Integrating and sharing information among care providers and patients is a big challenge for the health-care system. The situation is further complicated by the multiple formats and systems – both paper and electronic – providers use to record patient information over many years. The challenge can be substantially addressed by building and sharing electronic health records among a patient’s health-care providers.
Trillium Health Centre has made extensive progress with e-Health by building a fully operational information integration technology – referred to as a Health Information Access Layer (HIAL), and developing the foundational components of portals for employees, patients, consumers and providers.
“Trillium’s e-Health strategy enables the sharing of patient information across the entire range of care providers, while preserving the community’s investment in legacy information systems. We are connecting hospitals, clinicians and allied health providers with patients, their families and health-care stewards,” says Benoît Long, VP, Chief Information Officer and Chief Marketing Officer at Trillium Health Centre. “We call this the Community Care Services Model (CCSM). The original decision to begin with service-oriented architecture (SOA) is key to the successes we have enjoyed along the way.”
The HIAL is the interface solution developed by Trillium that enables information to be moved from numerous locations, integrated in a central hub and seamlessly delivered to a required destination in a manner that is meaningful to the user. Built using IBM’s Websphere suite of products, Trillium’s HIAL, the health-care ‘communication bus,’ is built to international standards such as Health Level 7 (HL7) and aligned with the e-Health blueprints of both the Ontario and federal governments.
“Once you have the core HIAL infrastructure in place, the rest becomes easier,” says Anu Tuli, Director, eHealth and Clinical Informatics. “When you’ve made the strategic investment in a HIAL and a standards-based architecture, many components become reuseable and re-deployable by others. There’s a very high degree of interoperability and flexibility.
Trillium’s HIAL connects its two sites in Mississauga and West Toronto, and is now integrated with the Summerville Family Health Team’s electronic charts, built using GE Healthcare’s Centricity, xwave’s electronic medical record system.
Now, an average of 1,700 diagnostic test results, hospital dictations, and notifications of hospital admissions, transfers and discharges are distributed weekly. The messages are securely delivered, in real time, to Summerville’s electronic chart, for use by the physicians and clinicians at one of the four Summerville offices in Mississauga and Etobicoke. This transfer takes five minutes or less compared with paper-based systems that took five to eight days to print, collate and deliver.
Enormous time-savings have been realized – time spent scanning has decreased an estimated 50 per cent – and easy access to accurate, up-to-date information from multiple sources translates to safer, more efficient care for patients.
“Part of having better care is having more integrated care,” says Summerville’s Dr. David Daien. “We didn’t want to create electronic silos. The information is all digital and integrated 100 per cent into our workflow,” he says. “Doctors don’t have to remember to open an application or download an update; the information is delivered directly from Trillium into their Electronic Medical Record at Summerville.” Once a patient has been discharged from Trillium, the Summerville family physician is in the loop immediately to support their patient’s follow up care and return to health.
Trillium received a Merit Award for Innovation from Showcase Ontario 2008 in September for its HIAL project. Winning projects had to demonstrate a successful merging of business and technology ideas to improve services to Ontarians.
“The Showcase Ontario Merit Award recognizes the unique work and accomplishments of our Trillium team which improve patient care through better information access,” says Long. “Our team has developed increased expertise in project management, change management, adoption strategies, community and vendor partnerships, and benefits realization as a result its four-year e-Health journey.”
In the future, Trillium’s HIAL allows this connectivity to be replicated to support other care providers in the community. And, by sharing its licenses, operations and development activities, Trillium can also help reduce costs within the Mississauga Halton LHIN, as well as better leverage limited resources through shared services.
However, capturing, integrating and organizing information isn’t enough. Security, user authentication and authorization, patient privacy and consent, and audit trails are critical. Trillium has achieved a good balance between user convenience and system security with the use of a single sign on.
“It’s exciting to have built the platforms that will provide patients and families with access to their electronic health information and other trusted information resources via the patient portal,” says Long. “This will enable patients to take a more active role in managing their health and wellness. This is particularly important as we evolve to offer enhanced care to those managing chronic diseases, like diabetes and heart disease.”
Trillium’s e-Health journey continues, rich with promise for health-care providers and the community.