provincial resource

Local Community

Multi- Community

LHIN Community


November 2010 4

The Provincial eHealth Strategy

eHealth Ontario, the provincial agency responsible for supporting the use of technology in the health system, has developed a provincial eHealth strategy (2009 – 2012). This strategy is intended to enable the realization of the provincial goal of creating an electronic health record (EHR) for all Ontarians by 2015. Hallmarks of this strategy include the following:

Alignment with the national eHealth strategy as set out by Canada Health Infoway, including the approved national architecture.

An Electronic Health Record that will include patient-specific information pertaining to lab tests, imaging results, drug use, immunizations, chronic disease management, hospital discharges, standardized assessments and other information as required/appropriate.

A set of principles to guide the development of eHealth projects in Ontario.

Three clinical priorities, including:

1. Diabetes Management;

2. Medication Management, and

3. Wait Times

Four foundational priorities, including:

1. Cornerstone information systems;

2. Clinical activity information systems;

3. Technology services; and

4. Enabling practices and talent management.

It is vitally important to ensure that, as the South West LHIN eHealth strategy is developed, in support of the Blueprint and IHSP, that it align with the Provincial eHealth Ontario strategy, now and as this strategy evolves.


November 2010 5

South West LHIN Referral Patterns In the South West LHIN, primary health care services are provided by organized family practice groups (Family Health Teams, Family Health Networks, Family Health Organizations, Family Health Groups, Community Health Centres, public health units, and individual practitioners). These providers are the first point of access to the health system and provide an array of services including early intervention and patient educational services.

The South West LHIN has three major acute care referral centres and networks:

Grey Bruce Health Services-Owen Sound in the north. This centre captures approximately 50% of all hospital admissions in the northern cluster of the South West LHIN.

Huron Perth Healthcare Alliance-Stratford General Hospital capture significant share of acute care provided in the central area of the LHIN with the service patterns extending beyond LHIN borders - 54% of total admissions coming from its immediate catchment area; and

London Health Sciences Centre and St. Joseph’s in the south manage the largest proportion of inpatient admission and have very large catchment areas, consistent with their role as tertiary care providers.

Of the LHIN residents, 6.7% are admitted for acute care services outside of the LHIN. Approximately 14% of acute care admissions in the LHIN are for residents from outside of the LHIN, with about half of these coming from the Eric St. Clair LHIN.

Each geographic cluster manages the majority of the general medicine-related need in its communities. A significant number of northern and central residents receive surgical care from the southern hospitals - 69% of surgical and 89% of medical ambulatory visits are captured in the south. The south has the highest volume of emergency visits, while the north has a greater proportion of visits per population.


November 2010 6

Approach to the development of the strategic plan

The framework used to prepare the South West LHIN eHealth plan is represented as follows:

Figure 2: SW LHIN alignment with eHealth Ontario at the strategic and tactical levels.

The diagram depicts the relationship and alignment of services and programs at the system level, as established by the Ministry of Health and Long Term Care, and the South West LHIN Blueprint and IHSP-2. A similar relationship and alignment for eHealth is depicted at the system level, as set forth by eHealth Ontario, and the South West LHIN eHealth Strategic Plan and supporting tactics for implementation.

As well, there is a horizontal relationship between programs/services and eHealth in that the latter is an enabler of the former, at the system, strategic and tactical level.

Health System Strategic Priorities

Ministry of Health and Long-Term Care

eHealth Ontario Strategic Plan

SW LHIN Strategic Priorities

SW LHIN eHealth Strategy

SW LHINTactics

SW LHIN IHSP - 2 eHealth Tactics

Programs / Services eHealth

SW LHIN Blueprint


November 2010 7

The South West LHIN eHealth Strategy Introduction

The eHealth strategy was developed under the direction of the South West LHIN eHealth Adoption Steering Committee, comprising a broad representation of LHIN leaders. In developing the eHealth strategy, an extensive cross section of stakeholders was engaged, leveraging existing structures, including the area provider tables, numerous LHIN committees, constituents and key players, eHealth project leads, Information Management/Information Technology leadership, physician groups, a broad range of external stakeholders and other LHINs. In addition, considerable and in-depth information was collected and compiled by means of an extensive survey of health service providers across the LHIN geography.

eHealth Vision, Guiding Principles and Evaluation Framework

Vision The eHealth vision adopted for purposes of the eHealth strategy is identical to the vision articulated by eHealth Ontario, that being:

“Achieving excellence in health care by harnessing the power of information.”

Guiding Principles Several principles were established to guide the development of the strategy, including:

Enhance the patient/client experience and health system performance

Engage all stakeholders and, in particular, the clinical leadership and health care/service providers

Strive to achieve integration and sustainability

Promote collaboration and partnership

Set measurable goals

Operate in a transparent manner

Leverage existing strengths and assets and industry best practices.

Evaluation Framework The development of the eHealth strategy was undertaken within a framework that was anchored in key strategic considerations derived from the LHIN mandate, Blueprint, Provincial eHealth strategy, and enunciated through extensive stakeholder consultation. The resulting Evaluation Framework has five domains and corresponding criteria as outlined on the following page.


November 2010 8

These domains and respective criteria were used to determine and screen the emerging current state themes/opportunities.

Domain Criteria

Strategic Fit Alignment with South West LHIN blueprint and IHSP2

Alignment with eHealth Ontario strategy

Alignment with the Canada Health Infoway blueprint

Alignment with regional priorities within the LHIN and five South West eHealth strategy future state priorities

Population Health

Supportive of clinical outcomes including quality of life

Supportive of patient safety objectives through reduced risk and better information sharing

Supportive of health promotion and disease prevention

Enables effective population based reporting

Integration and Interoperability

Adoption of technical standards supporting integration of systems across the health care sectors

Integrated service provision (e.g. referral management) and data sharing across the health sectors

System Values Person-centered

Leverage existing strengths and assets and industry best practices

Equity - balance across sectors and service providers and balance between clinical and corporate requirements

Service will support consistency in processes, practice, systems and standards through partnerships and collaboration

Public satisfaction and comfort with eHealth

System Performance

Efficient and effective system navigation

Supports quantification of benefit realization and return of investment

Efficiency – initiative supports reduced redundancy and leverages current systems and processes

Capacity – Support the creation of additional capacity through effective planning and sharing

Strategy Development Methodology

The development of the eHealth strategy was based on a comprehensive Current State Assessment that provided a baseline moving forward. The Blueprint and IHSP provided high level direction in terms of Future State, and this was further refined and articulated through extensive stakeholder engagement - through meetings, interviews and a survey. Based on a gap analysis of Current and Future State, a limited number of strategies were developed to guide and direct efforts and the allocation of resources to support eHealth projects and initiatives comprising the tactical elements of the plan. The selection of strategies and initiatives was guided by an evaluation framework.

Current State Assessment

A comprehensive current state assessment has been conducted as a baseline or reference document for the developing a standardized eHealth Strategy that considers both the shared and unique needs of service providers. The material contained in the current state assessment provides a compendium of baseline information and summary of salient topics, themes/opportunities and challenges. The information from the current state assessment will be used to inform and identify gaps and possible strategies for consideration in defining the future state.


November 2010 9

The current state was documented based on a comprehensive review and assessment of the following information and data sources:

Relevant documents, reports and reference material from the LHIN, health service providers and external stakeholders;

Stakeholder key informant interviews;

Focus group sessions;

Survey of health service provider organizations;

Analysis of the Ministry of Health and Long-Term Care data base;

Analysis of the Ontario Hospital Association HIMSS Analytics survey results;

Vendor input; and

Material from the available data repositories

Key elements of the current state assessment include the following:

1. Strategic eHealth-related issues analysis in relation to the LHIN Blueprint and IHSP;

2. Referral patterns in the South West LHIN, with a view to ensure that automated information flows support the continuity of care along these patterns;

3. A review of current South West LHIN eHealth projects/initiatives;

4. Primary care Electronic Medical Record adoption;

5. For each sector – acute, long-term care

and the community’s various sub sections;

a. A S.W.O.T. (Strengths, Weaknesses, Opportunities and Threats) analysis;

b. The state of adoption of electronic record keeping;

c. eHealth priorities ; d. Alignment of eHealth priorities with

the Blueprint priorities; e. Barriers to success in implementing

eHealth initiatives/projects; f. Capacity to address issues of privacy

and security.

6. Hospital Information Technology resources (both human and financial) analysis, Electronic Medical Record status and current and future priorities and initiatives;

7. A comprehensive summary of input from key stakeholder groups by sector and across sectors;

8. Highlights of innovative initiatives and projects; and

9. Emerging themes and current state themes/opportunities.


November 2010 10

eHealth Projects

The South West LHIN is engaged in several eHealth projects. Some of these have been initiated by the LHIN directly while others have been provincial eHealth initiatives in which the LHIN has participated to varying degrees. (Figure 3) is a summary and categorization of the many eHealth projects and initiatives currently underway.

LHIN Initiated Projects (eHealth/other)

Project Description

1 SPIRE Southwest Physician Office Interface to Regional Electronic Medical Record (SPIRE):Enables physicians with an Electronic Medical Record to receive radiology reports, lab results and notes electronically rather than by mail or fax.

2 Partnerships for Health

Applying the Ontario Chronic Disease Prevention and Management (CDPM) framework, the initiative helps practitioners integrate the component parts of the health care system by sharing information across the continuum of care. There is a specific focus on engaging external partners (Community Care Access Centres, diabetes education centers, mental health and community pharmacies) with primary care to form partnerships ensuring continuity of care, delivery of evidence-based care across the community, improved linkages to tertiary care, and engaging the patient in self-care.

3 Clinical Regional Viewer

A pilot project to ascertain the ability and feasibility of information exchange among mental health service providers across two LHINs

4 North-South Connectivity

A project designed to connect two Cerner hospital information systems – in Grey Bruce and Thames Valley. Project deployment is currently being reassessed.

5 Healthline.ca Single trusted source of information regarding health services and resources in the South West LHIN (sponsored by the South West Community Care Access Centre) accessible to the public

6 eShift Portable technology-based initiative, to support home care for complex paediatric patients, that connects an enhanced-skill Personal Support Worker (PSW) in the home with a nurse via a web-enabled devices, allowing one nurse and a group of PSWs can share a workload previously covered by several nurses. This model is now being used to support palliative care patients as well.

7 Patient Flow and Access

Develop standardized, LHIN-wide rules of interaction and communication between hospitals and physicians that will improve the patient referral and transfer process

Figure 3: LHIN Initiated Projects (eHealth/other)


November 2010 11

In addition to the LHIN-initiated projects, there are many projects initiated at the provincial level. These projects are summarized below, and the nature of involvement of the providers in each of these projects is noted.

Provincial eHealth Projects

Project Description SW LHIN Role

1 Chronic Disease Management System - Diabetes Registry and eHealth Portal

The Chronic Disease Management System - Diabetes will support diabetes care with evidence based guidelines. It will track test dates and provide lab results, give care providers and patient reminders, alerts and reports.

Lead

2 Diagnostic Imaging (DI/PACS)

DI/PACS is a secure information system that contains patient radiology reports and diagnostic images such as CT scans, ultrasounds, MRIs and x-rays.

SWODIN project management overseen by London Health Sciences Centre, and is one of a handful of provincial repositories

Lead

3 Alternate Level of Care/Resource matching & Referral (Alternate Level of Care/RM&R)

A provincial wait times reduction initiative with phase 1 completed in March 2010 Part of a four-LHIN initiative (with ESC, HNHB and WW LHINs) to move patients out of acute

facilities and into more appropriate environments, including rehabilitation, continuing complex care, long-term care and home via Community Care Access Centre

Phase 2 (recommended to proceed) defines the future state business process model and requirements and the technical requirements for an RM&R solution, as well as conducting a market assessment of RM&R solutions that will inform the requirements.

Lead

4 Regional Planning and Analysis for Integration

This project will help determine how LHINs should cluster together around eHealth projects. Active

5 Ontario Lab Information System (OLIS)

OLIS has been built to electronically store test results from Ontario’s medical laboratories, making them quickly available to authorized health care practitioners province-wide.

Grey Bruce Health Services has served as a provincial pilot site for OLIS, which is an early step in moving the health system away from paper-based records to more accessible, electronic files.

Active

6 Ontario MD Electronic Medical Record deployment

Intended to increase the number of Ontario physicians who use certified Electronic Medical Record solutions. The LHIN is supporting the integration of Hospital Information System to Electronic Medical Records as well as supporting the adoption and utilization of Electronic Medical Records.

Active

7 CritiCall Ontario A provincially-led initiative to address placement needs in critical care departments and finding appropriate specialists.

Currently LHSC, Grey Bruce Health Services-Owen Sound and Huron-Perth Healthcare Alliance -Stratford are involved in this initiative.

Active

8 Emergency Neurosurgery Image Transfer System (ENITS)

ENITS enables remote neurosurgical consultations for patients presenting with suspected brain injuries or illnesses by making secure digital CT images available through a centralized provincial Picture Archiving and Communication System (PACS) which can be accessed over the internet.

Observer

9 Wait Time Information System (WTIS)

WTIS is the first-ever information system to monitor, measure and publicly report wait times across the province. In addition to emergency room wait times, there is now a single system to capture and better manage wait times for cataract surgery, cancer surgery, cardiac surgery, hip and knee replacement surgery and MRI/CT scans.

In the South West LHIN, wait time data collection also includes all adult and paediatric elective surgeries. Emergency room and Community Care Access Centre integration and Emergency

Observer


November 2010 12

Project Description SW LHIN Role

room and alternative level of care planning are underway.

10 Community Care Information Management (CCIM)

Co-ordinate effort crossing community, long-term care, community mental health and the Community Care Access Centre.

Jointly funded by LHINs and MOHLTC. Implementation of business systems (MIS and HRIS) Implementation of Common Assessment Tool. Integrated assessment. Levering investments as appropriate.

Observer

11 ConnexOntario Comprehensive source of information for patients and providers. Funded and mandated by the MOHLTC – supporting the mental health and addictions (adult)

sector. Children’s services are to be included in the future. Several pilot projects underway. Automated daily updates are sent to two LHINs.

Observer

12 Ontario Network for eHealth (ONE)

ONE is eHealth Ontario’s suite of products and services that create electronic connections to improve the flow of patient information between health care professionals.

It includes the ONE Network, ONE Mail, ONE Portal, ONE ID, ONE Pages and ONE Hosting, all of which is backed up with ONE Support.

Observer

13 Drug Profile Viewer (DPV)

The DPV system is an electronic information system providing authorized health care providers in emergency departments and other hospital locations with secure access to drug claims histories. Histories are available for the 2.3 million recipients of the Ontario Drug Benefit Program (also includes the Trillium Drug Program). DPV helps providers quickly identify the potential for harmful drug interactions or lethal combinations of drugs

Observer

14 e-Prescribing E-Prescribing, or electronic prescribing, is the process of electronically generating, authorizing (“signing”) and transmitting prescriptions from physicians and other prescribers to pharmacists and other dispensers.

There is a pilot project in Barrie at a family health team.

Observer

Figure 4: Provincial eHealth Projects


November 2010 13

Current State SWOT Analysis by Sector

Long-Term Care The key eHealth issue for this sector is that a lot of information is still maintained on paper but does have some electronic documentation. The challenge remains with the exchange of information with other sectors, e.g. placement assessments.

There are 75 long-term care homes in the South West LHIN. Over 60 per cent have some form of electronic client registration. Just over one-third of the homes outsource their Information Technology in part or in whole.

With many of the LTC homes having established some sort of electronic systems, getting data to flow into those systems is a key challenge; automating this transmission of information would save a considerable amount of time. Electronic information exchange with the Community Care Access Centre was identified as a top priority. Other priorities included sharing of information within the circle of care and sharing patient information among health service providers. Figure 5 is a summary of the Current State of eHealth adoption for the LTC Home sector.

Snapshot: Long--Term Care

Current State: Strengths Current State: Weaknesses

Relatively higher level of automation. Most homes have adopted systems to manage resident admissions, care planning and assessments

50% of long-term care homes have electronic clinical documentation

Manual entry of data, particularly from Community Care Access Centres (assessments, patient transfers) and hospitals (lab results).

