Ontario healthcare organizations work to connect their systems

Ontario’s vision of achieving one provincial digital health record per patient, accessed by all levels of care, remains elusive. But that isn’t stopping key interoperability projects from moving forward, demonstrating that investments in facilitating bidirectional data exchange between hospitals, long-term care (LTC) homes, community agencies and primary caregivers can deliver measurable returns – both financially and clinically.

Project AMPLIFI – a province-wide clinical data integration initiative funded by the Ministry of Health and Ontario Health and led by St. Joseph’s Healthcare Hamilton – is using PointClickCare’s (PCC) Post-Acute Care Network Management integration software to facilitate information exchange when patients are transferred between health systems and long-term care homes.

The project supports sharing of discrete data related to allergies, medications, immunizations and problem lists so that any time a LTC resident visits a participating hospital, clinicians will have real-time electronic access to their secure, clinically pertinent health information.

Traditionally, there has been “a paper package that’s about 100 pages that can get sent between long-term care and hospitals at transitions of care,” explained AMPLIFI senior project manager Robert Steele. “We need to make that digital.”

When the team began their work in 2021, Epic was the only hospital electronic health record capable of sharing data within the parameters of the project.

Now, Oracle Health and Meditech sites are also live, with participating hospitals and homes successfully sharing data through the Oracle Ontario eHub Health Information Exchange and Meditech Traverse Exchange Canada respectively – information exchanges that were established in part due to the work of AMPLIFI.

To date, the interoperability effort is connecting 82 Ontario health systems with 525 LTC homes, and an additional 23 health systems are expected to be onboarded by end of March 2026.

The foundational work is being evaluated using both surveys and transfer/patient level data from participating hospitals and LTC homes, and initial measurements are showing tangible savings.
“We are really starting to see some hard numbers in the return on investment per patient transfer,” said St. Joseph’s vice-president and CIO Tara Coxon.

AMPLIFI research manager, Sarah Culgin notes that survey responses have been overwhelmingly favourable, with most users reporting that information sharing is improved. They are spending more time with patients and less time on data entry, and that patient safety is enhanced.

By applying user perceptions of significant time savings to data collected for each bi-directional patient transfer, the team calculates an average staff time savings (excluding physicians) of 58 minutes per transfer, which translates to just under $68 in wage savings – or an annual savings of $3.6 million based on about 57,000 patient transfers per year.

Existing evidence of reductions in readmissions in studies of similar interoperability implementations suggest that patient transitions supported by AMPLIFI could prevent more than 2,300 hospital readmissions, resulting in a return of roughly $16 million annually based on the cost of a standard hospital stay in Ontario.

The AMPLIFI team is currently evaluating this potential benefit through an IC/ES AHRQ project using coded data.

As a foundation for connecting community health information, AMPLIFI is proving to be valuable but there’s still plenty of work to do, said Steele. For example, some hospitals don’t have digital workflows in place for performing medication reconciliation, and there is variation in how immunizations and problem lists are recorded.

“Because the vendors also use different code sets, it hinders the workflow,” he said. “At the minimum (the information) gets crossed over as free text, at the worst it doesn’t cross over discretely at all.”

Awareness is another challenge. Because change management wasn’t mandated from the beginning, the project relies on a train the trainer approach and it can be a struggle to get staff to commit to the workflow necessary to facilitate information exchange.

For example, for information to be pushed from PCC to the hospital, long-term care staff have to follow steps in the system for discharging a patient to hospital or admitting them back in a timely manner.

If a resident leaves for hospital in critical condition at the end of a busy shift on a Friday, for example, there’s a chance that the Admission, Discharge and Transfer won’t be completed in the system until a clerk does it Monday morning.

“If you don’t complete that process, there’s no documentation that’s able to be sent to hospital,” explained Steele.

Steele points to AMPLIFI having created the foundation for achieving the vision of one patient record provincially but notes that “…in spite of the AMPLIFI team doing our best to advocate for data standardization, as well as to work with the vendors on optimizations, province-wide decisions need to be made regarding interoperability requirements for healthcare organization.”

Meanwhile, the East Toronto Health Partners Ontario Health Team – a group of more than 100 community, primary care, home care, hospital and social services organizations serving East Toronto – also identifies the need for either federal or provincial intervention to address governance, process and workflow challenges related to interoperability of health systems.

