JOANNA LIEBERT. Toronto Public Health CDIP/HC/HF Manager Quality Assurance USABLE: FLEXIBLE: INTEGRATED: SECURE

Transcription

1 USABLE: FLEXIBLE: INTEGRATED: SECURE JOANNA LIEBERT Toronto Public Health CDIP/HC/HF Manager Quality Assurance Toronto Community Health Information System 1

2 Agenda 1. TCHIS Overview Background Programs & Users Implementation Process 2. Electronic Documentation System Need Perceived value Selecting functionality To EMR or Not to EMR 3. TCHIS Suite of Functionality Unique Features & Customization 4. TCHIS Results Learning : In-house development & procured solution Sustainment TCHIS Benefits 5. Next Steps 6. Questions 2

3 TCHIS Overview Background Toronto Community Health Information System (TCHIS) is a web based electronic documentation system. Developed by Toronto Public Health using a combined approach of: in-house functional development Vendor purchased software/hardware TCHIS is not classified/certified as an EMR Released in May 2010, to 700 professional and para-professional staff working in 3 directorates at TPH Healthy Families (HF) Chronic Disease Prevention (CDIP) Healthy Communities (HC) 3

4 TCHIS Overview Programs & Users Nurses & Dieticians Specialists Support Assistants Community Health Officers Sexual Health Promoters Mental Health Nurses Management Community Nutrition Educators & Family Home Visitors 4

5 TCHIS Overview Implementation Process TCHIS Desktop Enhanced Reporting Integration Operational Handover Point of Care PROJECT PHASE Implementation included several multiyear projects Secured funding & resources (IT & Program) In-kind support from CDIP/HC/HF program Collaborative engagement from corporate partners Included design, development and implementation SUSTAINMENT PHASE Dedicated IT resources Program support integrated into organizational structure with current leadership for TCHIS assigned to CQI team. 5

6 Electronic Documentation System Need Amalgamation of 6 health units Quality impacts and inefficiency of paper based client records, documentation and files Difficulty complying with professional, corporate and divisional practice standards and guidelines High cost of maintenance and state of good repair requirements for disparate non integrated systems Transient client base 6

7 Electronic Documentation System Perceived Value Cost Avoidance Efficiencies Improved workflow Harmonization based on Best Practices Reduced Health Safety and Legal Liability Risks Timely Reporting 7

8 Electronic Documentation System Selecting Functionality To EMR or Not to EMR? Activity Timeline 2000 Business needs analysis initiated Project secured for implementation of electronic documentation system for CDIP HC HF programs 2003 Environmental scan completed. 30+ systems analyzed. Based on requirements and needs the decision was to build internally & not to purchase EMR TCHIS requirements & build with some external procurement Project secured for advanced reporting module development (datamart & GIS) May 31, 2010 TCHIS System Go Live Project secured for further Systems Integration work Project secured for TCHIS mobile enablement 8

9 Electronic Documentation System Selecting functionality: To EMR or Not to EMR Rationale: Not many EMRs available to review in Reviewed applications did not meet defined program functional & integration requirements without significant customization corporate technological standards of open, object-oriented architecture Users consisted of health professionals and non professional staff, documentation of medical/clinical services was not required. Needed ability to document services for various customer types Post amalgamation harmonization and redesign efforts were still underway and there was a high level of organizational immaturity and lack of stability. 9

10 TCHIS Suite of Functionality Unique Features & customizations SECURED WEB BASED APPLICATION Documentation Assessment Tools TCHIS POC App 10

11 TCHIS Suite of Functionality Unique Features: Security Infrastructure and Data Security Two factor identity authentication process Federated user identity / single sign on integrated with corporate user identity directories Audit trails Role based security Encryption and data storage based on best practice Policy enforced client hard drive hardening Completed TRA and VRA on all components to ensure system security and risk mitigation. 11

12 TCHIS Suite of Functionality Unique Features: Privacy Information Management and Privacy Role based access: allows users to see only what they need based on their role in providing the service Ability to develop and customize access roles as operationally required Audit trails Privacy Impact Assessment completed and passed. PHIPA compliant Ability to deploy and incrementally expand and tailor functionality with minimal business down time. 12

13 TCHIS Suite of Functionality Unique Features: Documentation CDO/CNO compliant, single source, accessible documentation Centralized access to secured single client record for all customer types Allows a full view of services for the client. Organizes content by service (issue) Allows for online documentation Organizes interactions in chronological order Allows inclusion of online tools and scanned paper documents. Permanent and non editable Electronically signed 13