25% do not have anyone responsible for privacy

Future State: Trends & Opportunities

Future State: Challenges

Staff scheduling / payroll implementations are underway at multiple homes

Drive to increase electronic information sharing with other health service providers

Sustainable funding No access to patient

records from encounters outside the long-term care home (such as hospital stays)

Figure 5: Current State of eHealth Adoption for LTC Home Sector


November 2010 14

Community Care The key eHealth issue for this sector is that most of the organizations use paper-based systems for information management, with the exception of the South West CCAC. The agencies are generally too small to undertake individually the investments required for transitioning from paper to electronic workflow. There are 103 Community Agencies in the South West LHIN, including Community Mental Health and Addictions, Community Support Services, Community Health Centres, and the South West Community Care Access Centre. The community sector represents a diverse range of services and size of organizations. Several initiatives are positioning these organizations for capturing and, where required, sharing standardized information across the continuum of care. They include: Use of CHRIS as the case management

system by the Community Care Access Centre. CHRIS data and client assessments will be integrated;

Sharing of referrals to contracted service providers through the Health Partner Gateway;

Community Care Access Centre and four main CSS organizations working on data integration;

Electronic Medical Record solution update by Community Health Centres;

Implementation of business systems (MIS and HRIS) in community support, long-term care, community mental health and addictions services through CCIM;

Implementation of the Common Assessment Tool (usually RAI, OCAN for mental health, Screener tool for some CSS organizations where an assessment is not necessary);

Integrated assessment data - inpatient and community mental health data, CSS

and Long-Term Care(targeted for November 2010);

Lack of IS/IT support is a key issue for many community agencies. Almost one-half of the agencies reported that they outsourcer IS/IT. Below is a summary of the current state of eHealth adoption for the community sector.

Snapshot: Community Care


South West Community Care Access Centre has a well-functioning system and processes in place.

74% of organizations have electronic systems for patient registration.

59% do the intake assessment electronically

30% reported having no Information Technology support.

32% have no disaster recovery plan.

On the Information Technology process risk matrix, 43% of critical Information Technology processes were implemented

Manual entry of data, particularly from Community Care Access Centres (assessments, patient transfers) and hospitals (lab results).

Future State: Trends and Opportunities


Top priorities are Information exchange with the Community Care Access Centre and hospitals – Number one regional priority is creation of Electronic Health Record

Increasing the level of automation within each organization

Information Technology Support

Sustainable Funding

Agencies reported that sharing patient information, particularly RAI assessment data, with other health service providers was a key priority to reduce manual processes along with sharing of information within the circle of care. Improvements to reporting (particularly streamlining and/or harmonizing LHIN and MOHLTC reporting requirements) were cited as an important priority for community agencies. A key priority for the Community Care Access Centre is to


November 2010 15

standardize processes and data exchange among hospitals.

EMR components currently in place > 60% of hospitals EMR components not yet in place

Laboratory Results

StandardizedAssessment

Diagnostic Reports

Patient Registration

Med Orders (PHA)

PACS HOBIC

Vital Signs

Nursing & Allied Health Progress

NoteseMAR/BMV

Scanned Documents

Specialized Documentation

ECG’s, Monitoring & Other Digital Images

Physician Documentation

CPOE

Dx Instructions/ Prescriptions/

Summaries

Emergency Record with Documentation

Intake & OutputTranscribed Notes

EMR components in place between 1 and 60% of hospitals

Huron-Perth Hospitals (excludes Listowel-Wingham

and Exeter)

Ambulatory Care Clinic Record

Non-Medication Order Entry

Non- Physicians

Care Planning

Computerized MAR

OR Record (Documentation)


November 2010 16

EMR components currently in place > 60% of hospitals EMR components not yet in place

Laboratory Results

StandardizedAssessment

Diagnostic Reports

Patient Registration

Med Orders (PHA)

PACS HOBIC

Vital Signs

Nursing & Allied Health Progress

NoteseMAR/BMV

Scanned Documents

Specialized Documentation

ECG’s, Monitoring & Other Digital Images

Physician Documentation

CPOE

Dx Instructions/ Prescriptions/

Summaries

Emergency Record with Documentation

Intake & OutputTranscribed Notes

EMR components in place between 1 and 60% of hospitals

Grey-Bruce Hospitals

Ambulatory Care Clinic Record

Non-Medication Order Entry

Non- Physicians

Care Planning

Computerized MAR

OR Record (Documentation)

Acute Care Sector The key eHealth issues for this sector include the lack of integration and the varying levels of adoption and utilization of clinical information systems varies widely across and within the three hospital networks of the South West LHIN.

The South West LHIN has three Hospital Information Systems supporting the hospitals of the LHIN. Hospital Information System deployment status by module within each network is represented by the following schematic and show the varying levels of adoption of clinical systems.

Comment [BA1]: Should this come before the puzzle diagrams?

Comment [GL2]: Brian – please put puzzle diagrams after and reference accordingly


November 2010 17

The table below provides a summary of the Current State for the acute sector.

Snap Shot: Acute Care


Hospitals are split into three clusters (Thames Valley in the south, Huron Perth in the central area, and Grey Bruce in the north cluster. Each cluster shares a Hospital Information System - which allows for sharing of patient health information within that cluster.

Systems are at or beyond the provincial average for automation

Systems responsible for improved patient safety (physician order entry, closed loop medication administration) are not in place

Paper chart still record of truth for a large piece of patient data. Electronic/paper split chart creates risk and encumbers clinician workflow.

Lack of information flow between the three Hospital Information System clusters

Future State: Trends & Opportunities


Increasing the level of automation within each organization

Connectivity with primary care physicians

Sustainable funding Lack of common clinical

standards or framework

Each of the Hospital Information System clusters is identified in the table below, along with their total budgets, Information Technology spend, per cent of Information Technology spend and HIMSS Analytics scores.

Area Budget ($000,000)

Information Technology

Budget ($000,000)

% Information Technology

Spend

HIMSS Adoption

Score

Thames Valley

$1,483 $74.9 5.1% 2.51

Huron Perth

$112 $2.5 2.2% 2.16

Grey Bruce $209 $5.8 2.8% 3.13

South West LHIN

$1,804 $83.2 4.6% 2.58

Province 3.5% 1.69

Across the LHIN, acute care Information Technology spending is above the provincial average (4.62% of operating budgets in the South West LHIN vs. 3.5% provincially) and this is accompanied by higher e-health adoption scores (2.58 average vs. 1.69 for the province). An ‘unusual’ situation appears to exist within the LHIN in regards to the relationship between HIMSS Adoption scores and Information Technology investment at the network level. Grey Bruce has a relatively low level of Information Technology investment (2.8%), and a relatively high HIMSS Analytics score (3.13). While these numbers do not reflect the entire situation, they do appear to suggest that the Grey Bruce Network has been able to leverage and, to some degree, optimize its Information Technology spend.


November 2010 18

The acute facilities are more focused on improving systems and tools within their organizations than the other sectors. Three of the top four initiatives in the hospital sector are focused on providing clinicians within the hospitals with better tools to do their job. In addition, developing a regional view of patient information was also a top priority. Other areas of internal focus include transcription/voice recognition; enhancing the Hospital Information System with the implementation of additional modules such as CPOE, Clinical documentation, and physician documentation; and the implementation of staff scheduling / payroll solutions.

eHealth Adoption

The state of eHealth evolution in the South West LHIN is reflected in the results of the eHealth survey of health service providers.

The survey results reinforce the observations garnered from the key stakeholder interviews. The internal focus of hospitals are hospital-specific priorities, and high priority placed on eHealth adoption in general. The priorities identified by the long-term care home sector do not tend to be similar to those in hospitals. The community sector, with the exception of the Community Care Access Centre, does not identify many eHealth adoption priorities.

Type of Information LTC Community Acute

Care Planning 81% 44% 31%

Standardized Assessments 69% 22% 31%

Patient Registration 63% 74% 100%

Intake Assessments 63% 59% 38%

Vital Signs 50% 15% 46%

Nursing / Allied Health Progress Notes

50% 11% 46%

Medication Orders (Pharmacy)

31% 11% 85%

Discharge Notes, Prescriptions, Summaries

31% 19% 46%

Computerized Medical Record

25% 15% 85%

Physician Documentation 13% 4% 8%

Lab results 6% 4% 100%

Diagnostic Reports 6% 7% 92%

Transcribed Reports 6% 7% 100%

Alignment with the LHIN eHealth Initiatives An assessment of the alignment of sectoral priorities with LHIN eHealth initiatives is displayed in the table below. In general, there is a fair degree of consistency of alignment across sectors. This is promising in terms of collaboration and consensus on future state priorities.


November 2010 19

Solution LTC Community Acute

LHIN wide multi-sector real-time Electronic Health Record, accessible to all health providers

2 (62) 1 (89) 1 (69)

Care-coordination system allowing organizations to make electronic appointment referrals and bookings across sectors

3 (59) 3 (78) 3 (49)

Repository of South West LHIN health services including capacity measurement and electronic booking

4 (46) 2 (87) 2 (51)

Telemedicine and telehealth services including specialize tele-consult services enabling treatment and referral

5 (44) 6 (42) 6 (27)

Personal health portal including self-assessment, self-management, and scheduling tools

6 (41) 4 (63) 5 (34)

enhanced functionality of critical system including LHIN wide capacity management, bed capacity reporting, physician consultation planning, etc

1 (63) 5 (61) 4 (43)

Percent of providers who indicated that they were engaged with the LHIN on eHealth matters/activities

20% 25% 33%

Primary Care Physicians Physicians are not under the auspices of LHINs. Yet there is a strong inter-dependency that has implications for both physician practice and the LHIN mandate for planning, integrating and funding health services. Further, physicians are an integral part of the electronic connectivity continuum. This is especially true for primary care physicians/family medicine.

There are approximately 700 physicians operating in 105 practices within the South West LHIN. Of the 105 practices, 41 use an Electronic Medical Record system. These 41 practices use systems from nine different vendors as shown in the chart below. Three out of five physician offices do not have an Electronic Medical Record, or if they do, the vendor is unknown. Outside of Practice Solutions, no one vendor has a market share of greater than 10%. This is problematic insofar as connecting physician-based Electronic Medical Records with hospital clinical information systems will necessitate dealing with a multitude of vendors, compounding the challenges of building interfaces

.


November 2010 20

What About Edith The current state assessment and emerging themes and opportunities speak to some of the challenges that Edith faces in navigating the health system. In many respects, Edith’s story reflects the current state of the health system, and opportunities for improvement. Indeed, this system is very much characterized as depicted below.

Do we not have the know-how, abilities, and technology to make the experience and outcome better?

The answer to this question is a resounding “YES!”

Getting there is the hard part. The South West LHIN is committed to the journey and the destination. Here’s how we plan to do so.


November 2010 21

Future StateTo enhance the patient experience and health outcomes, in other words, to get Edith from today (current state) to tomorrow (future state), the South West LHIN will commit to the following:

1. Capacity Management, Coordination and Collaboration: Build capacity and support better coordination and collaboration among health service providers under the auspices of the LHIN and beyond to better serve the users of the health system.

2. Quality and Process Improvement: Enhance the quality and outcomes of the health care/services provided to users of the health system.

3. Shared Electronic Health Record: promote the interoperability of electronic health/medical records and make them accessible to providers, as appropriate, and consumers.

4. Decision Support: Provide needed clinical and non-clinical decision support for better planning, management and understanding of evidence based health care and health system improvements.

5. Consumer Health: This includes the patient, resident, or client. This strategy promotes consumer empowerment and access to the system and uses consumer engagement and empowerment to drive system improvement.

The interdependencies and relationships of these commitments are captured in conceptual schematic above. It portrays the underpinnings of quality and process improvement and capacity management, coordination and collaboration, these being a shared electronic health record and decision support. All are designed to improve and enhance the experience and outcome of the user (consumer) of the health system. Progress and outcomes will be evaluated to determine their impact.

Resonating through all the strategies are preliminary initiatives to support the consumer eHealth movement - necessary steps towards achieving self management of health, for effective chronic disease management, and personal and community health targets.

Consumer

Consumer


November 2010 22

Strategies and Supporting Goals

Of the five eHealth strategies, the first two are outcome-oriented, focusing on tools of access and availability of services and ensuring that these services are safe and of high quality.

1. Capacity Management, Coordination and Collaboration

The focus of this strategy is to ensure that eHealth promotes maximization of capacity of health services, provider and patient awareness and utilization of these services; continuity of care for patients as they receive these services; and automation of the information exchange among service providers. Several initiatives form the basis for a broader consumer eHealth strategy that the LHIN may wish to formulate in the future.

This strategy is supported by several broader tactics: that support and enable LHIN leadership and sponsorship of achievement of an electronic data sharing environment and development of inter-LHIN relationships.

Strategy Goals Match clinical needs with available

providers

Utilize effective collaboration processes and tools, such as telemedicine, portals, eReferrals, eConsults, eReports (e.g. hospital reports)

Deploy collaborative tools for patient to provider and provider to provider communication and information sharing

Adopt the Ontario eReferral Specifications (release June 2010)


November 2010 23

Opportunities Acute Care and Sub-specialty Care

Referral System: Assess the feasibility of extending and/or replicating e-referrals from the Grey Bruce Information Network to the South West CCAC for oncology patient’s homecare, and using it as a model for other acute and sub-specialty clinical referrals.

Bed Board and RM&R Expansion: Build on the success of the RM&R Alternate Level of Care Project Phase 1 collaboration with the Erie St. Clair, Hamilton Niagara Haldimand Brant and Waterloo Wellington LHINs by moving ahead with Phase 2.

Regional Bed Board: Implement a Regional Bed Board, a South West LHIN tool that will track capacity, acuity, modeling and human resource requirements (recommended in the Blueprint). Similar to CritiCall, the initiative will be expanded to include acute care, CCC, RH, LTC, CCAC/homecare, supportive housing and other community providers. The RM& R work and FLO Collaborative have highlighted the opportunities for improvement.

Standardization: Standardize processes, technologies and best practices to save costs and improve patient care, e.g. electronic sharing of standardized assessment tools.

Use Regional Clinical Viewer for Referrals: Assess the feasibility of adopting a regional clinical viewer for effective referral to the non- acute care sector.

Expand Use of Telemedicine: Develop a funding strategy to leverage the valuable technology Ontario Telehealth Network provides - for equipment

(upgrades) and infrastructure costs of health service providers. Leverage telemedicine strategies to bridge the geographical service gap in the north and central area of the LHIN.

Provider Portal: Implement individual and provider health information portal(s) to support communication, knowledge sharing and information sharing.

Consumer eHealth: Assessment of solutions that support patient / client engagement in self care. This could include leveraging provincial projects (e.g. Diabetes Registry), and local projects (e.g. Healthline.ca).

Directory of Services: Continue efforts to make available a broad and deep repository of services (e.g. expand on thehealthline.ca) crossing all sectors supporting education, care coordination, real-time capacity availability and electronic booking (e.g. a “Choose and Book” type application) in both official languages, with access to First Nation’s languages.

Patient Portal: Assess patient portal technologies to support patient access and navigation to be more interactive with their health care record and LHIN resources.

Inter-LHIN Collaboration: Encourage inter-LHIN collaboration in principle and on specific initiatives in particular, including sharing / consolidation of resources, both human and capital, where appropriate.

Partnering with the Erie St. Clair LHIN: Undertake a concerted effort to assess the feasibility of a partnership with the


November 2010 24

Erie St. Clair LHIN on joint eHealth strategy and resource sharing.

Continue the Development of eHealth Initiatives that Support the realization of the South West LHIN Blueprint and Subsequent Cycles of IHSPs: Position the LHIN as a potential ‘broker’ for the health service providers, liaising with internal and external stakeholders as needed, to define and deploy an eHealth strategy that supports the key goals and directions of the Blueprint.

2. Quality and Process Improvement

The focus of this strategy is to ensure that eHealth supports are identified and delivered wherever such tools can improve safety and quality of care; and automate processes that can transform care delivery and ensure continuity of care. These opportunities and those described under the first strategy ensure that information precedes or follows the patient as care is accessed and delivered.

Strategy Goals Deploy applications that support patient

safety - electronic medication management, ePrescribing, quality and risk management

Automate and coordinate the referral process to enhance continuity of care

Share medication histories at all points of referral

Incorporate clinical guidelines and, evidence-base care into automated workflows

Leverage technology to transform workflow workflow and monitor improvements in clinical processes and outcomes

Opportunities Order Set Deployment: Develop a

strategy and funding support for the deployment of order sets / clinical guidelines across the three hospital networks, integrated into the Hospital Information System.

Implementation of Advanced Clinical Applications: Consider funding and setting targets for the deployment of advanced clinical applications in hospitals, e.g., eClinical documentation, CPOE and eMAR to support information sharing and interoperability.

