Rodney Burns
 

Go Ahead, Pick my brain..

 

Privacy: The Perfect Storm

I have been following the news with a fair bit of interest lately, especially the piece on the US intelligence leak and the privacy debate.

To be sure, privacy is a touchy topic. When personal secrets and sensitive information get shared without the appropriate consent structure in place, you just know you’re going to be hit with the perfect storm! 

Certainly, many First Nations have experienced this which has led to the adoption of the OCAP principles (Ownership, Control, Access, Possession) for health information of First Peoples under the Council of Chiefs in Ontario.

So what can we do to avert a similar storm on our shores?

Well, for starters, education is key, which was why we presented a detailed session on privacy and consent at this year’s AOHC conference. (If you missed the event but would like to see the slides, please email Charles Sagoe at Charles@aohc.org.)

It is vital that as custodians of our clients’ personal health information (PHI), we are in no doubt whatsoever as to what we can – and cannot – make available to others. The concept of Circle of Care makes intuitive sense, however, it is the details and obligations under PHIPA and OCAP that can make navigating the privacy world challenging.

This is a massive topic to cover in a blog post, but I want to share at least a couple of salient pointers here so you can give this some thought.

Consent – expressed, implied, assumed

First off, our consent model is client-centered. Our clients must understand, know and agree to the collection, use and disclosure of their personal health information (PHI). Of course, things are rarely, if ever, cut and dry. There will be many gray areas of concern and just as many questions. For example, what’s the difference between expressed, implied and assumed implied consent?

In brief, the first (expressed) is an unequivocal, free-will and informed agreement by the client, either verbal or in writing, as to what is being proposed or done in relation to his/her PHI. Sometimes, under certain circumstances, this consent is implied or assumed implied, i.e. a healthcare provider infers that the client would reasonably agree to having his PHI collected, used or shared. 

In an emergency situation like a car accident where a person may be unconscious, being brought into the Emergency Department of a hospital, an implied consent model is often used – assuming there isn’t a substitute decision maker or a consent directive known to the hospital.

In Ontario, there is already guidance on this matter, and I recommend reading this FAQ on the Personal Health Information Protection Act (PHIPA) - http://www.ipc.on.ca/images/Resources/hfaq-e.pdf.

Circle of Care & Health Information Custodians (HICs)

More to the point, I would like to draw your attention to the issue of accessibility, i.e. Who is entitled to access our clients’ PHIs?

I urge you to familiarize yourself with the concept of Circle of Care. The IPC has another excellent document on Circle of Care on their website. Doctors, nurses, therapists, CHCs/AHACs … these are Health Information Custodians (HICs), but please be mindful that volunteers, midwives, traditional healers, insurance companies and even the police fall outside of the Circle of Care and the attendant obligations under PHIPA.

Any disclosure of PHI to the latter group (non-HICs) MUST involve only expressed consent. Under no circumstances should this golden rule be breached, unless under a Court Order. If you are unsure at any point, I urge you to seek clarification and guidance.

Privacy is a serious matter, and rightly so. Both you and I are clients, too, and like me, I’m sure you won’t want your PHI to be shared indiscriminately.  Not everyone out there would use that information in our best interests. So let’s apply that universal standard of courtesy in our work – do unto others as you want to be done unto you.

We can all do our parts to build a culture of privacy awareness in the office.
Let’s be safe, not sorry!

Have a comment?
Contact me at Rodney@aohc.org

The First Dance …

The first dance always hurts, especially if you’re not the one wearing the heels! 

A week ago, I was invited to present at a Town Hall meeting to a vendor’s entire staff. I took the time and opportunity offered to learn their processes – and educate them about ours. I also clearly articulated our expectations and reliance on their products and services as a strategic partner.

At the end of my session, I shared a little nugget of truth that I’ve picked up along the way: All relationships (business or otherwise) that are worth investments of time and effort go through a time-tested series of “no pain, no gain” adjustments.

That is only to be expected.

So I was not entirely surprised when – like any new couple – our first “dance” with this vendor was not an altogether graceful one. Toes were definitely in danger and everybody’s sweat glands went into overdrive.

It sure wasn’t the most pleasant experience, but it was necessary, because now we know how the other party moves. More importantly, now we know in which direction to lead our partner.

I’ve always said that you can’t fix what you don’t know is broken. (For that matter, you don’t know how silly you looked dancing until your partner tells you, years later!)

Well, now we know what works and what doesn’t, and we’ve successfully fixed several of the latter. Overall, I think all parties involved have done a very decent job at fixing what should or could be immediately fixed. Yes, it took a little time, but in the greater scheme of things, I believe this was time that needed spending.

I’m glad the dust is starting to settle… We’ve learnt to tread a little more delicately, and dance a little closer with one another. We’re quickly learning where to put our foot in anticipation of our partner’s next step and we’re beginning to get into the rhythm of things. If all these translate to less swelling around the toes, I say Hooray!

I want to leave you today with a quotable quote I once came across: In life as in dance, grace glides on blistered feet. (Please pass the mole skin and dr scholls…)

And really, at this stage in a new relationship, when the night is still young, the important thing isn’t how well we move.

It’s the courage to get up and just dance.

Trust me, it won’t be long before we own the floor!

Have a comment?
Contact me at Rodney@aohc.org

“I.W.O.B.”

Quality improvement doesn’t always have to be about getting things right the next time. Sometimes, it’s about getting things progressively less wrong.

Of course, in an ideal situation, we wouldn’t make mistakes in the first place – but there are only two examples of infallibility that I’m aware of: A higher spiritual power, and my wife…!