As one of the province’s initial 12 Ontario Health Teams, ETHP has a strong vision to deliver integrated care, by establishing programs aimed at improving home care services, supporting youth wellness, helping patients transition safely home from hospital and providing alternative level of care services, among others.

As they implement different programs, they face the challenge of getting all providers connected so that everyone is working from the same central version of patient information, including items like the care plan, follow up, and services required.

In some instances – for example, the MGH2HOME care program to transition patients home safely after an acute care stay at Toronto’s Michael Garron Hospital (MGH) – the care team is granted access to existing systems, such as lead agency VHA Home HealthCare’s GoldCare HIS.

For other programs, like the Kew Beach transitional care unit that brings different organizations together to deliver alternate level of care, VHA staff are trained on Michael Garron Hospital’s Oracle/Cerner system.

To facilitate secure data transmission between primary care providers, pharmacists, allied health professionals and hospital specialists, Michael Garron Hospital introduced the Hypercare healthcare coordination platform.

According to MGH CIO Amelia Hoyt, the move was aimed at dissuading users from choosing less secure methods for provider-to-provider communication such as personal email, platforms like WhatsApp or even a phone call.

“We have so many disparate systems that are not integrated, and obviously in an ideal state they would be, but it’s just not so simplistic,” said Hoyt. “So, we’ve been looking at how we can either provide new solutions or do true integration, to have less of this printing out and faxing over.”

Recently, Michael Garron Hospital, VHA Home HealthCare and the Ontario Health Team partnered to build an online collaboration platform hosted on Microsoft SharePoint. Called ETHP Collaborate, it provides a central place for creating and accessing coordinated care plans, supports virtual rounding and documentation, and facilitates secure communication among care teams.

“If we want to integrate the hospital systems, the home care system, the primary care system – we need to develop a way for all of those systems to speak the same language,” said VHA Home HealthCare CIO and vice-president, digital health Alistair Forsyth, pointing out that the varying landscape of vendors is a major barrier.

“The province has been trying for years without success … As a result, we’re left with only one other option: to put in this collaboration layer and put whatever information we can into it and have the care team logging in and using that – which in and of itself is a bit of a barrier because they don’t want to log into another system,” added Forsyth.

ETHP Collaborate is currently being piloted in an integrated care planning program to support people with chronic obstructive pulmonary disease and congestive heart failure. As they work to expand the platform’s functionality, ETHP is now changing their thinking on how to incentivize providers to do the right thing when it comes to sharing information.

“One of the things that will address the interoperability challenge, beyond just ‘we need to standardize on systems, we need to have the ability to connect those systems,’ is also funding and the way that funding incentivizes behaviour, including the sharing of information,” he said. “If you incentivize people to act as a team and to share information, if you tie that to the money, then they’ll do it.”

Not only is it difficult to get all the participating community organizations to agree on processes, rules and responsibilities when it comes to sharing information, it’s also challenging to determine what the shared operating model should look like. Right now, VHA Home HealthCare is hosting ETHP Collaborate, yet the platform is owned by ETHP, for example.

Early feedback from the pilot suggests that those working in a care coordination role are benefiting most from the shared platform. Hoyt believes technology and the transition to digital health will only be able to bridge the communication gap so far. What’s needed, she said, is a more holistic top-down approach that examines how healthcare structures themselves are provisioned.

“If we need to now provide population health and integrated care, then the siloes we have with our current institutions need to be evaluated,” said Hoyt. “If those aren’t changing, the technology will end up being ineffective as a result … I don’t think it’s right that the technology is driving the governance process. I think that should be top-down from a provincial, or possibly federal, level.”

Hoyt uses hip surgery as an example. The province currently plans to standardize on e-referrals and a central intake system, but the starting point needs to be the referral form itself to ensure everyone is using standard data elements in a digitized form, she suggested.

Both ETHP and AMPLIFI are collaborating with Ontario Health to share lessons learned that could impact future provincial data repositories and sharing platforms. Based on the success of AMPLIFI in the long-term care space, the team is now looking at rolling out similar system interoperability for retirement homes, home care agencies and primary caregivers.

Dr. Dan Perri, chief medical information officer at St. Joseph’s Healthcare Hamilton and chief medical officer for Project AMPLIFI, points to the future of one patient record most likely sitting with patients themselves. He echoes the challenges faced in both the AMPLIFI and ETHP projects, highlighting complexities related to privacy, data ownership and governance. “Until patients are in charge of their own health data, provincial-level, or ideally federal-level, standardization decisions are required to attain true province wide interoperability.”