Medication Profile: Sharing medication profiles at all points of referral - build into eReferral projects and standards, and leverage SPIRE.

ePrescribing: Early adoption of ePrescribing functionality of the provincial Drug Information System (DIS), working with eHealth Ontario.

Chronic Disease Management and Prevention - Deployment of the Diabetes Registry: Build the capacity to work with eHealth Ontario and the Champlain LHIN to roll out and deploy the Diabetes Registry.

Referral Process Improvement Enabled by eReferral Tools: Leverage lessons learned from the St. Thomas-Elgin / Community Care Access Centre FLO Collaborative project.

South West LHIN Quality of Care Improvement Projects: support the adoption and use of technology by participants in these projects (e.g.


November 2010 25

Partnerships for Health) to enable the optimization of technology and meaningful use of information to monitor improvements in clinical processes and outcomes

***************************

The third and fourth strategies are foundational, focusing on the ehealth tools that each provider / organization will need to have to be able to participate in a collaborative environment, e.g. automation of their own workflow processes and decision support environment.

***************************

3. Shared Electronic Health Record

The intent of this strategy is to automate work flows of all service providers so that all patient information is captured, managed and shared electronically, within each practice and organization, and with a view to be shared across each individual’s circle of care and with the individual themselves.

Strategy Goals Implement information capture at the

point of care - discrete, standards-based data in shareable formats

Mobilize all data available on patients - e.g. Electronic Medical Record/Hospital Information System OLIS interfaces, access to regional PACS / DiR - access to view or to integrate into electronic records, as indicated by the care being provided

Integrate into the Electronic Medical Record data acquired through medical devices, mobile technologies and sensors

Access information external to the provider Electronic Medical Record - single sign on / ease of access

Initiate Electronic Health Record/EMPI/Clinical Repository initiatives to support information exchange with partners

Support clinical adoption through funding, coordination, change management and workflow redesign


November 2010 26

Privacy and security policies and procedures which permit the timely exchange of patient health information

Opportunities Promote Community-based Physician

Electronic Medical Record Adoption: Take an active role in promoting Ontario MD Early Adoption of Electronic Medical Record funding program by community-based physician practices and their interdisciplinary teams. Extend the project work done in this area in alignment with local physician needs, eHealth Ontario and Canada Health Infoway.

Leverage existing solutions for the Community Sector: Explore how to leverage and integrate other existing technology solutions, such as CHRIS, and Chronic Disease Prevention and Management Systems.

Shared Hospital Regional Electronic Health Record: Provide the necessary leadership to support the development and integration of systems to create a regional Electronic Health Record (with the three hospital networks – Thames Valley, Grey Bruce and Huron Perth).

Integrated Projects: Assess and determine how to better coordinate and possibly integrate local and provincial initiatives and projects.

Regional Clinical Viewer: Evaluate the clinical viewer pilot project to determine whether it should be extended throughout the LHIN and identify implementation challenges and opportunities.

Interoperability: Design interfaces to provide interoperability between legacy systems and new systems in place or planned, across health service providers in the LHIN.

Use of Portable Technologies: Develop a strategy respecting the use and funding for portable technologies / mobile devices for use in the community / home care settings.

Collaboration with eHealth Ontario: Establish a working relationship with eHealth Ontario to ensure effective and early deployment of provincial initiatives that support the Blueprint, such as Electronic Medical Record Adoption Program, hospital reports, OLIS-Electronic Medical Record integration, and community provider access to the DiR, ePrescribing and Drug Information System.

Leveraging the Existing Networks and Regional Systems: Build on the existing hospital networks (Thames Valley, Grey Bruce and Huron Perth) and the LHIN-wide systems used by the CCAC and deploy strategies to support clinical health information collection, sharing, storage and security within and among the networks and with other health service providers.

Network Connectivity: Develop an overall strategy to address the issues of poor connectivity (infrastructure) in rural areas. There may be an opportunity for the LHIN to work with eHealth Ontario and local municipalities to ensure that the issue is highlighted and the impact it can have on the delivery of community and LTC services is appreciated.

Information Technology Support for Community and Small Hospitals, Community Support Service Providers:


November 2010 27

Leverage the assets and infrastructure of the existing hospital networks to support other health service providers in participating in the collection, sharing, storage and security of information, for example, consider leveraging / extending the Grey Bruce Information Network model to support community and small hospitals in the Thames Valley hospital network.

4. Decision Support

The fourth strategy is the implementation of systems to support and deliver decision support and business intelligence services at the point of clinical and administrative decision-making.

Strategy Goals

Enter data once and use many times for care, clinical and administrative management purposes, as required

Integrate business and clinical systems

Standardize what and how data is shared.

Automate external reporting

Develop a LHIN-wide view of health resource planning and management

Opportunities Capacity Management and Forecasting:

Develop a standard data set to support referrals, capacity management and forecasting. This comprehensive system would support patient movement; access to appropriate services; and supports provides to plan for resource requirements. .

Data Availability: Address the growing need for data for analysis to plan and support program delivery.

Evidence-based Decision Making: Incorporate evidence-based information into electronic tools used for clinical and management decisions.

Population-based Health Data Reporting: Leverage available tools with incumbent systems. Integrate data with the data residing in primary care Electronic Medical Records.

South West LHIN Business Intelligence Tool: Explore the need for a LHIN-wide Decision Support / Business Intelligence tool, to acquire ability to develop balanced score cards/ dashboards with local and provincially-available data.


November 2010 28

5. Consumer Health

While the preceding four strategies are all intended, in one manner or another, to improve and enhance outcomes, they are primarily provider-facing, in that they do not involve or engage the consumer or user of the health system. The fifth strategy is consumer facing in that the themes/opportunities speak specifically to the users of the health system.

Strategy Goals Equip consumers with the tools and

capacity to assume active and shared ownership over decisions affecting their health

Support consumers in providing and accessing real time health information, when/where appropriate

Enable consumers to exercise more control over timely access to appropriate health resources

Opportunities Promote Community-based Physician

Electronic Medical Record Adoption: Take an active role in promoting Ontario MD Early Adoption of Electronic Medical Record funding program by community-based physician practices and their interdisciplinary teams. Extend the project work done in this area in alignment with local physician needs, eHealth Ontario and Canada Health Infoway.

Consumer eHealth: Assessment of solutions that support patient / client engagement in self care. This could include leveraging provincial projects (e.g. Diabetes Registry), and local projects (e.g. Healthline.ca).

Directory of Services: Continue efforts to make available a broad and deep repository of services crossing all sectors supporting education, care coordination, real-time capacity availability and electronic booking (e.g. a “Choose and Book” type application) in both official languages, with access to First Nation’s languages.

Patient Portal: Assess patient portal technologies to support patient access and navigation to be more interactive with their health care record and LHIN resources.

Use of Portable Technologies: Develop a strategy respecting the use and funding for portable technologies / mobile devices for use in the community / home care settings.

Population-based Health Data Reporting: Leverage current tools available within incumbent systemts. Integrate data with the data residing in primary care Electronic Medical Records.


November 2010 29

Alignment Alignment between Current State Themes/Opportunities and Strategies Opportunities emerging from the Current State can be organized and aligned within the South West LHIN eHealth strategic framework. Many of these are not mutually exclusive to one strategy, and are, indeed, overlapping. The table below shows the grouping of themes and opportunities by strategy.

Themes/Opportunity Strategy *

(see legend)

1 2 3 4 5

1 Continue the development of eHealth initiatives that support the operationalization of the South West LHIN Blueprint and subsequent cycles of IHSPs

2 Information Technology support for community and small hospitals, community support service providers

3 Bed board and RM&R expansion

4 Complex continuing care and rehabilitation care referral gate-keeping system

5 Acute care and sub-specialty care referral system

6 Chronic disease management and prevention - deployment of the Diabetes Registry

7 Regional clinical viewer

8 Referral assessment standards and tools

9 Consumer eHealth

10 Expand use of telemedicine

11 Provider portal

12 Use of portable technologies

13 Use regional clinical viewer for referrals

14 Inter-LHIN collaboration

15 eHealth partnership with the Erie St. Clair LHIN

16 Collaboration with eHealth Ontario

17 Leveraging the hospital networks

18 Order set deployment

19 Capacity management and forecasting

20 Promote community-based physician Electronic Medical Record adoption

21 Shared hospital regional Electronic Health Record

22 Leverage provincial and local systems

23 Implementation of advanced clinical applications

24 Establish a patient portal

25 Interoperability

26 Leverage CHRIS for the community sector

27 Network connectivity

28 Referral process improvement enabled by eReferral tools

29 Sharing medication profiles at all points of referral, and ePrescribing

31 Increased adoption of quality of care projects underway in the South West LHIN

30 Population-based health data reporting

31 South West LHIN business intelligence tool

32 Capacity management and forecasting

33 Data availability for program support and analysis

34 Evidence-based decision making support

STRATEGIES LEGEND

1. Quality and Process Improvement

2. Capacity Management, Coordination & Collaboration

3. Shared Electronic Health Record

4. Decision support

5. Consumer Health


November 2010 30

Alignment of Strategies and Themes/Opportunities with Stakeholder Benefits

By selecting a small number of opportunities that align well with the priorities of the LHIN, efforts and resources can be focused to improve the likelihood of success. Focusing on these opportunities does not preclude the inclusion of additional opportunities; rather, this focus provides an initial starting point to move forward the eHealth agenda. Moreover, focusing on these opportunities does not mean that current activities will cease; it simply means that the LHIN is committing to supporting these opportunities, perhaps alongside existing initiatives. What it does mean is that new or additional resources will not be allocated to existing or other activities unless they align with these new areas of focus or if the focus changes or expands.

These opportunities can also be positioned and considered from the perspective of, and possible implications for, the patient, health service provider and LHIN, as described below.

Information on resources from trusted sources - characteristics, availability, access

Self-service tools, e.g. self-scheduling

Collaboration with providers and other patients

Preliminary initiatives on accessto self-management of health

Automation of workflowTimely access to information to support the episode of careTimely access to information to support continuity of care

Support of workflow with order sets, evidence, guidelines

Adoption and system optimization supportCollaboration - with patients and with other providers

Leveraging existing investments

Information on resource availability and access

Timely, standardized information for system-wide management

System-wide quality and performance monitoring and evaluation

Health Service Provider

Patient

LHIN / Health System Manager


November 2010 31

Moving Forward – Strategic Priorities

There are many opportunities that align with the various ehealth strategies. Clearly, it is not possible, indeed, desirable, to pursue all of these opportunities, if, for no other reason than there is finite capacity and resources, both human and financial. To determine which opportunities to pursue, the criteria developed as a part of the Evaluation Framework, described earlier, were applied to identify the opportunities that best aligned with the LHINs’ priorities. The outcome of applying the criteria identified the following priorities to pursue in the near term, that is, over the next five years, a timeframe consistent with the IHSP-2 and IHSP-3.

The pursuit of these priorities is contingent on sufficient funding and resources in place throughout the deployment and on a sustained basis. In most instances, there will be an initial outlay or investment in deploying these solutions/systems, and a modest ongoing operating cost. It is anticipated that some one-time or start-up funds will be provided by eHealth Ontario, and in some cases by health service providers, brokered by the LHIN. In other cases, there may be a cost sharing arrangement. The LHIN should also create the conditions conducive to enabling some LHIN funding. The key factor in the

success of these initiatives in the longer term is ensuring that they are sustainable and that there are sufficient resources – both human and financial and sufficient capacity – both infrastructure and assets, to sustain the realization of the potential benefits.

The foregoing speaks to the LHIN role in eHealth, that being one of a local steward and overseer of the ehealth system. In fulfilling this role, the LHINs primary responsibilities include:

Creating conditions conducive for health service providers to effectively and efficiently deploy information technology and management that leads to better outcomes for consumers

Facilitating connectivity and interoperability among health service providers that enables information sharing for more timely and efficacious patient/client care and decision making

Enabling consumers to actively participate in the management of their personal health information and decisions affecting their health

Establishing priorities that are aligned with the Provincial eHealth agenda and coordinating the deployment of resources to achieve strategic goals.

The eHealth priorities of the South West LHIN are described below.

1. Deploy a Resource Matching and Referral solution, potentially in conjunction with solutions such as a Bed Board system or other applicable resource management systems, to optimize patient/client access and flow across the LHIN and beyond, and to enable referrals among acute and sub-specialities (in collaboration with the adjacent LHINs – Erie St. Clair, Waterloo Wellington and Hamilton Niagara Haldimand Brant)

The deployment of a Resource Matching and Referral system has many benefits, including:

Enhanced, and more timely patient/client access and flow to critical health system resources, including bed placement

More effective and efficient management of key health system resources


November 2010 32

A centralized, coordinated and integrated management system for matching patient/client needs with available resources

2. Deploy the Provincial Chronic Disease Management System to include diabetes initially (in collaboration with eHealth Ontario and other partnering LHINs and other stakeholders) to build capacity for chronic disease management and prevention. The deployment of the Provincial Diabetes registry will yield several benefits, including:

Identify the at-risk population and create a registry to capture information as to each individual’s condition and needs

Develop and support the use of tools for patients/clients to access relevant personal health information, secure education and information, better access resources in the health system, etc.

Provide lessons learned as to how to manage, support and coordinate care for other chronic diseases

3. Integrate the Electronic Health Record with tools such as portals and viewers to build and strengthen connectivity and interoperability among health service providers and sectors (in collaboration with hospitals, the Community Care Access Centre, LTC homes, community support services, mental health and addiction agencies, community health centres and primary care physicians). Developing and deploying portals and viewers will:

Enable the continuum of health service providers to readily access relevant patient/client information in a timely, comprehensive and secure manner

Strengthen connectivity of information systems to enable more effective information sharing

Provide patients/clients with access to personal health information for self-management purposes and more informed involvement in decision making

4. Build and implement standardization in the provision of care to include tools such as electronic intake and assessment processes, order sets, care pathways, methodologies/best practices and information management protocols to streamline the capture, sharing and access to relevant patient/client/user health information. Standardization will help to:

Streamline the processes for managing patient/client encounters with the health system

Create a common minimum data set for each user of the health system, thereby enabling providers to more effectively manage patient/client information

Capture, share and access patient/client information that is more readily and accurately descriptive of the individual’s health status

5. Design a multi-pronged consumer health (patient/client/resident/user-


November 2010 33

the consumer) facing program to equip and empower consumers to actively participate in the management of their health information and decision making by:

a. promoting the use of consumer solutions imbedded in electronic medical record systems and other patient information solutions;

b. promote the use of consumer tools such as portals and other solutions that allow access to information and health records,

c. promote the use of technologies that assist in health system navigation and other self care tool for all consumers to accommodate social-economic variation;

d. data available for health system planning.

The benefits of a consumer health strategy are considerable, and include:

Better informed, educated and equipped patients/clients who can take a more active role in decision making impacting their health

More effective and enhanced abilities to capture and monitor health on a real-time, ongoing basis, leading to safer care and better health outcomes

More customized individual-specific treatment, intervention and support

These five priorities support all five strategies and align with several emerging themes/opportunities from the Current State Assessment. A timeline for the high level deployment of these priorities over the next five years is presented below. In addition, potential additional priorities, drawing form other emerging current state themes/opportunities, beyond the five year time horizon are presented for future consideration.


November 2010 34


November 2010 35

Tomorrow (future state) All things considered, it had been a good month for Edith.

