October 4, 2004

1. Integrated Public Health Information System(i-PHIS)An Update For OntarioPublic Health Epidemiologists October 4, 2004

2. i-PHIS - Rationale For Change • SARS outbreak highlighted “serious deficiencies” in Ontario’s current Reportable Disease Information System (RDIS) • i-PHIS was recommended by the Walker Report • i-PHIS to be the replacement system for RDIS and rolled out to all Ontario Health Unit’s by June 2005 • Recommended and supported by Health Canada • In use in a number of other jurisdictions of Canada

3. Review of RDIS 37 stand-alone versions of RDIS • No data sharing across health units • Creation of duplicate clients and episodes • Re-entry of cases and contacts • Infrequent provincial system updates • Health unit customization • No real-time data collection • Inability to rapidly detect trends and outbreaks and put in place timely public health interventions

4. Review of RDIS Difficult for front-line staff to learn and use • RDIS became a “reporting” system to many health units rather than a “case management system” • Resulted in creation of multiple-systems Lack of quality assurance and data standards • “Garbage in” ---> “garbage out” • Poor data to make decisions • Lost opportunity to report findings

5. Review of RDIS Limited case/contact/outbreak management • Contacts are linked to cases not to “events” • No ability to capture College of Nurses compliant nursing notes • Summary level outbreak information collected only Poor graphics and word processing • Routine extractions of data to other systems required • Reliance on other systems to generate letters, worksheets, reports, tables and graphs

7. iPHIS Rollout Concept Rollout out of iPHIS for emergency outbreak response is planned for November. Some PHUs/PHD to implement. Ont. Release 1 Ont. Release 2 Future 2004 2004 2005 2005 2005 2005 2005 2005 2005 2006 11 12 01 02 03 04 05 06 09 # PHUs 4 4 4 - 8 8 8 1 4 8 12 12 20 28 36 37 Total # PHUs +PHD iPHIS Version 6.4.2 7.0 7.1 6.5 + + + ON Evaluation Gaps + Outbreak Module 5 gaps identified 8 gaps identified Case management early adopters would begin rollout preparation in November for an early 2005 Go Live date.

8. iPHIS Configuration SSHA Datacentre 1 Public Health Units Web VPN Server Cognos gateway - Reporting SecureID Engine App . for now , Server PKI later SSHA Satellite Offices Managed Private SSHA Network eWAN Oracle Oracle Replication Replication Public Health Division INP ...... SSHA Datacentre 2

9. i-PHIS Functionality Data Sharing ‘On’ • Data will be stored in a central database • Near real-time data access • Reduce duplicates • Ability to transfer clients information • Improved communication between PHUs and ministry • Improved ability to handle cross-jurisdictional outbreaks • Automatic roll-up of outbreak information for reporting purposes

10. i-PHIS Functionality Increased Accessibility • i-PHIS is a web-based application • Users will view and input data using Internet Explorer (version 5.5 or higher ) Improved Reporting Tools • Business intelligence tool (Cognos) used for reporting • Drag and drop report creation • Potential letter & worksheet creation • Decreased reliance on other software (e.g. SPSS, PowerPoint, etc.)

11. i-PHIS Functionality Improved Support And Easily Upgraded • iPHIS is a thin-client solution and requires minimal software to be installed on the desktop • Built with industry standard Oracle database Improved Ability to Enforce Data Standards • Filtered drop lists for key disease fields • Expanded external sources (e.g. schools, day nurseries,etc,) • Build-in business logic to enforce business rules • Revised disease codes (e.g. ICD-10 compliant) • Detailed glossary and data dictionary

12. i-PHIS Functionality Improved User Aids • On-line help • i-PHIS User Manual • Call Centre Support Improved Security • Hosted by Smart Systems for Health Agency (SSHA) • VPN and Key fobs for secure access Interoperability • GIS, Ontario Laboratory Information System (OLIS), etc.

13. Outbreak Cases Exposures Contacts i-PHIS Functionality - Outbreak Module • Creation/deletion • Search • Link/Unlink • Assignment

14. Base info required to define an outbreak Management of the events within the outbreak

15. i-PHIS Outbreak Module Enhanced Search Functionality • by outbreak • by case or by contact details • by exposure details • by client • employs soundex, alias and reverse look-up • within and outside of an outbreak

16. i-PHIS Outbreak Module Outbreak Management Enhanced Case & Contact Management • capture progression (daily follow-ups and outcome) • detailed intervention history • detailed prophylaxis, treatment (with sensitivities) and immunization information • linking and unlinking from current outbreak or from exposures • defining new exposures

17. i-PHIS Outbreak Module Enhanced Work Assignment Capability Can assign responsible HU and primary and additional investigators to: • outbreaks • workgroups • cases and/or contacts • exposures (e.g. locations)

18. i-PHIS Outbreak Module Enhanced Exposure Management - Linkages Level 1 Index case Level 2 Level 2 Level 2 1st Generation 2nd Generation Level 3 Level 3 Level 3

19. Future Release of Outbreak Module • College of Nurses of Ontario Compliant Progress/Nursing Notes • Create/update cases based on predefined case definitions • Supplies Management • Legal Order Recording and Tracking

20. Cognos Business Intelligence Tools • Currently, Health Canada recommends Cognos Impromptu, Cognos Internet Web Reports (IWR) for use with i-PHIS • Cognos is migrating current users to Report Net • Current i-PHIS project activities are focussed on: • Evaluating Report Net • Identifying ‘standard reports’ to be available at roll-out • Creating easy to understand ‘catalogues’ • Developing excellent training material

21. Suggested i-PHIS ‘Canned’ Reports Disease Reports (by disease, HU and time frame) • Incidence by age and sex • Incidence of disease by risk factor and/or risk setting • Incidence of disease by case classification Outbreak Reports • Epidemic Curves • Line Listings • Number of enteric outbreaks by month • Number of respiratory outbreaks by month Quality Assurance/Workload Reports • Number (%) of cases closed within 30 days • Number (%) of cases assigned by investigator • Number (%) of cases assigned by disease type

22. Impact On CD Surveillance & Reporting Units Reporting • Non-nominal data required by the Ministry will be accessed by the Ministry for the required reports • “Canned” reports should decrease epidemiologist/data analyst time filling data requests • Epi’s and data analysts will require training to become proficient users of Cognos tools Use Of RDIS Post Rollout • Most data, other than demographics, will not be migrated to i-PHIS and may remain in RDIS or another format • Trend data should be run prior to implementation • Staff will have to keep reporting skills current in RDIS for some time

23. Conclusions • Ontario’s public health system has been given a tremendous opportunity to improve its communicable disease information system; • i-PHIS will not solve all of Ontario’s communicable disease information system needs immediately; • System development is an iterative process and Ontario must work collaboratively with Health Canada to ensure that requirements are met.