April2006Sandra

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Canadian College of Health Service Executives Bluenose Chapter The Journey toward an Electronic Health Record in Nova Scotia: An Update and a Story from the Field April 2006

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Agenda Successes Challenges Planning Well Positioned for continued success!

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Successes

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Nova Scotia PACS Implementation Timeline 1997-1998 Victoria General Hospital implements PACS on a local archive 2003-2005 PACS initiatives in DHA 3 and parts of other Districts 2000-2002 New District hospitals with full PACS on local archives Current PACS Expansion Project (April 05 – June 06) 100% Aug. 05 DHA 1 Jan. – June 2006 Remaining sites in all DHAs Dec. 05 DHA 4 and Parts of DHAs 5, 8 & 9 91% 54% Approximate Percent of Images on the Provincial PACS Archive 2002 VG Hospital archive becomes Provincial Archive with all hospital CT machines linked. Sept. 05 DHA 7 Nov. 05 DHA 6 = Full PACS = CR Unit = June, 2006

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Nova Scotia Hospital Information System Timeline 1998 – Meditech Selected 2001 – Planning Begins 2003 – Implementation Starts 2006 - Completed March 2006 Project Profile Implemented Meditech - 34 Hospitals Master Patient Index - Over 1 million names Active users – 8675 Lab Analysis devices interfaced – 180 Peak implementation - 21 classrooms in use January 2005 – January 2006 Admissions: 44,000 Clinical visits: 1,136,000 Emergency room visits: 360,000 Same Day Surgery visits: 43,000

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Nova Scotia Telehealth Network Clinical Programs Dermatology Genetics Geriatrics Lung Transplant Mental Health Oncology Preoperative Rehabilitation Visitation … Educational Activities Continuing Nursing Education Continuing Medical Education Other Healthcare Professionals Medical Rounds Patients and Families Administrative Meetings 2000/01 - 1,200 sessions 2004/05 - 2,700 sessions (125% incr.)

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Nova Scotia Network .nshealth.ca Health Data Centres HIT-NS host site for Meditech C/S, PHIM, PACS archive, SeaScape, Network core routing, off site data replication for CDHA Capital Health hosts internet service, firewall, remote access service, PACS archive and web service, all CDHA applications, some provincial programs IWK hosts Meditech magic, IWK applications and some provincial programs Single Provincial Data network Links 34 tertiary care facilities with IWK and CDHA Redundancy built in where possible Both primary service providers in province Private fiber link between Health Data Centers Central firewall on single provincial Internet service Supports Meditech, PACS, internet, email, DHA specific applications, DHA facility based PHIM sites and testing TeleHealth IP based Video Conferencing Change Management Process in place to manage the network Twice monthly working group meetings with DHA administrators and one with primary provider.

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Nova Scotia HITS-NS H – Health I – Information T –Technology S - Services N - Nova S - Scotia New Operational Support Structure NShIS – (Meditech System and Interfaces) PACS (Agfa System) NS Telehealth Network SEAScape (Single Entry Access) Primary Healthcare Information Management Future – Client Registry, Interoperability, and other provincial systems Current Status (in progress) 2006-07 First Fiscal Year of Operation Executive Director in place Management Committee Structure Organization Chart Budget

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Nova Scotia PHIM Current Status (in progress) Clinics Live Clinics in Planning System Solutions myNightingale, sole EPR hosted solution myNightingale & Practimax local client server Established a hosting centre (HITS-NS) EPR – for Primary Care Health Transition Funds – Health Canada Sustaining Funding - Nova Scotia Department of Health Enabled the launch of an innovative Primary Healthcare Information Management solution Objective: To assist primary healthcare providers improve the management of health care information through the use of approved Electronic Patient Record (EPR) systems.

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Nova Scotia Health Administration Systems Project (HASP) The Department of Health, in conjunction with all District Health Authorities and the IWK Health Centre, has initiated this project to implement integrated administrative systems throughout the Provincial Health Care Sector. Foundation in core systems such human resources, payroll, budgeting, procurement and inventory management. HASP will result in the standardization of financial accountability and reporting, and the adoption of standards and best business practices Improved planning through evidenced based decision making Project preparation stage with detail system design to be completed by the end of 2006. Core systems targeted to be implemented province-wide by the end of 2009.

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Challenges

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The Challenges Resources (people and funding) Trying to do 10-15 years worth of work in 5 years Ensuring an appropriate balance between access and privacy Project Demands from everywhere! Communicating the ongoing support requirements Entering a New Phase (Long Term Strategic Plan) They are starting to get it/IT! And Demand it/IT! Prove this is a good thing! – Benefits Analysis

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Planning

Business Planning (Short Term): 

Business Planning (Short Term) TCA (Tangible Capital Assets)

Business Planning (Short Term): 

Business Planning (Short Term) New/Expanded

Business Planning (Short Term): 

Business Planning (Short Term) Other Projects

Business Planning (Short Term): 

Business Planning (Short Term) Other Projects (TBD)

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Planning – Long Term Launch major IM/IT Strategic Planning Initiative in 2006-07

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Positioned for Success

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Nova Scotia Positioned for Success Three Lab Systems No Private Labs DHA 1-8: Meditech (C/S) Lab DHA 9: Cerner Lab IWK: Meditech (Magic) Lab Three Health Data Centres HIT-NS Capital Health IWK Three hIS in NS DHA 1-8: Meditech (C/S) DHA 9: “Best-of-Cluster” IWK Health Centre: Meditech (Magic) Three DI Systems No Private DI Clinics DHA 1-8: Meditech (C/S) ITS DHA 9: Cerner DI IWK Meditech (Magic)

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Nova Scotia Positioned for Success HITS NS – Operational Support Structure One Data Network .nshealth.ca One Telehealth Network One Major Primary Healthcare EPR “Provincial Think” is Our Systems Strategy We have proven we can and do work together One Interoperable PACS Privacy & Security – part of every project

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Nova Scotia Positioned for Success Electronic Health Record