After all, her hypertension seemed to be in check, her meds were stabilized and her diabetes was under control. Moreover, she felt as though her energy levels were to the point where she was able to get through most days

without needing a mid-afternoon nap, something that had become a mainstay over the past several months. Not bad for a 78-year old widow and grandmother of two. When she woke up that morning, she was confident her visit from the home care nurse from the Community Care Access Centre would go well. After all, the mobile monitoring device she had been using indicated that her pulse, blood pressure and other readings were all within normal limits. While Edith didn’t always remember what “normal” was, she was comforted by the knowledge that, if the readings weren’t normal, she would have received a call from her doctor’s office where the information was transmitted instantaneously. Shortly after Edith had finished breakfast, Edith logged onto the patient portal on her computer, used the optical scanner to confirm her identity and opened up her personal health record in the home. She marvelled at how easy it was and how comfortable she was accessing and understanding the health information, remembering how difficult it was when she first started using the system. She was looking at her blood pressure readings over the past few months since starting her new medication, and how stable it had been, when the doorbell rang, and Genevieve breezed in, asking Edith how she was feeling today. Genevieve quickly opened up her computer tablet and input Edith’s blood pressure and vitals wirelessly transferring them to Edith’s health record on the encrypted intranet. Genevieve was able to immediately compare Edith’s reading to those over the previous several months, including her visit to her family doctor, the hospital clinic and her cardiologist. Edith looked approvingly at the graph, and triumphantly said to Genevieve: “Just as I expected!” Edith mentioned to Genevieve that she had been experiencing some discomfort in her left arm and

shoulder area, so Genevieve quickly entered onto her computer tablet a request for a previous history of related tests and assessments. Based on this information, pulled from Edith’s previous hospital stays, ER visits and appointments with her family doctor and heart specialists, Genevieve put in a request for a consult, and promised Edith that the hospital clinic at the London Health Sciences Centre would contact her later that day to schedule an appointment. When Genevieve pulled the information, a ‘flag’ alert appeared, indicating that one of the medications Edith was taking had a side effect that could have been responsible for Edith’s symptoms. Genevieve immediately sent in a high alert request for an immediate response from Edith’s cardiologist to advise on a modified medication regimen. This request was sent to Edith’s common medical record to which the cardiologist had pre-approved access. Genevieve indicated, with some confidence, that she expected a response from the cardiologist before the day was out, because the information had been sent directly to his blackberry. After a few more questions which Genevieve was able to easily answer by querying Edith’s integrated medical record, Genevieve was able to see Edith’s last visit notes from her family physician and was able to ask her about the call she put in to Telehealth Ontario. After reviewing her records, Genevieve pronounced Edith fit to take on the world (again). Because of Edith’s shoulder/arm pain, Genevieve booked a follow-up visit on the electronic

patient scheduling system that also alerted Edith’s family doctor and cardiologist. Genevieve departed, thanking Edith for the cup of tea. As Edith got along with her day, she marvelled at how things had changed and how the timeliness, quality and convenience of the care she received had improved. “These folks finally have their act together,” she said to herself. Edith’s journey in the future will look quite different than it does today. If we are successful in moving our eHealth strategy forward, we will have been successful in supporting the key priorities in our IHSP and Blueprint, improving the quality,

timeliness and outcome of the services and care Edith and others receive from the health system.

Edith is 78 yrs. old and suffers from hypertension and diabetes

ER Visit (Seaforth)

ER Visit (Stratford)

Cardiologist(London HSC)

Cardiac Surgeon

Hospital Stay (London HSC)

GP Visit

Lab Tests

OTN

ImagingTests

CCAC

SharedElectronic Health Record

LEGEND


November 2010 36

List of AcronymsAcronym Term

ALC Alternate Level of Care

BSM Blended Service Model

CCC Complex Continuing Care

CCAC Community Care Access Centre

CCIM Community Care Information Management

CCM Comprehensive Care Model

CHC Community Health Centre

CHI Canada Health Infoway

CHRIS Client Health Related Information System

CPOE Computerized Provider / Physician Order Entry

CT Computerized Tomography

DIS Drug Information System

DPV Drug Profile Viewer

Electronic Health Record


eMAR Electronic Medication Administration Record

EMPI Enterprise Master Patient Index

Electronic Medical Record


ENITS Emergency Neurosurgery Image Transfer System

ER Emergency Room / Department

ESC Erie St. Clair Local Health Integration Network

FHG Family Health Group

FHN Family Health Network

FHO Family Health Organization

FHT Family Health Team

GBHS Grey Bruce Health Services

GBIN Grey Bruce Information Network

HIMSS Health Information Management Systems Society

HIS Health / Hospital Information System

HRIS Human Resources Information System

HOBIC Health Outcomes for Better Information and Care

HNHB Hamilton Niagara Haldimand Brant Local Health Integration Network

HSP Health Service Provider

ICU Intensive Care Unit

Acronym Term

IHSP Integrated Health Service Plan

IS / IT Information Systems / Information Technology

LTC Long Term Care

MDS Minimum Data Set

MIS Management Information System

MOHLTC Ontario Ministry of Health and Long Term Care

MRI Magnetic Resonance Imaging

NRS National Rehabilitation Reporting System

OHA Ontario Hospital Association

OLIS Ontario Laboratory Information System

ONE Ontario Network for eHealth

OTN Ontario Telemedicine Network

P4H Partnerships for Health

PACS / DiR Picture Archiving and Communication System / Diagnostic Imaging Repository

PSW Personal Support Worker

RAI Resident Assessment Instrument

RH Rehabilitation Health

RM&R Resource Matching and Referral

RN Registered Nurse

SPIRE Southwest Physician Office Interface to Regional Electronic Medical Record System

SOUTH WEST LHIN

South West Local Health Integration Network

SWODIN South West Ontario Diagnostic Imaging Network

SWOT Strengths Weaknesses Opportunities Threats

WTIS Wait Times Information System

WW Waterloo Wellington Local Health Integration Network


November 2010 37

Appendix 1 - Emerging Current State Themes / Opportunities

Emanating from the current state assessment is a range of potential opportunities that will be considered going forward, including:

South West LHIN

1. Position the LHIN as a potential ‘broker’ for health service providers, liaising with internal and external stakeholders as needed, to define and deploy an eHealth strategy that supports the key goals and directions of the Blueprint.

2. Encourage inter-LHIN collaboration in principle and on specific initiatives in particular, including sharing / consolidation of resources, both human and capital, where appropriate.

3. Undertake a concerted effort to assess the feasibility of a partnership with the Erie St. Clair LHIN on joint eHealth strategy and resource sharing.

Hospital Networks

4. Build on the existing hospital networks (Thames Valley, Grey Bruce and Huron Perth) and deploy strategies to support clinical health information collection, sharing, storage and security within and among the networks. Leverage the assets and infrastructure of the existing hospital networks to support other health service providers in participating in the collection, sharing, storage and security of information.

5. Consider funding of advanced clinical systems where appropriate.

Patient Referral

6. Build on the success of the RM&R Alternate Level of Care Project Phase 1 collaboration with the Erie St. Clair, Hamilton Niagara Haldimand Brant and Waterloo Wellington LHINs by moving ahead with Phase 2.

7. Develop a standard data set to support referrals and capacity management and forecasting: A comprehensive system that supports patient movement; access to appropriate service and supports providers to plan for resource requirements.

8. Implement a regional bed board that will track capacity, acuity, modeling and human resource requirements (recommended in the Blueprint). Like CritiCall but expanded to include acute care, CCC, RH, supportive housing, CCAC, long-term care, etc. RM&R work and FLO Collaborative have highlighted the opportunity for improvement. This is an opportunity to build South West LHIN tool to support regional bed management.

9. For clinical referrals for acute and specialty services, explore the potential ability to expand / replicate the current initiative at GBHS which has implemented e-referral with the South West CCAC for oncology patients home care

10. Explore how to leverage and integrate other existing technology solutions such as CHRIS, and Chronic Disease Prevention and Management Systems.


November 2010 38

Chronic Disease Prevention and Management Systems

11. Build the capacity to work with eHealth Ontario and the Champlain LHIN to roll out and deploy the Chronic Disease Management System - Diabetes Registry.

Connectivity

12. Design interfaces to provide interoperability between legacy systems and new systems in place or planned, across service providers in LHIN.

13. Implement individual and provider health information portal(s) to support communication, knowledge sharing and information sharing.

14. Evaluate the clinical viewer pilot project to determine whether it should be extended throughout the LHIN and identify implementation challenges and opportunities.

15. Develop a strategy respecting the use and funding for portable technologies / mobile devices for use in the community / home care settings.

16. Leverage telemedicine strategies to bridge the geographical service gap in the north and central area of LHIN.

17. Assess patient portal technologies to support patient access and navigation to be more interactive with their health care record and LHIN resources.

18. Address the issues of poor connectivity (infrastructure) in rural areas. There may be an opportunity for the LHIN to work with the eHealth Ontario and the local municipalities to ensure that issue is

highlighted and the impact it can have on the delivery of community and long-term care services.

19. Develop a funding strategy to leverage the valuable technology Ontario Telehealth Network provides - for equipment (upgrades) and infrastructure costs.

Standardization

20. Standardize processes, technologies and best practices to save cost and improve patient care, e.g. electronic sharing of standardized assessment tools.

Physicians

21. Examine role of the LHIN in promoting Ontario MD Early Adoption of Electronic Medical Record funding program.

22. Extend the project work done in this area in alignment with local physician needs, eHealth Ontario and Canada Health Infoway.

Coordination

23. Provide the necessary leadership to support the development and integration of systems to create a regional Electronic Health Record (London, GBHS and Huron Perth).

24. Assess and determine how to better coordinate and possibly integrate local and provincial initiatives and projects.

25. Consumer needs for communication, collaboration and self-management tools.

26. As mentioned in the IHSP and Blueprint, there is a need for a broad and deep repository of services crossing all sectors supporting


November 2010 39

education, care co-ordination, real-time capacity and electronic booking.

27. Assess solutions that support patient / client engagement in self care. This could include leveraging current projects as well as provincial projects.

Decision Support

28. Address the growing need for data for analysis to support program delivery,

29. Improve coordination of providers within the LHIN and provide tools to better leverage available resources

30. Support evidence based decision making

These opportunities, along with other considerations, are used as a basis for defining the future state described in the following section.

A Healthier Tomorrow

Agenda Item 5.3c

South West LHIN

eHealth Strategic PlanPresented to

South West Local Health Integration Network (LHIN)

Board of Directors

Wednesday, December 16th, 2010

By Glenn Lanteigne

CIO, South West LHIN


eHealth Strategy: Update

• Over the summer, a comprehensive Current State Assessment has been developed, and is captured in a 100 page document prepared by Healthtech Consultants.

• The document has been reviewed by and vetted with LHIN staff, eHealth Steering Committee and Health Service Providers at Area Provider Tables.

• The Current State Report is being used as one point of reference and will contribute to the eHealth Strategy Document.

• A draft eHealth Strategy Document was approved by the South West LHIN eHealth Steering Committee on Nov. 25th

2


• The Final Version of the eHealth Strategy Document is being provided for Board review and approval at the December 8th meeting.

• The eHealth strategy document will be ready for publication and posted to the South West LHIN Website by December 17th.

eHealth Strategy: Update (continued)

3


Align with the Blueprint

• Direction for future detailed eHealth services design

• Ensures all eHealth projects align with a single, unified system

• Aligns long-term vision - 2022

Align with the IHSP

• Identifies eHealth directions for next 3 years

• Describes integrated system, alignment with provincial priorities, rationale for strategic directions

• Informed by provider and community engagement

4


Approach to the development of the strategic plan

Programs/ServicesPrograms/Services eHealtheHealth

Ministry of Health

and Long Term Care

Ministry of Health

and Long Term Care

eHealth Ontario

Strategic Plan

eHealth Ontario

Strategic Plan

SW LHIN

eHealth Strategy

SW LHIN

eHealth Strategy

SW LHIN

Blueprint

SW LHIN

Blueprint

SW LHIN

IHSP - 2

SW LHIN

IHSP - 2

eHealth

Tactics

eHealth

Tactics

5


eHealth Vision

Vision

• The eHealth vision adopted for purposes of the eHealth strategy is identical to the vision articulated by eHealth Ontario, that being:

“Achieving excellence in health care by harnessing the power of information.”

6


Guiding Principles

Several principles were established to guide the development of the strategy, including to:

• Enhance the patient/client experience and health system performance

• Engage all stakeholders and, in particular, the clinical leadership and health care/service providers

• Strive to achieve integration and sustainability• Promote collaboration and partnership• Set measurable goals• Operate in a transparent manner• Leverage existing strengths and assets and industry

best practices

7


eHealth Strategies

Alignment with eHealth Ontario, Canada Health Infoway and reflecting local requirements.

LHIN wide ElectronicHealth Record (EHR)

Capacity Management ,Coordination and

Collaboration

Quality and Process Improvement

Decision Support

Consumer

8


Alignment with eHealth StrategiesCapacity Man. Quality Decision

Project EHR Coordin/Collab Process Impr. Support Consumer

1 Ontario Lab Information System

2 Clinical Viewer

3 SW Ontario Diagnostic Imaging

4 North South

5 Drug Information System

6 OntarioMD

7 ONE Network

8 Community Care Information System

9 RPAIP

10 eShift

11 CDMS - Diabetes

12 Partnerships for Health

13 Ontario Telehealth

14 Patient Flow & Access

15Emergency Neurosurgery Image Transfer System

16 Resource Matching and Referral

17 Program & Services Inventory

18 SPIRE

19 SharePoint Use/Access

9


Strategies

• Capacity Management, Coordination and Collaboration:Build capacity and support better coordination and collaboration among health service providers under the auspices of the LHIN and beyond to better serve the users of the health system.

• Quality and Process Improvement: Enhance the quality and outcomes of the health care/services provided to users of the health system.

• Shared Electronic Health Record: promote the interoperability of electronic health/medical records and make them accessible to providers, as appropriate, and consumers.

10


Strategies

• Decision Support: Provide needed clinical and non-clinical decision support for better planning, management and understanding of evidence based health care and health system improvements.

• Consumer Strategy. This includes the patient, resident, or client. Promote strategies that support consumer empowerment and access to the system. Use consumer feedback to lead system improvement.

11


Moving Forward• Many opportunities that align with the various eHealth

strategies

• Not possible/desirable to pursue all of these opportunities

• There is finite capacity and resources, both human and financial.

• To determine which opportunities to pursue, the criteria developed as a part of the Evaluation Framework, were applied to identify the opportunities that best aligned with the LHINs’ priorities.

• The outcome of applying the criteria identified the following opportunities to pursue in the near term, that is, over the next 2-3 years, a timeframe consistent with the IHSP-2.

12


Resource Matching and Referral

• Deploy a Resource Matching and Referralsolution, potentially in conjunction with solutions such as a Bed Board system or other applicable resource management systems,

• to optimize patient/client access and flow across the LHIN and beyond, and to enable referrals among acute and sub-specialities

• (in collaboration with the adjacent LHINs – Erie St. Clair, Waterloo Wellington and Hamilton Niagara Haldimand Brant)

13


Chronic Disease Management System

• Deploy the Provincial Chronic Disease Management System to include diabetes

• in collaboration with eHealth Ontario and other partnering LHINs and other stakeholders

• to build capacity for chronic disease management and prevention

• Leverage current projects like Partnerships for Health and thehealthline.ca

14


Portals and Viewers

• Integrate the Electronic Health Record with tools such as portals and viewers

• To determine the best architecture possible and the role of Central Data/Document Repositories

• to build and strengthen connectivity and interoperability among health service providers and sectors (in collaboration with hospitals, the CCAC, LTC homes, community support services, mental health and addiction agencies, community health centres and primary care physicians)

15


Standardization

• Build and implement standardization in the provision of care

• to include tools such as electronic intake and assessment processes, order sets, care pathways, methodologies/best practices and information management protocols

• to streamline the capture, sharing and access to relevant patient/client/user health information

16


Consumer Health

• Design a multi-pronged consumer health (patient/client/resident/user- the consumer) facing program to equip and empower consumers to actively participate in the management of their health information and decision making by:

• promoting the use of consumer solutions imbedded in electronic medical record systems and other patient information solutions;

• promote the use of consumer tools such as portals and other solutions that allow access to information and health records,

• promote the use of technologies that assist in health system navigation and other self care tool for all consumers to accommodate social-economic variation;

17


Strategic Priorities Timelines


Acronym TermALC Alternate Level of Care

BSM Blended Service Model

CCC Complex Continuing CareCCAC Community Care Access Centre

CCIM Community Care Information Management

CCM Comprehensive Care Model

CHC Community Health CentreCHI Health Infoway

CHRIS Client Health Related Information System

CPOE Computerized Provider / Physician Order Entry

CT Computerized TomographyDIS Drug Information System

DPV Drug Profile Viewer



eMAR Electronic Medication Administration Record

EMPI Enterprise Master Patient Index



ENITS Emergency Neurosurgery Image Transfer System

ER Emergency Room / Department

ESC Erie St. Clair Local Health Integration Network

FHG Family Health Group

FHN Family Health Network

FHO Family Health Organization

FHT Family Health Team

GBHS Grey Bruce Health ServicesGBIN Grey Bruce Information Network

HIMSS Health Information Management Systems Society

HIS Health / Hospital Information System

HRIS Human Resources Information System

HOBIC Health Outcomes for Better Information and Care

HNHB Haldimand Brant Local Health Integration Network

HSP Health Service ProviderICU Intensive Care UnitIHSP Integrated Health Service PlanIS / IT Information Systems / Information

TechnologyLTC Long Term CareMDS Minimum Data SetMIS Management Information SystemMOHLTC Ontario Ministry of Health and Long Term

CareMRI Magnetic Resonance ImagingNRS National Rehabilitation Reporting SystemOHA AssociationOLIS Laboratory Information SystemONE Ontario Network for eHealth OTN Telemedicine NetworkP4H Partnerships for HealthPACS / DiR Picture Archiving and Communication

System / Diagnostic Imaging RepositoryPSW Personal Support WorkerRAI Resident Assessment InstrumentRH Rehabilitation HealthRM&R Resource Matching and ReferralRN Registered NurseSPIRE Southwest Physician Office Interface to

Regional Electronic Medical Record SystemSOUTH WEST LHIN

South West Local Health Integration Network

SWODIN South Diagnostic Imaging Network

SWOT Strengths Weaknesses Opportunities Threats

WTIS Wait Times Information SystemWW Local Health Integration Network

List of Acronyms


Thank you

www.southwestlhin.on.ca

[email protected]

1-866-294-5446

Glenn Lanteigne, Chief Information [email protected]

20

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Report to the Board of Directors South West Community Care Access Centre

Revisions to 2009-11 Multi-Sector Service Accountability Agreement

Meeting Date: December 16, 2010 Submitted by: Mark Brintnell, Senior Director, Performance, Contract and Accountability Scott Chambers, Team Lead, Finance Submitted to: Board of Directors Board Committee Purpose: Information Decision

Purpose: The purpose of this report is to provide an update on the allocation of the 2010/11 funding increase to the South West Community Care Access Centre (CCAC) and associated amendments required to the performance obligations identified in the current Multi-Sector Service Accountability Agreement (M-SAA). Background: The South West CCAC 2009-11 M-SAA is based on the Community Annual Planning Submission (CAPS) drafted in the fall of 2008. M-SAA budget and service activity projections were intended to stand for the two year term, however now need to be amended to account for the confirmation of the 2010/11 funding increase and other operational and budget matters including:

• Adjusting for confirmed funding increase of 2.5% vs. planning funding target increase of 5%; • Recouping the 2009/10 fiscal year $1.6 million deficit position; • Adjusting performance indicators; • Committing to a balanced operations budget for the 2010/11 fiscal year.

