Canadian Health Outcomes for Better Information and Care

1

• Canadian Health Outcomes for Better Information
  and Care

2
Participants

• Sponsor
• Canadian Nurses Association
• Provincial partners
• Ontario Ministry of Health and Long-Term Care
  Health System Information Management Division,
  Health Outcomes for Better Information and Care
  Health Human Resources Division, Nursing
  Secretariat and e-Health Program
• Saskatchewan Health Health Information Solutions
  Centre and Workforce Planning Branch
• Prince Edward Island Ministry of Health
  Community Hospitals and Continuing Care Division,
  Provincial Acute Care Division and CIS Project

3
C-HOBIC project team

• Kathryn Hannah, Executive Project Leader
• Peggy White, National Project Director
• Sharon Paton, National Project Manager
• E-mail chobic_at_cna-aiic.ca

3
4
Funding

• Canada Health Infoway
• 750,000
• In kind - Ontario, Prince Edward Island,
  Saskatchewan
• 2,058,000

5
Objectives

• Standardize the language concepts used by Health
  Outcomes for Better Information and Care (HOBIC)
  to the clinical reference terminology of nursing,
  the International Classification for Nursing
  Practice (ICNP)
• Capture nursing-related patient outcome data
  across four sectors (acute care, complex
  continuing care, long-term care and home care) of
  the health system all four sectors in Ontario,
  two acute care settings in P.E.I., and 35 of
  long-term care facilities in Saskatchewan
• Store the standardized data in secure
  jurisdictional data repositories or databases in
  preparation for entry into provincial electronic
  health records (EHRs)

6
Benefits to Canadas Health System

• Development of a consistent methodology that will
  contribute to patient outcome data for the EHR
• Standardized assessment and documentation of
  patient outcomes by nurses in participating
  provinces
• Standardized entry of patient outcomes into EHRs
  by nurses
• Increased user uptake of the EHR by nurses by
  providing EHR content that is useful in nursing
  practice
• Foundation laid for the collection of health
  outcome data across the health system by all
  clinicians

7
Benefits to Canadian health-care renewal

• Improved patient safety
• Increased accountability
• Real-time data on clinical outcomes related to
  primary care and home care
• Increased use of information technology

8
Background

• HOBIC is an initiative of the Ontario Ministry of
  Health and Long-Term Care www.health.gov.on.ca/ho
  bic
• A set of evidence-based, nursing-related patient
  outcomes that can be collected systematically and
  standardized across the health system related
  to
• Functional status
• Therapeutic self-care
• Symptoms pain, nausea, fatigue, dyspnea
• Safety outcomes falls, pressure ulcers
• Satisfaction with care

9
Collecting nursing-related patient outcomes

• Outcomes are collected on admission and at
  discharge for patients receiving acute care, and
  on admission, quarterly (if condition changes)
  and at discharge for patients receiving complex
  continuing care, long-term care or home care
• Provides real-time information to clinicians so
  that they can more effectively plan and evaluate
  care
• Provides data for monthly reports for nurse
  managers and nurse executives to use when
  examining the quality of care provided by their
  units and organizations

10
Implementation

• Ontario
• Electronic collection of HOBIC measures in acute
  care, complex continuing care and long-term care
  25 sites in 2006/07, provincial roll-out by 2009
• Working with multiple vendors in all sectors
• Health outcomes abstracted onto the HOBIC
  database
• Education Strategy
• Value of this information to the nursing
  profession making nursing visible
• Integration into nursing curricula in Ontario to
  support sustainability

10
11
Implementation continued

• Saskatchewan
• Implementation in 35 of long-term care
  organizations in two regions
• Clinical information systems provided by Momentum
  
• Prince Edward Island
• Implementation in two acute care hospitals
• Clinical information system provided by Cerner

11
12
Other initiatives for C-HOBIC Mapping to ICNP

• International Classification for Nursing Practice
  (ICNP) is an initiative of the International
  Council of Nurses developed over 18 years
  http//www.icn.ch/icnp.htm
• ICNP serves as a unifying nursing language system
  for international nursing based on
  state-of-the-art terminology standards and
  represents nursing concepts used in local,
  regional, national and international practice,
  across specialties, languages and cultures.

12
13
Mapping to ICNP continued

• Goals of C-HOBIC terminology mapping
• Standardize the concepts used by HOBIC in
  accordance with ICNP
• Demonstrate the value of mapping current
  information, and position nursing-related patient
  outcomes for inclusion in the pan-Canadian health
  record
• Mapping provides an approach to coding nursing
  information that supports interoperability,
  consistency and comparability of clinical
  information that reflects nursing practice across
  the health system and facilitates future mapping
  of these concepts to SNOMED-CT (Systematized
  NOmenclature of MEDicine Clinical Terms)
• A focus group of experts from across Canada will
  meet on September 30, 2007, with the goal of
  reaching consensus on the proposed mapping of
  patient outcomes to ICNP

14
Other initiatives for C-HOBIC Evaluation

• As part of Canada Health Infoways End User
  Acceptance Strategy, C-HOBIC will conduct an
  evaluation. This evaluation will
• Examine the value of C-HOBIC information to
  nurses in planning for and evaluating patient
  care
• Explore how C-HOBIC information is integrated
  into the work flow of nurses daily activities
• Consider how the aggregated data is used by
  managers and policy-makers
• Identify parameters that need to be implemented
  within four types of settings (acute care,
  complex continuing care, long-term care and home
  care) to ensure conditions for success and
  nursing uptake of technology

14
15
Key Deliverables

• Quarterly progress reports
• Report on terminology mapping
• Report on evaluation of end-user acceptance and
  benefits
• Toolkit for other provinces or organizations
  interested in implementing C-HOBIC
• Final report to Canada Health Infoway

15
16

• All partners
• Support the creation of a national clinical
  terminology standard that meets the needs of
  nursing practice.
• Recognize that the clinical information of all
  health-care providers needs to be integrated
  within the EHR.
• View C-HOBIC as a way to begin the process of
  standardizing clinical information for all
  clinicians.
• Only this integration will achieve
• the best information to improve patient outcomes.

17

• 
  C-HOBIC