Can you say Collaboration with Innovation? Strategic Directions for Health Libraries

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Can you say Collaboration with Innovation?
Strategic Directions for Health Libraries

• Rebecca Zakoor
• St. Michaels Hospital, Toronto

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Healthcare Trends

• Electronic Health Record Integration of
  resources into the EHR (PRIVACY)
• Programmatic models of healthcare delivery
• LHINs Local Health Integration Networks
• Consortial/provincial licensing-Knowledge Ontario
• Patient centric portals

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Moving to an EHR

• In 2005 in Canada, 322 million office-based
  physicians visits-94 resulted in handwritten
  paper records.
• Approx. 2,000 health care transactions per
  minute, many quite complex, and all requiring
  documentation and information flow.

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Electronic Health Record

• In November 2002, the Romanow Commission issued
  Building on Values  The Future of Health Care in
  Canada (hereafter the Romanow Report),
  emphasizing the importance of electronic health
  records as one of the keys to modernizing
  Canadas health care system and improving access
  and outcomes for Canadians

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Experience as a Patient

• Online results for tests while you wait
• Every physician/healthcare provider you see has
  your history, etc. right in front of them, in
  electronic format
• Privacy of your records-PHIPA 2004
• Personal Health Information Protection Act

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PHIPA Personal Health Information Protection
Act-2004

• Sets out rules that healthcare providers must
  follow when collecting, using and sharing your
  personal health information.
• Gives you the right to see your health records
  and correct any mistakes.

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EHR

• National Electronic Health Record-Canada Health
  Infoway
• Smart Systems for Health (SSHA) Ontario
  Government-e-Health

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Smart Systems for Health

• SSHAs suite of products and services - Ontario
  Network for e-Health (ONE) - create electronic
  connections that improve the flow of patient
  information between health care professionals.

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Electronic Health Record-Canada Health Infoway

• http//www.infoway-inforoute.ca/en/home/home.aspx
• Electronic Health Records help improve the
  Access, Quality and Productivity of Canada's
  Healthcare System.Infoway invests with public
  sector partners Canada-wide to implement and
  reuse compatible health information systems to
  support a safer, more efficient healthcare system
  

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EHR Electronic Health Record

• EHR Improves Access
• Ability to Access Care Improved wait times and
  capacity to deliver needed services
• Patient Participation Patient access to the
  electronic health record.
• Availability Greater access to healthcare
  services in the home and community

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EHR Electronic Health Record

• EHR Increases Quality
• Safety Fewer medical errors and adverse drug
  events
• Effectiveness Achieving desired health outcomes
• Appropriateness Informed prescribing and
  clinical decision-making

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EHR Electronic Health Record

• EHR Increases Productivity
• Efficiency Reduced administrative time and costs
  
• Care Coordination Complete patient information
  for sharing across the continuum of care

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Electronic Health Record

• Electronic health record for children already in
  place- http//www.echn.ca/
• eCHN's vision is that electronic health
  information in Ontario and Canada should be a
  universal system that is inter-operable,
  comprehensive, accessible, flexible and available
  in a secure and controlled environment.

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Electronic Child Health Network- eCHN

• eCHN (electronic Child Health Network) is a
  non-profit, government-funded organization
  dedicated to providing electronic solutions that
  permit the sharing of healthcare information
  among authorized healthcare providers.

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Information Provision in Healthcare

• Information is core to the Healthcare system.
• In 2005 in Canada, 60,000 physicians faced 1.8
  million new medical papers in 20,000 journals and
  300,000 clinical trials.
• JIT Delivery/Just in Time/Research/Teaching
• Print- being replaced by electronic to some
  degree.
• Physical spaces- reduced-virtual collections.

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Information Provision in Healthcare

• Biggest challenge integrating our
  Resources/Tools at the Point of Care
• Handhelds- JIT Delivery-Tablet PCs, Carts,
  PDAs.
• Improving Patient Care-ultimate mission
• Strategy must be intertwined with that of the
  healthcare institution
• COLLABORATION with all the players Information
  Technology, Research, Administration

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Programmatic Models of Healthcare Delivery

• Programmatic structure within larger health
  libraries SMH one of the first.
• Information specialists need to be COLLABORATING
  and integrated into various programmatic teams
• VALUE-Research/ Teaching
• Clinical librarians patient education policy
  development

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Local Health Integration Networks (LHINS)

• Created based on the idea that people know what
  kind of health care services they really need
  close to home.
• www.lhins.on.ca/english/main/home.asp
• 14 LHINS

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Ministry of Health and Long-Term Care-Ontario
LHINS

• Map out priorities for health system
  transformation at the local level in Integrated
  Health Service Plans (IHSPs).
• Part of each LHINs IHSP is an e-Health strategy
  that supports/enables health service providers in
  ensuring clients receive safe, high quality,
  effective and efficient health services.