The revised 2010/11 budget submitted by the CCAC includes a base funding increase of $3.9 million (increase of 2.5%) and confirms the additional $2.8 million to increase service maximums for home care personal support and homemaking services. The CCAC is using the additional base funding to restart the Wait at Home and Safe at Home programs, and the service maximum funding will provide more eligible home support and to reduce inappropriate hospital placement. The South West CCAC has received over $6.5 million in base or one-time adjustments since 2008/09 for Aging at Home programs. The information contained in Appendix 1 and 2 is submitted by the South West CCAC and provides insight into the service activity that drives the costs structure of the CCAC. Both graphs illustrate the

Agenda Item 5.4

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increase in activity in early 2009/10, the impact of ‘bending the curve’ to mitigate the projected deficit in 2009/10, and finally the projected goal of sustainable service levels for the balance of 2010/11. This information is helpful in understanding the CCAC’s actions to remain within its approved fiscal funding allocation. Appendix 1: details the hours of service trend for 2009/10 – 2010/11 as at October 15, 2010. Appendix 2:

shows the number of individuals served for the same period.

The revised M-SAA does not produce the service level enhancement that would have been possible using a 5% budget increase and takes into consideration the requirement to recoup the 2009/10 deficit amount, but service levels are projected to be maintained at a sustainable level and permits the South West CCAC to reach its balanced budget commitments. Next steps The South West LHIN will issue an amended M-SAA to the South West CCAC based on the confirmed CAPS. South West LHIN staff will continue to meet with the CCAC staff on a monthly basis to discuss programming, budget information and overall achievement against performance obligations. The South West LHIN Board is not required to approve the amendments to the current M-SAA given the confirmed funding level is within the original approval granted by the LHIN and the CCAC is operating within the approved financial allocation. End.

Refresh Date: 10/15/2010

100,000

120,000

140,000

160,000

180,000

200,000

220,000

240,000

Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11

Un

its/

Ho

urs

of

Serv

ice

FY09/10 & FY10/11

Visits/ Hours of ServiceApril 2009 to March 2011

Actual

LE1011-03

LE1011-04

Actual to date

Agenda Item 5.4b

Refresh Date: October 15, 2010

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10

Un

its/

Ho

urs

of

Serv

ice

Months

Paid Visits/Hours of Service (Summary)April 2009 to September 2010

Nursing - Visiting

Nursing - Shift Hours

Clinics Visits

Physiotherapy Visits

Occupational Therapy Visits

Social Work Visits

Speech Therapy Visits

Dietetic Services Visits

Combined Homemaking Hours

Agenda Item 5.4b

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Report to the Board of Directors London Health Sciences Centre – Child and Adolescent Mental Health –

Transfer of Funding from Community to Hospital Envelope

Meeting Date: December 16, 2010 Submitted by: Mark Brintnell, Senior Director, Performance, Contract and Accountability Submitted to: Board of Directors Board Committee Purpose: Information Only Decision

Suggested Motion: THAT the South West Local Health Integration Network Board of Directors approve the reallocation of $2.35 million from the Community Mental Health allocation to the Hospital allocation within London Health Sciences Centre in support of the Child and Adolescent Mental Health Program, it being noted that the Child and Adolescent Mental Health Program will continue to provide the same services and that the funding will be dedicated to the program within the current Hospital Service Accountability Agreement. Purpose: London Health Sciences Centre (LHSC) has formally requested a permanent reallocation from the Community Mental Health allocation to the Hospital allocation (i.e. global allocation) to allow LHSC to better integrate the management and operations of the Child and Adolescent Mental Health Program. This reallocation would alter the allocation of funding in the Ministry-LHIN Performance Agreement (MLPA) and requires LHIN Board approval. Background: In 1993, the Ministry of Health and Long-Term Care established the Child and Adolescent Inpatient Mental Health Program at Children’s Hospital of Western Ontario/LHSC. The program complements the existing outpatient children’s service. The following services are funded through the Community Mental Health

• Seven (7) child and adolescent mental health beds, with a multidisciplinary team providing support service, these beds serve patients with urgent/emergent needs;

allocation:

• Four (4) eating disorders beds, with a multidisciplinary team providing support service, these beds serve patients throughout the southwest region

• Other eating disorders programs

Agenda Item 5.5

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The following services are funded through the Hospital• Child and adolescent mental health day treatment program

(i.e. global) allocation:

• Child and adolescent mental health outpatient services As a separate community vote program (i.e. how it is funded), with no funding increases between 1992 and 2004, the unit has been underfunded but has cost obligations through unionized salaries, drugs and other structural costs. This inpatient unit is the only unit at LHSC that isn’t covered through the hospital global allocation, thus reducing opportunities for efficiencies. The 11 bed Child and Adolescent Inpatient Unit is integrated with the hospital in terms of intake, emergency room coverage, physician and team support, staffing, patient programming, etc. but the funding stream is deemed separate. Five new child and adolescent mental health beds (as part of the LHSC redevelopment capital plan) are being funded from the hospital global budget but are part of the same unit. This artificial funding and reporting boundary reduces program flexibility and increases management burden at the expense of direct services. Unspent community sector funding is subject to recovery at the end of the fiscal year, while hospital funding can, generally speaking, be retained. The community child and mental health program has had both surplus and deficit year end results over the past two fiscal years (related to staff gapping and backfill) and while the surplus amounts are recovered, the deficits must be funded from the hospital budget. The reallocation will enable the hospital to manage the funding of the program while maintaining or enhancing the level of service. As a community sector program, quarterly reports indicating actual and projected year-to-date service activity are provided to ensure compliance with the M-SAA performance standards. The same Ontario Healthcare Reporting System (OHRS) service activity codes used to track the community program can be used to track the program within the hospital. Health service activity levels consistent with the current M-SAA agreement can be added into the current H-SAA to ensure LHSC maintains or enhances the program service level. Next steps: Subject to LHIN Board consideration, the LHSC H-SAA will be amended to reflect the program and all performance obligations currently defined within the M-SAA. End.

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Report to the Board of Directors

Alloc ation of P s yc hiatric S es s ional F ee F unding

Meeting Date: December 16, 2010 Submitted by: Mark Brintnell, Senior Director, Performance, Contract and Accountability Kelly Gillis, Senior Director, Planning, Integration, and Community Engagement Submitted to: Board of Directors Board Committee Purpose: Information Decision Suggested Motion: THAT the South West Local Health Integration Network Board of Directors approve the allocation of new psychiatric sessional fee funding of $306,806 in one-time funding in 2010/11 to Western Ontario Therapeutic Community Hostel, and that the new 2010/11 funding be thereafter reallocated based on criteria developed by the South West LHIN Addiction and Mental Health Coalition and approved by the South West LHIN. Background Psychiatric sessional fee funding is used to support a variety of indirect psychiatric services provided by psychiatrists and general practitioners. In most cases psychiatric services are delivered by an inter-disciplinary team including a physician. The funding provides compensation for indirect case management and other consulting work that cannot be billed to OHIP. Sessional fee funding is protected (i.e. the funding can only be used for sessional fees). Section 7.1.4 of the 2008 Physician Services Agreement (PSA) includes a commitment to increase the number of allowable sessionals. The provincial total required to support the PSA commitment was allocated to the LHINs using the Health Based Allocation Model (HBAM). Currently, the South West LHIN has a total allocation of $624,142 in the system allocated to 5 hospitals (through their community programs) and 9 community mental health agencies. With this new funding the total sessional fee funding investment across the LHIN is $930,948. The intention is to develop an investment plan for the total funding available for 2011/12. Allocation of incremental funding The South West LHIN Addiction and Mental Health Coalition (mental health and addictions HSPs from across the LHIN) has been engaged to develop criteria for allocating the new funding to best support South West LHIN needs, while also advancing provincial goals of addressing unattached patients, reducing emergency department congestion, and to support the provincial strategy on mental health and addictions.

Agenda Item 5.6

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In the last few weeks, the Coalition HSPs have met within each of the LHIN’s planning areas to conduct stakeholder engagement and consultation sessions, which included consumer and psychiatric representatives. The discussion focused on distribution methodology options, as well as perceived differing approaches to MOHLTC reporting that has historically existed for sessional fees. The sector also recognizes that there is variability in the dispersion of sessional fees, and as such, by moving to a centralized model, enables a more standardized, consistent and transparent approach for all organizations accessing sessional fees, and subsequently, reporting sessional fee reconciliations to the LHIN and MOHLTC. For the 2010/11 fiscal year, it is recommended that WOTCH serve as paymaster (i.e. distributer and reporter) of the funding while the allocation plan finalized. The organizations contracting physician services will use a standard tracking and recording template to submit to the reporting organization for accounting of services provided which will then be used to report to the LHIN and MOHLTC. Next Steps: Subject to LHIN Board consideration of this request, the Multi-Sector Service Accountability Agreement (M-SAA) for WOTCH will be amended to include the increased sessional fee funding, as well as enhanced reporting requirements adhering to both LHIN and MOHLTC standards. South West LHIN staff will work with the South West LHIN Addiction and Mental Health Coalition to finalize a plan to distribute the 2010/11 funding to the partners and communicate the strategy with all eligible providers in the South West LHIN. End.

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Report to the Board of Directors Update on Integration: Choices for Change and Huron Addiction Services

Meeting Date: December 16, 2010 Submitted by: Mark Brintnell, Senior Director, Performance, Contract and Accountability Carolyn Ridley, Financial Analyst Submitted to: Board of Directors Board Committee Purpose: Information Decision Purpose The purpose of this report is to provide an update on the expansion of Choices for Change (CFC) services to include the provision of addiction services for Huron County as a result of the Huron County Board of Health’s decision to terminate its current M-SAA as of December 31, 2010. In addition, the report highlights the amendments required to funding and performance obligations identified in the current Multi-Sector Service Accountability Agreement (M-SAA) with CFC. Background As the Board of Directors is aware, Huron Addiction Services (HAS) notified the LHIN of its intention to discontinue providing addiction service effective December 31, 2010. At its September 22, 2010 meeting, the LHIN Board of Directors passed a motion to support the expansion of CFC services to include the provision of addiction services for Huron County (formerly delivered by HAS) effective January 1, 2011. This support included the approval of up to $214,000 in one-time funding to CFC to support the integration of services. The one-time funding is being used to address the legal requirements associated with the transition and supporting the readiness of CFC to support the additional service in Huron County. As a condition of the integration, CFC and HAS worked collaboratively to submit a transition plan to the LHIN which provided an update on the milestones identified in the Project Charter. The transition plan which included a three-month fiscal plan and projected service targets was received by the LHIN on November 19, 2010 and was reviewed by LHIN staff. The CFC management team in connection with HAS assessed the existing services and have made the necessary alignments for January 1, 2011 to ensure a smooth transition of service delivery to the existing clients and be able continue to address the needs of the clients by minimizing disruption to services. The following items have been adequately addressed in the transition plan:

• All clients in Huron County will continue to be seen in a location most convenient for them. • Service locations in Clinton and Seaforth have been maintained to ensure continuity for

clients. For example, CFC is partnering with the community health program of Alexander Marine & General Hospital for space in Clinton.

Agenda Item 5.7

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• Human resource planning is complete ensuring consistency in the delivery of service to existing clients.

• Agreement reached regarding transfer of assets and records. • A Communications Consultant has been retained to assist with news releases, and

communication with clients and partners.

LHIN staff has confidence that the transition plan has addressed all the necessary steps for planning for a smooth transition of service delivery and for the continuity in service to meet the needs of the clients and that the budget and service activity projections are adequate for the three month period. The 2009-11 M-SAA with the County of Huron will be terminated on December 31, 2010. The organization will need to continue to meet the terms and conditions of its signed M-SAA, under Article 8 – Reporting, Accounting and Review and Schedule C – Reporting Requirements. CFC has agreed to the following amendments to the CFC 2009-11 M-SAA:

• Schedule B – Summary of Revenue and Expenses has been updated to include fiscal funding for three months, January 1 to March 31, 2011 in the amounts of $75,022 for substance abuse and $20,074 for problem gambling.

• Schedule E – Performance Indicators has been updated to reflect revised service volumes and Proportion of Budget Spent on Administration.

The CFC M-SAA Amended Schedules are attached as Appendix A for information. Next Steps The annualized base allocation of $300,087 for substance abuse and $80,301 for problem gambling currently allocated to the County of Huron will now be allocated to CFC beginning April 1, 2011 and will be included in the planning targets for CFC in the negotiation of its new service accountability agreement expected to be in place by April 1, 2011.

Baseline

2009/10 Performance

Target

2009/10 Performance

Standard

2010/11 Performance

Target Amended

2010/11 Performance

Standard

Cost per individual served

Vacancy Rate

CCAC ONLY

Turnover Rate

CCAC ONLY

CCAC ONLY

HSP: CHOICES FOR CHANGE ALCOHOL DRUG ANG GAMBLING COUNSELLING Centre

TBD

0 -#VALUE!-

0

#VALUE!

#VALUE!

0.0%

< 0 >

TBD

N/A n/a

< 0 > 0

28.79%

Variance Forecast to Actual Expenditures 0

Proportion of Budget Spent on Administration 32.09% 38.51%

Schedule E-1 2009/11

Indicators

Balanced Budget 0 0.00%1 0 0.00%1

Performance Indicators

34.55%

- #VALUE! - #VALUE!

N/A n/a

TBD

TBD

TBD

- #VALUE!

