Information Technology at North Bay General Hospital

1. Information Technology at North Bay General Hospital

2. Introductions Lori Thibodeau, Information Systems Applications Analyst • Sunnybrook Health Science Center 1999 – 2003 • CTS Canadian Career College 2003 – 2005 • NBGH 2004 - present

3. Introductions Tim Wells, Network/Systems Administrator • Electronics Engineering Technology – Cambrian College • Technical Support – Cambrian Computer Consultants • 1996 – present – North Bay General Hospital

4. Introductions Brenda Monahan, PACS/RIS Coordinator • 1990-92 Lab Technician, MDS Sudbury • 1992 Nuclear Medicine Technologist, NBGH • 2003 Information systems RIS Analyst • 2004 PACS Project Manager

5. NBGH Overview • Previously 2 separate hospitals, the Civic and St. Joseph’s Hospitals merged in 1995 to form the North Bay General Hospital. • 204 beds • 1200 Staff • Level “C” hospital - district referral centre • Catchment area covers an area of 30,717 km², serving a population of 129,000 • Currently building and planning for transition to the North Bay Regional Health Centre

6. Information Systems Dept. • Centralized model, 14 staff • Some “super” users in other departments • Currently provide services for:

7. Information Systems Dept.(cont’) • Manage approx. 80 servers and 700 workstations • Manage remote connections with many outside agencies and vendors • Wireless LAN spanning both campuses for VoIP, wireless computing, etc. • Provide remote connectivity to hospital’s Electronic Health Record (EHR) for community based healthcare providers including physicians, specialists, homecare, etc.

8. Building the Electronic Health Record The ultimate goal is to build a complete EHR, accessible across the continuum of care in Ontario and eventually across Canada Challenges: • Common Patient Identifier • Legacy medical equipment • Disparate Systems • Privacy laws • Resources- $$$ and people • Existing medical record

9. Building the Electronic Health Record cont’ EHR should contain all medical information including: • Patient demographic information • Visit history • Drug profile • Lab tests and results • Diagnostic tests and results • Psychiatric assessments • *Patient consent directives*

10. Current H.I.S. Applications Patient Registration (ADT) • All patient demographic info, visit info and insurance info is managed in a single application • Application utilizes Health Card Validation • This becomes the source system for all other clinical applications in the HIS environment. • The objective is to eventually interface all hospital ADT systems to the Provincial Client registry… a.k.a the EMPI. This will provide a common patient identifier to link patient records across multiple systems and jurisdictions.

11. Current H.I.S. Apps (cont’) Community Wide Scheduling • Master scheduler for hospital visits, surgery, appointments, etc • Interfaced to Admissions to reduce redundant data entry • Also collects data to fulfill Wait Time Information System (WTIS) reporting. • Eventual objective is to allow physicians and/or admin staff access to a scheduling portal for their patients.

12. Current H.I.S. Applications Laboratory Information System • All lab instruments are connected to the Laboratory Information System (L.I.S.) • Test is ordered through the LIS and a bar coded label identifying the patient and the test ordered is printed and affixed to the specimen • Specimen is loaded in to the appropriate lab analyzer ,the bar code is scanned, and the appropriate test is performed. • Patient ID, test ID and results are sent back to LIS to be added to the patient’s record. • Ordering physician is notified of the results. • Lab results are also shared with provincial repositories to provide centralized longitudinal access to lab results.

13. Current H.I.S. Applications Radiology Information system • Manages radiology patient visits, exams and reports. • Is interfaced with the ADT system, Billing system and PACS application. • PACS application is interfaced to many 3rd party plug-ins to manage the DI workflow. Ex: paper scanners, electronic forms, 3D apps, dictation. • The environment is virtually paperless, filmless.

14. Current H.I.S. Applications Pharmacy - Automated Medication Dispensing Cabinets • Access patient medication information directly • Secure access • Secure vault and refrigeration

15. Individually packaged medications with barcode technology • Bedside verification for delivery of medication

16. Current H.I.S. Applications Scanning and archiving • Provides ability to scan printed medical information and attach it to the electronic health record • Can be used to integrate data from legacy equipment (if it can be printed, it can be scanned)

17. Current H.I.S. Applications Patient Care Inquiry (NBGH’s EMR) • Hospital wide view of patient record including all visits, consultations, diagnostics, reports. • Role based access for all users. This gives us the ability to customize the user’s menu to their needs. • Ability to audit user or patient. (ex. VIP) • Eventual objective is to manage patient consent directives and leverage to comply with Privacy legislation. (PIPEDA, HIPPA)

18. Current H.I.S. Applications Dictation Systems • Electronic dictation system, accessed throughout the hospital via phone system for the purpose of dictating results and findings by healthcare providers. • Voice recordings are accessed from network remotely and typed in to the E.H.R. • Some voice recognition is being done but must still be reviewed by someone

19. Current H.I.S. Projects Nursing Documentation • Ability for Nurse to do all charting electronically at the bedside. Currently done on paper and therefore, not completely captured in E.H.R. • Many options are available for bedside computing:

20. Current H.I.S. Projects Forms on Demand • Enables staff to produce forms, charts, and packets of forms when they are required • Automatic delivery of paper forms for the right person, right time and to the right place. • Completed forms with patient information, including barcodes for patient identifiers

21. Drug Profile Viewer (DPV) • The Drug Profile Viewer system is an electronic information system, which enables the ministry to share prescription drug claim histories of Ontario Drug Benefit (ODB) recipients (including Trillium Drug Program) with health care providers for the purpose of providing care. • Over 2.5 million ODB patient’s consented • Ontario Emergency Departments are currently using DPV • Expansion to Acute Care Hospitals in Dec 2007

22. Current Facilities Support Applications Nurse Call • Ability for Nurse to do all charting electronically at the bedside. Currently done on paper and therefore, not in E.H.R. • Many options are available for bedside computing:

23. Telemedicine • Telehealth is the use of information and communications technology to deliver health care services over large and small distances to remote, rural, under-serviced and aboriginal communities in Ontario. • TeleHealth system is a member of the Ontario Telemedecine Network (OTN), which deliver programs and services, offering over 70 specialties and sub-specialties through a number of well-established telehealth programs, including: cardiology, dermatology, mental health services, public health, burn/wound management, Telestroke, geriatrics and rehabilitation.

24. Telerobotic Surgery • Pilot project, proof of concept • first telerobotic in Canadian history, Feb 23, 2007 • Infrastructure was also used for “Telementoring” for CMAS

25. Image Guided Sinus Surgery System (IGS)

26. eCHN Ontario's Paediatric Electronic Health Record, delivered through the electronic Child Health Network (eCHN), provides access to health information in an electronic patient chart format to paediatric health care professionals in 52 hospital sites and nine Community Care Access Centres across the province

27. Security • IT security • Staff security • Patient security • Infant Abduction systems • Asset security- RFID, card swipes, etc

28. Remote monitoring systems • Renal - Home • CCIS/Remote CCU • Anything else you can think of that goes in here Tim? Where does Bedside Appliance fit in to this?

29. Communication Systems • VoIP • Wireless • SSO

30. Smart Systems for Health Agency The Smart Systems for Health Agency is deploying a number of key components of Ontario's e-Health strategy: ONE Network is the common connectivity that is being made available across the health care sector. ONE ID is the systems and process that allows health care professionals access to applications and systems hosted or operated by SSHA. ONE Mail is e-mail that is secure and reliable enough for health care providers to send health and personal information electronically. ONE Pages is the directory listing of health care providers to whom information can be e-mailed securely using ONE Mail. Health care providers will be able to share information about their patients knowing that data sent over the Internet is fully protected.

31. Canada Health Infoway http://www.infoway-inforoute.ca • CHI is a federally-funded, independent, not-for-profit organization whose Members are Canada’s 14 federal, provincial and territorial Deputy ministers of Health. Infoway is Canada’s catalyst for collaborative change to accelerate the use of electronic health information systems and electronic health records across the country. • Since it’s inception, Infoway has approved more than 227 projects in the following targeted program areas:

32. CHI Investment Programs • Diagnostic Imaging Systems -shared DI repositories • Drug InformationSystems-including potential errors, interactions and allergies. • Laboratory Information Systems-standards based • Infostructure-architecture, interoperability, standards, privacy, security, maintenance and conformance. • Innovation andAdoption-solutions should be COTS, replicable and sustainable. • Interoperable EHR-50% Canadians captured by 2010 • Public HealthSurveillance-communicable disease tracking • Registries- Client, Provider, and Service Delivery Location • Telehealth- move the data, not the patient/physician.

33. How much data is that?

34. Regionalization projects at NBGH • eCHN- early adopter in 2002 • OLIS- Information sharing among physician’s offices and lab providers. (long. Record at point of service, fewer unnecessary repeat tests, saving patient stress, time and $$$ • PNOPP- Pan Northern Ontario PACS Project, LIHN13/14 DI Repository • Ontario Client Registry- Provincial EMPI • WTIS- Ontario’s Wait Time Information system. Currently limited to OR/DI but expected to expand.

35. New Health Centre Project • To open December 2010 • Co-location of NBGH and North East Mental Health Centre • Increased services/beds • “state of the art” facility – level of integration means an expansion in scope and role for the hospital’s I.S. department • Network will be key, must be 99.999% reliable

36. New Health Centre Project

37. New Health Centre Project

38. New Health Centre Project

39. Security Systems (CCTV) • CCTV systems • Infant Abduction • Patient Wandering • Staff duress system • Door access

40. Building Automation Systems • HVAC • Fire Alarms • Intercom/Paging system • Door access • Continuous Emissions Monitoring System • Master clock system • Nurse Call System

41. Others • VoIP • Single Sign On • Biometric authentication • RFID

42. Bedside Terminal • Phone • Entertainment system • Internet • Education resource • Data terminal for Healthcare provider • Possible source of revenue

43. Further information? • www.nbrhc.on.ca • www.health.gov.on.ca/ehealth • www.northernontarioe-healthoffice.ca • www.ssha.on.ca • www.infoway-inforoute.ca

44. Questions and Answers? • Any questions?

45. Thank You!