14 TCHIS Suite of Functionality Unique Features: Client Profiles Unique profile screens for client types Individuals (known & unknown) Families External Organizations Populations (currently not used) Groups (currently not used) 14

15 TCHIS Suite of Functionality Unique Features: Client Service Record View full history of services for clients Visibility of collected client consent and status changes Integrated service time tracking functionality View full details of active service Maintain customer profile throughout service Document details of service related interactions incl. type (fax, written, face to face, telephone etc.) Manage staff resources and service lead roles throughout service delivery period 15

16 TCHIS Suite of Functionality Unique Features: System Administration TCHIS Administrative Modules enable Immediate customization of system structure Development of screening and assessment tools Modifying organizational structure (teams, offices, staff) in response to operational & organizational changes Definition and allocation of census tracts for service distribution and definition for service delivery areas (queues) 16

17 TCHIS Suite of Functionality Unique Features: Canned Reporting Immediate access to service, operational and aggregate reporting. Service Reports: provide service and customer details required for service delivery Operational Reports: monitor customer service, service totals, performance & service provision Respond to legal inquiries 17

18 TCHIS Suite of Functionality Unique Features: Datamart & GIS TCHIS Datamart anonymizes and aggregates TCHIS data to allow ad-hoc reporting for purposes of monitoring, planning and forecasting of services and performance measures. DataMart is responsive to Program specific reporting requirements Geographic Information System (GIS) enables visual representation of geographic service data on a map 18

19 TCHIS Suite of Functionality Unique Features: TCHIS App: TCHIS To Go! The TCHIS POC App optimizes key functions of the TCHIS system to work on Smartphones (Android). Enables staff working in the community to securely access the TCHIS system directly from the field allowing CDIP HC HF staff to take TCHIS To Go! Solution communicates directly with backend database for seamless live integration 19

20 TCHIS RESULTS Learning: In-house development & procured solution In House Development Process is time consuming Create a common understanding of PH service and needs. Document and validate requirements Organizational readiness/maturity, user readiness are critical success factors Expectations must be managed at all stages of development cycle Be adaptable to environmental, organizational and operational change Collaborate, communicate and leverage internal resources/relationships Integrated IT and program professional teams throughout all stages of the process ensures shared vision, joint decision making and leads to long term commitment and ownership. Procurement Procurement and legal are time consuming Sustainment of purchased solutions is expensive and fraught with SOGR & integration issues Corporate direction for purchased solutions change and this is not always aligned with program needs Reliance on external 3 rd party technical support can be challenging Overall: Being innovative & leading technical development in a multilayered corporate infrastructure can be challenging. Be aware and manage interdependencies Training, communication and support is a critical success factor 20

21 TCHIS RESULTS Sustainment FTEs Dedicated TPH IT FTEs for TCHIS Suite support QA dba Developer BSA GIS Reports HW/SW costs Licensing Architecture & Infrastructure SOGR Privacy & Security TPH Dedicated IT Corporate IT CDIP/HC/HF CQI Team FTEs Dedicated Corporate IT FTEs for Infrastructure support FTEs Maintenance & sustainment is integrated into program quality assurance structure and process Program based CQI FTEs allocated to on going support and maintenance 21

22 TCHIS RESULTS Benefits Cost Avoidance Service Quality Improvement Increased accountability and program monitoring Improved compliance with professional standards & privacy requirements Service Efficiencies Improved workflow & workload distribution Standardization, harmonization and improved operational processes Reduced Legal Liability Risks Timely Reporting Centralization Data Quality Improvements Strengthened partnerships & collaboration Policies & procedures Integration with centralized data sources Customized training, processes and materials for program users Organizational agility and adaptability Increased efficiency for service delivery in community settings Client information that is single source, accurate, accessible, secure private 22

23 TCHIS Next Steps Elimination of 3 rd party tools for identity management and data reporting Introduction of additional functionality for collection of demographic information at Individual profile Improvements in functionality that supports client privacy; functionality for record level lockbox and visible interaction content encryption Enhancement of Health Record Auditing to improve auditing efficiencies (e-phipa) and proactive monitoring Implement e-record dating and destruction capabilities Functional Improvements to streamline duplicate record identification processes Improve user interface (better support AODA) Implement integrated client self service registration portal for CDIP HC HF group health education services. Functional improvements for TCHIS mobile application based on user requirements. 23

24 Questions USABLE: FLEXIBLE: INTEGRATED: SECURE 24