Wait Times2 A t t i i iti ti

N/A N/A TBD

1b. From Referral date to Assessment date (90th percentile referrals from hospital)

Wait times: 1a.From Referral date to Assessment date (90th percentile referrals from community)

-

LHIN11-101A

> No negative variance is accepted for total margin> Proportion of Budget Spent on Administration will be Direct Care / Service for 2010-11> n/a - not a performance indicator in 2009-10> tbd - target will be set by 3/31/10 for 2010-11> Baseline is 2007-08

TBD2. Assessment to service initiation

N/A N/A TBD

LHIN11-101A

haym

Typewritten Text

Appendix A - 1

HSP: Choices for Change Alcohol Drug and Gambling Counselling Centre

OHRS Description OHRS FC* Health Service Activity2009/10

Perf TargetService Units

Perf Std

2010/11 Perf Target Amended

Service Units Perf Std

72 5 09 78 11 Visits Face-to-face

345 259 - 431 345 259 - 431

72 5 09 78 11 Individuals Served

552 469 - 635 552 469 - 635


2223 2001 - 2445 2573 2316 - 2830


496 372 - 620 537 456 - 618


374 281 - 468 399 299 - 499


25 19 - 31 30 23 - 38


555 472 - 638 650 553 - 748


504 428 - 580 559 475 - 643

72 5 50 78 20 Service Recipients

0 0 - 0 113 85 - 141


0 0 - 0 78 59 - 98

1

COM Health Prom./Educ Addictions - Problem Gambling Awareness

COM Health Prom./Educ Addictions - Problem Gambling Awareness

COM Primary Care - Initial Assessment and Treatment Planning

COM Primary Care - Initial Assessment and Treatment Planning

COM Primary Care - Addictions Treatment-Problem Gambling

COM Primary Care - Addictions Treatment-Substance Abuse

COM Primary Care - Addictions Treatment-Problem Gambling

COM Primary Care - Addictions Treatment-Substance Abuse

COM Case Management Addictions - Substance Abuse

COM Case Management Addictions - Substance Abuse

Performance Indicators Schedule E-2- CSS & CMHA

LHIN11-101A

haym

Typewritten Text

Appendix A - 2

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Report to the Board of Directors

Woods toc k G eneral Hos pital R eques t to Amend F unc tional P lan to Ac c ommodate Additional S ys temic T herapy (C hemotherapy) S ervic es

Meeting Date: December 16, 2010 Submitted by: Kelly Gillis, Senior Director, Planning, Integration and Community Engagement Laura Salisbury, Financial Analyst, PCA Susan Warner, Project Lead, Planning and Integration Submitted to: Board of Directors Board Committee Purpose: Information Decision Suggested Motion: THAT the South West Local Health Integration Network Board of Directors endorses changes to the approved Woodstock General Hospital (WGH) September 21, 2007 Functional Program to accommodate an increase to up to 270 systemic therapy cases (2,700 visits) from up to 75 cases (750) visits per annum; AND THAT one-time and ongoing base operational funding for the increase in service volume for costs not covered by Cancer Care Ontario be negotiated with the Ministry of Health and Long Term through the Post Construction Operating Plan process associated with the capital development project currently underway at WGH. Background WGH is in final stages of building a new, 178 bed state-of-the art hospital to serve Woodstock and Oxford residents. The associated Functional Plan (FP), approved in 2007, incorporated a new systemic therapy program, based on 2007 projected volumes of 75 cases, or 750 visits, per annum. In addition, WGH’s PCOP was submitted to the MOHLTC – Health Capital Investment Branch (HCIB) on October 3rd, 2010 for their preliminary review and consideration. As such, should this proposal be endorsed by the LHIN, the proposed expansion would amend the FP and PCOP submission. While the LHIN acknowledges that a detailed plan for this expansion was submitted by WGH, further dialogue and negotiation regarding funding details will need to occur between WGH, SWRCP and the MOHLTC – HCIB.

Agenda Item 5.8

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Since the 2007 approved FP, several changes have occurred and are driving the recommendation to expand WGH’s volume of systemic therapy visits.

1. In 2008, Cancer Care Ontario (CCO) directed each region to develop a regional plan for delivering systemic therapy that distributes different levels of care throughout the region as appropriate. Levels of care are driven by provincial standards and range from 1 to 4, with Level 4 being the least complex and delivered by a Systemic Therapy Satellite. The South West Regional Cancer Program (SWRCP) has implemented four Level 4 systemic therapy satellites in the South West LHIN as part of its regional systemic therapy plan, and has recommended adding a fifth Level 4 systemic therapy satellite at the WGH.

New Regional Model for Delivering Systemic Therapy

The 2008 SWRCP Regional Systemic Therapy October 2008i

• An immediate need to increase capacity for systemic treatment in the South West LHIN;

plan identified:

• Capacity exists to increase treatment in all regional sites (except LRCP) if sustainable funding is made available for infrastructure build and operating improvements; and

• An anticipated increase in types of cancers and related treatment regimens.

2. One of the goals of CCO’s and by extension SWRCP’s regional systemic therapy program is to provide safe, standardized, evidence-based care to patients as close as possible to their homes. The SWRCP plan identified that sufficient demand exists in Oxford County to create a viable Level 4 Satellite program for systemic therapy in Woodstock. In 2009/10, in descending order, Oxford County residents sought systemic therapy care at LRCP, Grand River, Kitchener, Juravinski, Hamilton and Princess Margaret, Toronto. In 2009/10, 12% of London Regional Cancer Program’s (LRCP) systemic therapy visits were from Oxford County residents, representing 2,716 visits that could have been repatriated from London to a systemic therapy satellite in Woodstock if one existed.

Opportunities to Repatriate Oxford Residents

3.

WGH’s approved Revised 2007 Functional Program used data from 2001/02 to project systemic therapy service volumes. Since then, Cancer Care Ontario has established a more robust data tracking system and has improved its ability to make projections based on more current data. New projections based on 2009/10 data predicts 5,252 new cancer cases will be diagnosed in the South West LHIN annually. Based on patterns of diagnosis and treatment, it is estimated that 15-20% of these new cases will require systemic therapy treatment.

New Projections of Cancer Incidence

In addition to revised projections of cancer incidence, since the 2007 Approved FP, there has been an increasing trend of cancer recurrence and cancer is now often considered to be a chronic disease. CCO has reported that the provincial demand for systemic therapy treatment is expected to increase from 11% in 2007/08 to 17% in 2012/13.ii Based on a higher than provincial rate of seniors (55+) in the South West LHIN, and in Oxford County, and given that the incidence of

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cancer in seniors is higher than in other age groups, the SWRCP predicts that between 15% and 20% of cancer patients in our LHIN will require systemic therapy.

4. In conjunction with Cancer Care Ontario’s Regional Systemic Therapy plan, new standards of care and protocols have been established to ensure consistent standard of care in a decentralized regional model. These standards of care are responsive to changes in chemotherapy drugs, education, and best practice standard and pharmaceutical protocols.

New Treatment Regimes and Related Standards of Care

Potent drugs such as cytotoxins are used with more frequency to treat cancer. Changes to frequency and / or duration of drug administration impact the number or length of visit(s) per patient. New standards also require standardized Oncology Nurse training and define nurse to patient ratios.

WGH Proposal Based on the changes and evidence summarized above, WGH has submitted a MOHLTC/LHIN Pre-Capital Health Services Improvement Proposal requesting approval to amend its 2007 Approved FP to accommodate an increase to up to 270 systemic therapy cases (2,700 visits) from up to 75 cases (750) visits per annum. The proposed volume increase, along with new provincial standards, means that staffing will need to increase as follows:

• 0.5 FTE Nurse Oncologist to 2.4 FTEs; • 0.0 FTE Pharmacist to 1.0 FTE; • 0.0 FTE IS/Monitoring to 0.4 FTE; • 0.0 FTE Booking Clerk to 0.4 FTE; and • 0.0 FTE General Internist to 1.0 FTE (3 physicians rotating) will need to be added to the

program. In order to accommodate the increased service volume, WGH is proposing to offer the systemic therapy program 5 days per week, rather than 3.5 days per week per the 2007 Approved FP. This approach affords improved efficiencies and enables better human resources planning. This proposed change in FP does not necessitate any change to the overall construction project. Related minor space modifications to accommodate the increase in equipment needs and staffing will occur within the context of the current construction process. Note that no new chemotherapy bed / chairs will be required because the increased volume can be accommodated with 5 day operation and minor space reconfiguration. WGH will negotiate additional one-time and base operating funding with the MOHLTC – HCIB through the PCOP. Repatriation planning has occurred with the intention to ramp up to full service in 3 years and repatriation will be driven by LRCP Oncologist referral patterns, supported and monitored by SWRCP. Costs and implementation plans will be detailed in an amendment to the PCOP. The

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Woodstock General Hospital Foundation has committed to funding the related minor capital costs for the WGH Regional Systemic Therapy Program. Detailed supporting documentation is available to the South West LHIN Board on request. South West LHIN Review and Conclusion

• WGH has undertaken a comprehensive planning process in partnership with SWRCP • In addition, conducted community engagement with local health service partners, both hospital

and community based • Based PCOP planning on achieving CCO standards and used HPHA – Stratford General

Hospital as their benchmark for establishing the plan • SWRCP has engaged fully in this planning and will apply lessons learned and similar rigor to

annual planning with other Level 4 satellites • In 2009/10, SWRCP Systemic Therapy wait times did not meet the provincial target • SWRCP has indicated that currently there are no other Level 4 satellites that are able to

accommodate these volumes without additional operational and capital funding. Currently LRCP is running at full capacity and is experiencing increasing waits for systemic therapy. Without leveraging the potential for additional capacity at WGH, LRCP Systemic Therapy wait times will continue to increase

• Increased operational efficiencies by operating 5 days / week – increased opportunity to hire qualified clinical staff at full time levels

Risk Mitigation

Additional one-time and operational funding for the full incremental increase is not supported through PCOP process.

• WGH and SWRCP will form and sign its cancer services funding agreement based on the level funded through the PCOP.

Volume projections are high or low • SWRCP negotiates service levels annually with its Level 4 satellite sites based on volume allocations provided by CCO. This represents an opportunity for annual reconciliation process.

Oncologists don’t refer to WGH Satellite Program

• SWRCP will work with Oncologists to facilitate changing their referral patterns.

• SWRCP is establishing a system to monitor regional referrals for systemic therapy.

Increased Emergency Department (ED) visits and Acute admissions to WGH, Tillsonburg and Alexandra

• As the existing volumes are being repatriated from another site/geographic location, there is no significant increase expected in ED visits in Oxford County

• Given that patterns of ED use indicate that people access the ED closest to their homes, it can be extrapolated that Oxford patients receiving systemic therapy in London are currently accessing one of the Oxford County hospital EDs. Therefore, ED visit increases are expected to be minimal and will be in proportion to the increase in patients served.

• Most chemotherapy-related emergency department

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Risk Mitigation visits are related to fever and a condition called “neutropenia” (dangerously low white blood cell counts). SWRCP has recently implemented the use of “Fever Cards” for its chemotherapy patients. These cards contain treatment guidelines for use by attending emergency physicians. All Oxford hospitals use these cards and have adopted a common protocol. This process is intended to facilitate improved patient care and prevent avoidable acute care admissions.

• The CCAC has been engaged in dialogue related to community support for these patients

Operational impact without PCOP approval

• The WGH implementation timelines are not aligned with the MOHLTC PCOP approval process. Hiring, training and education for this specialized clinical group will commence prior to receiving PCOP funding confirmation. Service delivery is anticipated to commence with the hospital’s opening in Nov. 2011. As such, should the PCOP funding for this expanded service not occur with the commencement of implementation, WGH may need to scale back its operation for the approved dollars and corresponding service activity.

Conclusion In consideration of all proposal documentation reviewed and evaluated, including but not limited to the Briefing Note and Amended FP for the Regional Systemic Therapy program, the WGH Proposal for chemotherapy service expansion is aligned with Oxford’s regional need and demand for systemic treatment. With the construction of a new site, WGH is in the remarkable position to be able to add capacity to the LHIN system. In addition, the documentation provided is thorough, and has undergone a rigorous, multi-year, multi-partner process to enable the regional collaboration which has occurred in order to plan effectively for this expansion. Employing a consultative approach through formal partner engagement has helped to build the foundation in relationships as will be required in the redesign and flow for patients between LRCP and WGH, and surrounding area health partners. In addition, multiple conversations and meetings occurred between the South West LHIN, SWRCP and WGH to ensure continued joint planning and understanding of implementation strategies and impacts with the proposed expansion. While a list of risks does exist for WGH in this expansion, and by extension, the LHIN, the mitigation strategies currently in place or being developed provides a level of confidence to a successful

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outcome of this expansion plan. Lastly, there is alignment between WGH RST and the LHIN’s Blueprint in helping to move forward provincial and local strategies such as improved wait times, and ensuring a patient-centric model, enabling patients to receive care closer to home. Next Steps Should the South West LHIN Board of Directors endorse the proposed plan for systemic treatment expansion, the letter of endorsement (including motion) from the South West LHIN to MOHLTC LHIN Liaison Branch and Health Capital Investment Branch will be forwarded with all accompanying documentation, for subsequent ministry review. i South West RST Plan, October 2008 ii Cancer Care Ontario Regional Systemic Treatment Program Provincial Plan, September 2009.

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Report to the Board of Directors Health Service Provider 2010/11 Second Quarter Reports

Meeting Date: December 16, 2010 Submitted by: Mark Brintnell, Senior Director, Performance, Contract and Accountability Scott Chambers, Team Lead, Finance Submitted to: Board of Directors Board Committee Purpose: Information Decision

The purpose of this report is to bring forward an assessment of the South West LHIN Health Service Providers (HSPs) 2010/11 Second Quarter (Q2) Reports submitted on November 7, 2010. Hospitals Hospitals recently submitted the Hospital Service Accountability Agreement (H-SAA) 2010/11 budget documents at the end of September, so the information in the Q2 reports are reflective of the H-SAA amendments recently completed. Appendix 1 provides a table that lists the year-end projected numbers against the key H-SAA financial indicator: year-end total margin. It should be noted that in-year surplus amounts for hospitals cannot be recovered due to the provincial BOND policy. All hospitals are within the performance standard for the other H-SAA performance measures (e.g. inpatient weighted days, ambulatory care visits etc.). Alexandra Hospital (Ingersoll) and Tillsonburg District Memorial Hospital are projecting negative total margin positions as noted in Appendix 1. Both hospitals have a balanced budget waiver in their current H-SAAs allowing the deficit position. The deficits will be the sole responsibility of the hospital and the LHIN will not be providing additional funding. Both hospitals have plans in place to achieve a balanced budget by 2011/12. Community Health Service Providers Appendix 2 provides a list of the year end forecast Fund Type 2 (LHIN funding) financial position for the community sector HSPs as at the end of the second quarter. Community HSPs typically receive funding from various sources and apply other Fund Types, e.g. fundraising revenue, to reach a balanced financial position. In-year surplus amounts can be reallocated within a HSP budget (e.g. salary surplus applied to one-time capital project) if the request is approved in advance by the LHIN. In-year surplus amounts can

Agenda Item 5.9

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also be reallocated to other HSPs. Some projected surpluses that can be reallocated have been identified at the mid-year point however, a separate report provides options for reallocating the Q2 surplus amount. Monitoring the community sector quarterly report service activity level projections for health system performance and risk identification purposes is a work in progress. The Q2 reports highlight HSPs who are currently outside performance standards for services. LHIN staff is following up with those providers to discuss mitigation measures to ensure compliance with all performance standards. Efforts to improve future reporting include:

• Immediate feedback to HSPs on all significant reporting errors with direction for improving future reports;

• Distribution of HSP second quarter service activity reporting tables as part of the upcoming M-SAA training package (to highlight incorrect budget levels);

• OHRS service activity definitions to be reviewed as part of M-SAA training • Review of selected services between quarterly reports to understand reporting variation

between HSPs and to begin to develop cost benchmarks Analysis of increased service pressures and service capacity issues will proceed over the next few weeks to ensure HSPs are able to meet their service commitments and to avoid providing service levels not supported by the funding allocation. In addition, the information gleaned will be incorporated into the 2011-13 M-SAA process when setting those agreements. It should be noted that service activity in the community sector is often more volatile than in the hospital sector given the small numbers of staff and clients associated with a service (e.g. if one of three staff members providing a service leaves for a new position) the hiring/training gap can reduce the service activity level below the target. AttachmentsAppendix 1

:

Appendix 2 End.

