Projects in Alberta, Ontario win Ingenious Awards
November 16, 2016
TORONTO – The Information Technology Association of Canada (ITAC) recognized two Canadian healthcare organizations at the 2016 Ingenious Awards, an annual celebration of excellence in the use of information and communications technology (ICT).
The University Health Network, in Toronto, won in the Large Public Organization category for the Implementation of the UHN Advanced Clinical Documentation Tool for Severe Obesity Care: A Model for Leveraging Technology to Improve Patient Outcomes.
In the Small/Medium Public Organization category, the winner was Alberta’s First Nations Integrated Health Solution: Home Care Reporting System Implementation Project (InterRAI).
When the University Health Network needed a better way to prepare clinically obese patients for bariatric (weight loss) surgery and follow up care, it partnered with IT consulting firm SyLogix to develop a solution that has revolutionized its patient care process.
The UHN Advanced Clinical Documentation (ACD) mobile tool revamps a complex and entirely paper-based system to allow effective and efficient documentation of a healthcare journey involving multiple-parties and multiple treatment modalities.
Preparing obese patients for bariatric surgery is a sensitive and intricate process. They must see practitioners from five different disciplines in a specific order.
Initially, they consult with a nurse before seeing a social worker, and then a dietitian. From there, they must be interviewed by a psychiatrist or psychologist, and finally the surgeon, who must have all of the information collected by the other practitioners.
“This is a life-changing process for a patient,” explained Victoria Ramirez, senior project manager for IT transformation at UHN. “The preparation involves everything from dietary changes to monitoring the patient’s mood and sleep patterns. All of these steps, and the hand-off between those steps, is critical.”
There was no electronic record management system designed to support the creation and exchange of these records between all of the practitioners, but in 2012 the UHN team began thinking about what it would look like.
Michael Caesar, senior director of information management at UHN, said the organization didn’t simply want to digitally replicate existing paper-based forms. “This project tried to scrape away the old way of doing things, and look at it in a different way. We looked at what information the care provider needed to care for the patient, when they need it, what do they have to capture during their interaction with the patient and how is that information shared downstream?”
Rethinking the information gathering process has also led to some longer-term benefits, explained Dr. Sanjeev Sockalingam, the psychiatry lead for the project.
“The ability to document post-operative assessments allows for historical data to be easily viewed and trended, and clinicians will be able to pick up on signals much faster with longitudinal data,” Sockalingham said. “The ability to pull data to trend how the patient progresses is a quick win for the application.”
The project was completed in 2014, and the team has had time since to evaluate its results. It found a 33% increase in the number of patients seen within three months of deployment, and the system slashed surgery wait times in half from 128 to 63 days.
On the financial side, Ramirez notes that dictation time used by clinicians fell by 80%, representing a total saving so far of $240,000.
Every Albertan seeking placement in a provincial supportive living or long-term care facility requires an InterRAI placement assessment, but delays with some aspects of implementation meant Home Care clients on-reserve were experiencing wait times of up to 18 months while most Albertans have a significantly shorter wait time.
Health Canada’s First Nations and Inuit Health Branch – Alberta Region (FNIHB-AB) became aware of the significant delays in 2007 on the heels of InterRAI becoming the provincial standard. First Nations community health centres were not using the InterRAI system, while Alberta Health Services nurses were required to travel to remote First Nations communities to perform assessments. The co-ordination between the two health authorities would take weeks, sometimes months, which meant there was a clear inequity in terms of access to health services.
“We knew there had to be some other option,” said Lorene Weigelt, senior officer with Health Canada. The obvious solution was to implement the InterRAI system and tools in the health centres on reserves so that community nurses could complete the assessments on site, share the results with the provincial facility, and reduce wait times overall.
The project was very much a partnership, as First Nation communities in Alberta took a lead role in moving it forward. FNIHB-AB played the coordinating role and sought out communities that would be willing to participate in the pilot project.
The first step was to assess the process needed to work with the provincial system, with the ultimate goal of achieving seamless service delivery on and off reserve. “We had to have their engagement,” Weigelt said. “It needed to be community led.”
Beyond improving assessment access for First Nation community residents, Weigelt said there were some other broader goals, including improved co-ordination of care and more consistent documentation, as well as compatibility with the overall healthcare system to allow for a seamless client transition between home and healthcare facility.
“From an actual logistics and technological perspective, the biggest challenge was getting nurses working in real time in client homes in remote, isolated communities,” said Weigelt. “The answer was software that could support an asynchronous connection. Assessments are done on a laptop in the home and the information gathered can be synched at a later date.
For the 24 of 46 communities that have been completed, the solution has drastically reduced the time for assessment to care. The success of the project speaks to the power of collaboration and partnership,” noted Weigelt.