COVID-19 had a big impact on data management

Hospitals in Ontario – and the rest of Canada – became aware of the importance of accurate data like never before during the COVID-19 pandemic.

“What became really clear was the importance of data integrity,” said Tara Coxon, vice president and CIO at St. Joseph’s Healthcare, Hamilton.

She said that to check on data integrity, “We sometimes had to walk around the hospital to make sure our data was accurate, that beds were actually available in the ICU.”

Coxon was one of a group of healthcare executives addressing the changes brought about by the COVID-19 pandemic. She was speaking at the UpOnDigital conference, an annual event organized by Digital Health Canada.

Coxon commented that because patients were being shuttled around the province, to even out the patient load among hospitals, data and numbers became even more important. To quickly share information, the numbers had to be in formats that were understandable by a variety of I.T. systems used in different facilities.

“We all had to be speaking the same language,” said Coxon, noting that standards became even more critical than before. “And when sharing data, interoperability is the holy grail to aspire to.”

She noted that the healthcare system still hasn’t arrived at true interoperability, and hospitals and other organizations continue to work at it.

Coxon observed that the COVID crisis ushered in other trends, such as remote monitoring of patients in their own homes.

“People didn’t want to come into the brick-and-mortar hospitals, and some still don’t,” she said. That has led hospitals to treat them using various forms of telehealth.

St. Joseph’s in Hamilton was a provincial leader in remote care of patients before the pandemic hit in 2020 and has since then increased the scope of its telehealth activities. “We’re looking into remote management of these patients, not just remote monitoring,” said Coxon.

Dr. Sarah Muttitt, vice president and CIO at The Hospital for Sick Children, said one of the biggest changes brought about by the COVID pandemic has been the shift to virtual.

“Virtual care is here to stay,” she asserted. “It’s now a standard of care.”

As well, for many administrative staff, work can be performed from any location. As Dr. Muttitt said while speaking on webcam, “Welcome to my kitchen. I’ve been working here for a few years, and I’ll probably be here a bit longer.”

She noted that people now have more choices about where they work, and they don’t need to commute every day to an office.

The acceleration of computerized work has led to other developments, she said. For example, Sick Kids is building a new tower on its campus that will contain no storage for paper documents. Instead, the idea is to become truly paperless.

Dave Brewin, CIO of the CARE4 Regional IT Partnership, observed that the traditional role of a CIO “used to be about the four walls of a hospital.”

CARE4 is regional partnership between Collingwood General and Marine Hospital, Georgian Bay General Hospital (Midland), Headwaters Health Care Centre (Orangeville) and Royal Victoria Regional Health Centre (Barrie).

Now, however, there is more regional collaboration going on, meaning the focus for CIOs is much wider. For Brewin, that means sharing data with partners in the continuum of health, such as primary care, long-term care, and others.

In Ontario, these care providers are being organized into Ontario Health Teams (OHTs), which are now working to address data standards and interoperability to better share data.

As an example, Brewin noted that his organization has adopted e-Referral and e-Consult solutions that enable area GPs and specialists to communicate faster and more efficiently.

The hospital will soon launch a patient portal, moreover, that will give patients access to much of the data in their electronic health records.

Shiran Isaacksz, vice president of Altum Health & Connected Care at the University Health Network, said that during the height of the pandemic, much of his time was dedicated to supporting the management of COVID patients.

He emphasized the importance of collaboration among various levels of the healthcare system – such as hospitals working with long-term care – and the coordination of patients moving from one jurisdiction to another.

While there were great successes in these areas, Isaacksz noted some gaps in the provision of care.

He observed that health equity is still a glaring problem; it’s well and good to have patient portals to access information, and online registration for tests and treatment. However, if some patients don’t have smartphones or access to computers, and if they don’t have computer literacy, such assets won’t help them at all.

Karen Macauley, director of eHealth and IT Services at CHEO, in Ottawa, noted the growing importance of data for decision-making. Like Tara Coxon, she put an emphasis on the need for clean and accurate data.

In addition, she said that data is being increasingly shared across the organization to help understand issues like wait times and patient flow. Many more people are making use of the data than ever before.

For this reason, the quality of the data must be high, and the origins and meaning of the data must also be clear, so that users “are comparing apples with apples,” and not with oranges.

“We want to make sure that we’re using our resources well, and we need good data for this,” said Macauley.

Mari Teitelbaum, VP of Provincial Programs and chief innovation officer at CHEO noted some success stories for the organization during the pandemic. A major one has been the achievement of Stage 7 in the HIMSS EMRAM rankings, in conjunction with the Hospital for Sick Children.

Ron Riesenbach, vice president, innovation and chief technology officer at Baycrest, in Toronto, focused on challenges that remain for healthcare providers. He observed that Ontario currently has 500,000 people with dementia, a number that’s forecasted to reach 900,000 by 2030 – with two-thirds of them being women.

“We don’t have enough long-term care beds for them,” he lamented.

To help with this issue, and with others, Baycrest has launched a program called “Baycrest at Home.”

“Rather than taking your mom to Baycrest, we’re Baycresting your mom,” said Reisenbach.

The program will bring a mixture of technologies and management right into the homes of patients. Moreover, it’s designed to be a holistic strategy.

“It’s not just a matter of pills, injections and therapies,” said Reisenbach. “Things like poverty, loneliness and despair kill, too.”

The Baycrest at Home program is designed to address all these issues.

As well, it’s important to pay attention to the care givers, too, including family members.

“As soon as the adult daughter – and adult daughters are usually the ones providing the most care – gets exhausted, she stops taking care of her parent with dementia. And when that happens, the parent ends up in the ER.”

Rachel Solomon, chief data officer at SickKids, put a spotlight on the issue of health equality. “COVID has exposed disparities,” she said.

To truly care for patients, she said, we need to be collecting more information about sociodemographics, including income, education levels, and race.

“The onus is on us to collect this information and to use it,” she said. “We need to push it out to clinicians.”

However, she noted that it must be collected in a way so that patients feel safe in disclosing it.

By collecting and using the data, Solomon said, caregivers will be able to provide more personalized care. “So, we’re not just planning for the average patient,” she observed. With sociodemographic data, “we’re able to look at who the system has not been designed for.”

Because of the growing need for data, Solomon asserted that “the pandemic has made us all statisticians.”

For her part, Cindy Fedell, regional chief information officer at Northwestern Ontario Hospitals, also emphasized the data that has been traditionally missing from the healthcare system when treating patients. She accentuated the needs of patients in her region, where half of the population lives in rural settings outside of cities.

Typically, there’s not a lot of data on these patients to begin with. “They often don’t participate in Statistics Canada surveys,” she said. “They often don’t trust government surveys.”

As a result, there is a lack of data on things like housing, she said, as well as other indicators associated with health.

However, these data could be collected by the healthcare system. Said Fedell: “We’re transitioning now to put in the right data infrastructure.”

In closing remarks, Mark Casselman, CEO of Digital Health Canada, noted the power of the professional community as a key to success in navigating an accelerated digital world together.

“It was great to see the many parts of our health ecosystems coming together as collaborators today,” said Casselman. “These healthcare leaders are partnering across care settings, using digital tools and data, to deliver quality outcomes and an improved experience for patients.”