Appendix 1 - Hospital Projected Year End Surplus / Deficit as at Q2 (Sorted By Ratio: Total Margin as % of Projected Revenue)

Name Surplus/(Deficit) Fund Type 1

Surplus/(Deficit) All Fund Types Total Margin

Ratio: Total Margin as % of

RevenueWorking Capital Note:

Alexandra Hospital (Ingersoll) (284,332) (377,342) (265,482) -1.48% 83,895Tillsonburg District Memorial (115,863) (550,863) (115,863) -0.44% 5,827,602Alexandra Marine & General (Goderich) 0 (354,280) 0 0.00% (2,055,144)Wingham & District 1,707 (233,293) 1,707 0.01% 2,752,265South Bruce Grey Health Centre 28,800 (517,200) 28,800 0.07% 4,852,102Woodstock General 122,000 0 122,000 0.19% (1,240,000)Stratford General 276,700 (579,666) 276,700 0.31% (7,665,237)St. Marys Memorial 37,000 (152,739) 37,000 0.39% 1,461,271Clinton Public 45,300 (105,988) 45,300 0.41% 1,141,096Seaforth Community 34,600 (49,421) 34,600 0.44% (362,963)South Huron Hospital Assoc. (Exeter) 82,482 (31,120) 82,482 0.78% (383,493)St. Thomas Elgin General 674,936 (674,376) 674,936 0.85% (12,141,260)Grey Bruce Health Services 1,905,408 600,000 1,905,408 1.14% 2,789,940St Joseph's Health Care, London 20,957,523 3,900,000 5,788,380 1.22% 10,051,666Hanover & District 283,042 105,642 283,042 1.68% 1,038,852Four Counties Health Services 303,833 61,468 186,579 1.68% 2,480,500Listowel Memorial 316,621 10,121 316,621 1.76% 3,842,915London Health Sciences Centre 22,400,000 12,400,000 18,200,000 1.85% (47,500,000)Strathroy Middlesex General 1,131,782 557,181 1,063,769 3.06% (64,000)Woodstock Private Hospital 58,000 58,000 58,000 5.27% (10,850)

48,259,539 14,066,124 28,723,979 (35,100,843)

Definitions

Fund Type 1 surplus/(deficit):

Surplus/(deficit) all Fund Types:

Total Margin:

Surplus/(deficit) from hospital operations including building amortization and amortization of related donations, interest on long term liabilities, and grants and unrealized gains and losses

Fund Type 1 above plus Fund Type 2 (community programs) plus Fund Type 3 (other, e.g. Federal Gov't program)

Surplus/(deficit) all Fund Types excluding building amortization and amortization of related donations and grants, interest on long term liabilities, and unrealized gains and losses (exlusion applies to all three Fund Types)

1

Appendix 2: Community Sector Projected Year End Surplus/(Deficit) as at Q2

NameFund Type 2

Surplus/(Deficit)

Surplus/(Deficit) as a % of Fund

Type 2 Revenue*Note

ADDICTION SERVICES OF THAMES VALLEY - CMH&A 33,459 2.46% Request for internal reallocation on file

ALEXANDRA HOSPITAL - CMH&A 0 0.00%ALEXANDRA MARINE AND GENERAL HOSPITAL - CMH&A

0 0.00%

Alzheimer Society of Elgin-St. Thomas 0 0.00%Alzheimer Society of Grey-Bruce 0 0.00%Alzheimer Society of Huron County Inc. 0 0.00%

Alzheimer Society of London and Middlesex 45,488 10.10%Potential request for internal reallocation - to be confirmed.

Alzheimer Society of Oxford (125,130) -25.82% HSP will offset with Fund Type 3 revenueAlzheimer Society of Perth County 0 0.00%Blue Water Rest Home Inc. 0 0.00%Boys' and Girls' Club of London 0 0.00%CANADIAN MENTAL HEALTH ASSOCIATION, ELGIN BRANCH - CMH&A

0 0.00%

CANADIAN MENTAL HEALTH ASSOCIATION, GREY BRUCE BRANCH - CMH&A

38,927 2.41%Sessional fees make up $12,000 of surplus; this amount may be used before year end

CANADIAN MENTAL HEALTH ASSOCIATION, HURON PERTH BRANCH - CMH&A

3,027 0.14%

CANADIAN MENTAL HEALTH ASSOCIATION, LONDON-MIDDLESEX BRANCH - CMH&A

0 0.00%

CANADIAN MENTAL HEALTH ASSOCIATION-OXFORD COUNTY BRANCH - CMH&A

0 0.00%

CAN-VOICE CONSUMER/SURVIVOR COMMUNITY SUPPORT SERVICES - CMH&A

0 0.00%

Central Community Health Centre 885,815 70.33%Request for internal reallocation on file; potential for reallocation to other providers

Cheshire Homes of London, Inc. 41,820 0.46%Chippewas of Nawash Unceded First Nation Nil Nil Report not filedCHOICES FOR CHANGE, ALCOHOL, DRUG AND GAMBLING COUNSELLING CENTRE - CMH&A

23,657 2.45% Integration pending; surplus may be needed

Community Health Services - Canadian Red Cross, Woodstock Branch

5,732 0.52%

Corporation of the City of London (Dearness Home) 967 0.17%Corporation of the City of St. Thomas - Valleyview Home

0 0.00%

Corporation of the County of Elgin 0 0.00%

CORPORATION OF THE COUNTY OF HURON - CMH&A 0 0.00%

Council for London Seniors 0 0.00%Craigwiel Gardens 0 0.00%CREST SUPPORT SERVICES (MEADOWCREST) INC - CMH&A

0 0.00%

Dale Brain Injury Services Inc. 0 0.00%FAMILY SERVICE THAMES VALLEY - CMH&A 3,678 1.14%Family Services Perth-Huron 0 0.00%Four Counties Health Services (0) 0.00%G & B HOUSE - CMH&A (64,684) -16.98% HSP will offset with Fund Type 3 revenueGoverning Council of the Salvation Army in Canada (The)

0 0.00%

GREY BRUCE COMMUNITY HEALTH CORPORATION - CMH&A

0 0.00%

GREY BRUCE HEALTH SERVICES - CMH&A 38,123 0.98%

Home and Community Support Services of Grey-Bruce 0 0.00%

Hospice of London Inc. 68,055 10.52%Potential request for internal reallocation - to be confirmed.

Huron Hospice Volunteer Service 21,142 18.41% Surplus to be confirmed

Hutton House Association for Adults with Disabilities 0 0.00%

Ingersoll Services for Seniors 27,158 6.86%Potential request for internal reallocation - to be confirmed.

KIIKEEWANNIIKAAN SOUTH WEST REGIONAL HEALING LODGE - CMH&A

79,211 42.87% Surplus to be confirmed

Knollcrest Lodge Limited 0 0.00%LONDON HEALTH SCIENCES CENTRE - CMH&A 2,324 0.04%

LONDON INTERCOMMUNITY HEALTH CENTRE 232,423 4.14%Request for internal reallocation on file; potential for reallocation to other providers

London Regional AIDS Hospice, O/A John Gordon Home 0 0.00%

McCormick Home for the Aged (Women's Christian Association)

0 0.00%

Meals on Wheels London (76,623) -5.75% HSP will offset with Fund Type 3 revenueMidwestern Adult Day Services (22,366) -1.74% HSP will offset with Fund Type 3 revenue

2

Appendix 2: Community Sector Projected Year End Surplus/(Deficit) as at Q2

NameFund Type 2

Surplus/(Deficit)

Surplus/(Deficit) as a % of Fund

Type 2 Revenue*Note

MISSION SERVICES OF LONDON - CMH&A 0 0.00%Mornington, Ellice and Milverton Wheels to Meals 0 0.00%North Perth Community Hospice Inc. (9,965) -18.59% HSP will offset with Fund Type 3 revenueONEIDA FIRST NATION OF THE THAMES - CMH&A 226,057 54.69% Surplus to be confirmedOver 55 (London) Inc. 0 0.00%OXFORD SELF-HELP NETWORK - CMH&A 0 0.00%Participation House Support Services - London and Area

(114) 0.00%

Participation Lodge - Grey Bruce 0 0.00%PHOENIX SURVIVORS, PERTH COUNTY - CMH&A 3,699 2.99% Not material for Q2 recoveryPSYCHIATRIC SURVIVORS NETWORK OF ELGIN - CMH&A

0 0.00%

Ritz Lutheran Villa 0 0.00%SEARCH COMMUNITY MENTAL HEALTH SERVICES - CMH&A

2,453 0.23%

Sherwood Forest (Trinity) Housing Corporation Nil Nil Report not filed

South West Community Care Access Centre 1,236,560 0.71% Surplus is from Residential Hospice base funding

SOUTHWEST ONTARIO ABORIGINAL HEALTH ACCESS CENTRE - CMH&A

0 0.00%

Spruce Lodge Home for the Aged 0 0.00%ST JOSEPH'S HEALTH CARE, LONDON - CMH&A 0 0.00%St. Joseph's Health Care - Parkwood Pain and Symptom Management

0 0.00%

St. Joseph's Health Care London - Third Age Outreach Program

3,542 1.26%

St. Mary's and Area Home Support Services 0 0.00%St. Marys And Area Mobility Service 0 0.00%STRATFORD GENERAL HOSPITAL - CMH&A 0 0.00%

Stratford Meals on Wheels and Neighbourly Services 0 0.00%

The Canadian Hearing Society - London Region 0 0.00%The Canadian National Institute for the Blind - Ont Div - London

(297,821) -65.47% HSP will offset with Fund Type 3 revenue

The Governing Council of Salvation Army Canada - London Village

6,930 2.33%

Tillsonburg & District Multi-Service Centre 7,853 0.54%Town and Country Support Services 0 0.00%TURNING POINT INCORPORATED - CMH&A 0 0.00%Victorian Order of Nurses - Oxford Branch 0 0.00%Victorian Order of Nurses - Perth-Huron Branch 0 0.00%Victorian Order of Nurses for Canada - Ontario Branch Grey-Bruce

0 0.00%

Victorian Order of Nurses for Canada - Ontario Branch Middlesex

358,416 6.90%Potential request for internal reallocation - to be confirmed.

VIOLENCE AGAINST WOMEN SERVICES, ELGIN COUNTY - CMH&A

0 0.00%

WEST ELGIN COMMUNITY HEALTH CENTRE 310,711 7.45%Potential request for internal reallocation; potential for reallocation to other providers

WESTERN ONTARIO THERAPEUTIC COMMUNITY HOSTEL - CMH&A

0 0.00%

WOMEN'S EMERGENCY CENTRE-OXFORD, INC. - CMH&A

15,704 68.15% Surplus to be confirmed

WOMEN'S SHELTER, SECOND STAGE HOUSING AND COUNSELLING SERVICES OF HURON - CMH&A

Nil NilQ2 submission with errors; waiting for revised submission

Woodstock and Area Community Health Centre 686,573 29.01%Potential request for internal reallocation; potential for reallocation to other providers

WOODSTOCK GENERAL HOSPITAL - CMH&A 0 0.00%Total 3,812,803

*Threshold LegendIf the % is <=2% - HSP will manage operating balanceIf the % is between 2.1% and 4.99% - LHIN will reassess operating balanceIf the % is >=5% favourable to budget - LHIN will reassess for potential redistributionIf the % is >= unfavourable to budget - HSP to submit a plan to reach a balanced positionFund Type 2 - captures revenue and expenses applied to the community sector (e.g. community support services, community mental health)Fund Type 3 - captures funding and associated expemses from other levels of government and other sources

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Report to the Board of Directors C ommunity S ec tor One-Time Minor Infras truc ture P rogram

Meeting Date: December 16, 2010 Submitted by: Mark Brintnell, Senior Director, Performance, Contract and Accountability Submitted to: Board of Directors Board Committee Purpose: Information Decision Suggested Motions: That the South West Local Health Integration Network Board of Directors approve up to $4,400,000 from Health Service Provider 2010/11 in-year surplus funding to be allocated between community allocations to fund a Community Sector One-Time Minor Infrastructure Program. That the South West Local Health Integration Network Board of Directors approve $90,313 from Health Service Provider 2010/11 in-year surplus funding to be allocated to the CMHA Oxford Branch for reimbursement of expenses previously approved by the LHIN and planned to be recovered by the Ministry of Health and Long Term Care. Purpose: The purpose of this report is to seek South West LHIN Board approval for the use of 2010/11 in-year surplus funding. The reason the motion is stating an “up to” funding amount is that several potential surplus amounts still require confirmation by the providers and certain providers have filed requests for use of their identified surplus amounts that are currently under review. Therefore, the actual amount designated for the Community Sector One-Time Minor Infrastructure Program will highly likely be lower than the $4.4 million amount. Background:

Most community sector health service providers have an ongoing challenge to identify adequate resources from within their fiscal funding to invest in infrastructure items as no structured provincial program exists (unlike in acute sector). Minor infrastructure items would include items like information technology (hardware/software), minor renovations, equipment and furnishings, etc. A very similar program was used in 2008/09 and 2009/10 and was deemed to be successful and greatly appreciated by the providers.

One-Time Minor Infrastructure Program

The program has eligibility criteria to guide provider submissions and inform approvals. Criteria guiding the program include:

• One-time costs only and cannot create ongoing operational cost impacts;

Agenda Item 5.10

of 2

• Current base operating pressures cannot be considered; • Funding must be spent within fiscal year it is approved; • Funding must support a LHIN-funded program or service; • HSP must be current with all reporting requirements to be eligible; • Request must be supported by HSP CEO/ED.

South West LHIN Health Service Providers submitted Q2 reports at the beginning of November. The analysis identified a potential in-year surplus amount of $4.4 million from our allocation to several community sector HSPs. The exact amount available for reallocation will be contingent on final confirmation of budget projections and evaluation of requests from these HSPs to reallocate funding internally. Part (i.e. $1.2 million) of the available surplus stems from Residential Hospice operations funding as the remaining two residential hospices (London and Grey Bruce) will not be operational this fiscal year. Please note hospital in-year surplus cannot be recovered due to the BOND policy. Subject to LHIN Board consideration of this request, the process to complete the Community Sector One-Time Minor Infrastructure Program would be launched in December by sending an electronic application to all eligible health service providers. LHIN staff will review the applications against a set of criteria (similar to previous fiscal years) and confirm approvals. Final approvals would be issued to providers in January 2011. The results of the program will be shared with the Board.

CMHA Oxford approached the LHIN during the 2008/09 fiscal year to request that $90,313 be approved to be carried forward to 2009/10 to offset a wage settlement would not be finalized before the end of the fiscal year. This was a reasonable request given that the liability for the potential payment was tied to the 2008/09 fiscal year, and the surplus would otherwise been recovered to the provincial treasury. The LHIN approved the request. The Ministry of Health and Long Terms Care’s Financial Management Branch does not accept the LHIN approval as it is not consistent with the Community Financial Policy and is recovering the amount. CMHA Oxford came to the LHIN at the appropriate time and made a reasonable request and therefore it is recommended that CMHA Oxford be reimbursed for the amount to be recovered.

CMHA Oxford Branch

End.

- 1 -

Report to the Board of Directors Behavioural Support System for Older Adults

Meeting Date:

December 16, 2010

Submitted By:

Kelly Gillis, Senior Director, PICE Julie Girard, Team Lead, Planning and Integration

Submitted To:


Purpose:


Background The purpose of this briefing is to provide the South West LHIN Board of Directors with an update regarding initiatives that are moving forward to address the needs of individuals with behavioural issues living in long term care homes or in other community settings. This update is in response to a request for information made at the Board of Director’s meeting on October 27, 2010.

Provincial Behavioural Support Systems (BSS Project)

The overall objective of the Behavioural Support Systems (BSS) project is to create a framework for transforming the health care system for Ontarians with behaviours associated with complex and challenging mental health, dementia or other neurological conditions living in long-term-care homes or in independent living settings. Central to the success of the project is creating a system that ensures individuals are treated with dignity and respect in an environment which supports safety for all and is based on high quality and evidence based care and practice.

The project has been lead by the North Simcoe Muskoka LHIN in partnership with the Alzheimer Society of Ontario, the Alzheimer Knowledge Exchange, the Ministry of Health and Long-Term Care and supported by the Ontario Health Quality Council (OHQC).

The BSS project team has completed a draft Phase One report. The draft is undergoing some review before it becomes a final product and the current plan is to post the report on the BSS website once it is approved. The team is proposing a second phase to the project which would involve testing and learning more about the BSS model and this is under consideration by the MOHLTC. See the attached Newsletter: Issue 6.