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Whats e-Health?

• Ontario Hospital Association definition
• a consumer or client centred model of health
  care where stakeholders collaborate utilizing
  Information and Communications Technology,
  including Internet Technologies, to manage
  health, arrange, deliver and account for care,
  and manage the health care system
• E-Health helps everyone in health care work
  together better for benefit of all those who
  participate in the system, including consumers,
  providers and organizations.

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LHINs and Health Libraries

• Examination of health library services and
  consideration of new methods for delivery of
  resources and provision of library/research
  services province-wide

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Health Sciences Information Consortium of Toronto
( HSICT)

• Successful model of collaboration for 17 years!
• Emulated elsewhere.
• 30 Teaching and Community Hospitals and
  Healthcare Institutions
• Achieving cost savings, facilitating professional
  development, and providing valuable instructional
  programs-not just licensing!
• COLLABORATIVE collection development.
• Union List journals/SIRSI development

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Health Sciences Information Consortium of Toronto
( HSICT)

• Strategic Issues Subcommittee has established, in
  consultation with the Consortium membership and
  Board, a set of guiding principles that are
  essential to any discussion of a new model for
  health library service in the province of
  Ontario.
• Consortial/Provincial licensing-COLLABORATION
• Recommendations to be made to the LHINs.
• HSICT is GTA centric/straddles LHIN boundaries

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Model for Information services for health
professionals in Ontario

• Comprehensive svc delivery-access, training,
  reference, research-support quality patient care,
  research and teaching
• Scope-needs of medical/allied health
  professionals who dont have cross appts to
  universities, other institutional affiliations,
  or other means of access
• Specialized collections-ie pediatrics, mental
  health, geriatrics, rehabilitation, oncology, etc.

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Model for Information services for health
professionals in Ontario

• Professional expertise-onsite reference,
  orientation, training and support
• Hospital accreditation-Lib/inf services must
  support Canadian Council on Health Services
  Accreditation standards.
• Local needs and priorities/LHINs
• Licensing funded by MOHLTC would free up funds
  within institutions (change in govt?)

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Ontario Health Library Service Model

• Structure?
• Funding model/business case
• Members with full library services
• Partner members who contract for library services
• Governance? University controlled (NO)-not by one

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Consortial/Provincial Licensing-University
Centric Models

• Health Sciences Information Consortium, Toronto
• McGill University-difference-same network
  backbone shared by hospitals.
• Hamilton-McMaster

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University Managed Models

• University of Manitoba-No remote access
• Queens University- fee for service-closed local
  hospital libraries
• University of Alberta and University of
  Calgary-Health Knowledge Network HKN-hospitals,
  organizations, individuals can buy memberships.
• COAHL Consortium of Academic Health Libraries
  cooperative of six medical schools

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Regional and Provincial Models

• e-HLbc- 2006- Electronic Health Library of BC-
• Health authorities, post secondary instits,
  provincial ministries, Coll of Physicians and
  Surgeons
• Saskatchewan Health Information Resources
  Partnership
• NOVL-Northern Ontario Virtual Library-Northern
  Ont. School of Medicine
• Knowledge Ontario!
• Public Health Div-OMHLTC
• Province of Quebec-4 geographic regions/one per
  medical school-RUIS

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Other Initiatives

• Ontario MD provinces physicians- Ontario
  Medical Association.
• Nurse One- Canadian Nurses Association Portal
• June 2006
• Canadian Health Libraries Association (National
  Network of Libraries for Health)-possibility of
  linking health libraries nationally.

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Provincial/consortial licensing

• being spent that is duplicated duplicate
  access ie physicians, nurses
• Number of initiatives-need to bring them all
  together common direction.
• Smaller libraries/remote libraries.

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Patient Centric Portals

• Web based personal health application that can
  integrate with a patients electronic health
  record, supporting the patient in management of
  his/her own health care

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Patient Centric Portals

• Chronic Kidney Disease Patient Portal initiative
  -December 2006-online tool for Ontarians with
  chronic kidney disease management of their own
  care-operational by March 2008
• Grand River Hosp, Hamilton HS, University Health
  Network and Canada Health Infoway.
• Better adherence to care plans.
• Secure login process

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Strategic Future for Health Libraries

• EHR Integration- Point of Care Tools and presence
• Continuation of Programmatic Models-Integration
  into health teams
• LHINs Local Health Integration Networks-Models
  for delivery of information services
• Consortial/provincial licensing-increase
• Patient portals/access/patient education

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Questions?
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