Project Update

Agenda Item 5.11

- 2 -

South West LHIN Behavioural Support System for Older Persons with Responsive Behaviours

The South West LHIN Board approved this aging at home project ($3,083,500) at its February 2010 Board meeting. The funds were subject to approval through the provincial estimates process which was received in June, 2010. A Project Steering Committee began meeting monthly in July and has made great progress to begin implementing the services. A project lead began October 1, 2010 and it is expected that the project charter and Memorandum of Agreement between the hospitals will be finalized by Dec. 15th. Key elements of this service include:

• Three Geriatric Mental Health Response Teams (north, central and south) integrated within geographically designated Geriatric Cooperatives (all providers of geriatric services), and will build upon the local capacity necessary to address challenging behaviours where people reside (Long Term Care Homes, homes). Individuals with challenging behaviours will be able to remain in their current surrounding and remain connected to their current community support system (families, Long-term Care Homes, Adult Day Programs) with less reliance/utilization of emergency rooms and acute care hospital beds.

• The response teams will be attached to the Schedule 1 hospitals in addition to specialist resources at Regional Mental Health Care thereby aligning local, multi-community and LHIN wide resources to support the range of need at the local level.

• Funding to purchase telemedicine units for 17 Long Term Care Homes (LTC) has also been approved to provide support to LTC homes so that residents travel less and receive care in their home settings. Staff training and education will also be provided through the units.

• On November 25, the South West BSS Steering Committee met with David Harvey, Ontario Alzheimer Society, who is co-leading the Provincial BSS project to discuss the alignment of the provincial project with the South West LHIN project. The South West BSS project contains many of the same elements of the provincial framework. It is expected that the South West LHIN project will help test components of the provincial framework and inform future modifications. The South West LHIN project will also work with the Provincial BSS project to refine project indicators. .

August 2010

Volume 1, Issue #6

Ontario BSS Project-Phase 1

“Keeping you in the know”

Individual Highlights:

Your initial thoughts 1 Priority Target Population 1 Principles 2 The 3 Pillars 3

We are now nearing the end of phase 1 of the BSS project and the ideas and concepts are beginning to take shape.

We are well on the way to proposing a system model for consideration and testing in phase 2. The draft model has been based on the best information we can gather from other jurisdictions and as well from innovations and ideas

Your initial thoughts……

Some Key Concepts of the BSS Initiative

gathered from Ontario including advice from caregivers obtained in our recent Conversations about Care initiative

Elements of the model have been discussed and presented in many different conversations – in order to get us to a starting point for Phase 2.

As these initial engagements continue, we

would also like to take this opportunity to share a few key concepts with you today and ask for your initial reaction.

As you can imagine, working toward a cohesive and practical model takes time and needs to build on the most current ideas and strategies in the field. So if you have the opportunity, we would appreciate your initial reaction.

Please visit the website and click on: “Initial Feedback on Key

Concepts” and add your voice.

PRIORITY TARGET POPULATION There has been a great deal of discussion on the target population for this initiative. It is important to provide a focus for the work that is doable and as well, is inclusive of a group with similar needs and concerns. The working definition is as follows:

Older adults with complex and responsive behaviours associated with cognitive

impairments due to complex mental health, addictions, dementia, or other neurological

conditions and their caregivers

Other populations have been identified as having some similar issues and needs, and at the same time, unique and important concerns.

The current plan is to identify these groups during phase 1, and during the testing phase examine in more detail how the vision, guiding principles and overall framework can be applicable to these populations. These might include: individuals with an acquired brain injury, and younger adults with age-related and neurological illnesses.

The phase 1 BSS team has begun to have discussions with groups who could shed light on the concerns of the included and related populations and as well to identify key learnings that could apply to the current BSS Model development.

Ontario BSS Project-August 2010

Page 2 of 3

Key Concepts of the BSS Initiative cont.

Inside Story Headline

“Person and Caregiver

Directed Care is a key

overarching principle of the

proposed Ontario

Behaviour Support System

Model”

PRINCIPLES Guiding principles for a system model are critical to ensuring that the directions reflect shared concepts and have a solid foundation. The proposed principles are values based and guide the development of health care services for people with responsive behaviours and direct the implementation goals of the model.

The principle of person and caregiver directed care has been put forward as a key, overarching principle that needs to be reflected strategically as well as in day to day practice. All persons must be treated with respect and accepted “as one is”, the older person and caregiver/family/social supports have a central voice and are the driving partners in the care and life goal decisions.

Other proposed relevant principles include:

1. Behaviour is Communication

Challenging behaviours can be minimized by understanding the person and adapting the environment or care to better meet the individual‟s unmet needs.

2. Diversity

Practices must value language, ethnicity, race, religion, gender, beliefs/traditions and life experiences of the people being served

3. Collaborative Care Accessible, comprehensive assessment and intervention requires an interdisciplinary approach which includes professionals from different disciplines, as well as the client and family members, to cooperatively create a joint, single plan of care.

4. Safety

The creation of a culture of safety and well-being is promoted where older adults and families live and visit and where staff work.

5. System Coordination and Integration

Systems are built upon existing resources and initiatives and encourage the development of synergies among existing and new partners to ensure access to a full range of integrated services and flexible supports based on need.

6. Accountability and Sustainability The accountability of the system, health and social service providers and funder to each other is defined and ensured

of 3 Ontario BSS Project-August 2010

Ontario BSS Project-

Phase 1

Do you have questions or comments?

Send them along to:

E-MAIL: [email protected]

We‟re on the Web! See us at:

www.bssproject.ca

The Three Pillars of the BSS Model

Pillar #1

System Coordination

Coordinated cross-agency, cross-sectoral

collaboration and partnerships based on

clearly defined roles and processes to facilitate

„seamless‟ care.

Pillar #2

Interdisciplinary

Service Delivery

Outreach and support across the service

continuum to ensure equitable and timely access to the right

provider for the right service.

Pillar #3

Knowledgeable Care

Team and Capacity

Building

Strengthen capacity of current and future

professionals through education and focused training to transfer new

knowledge and best practice skills for

continuous quality improvement.

Pillar #1

System

Management

and

Accountability

Governance through LHIN wide regional organizational structure

Program Level Coordinated Network at operations level

Regional System Coordinator

Integrated,

collaborative

intake,

transition and

referral

Pillar #2

Collaborative/Shared

Care Service Delivery

Bio-Psychosocial

Environmental Model

Least restrictive and

least intrusive

approach

Supported by:

Mobile Interdisciplinary Support Teams

Case management and supported transitions

Enhanced day treatment & respite care

Specialized Residential treatment (Behavioural Support Units-for short stay; units in LTCH for long-stay)

Pillar #3

Learners need best

knowledge, skills, attitudes at

point of care, organizational

level and across the system

in these areas:

Clinical for prevention, management of responsive behaviours

Caregiver support Self- management to help

make informed choices Capacity building to create

supportive learning infrastructures

Collaboration within between individuals, teams, organizations, systems

Innovation for cutting edge research and use of new technologies

Resource investment to support efficient, effective use of scarce HR and evidence based resource decisions

Some essential elements of each pillar:


http://www.bssproject.ca/

of 5

Report to the Board of Directors Senior Leadership Report

Meeting Date:

December 16, 2010

Submitted By:

Michael Barrett, Chief Executive Officer Kelly Gillis, Senior Director, Planning, Integration & Community Engagement Mark Brintnell, Senior Director, Performance, Contract and Accountability Glenn Lanteigne, Chief Information Officer and eHealth Lead Julie White, Director, Communications and Customer Service

Submitted To:


Purpose:

Information Decision

Strategic South West Ontario Eating Disorders Initiative – London Health Sciences Centre London Health Sciences Centre (LHSC), in partnership with Western Ontario Therapeutic Community Hostel (WOTCH) and the Eating Disorders Foundation of Canada (EDF) previously submitted a proposal to the Ministry of Health and Long Term Care to develop an adult South West Ontario regional treatment service for eating disorders. The Ministry has recently requested that the proposal be updated and resubmitted to the Ministry along with a confirmation of LHIN support for the initiative. There are currently no coordinated treatment programs that deal with adult eating disorders in the South West area, either in hospital, day care or residential facilities so that accessing care close to home becomes challenging. The predominant focus of this initiative therefore, is on a continuous care model at LHSC, which will serve as a provincial resource, primarily for those patients with anorexia nervosa, bulimia nervosa, and binge eating disorders. Access to the Ontario based services, including LHSC, will be coordinated with the treating physician and a provincial coordinator to help clients access care close to home as soon as possible. As other components including prevention, support groups, psycho-educational groups, and transitional services, are vital links in the service system, resources will also be invested in local communities and linkages established with family physicians and other service providers in order to achieve seamless care and effective outcomes. Next steps include the design of this project proposal mirrors the plans articulated by the Provincial Eating Disorders Network. Care is provided as close to home as possible while based on critical mass to ensure quality of care and efficient service delivery. Inpatient care is utilized only in the most severe, unstable cases.

Agenda Item 7.1

of 5

LHSC is currently updating the Project Charter and will be submitting it to the LHIN office for review. Funding is anticipated in the amount of $2 to 3 M. The funding will be flowed through the South West LHIN specifically dedicated to the support of Eating Disorder programming and services. It is anticipated that a LHIN staff letter of support will be forwarded to the MOHLTC along with the Project Charter during the month of December. The LHIN Board of Directors will be updated in the New Year regarding the status of this initiative. Chronic Disease Prevention and Management – Self Management

The Ontario Diabetes Strategy – Self Management Initiative will be providing funding to the South West LHIN for 2010-11 for the purposes of expanding self-management capacity for health service providers and clients. The initiative is intended to be coordinated by a health service provider organization, with the support and oversight of the LHIN.

Currently, the South West LHIN has invested in a LHIN-wide Self-Management Strategy funded through Aging at Home dollars. The lead organization for the South West LHIN Self-Management Strategy is the South West CCAC. To ensure continuity and alignment of the South West LHIN’s Self-Management Strategy and the ODS – Self Management Initiative, the South West LHIN will receive the funds from the MOHLTC and flow the funds to the South West CCAC.

The funding agreements continue to move through the MOHLTC’s internal approval process, and exact amounts and deliverables have not yet been confirmed. However, it is anticipated that the funding will be in the range of $60,000 to $90,000, and will include deliverables for provision of self-management training to health service providers and self-management sessions to clients living with, or at risk of diabetes.

LHIN Shared Services Office (LSSO) and LHIN Collaborative (LHINc) Governance Review As the accountable organization for LSSO and LHINC, the Toronto Central (TC) LHIN Finance and Audit Committee and the LSSO/LHINC Audit Sub Committee have requested a governance review of both LSSO and LHINC. The TC LHIN has engaged Deloitte and Touche for this review following a competitive process.

Deloitte has completed the first important milestones, including interviewing a sample of Board Chairs, CEOs and other key stakeholders and completing an analysis of the effectiveness, strengths and weaknesses of the current governance and decision-making models based on interviews and a consideration of comparable models in Ontario, other jurisdictions and other sectors and industries.

The project is on track with the established time lines. A final report with recommended options and an implementation plan is to be completed by mid December. The report will be tabled at a special meeting of the TC LHIN on December 14, 2010 after which it will go to the respective chairs of LSSO Management Committee and LHINC Council for decision making and communication.

of 5

Operations

Annual Business Plan Component of the 2011/12 Annual Service Plan The Ministry-LHIN Performance Agreement (MLPA) defines the Annual Business Plan (ABP) as "the plan for spending the funding received by the LHIN from the MOHLTC and included in this Agreement as required by s. 18(2) (d) of the LHSIA."

The ABP and the Multi-year Consolidation Report are the two components of the LHIN Annual Service Plan (ASP). Only the ABP of the ASP is made public.

The ABP is the LHIN’s 3-year business plan produced for the public, health service providers and government stakeholders to fulfill the LHIN’s obligations under the Agency Establishment and Accountability Directive and to specify how the LHIN will allocate its resources to meet the objectives of its Integrated Health Service Plan (IHSP). The MLPA requires the LHIN to finalize the Annual Business Plan within 120 days of a budget announcement by the Government of Ontario and append to the MLPA.

Multi-year risks are currently being captured as part of the Quarterly Risk Reports and therefore are not included at this time with the Annual Business Plan submission.

Next Steps

• January 12, 2011: Board will receive draft ABP (for review and approval at January 26, 2011 Board of Directors Meeting)

• January 31, 2011: Final draft ABP submitted to LHIN Liaison Branch (LLB); feedback expected by end of February 2011

• March 2011: Budget announcement expected; updates made to draft ABP accordingly • April 2011: Board to receive revised draft ABP • Early May 2011: Revised ABP resubmitted to LLB; feedback expected by end of May 2011 • July 2011: Final ABP approved by Board Chair submitted to Minister 120 days following budget

announcement • September 2011: Multi-Year Risk Report component of the ASP will be brought to the Board Communications Media Overview Over the course of November, there were 12 media stories tracked by the Communications team that directly mentioned the South West LHIN. This is down from 21 in October. One of the pieces was a feature story in Healthcare Quarterly magazine on the SPIRE project. South West LHIN Electronic and Social Media In November, the LHIN website had 13,238 visitors. A site visit is defined as a series of page requests from the same uniquely identified user with time of no 197,762 page views between November 1 and

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30. For the first time, our “Board meetings” page had more viewers than the LHIN’s most popular page historically, careers, with 853 viewers in November compared to 780 careers page viewers. A page view is defined as the loading of a single page of information in response to a user clicking on a link. In November, there were 896 MyPage subscribers – up 3 from October. As of November 30, there were 115 fans of the South West LHIN facebook page. The page was updated with 7 posts during the month. On Nov. 30, there were 756 followers of the South West LHIN on Twitter (up 94 from the previous month) – and the LHIN has amassed 1,716 “tweets”. The GET_ENGAGED account has 1,168 followers and has posted 3,292 tweets. eHealth The South West LHIN continues its work as the early adopter site for the Chronic Disease Management System for Diabetes. As the early adopter, the South West LHIN will be responsible for the Limited Production Release (LPR) of this system in Ontario. The LHIN will provide leadership to support Ontario’s Chronic Disease Prevention and Management (CDPM) Strategy and is in the process of selecting and recommending 10 sites to MOH/eHealth Ontario. The Registry will be an interactive, real-time information tool to help physicians ID diabetic patients that will monitor their clinical results and better manage their care according to recommended guidelines (CDA – 2008) with comparisons to peer groups (LHIN, Province). The LPR objectives include to prove system value to stakeholders, prove solution functionality, prove site delivery/adoption process, and the determine training requirements for roll out. The timing for the project includes site selection by 20 December 2010, site readiness assessments by Spring 2011, go live by Summer 2011, and evaluation of the LPR by Fall 2010. The eHealth team has continued to engage organizations via the Area Provider Tables (APTs) and has met with them in Owen Sound most recently. Other engagement sessions include 2 physician sessions in partnership with the OMA in London and Stratford and well as one upcoming in Owen Sound. Key feedback to date include the success of the SPIRE project as physicians get hospital reports send directly to their electronic medical record systems. Expressions of interest were also provided by the physician community for inclusion in the LPR phase of the Diabetes Registry. The eHealth Strategy Document is now complete and is being submitted for final Board approval at the December 8th meeting. All stakeholders have been engaged including the LHIN staff, LHIN Providers, other LHINs, eHealth Ontario, the Community Care Access Centre (CCAC), and the eHealth Steering Committee, the Health System Leadership Council, the CEO Forum as well as the Area Provider Tables (APTs). In addition, we are continuing to engage providers in the LHIN, and also working with neighboring LHINs to ensure that eHealth activities are aligned. A 4 LHIN workshop has been conducted to align and leverage eHealth projects in South Western Ontario and subsequent meetings are planned to ensure strong alignment with Erie St Clair, Waterloo Wellington, Hamilton Niagara Haldimand Brant.

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Staffing Updates The LHIN is pleased to announce that Evan Harris has accepted the position of Project Management Office (PMO) Lead and will be joining the South West LHIN team on Monday, December 20th. Evan has over 10 years of project management experience working in the technology field. Evan’s diverse background includes the positions of Business Project Manager – IRIS Planning and Project Management Control Analyst with London Life, as well as other projects with the Children’s Aid Society and General Dynamics in London. In addition, Evan is currently an instructor at Fanshawe College for courses including Project Management. Evan has his Project Management Professional (PMP) designation and is working towards his Bachelor of Education at Brock University. Evan brings a strong background and knowledge of project management tools, methodologies and approaches that will be a wonderful addition to the South West LHIN team. Please join me in welcoming Evan to our organization. The LHIN has welcomed Sarah Davis to the team as a Financial Analyst. Sarah started on November 29th and will be working closely with our health service provider partners in the North geographic area. Sarah brings to our team skills in the areas of financial analysis and assessment from her various accounting roles within the private sector. Most recently, Sarah held the position of Accountant with Lanier Healthcare Canada. Welcome Sarah!