How many times did you think Thomas Edison tried before the light switch in his mind finally went on? – It took 3,000, to be exact. Of these, 2,998 failed and only in two cases did his experiments about the electric light bulb prove acceptable.*

I’m talking about this now because I think it’s time to rip up the ‘culture of fear’ still surrounding us. In its place, I have had success with I.W.O.B. – Improvement without Blame. The TQM (Total Quality Management) guru Edward Demings noted that 95 percent of all defects are systemic issues – not people issues.  If we are to take quality improvement (QI) seriously, and apply it to every aspect of what we do in public healthcare, we must, as a sector, embrace this concept, from data and processes to behavior and action.

Tell me, are you at all tentative about sharing your Centre’s data? Will you openly invite scrutiny from your peers? I’m sure some of us feel hesitant, especially if our data isn’t stellar. But really, so what?  The best place to go from there is up!

So what if your Centre faces more quality improvement issues than others? There is no need to feel bad, because there’s no shame in sharing and learning in the spirit of improvement. How else can we seek to borrow best practices, or develop strategies moving forward? With 86 centres to call our own, we’re in a fully advantageous position compared to other organizations – mainly because we have such depth in the peer-support well. So let’s tap it!

But why stop there? - Quality improvement doesn’t always have to be abstract; or about indices and matrices. It could also be about the small, every day, human stuff…

I’ll tell you a story: I was in a hospital Emergency Department once. As usual, it was hassle and bustle. There was a queue to register so I waited in line. Then I noticed a nurse quietly leading an elderly woman to a seat – and registered her there instead of at the desk. Now, tell me, isn’t that classic QI? This healthcare worker could have sat herself at the table and waited, but she bothered to get up, come around and “improve” her client service by making life a little less painful for someone in distress and I know you can recant similar experiences from your Centre as well.

Sometimes, when we look at data for hours on end, we forget that those “service or poverty or homeless” scores actually have human faces. When we remember that, we’ll be more open to sharing data – and sharing ways to improve such data.  It is really hard to argue the need for this when you have a truly person-centred approach to service delivery.

And please, please don’t feel bad if your data isn’t all it should be, because becoming stellar is about trying 3,000 different ways to improve – and have 2,998 of these fail.

All you need, really, is one or two winning ways and you’ll be out shining the light for others before you know it!

The Chinese proverb “The journey of a thousand miles begins with a single step” aptly describes the QI journey we are beginning.  I, for one, am excited by the prospect of using data to make improvements and taking the second and third steps along this journey…

__________________
* Quoted in "Talks with Edison" by George Parsons Lathrop in Harpers magazine, Vol. 80 (February 1890), p. 425.

  

 Wanted: Trust Blinders



We all know the tale of Christopher Columbus: Had he been just a little less stubborn, or just a little more willing to listen to prevailing reasons, he wouldn’t have discovered America! What does this tell us?

In a nutshell, Columbus’ life story teaches us that sometimes, we have to put on “trust blinders” and force ourselves to look beyond the immediate distractions, obvious hurdles, and tedious detours, in order to reach our final destination.

Hindsight is 20/20, folks. Columbus didn’t know for certain that he would make an earth-shattering discovery, but he certainly believed it. He had no doubt, whatsoever. He clearly had a vision.

Psychologists call this belief perseverance – a case of persisting with one's initial ideas even when those ideas may have been discredited.  Not surprisingly, it is also one of the five tenets of Tae Kwon-do, a martial arts that I have practiced for over 10 years.

Columbus had faith in his cause, and that was reason enough for him to bull-doze his way through all obstacles. This contributed directly to his success. Can we learn from his example? Should we?

I’m inclined to say we can… and we should. Here’s why: Like Columbus, we’ve had our own naysayers to contend with. In the early days of our EMR project, we’ve heard concerns about whether Nightingale on Demand (NOD) will be a white elephant. Can we afford it? Will it ever get off the ground?

Well, folks, with help from our funding stakeholders we did find budget for it – and it’s, “wheels up and well off the ground”.

So we’ve completed the first set of obstacles. Now, it’s time to navigate the next series of challenges: EMR performance and user adoption. (I have already written about “adoption” in my previous post, so I will focus on performance matters today.)

Our EMR implementation team has received feedback from several live sites regarding performance issues within NOD. We are aware there are time-out issues, network errors, deadlocks, scanning problems and load delays, amongst others.

These, admittedly, are very annoying hiccups that must be resolved and we have flagged such problems with the vendor. They have promised to resolve the current impasse and the team is working tirelessly to address each site’s concerns.

I, too, am frustrated that EMR performance isn’t where it should be, but experience has taught me to be practical. Massive system implementations like ours seldom happen without a period of adjustments and fine-tuning. It’s tedious, inevitable, and necessary.

It’s almost like a marriage … You can fall in love all you want, and think your spouse the best person in the world, but living together takes some getting used to, and it takes time to learn each other’s traits.

So for those of you who are facing performance issues, I beg a little patience.

Like Columbus, now’s the time to put on those “trust blinders” (before you get distracted with this term, think laser-focus instead of blind followership), secure in our knowledge that we’re doing right in the interest of our clients, and working collectively to clear the hurdles as they arise.

After all, we have one advantage over ole’ Christopher … we have line of sight. The collective experience and skill of the staff in our health centres, the EMR Team at the AOHC and Nightingale Informatix Corporation that have gained experience in over 20+ EMR go-lives will ensure we continue to be successful. This implementation process may not be a straight path, but if we stay the course and steer true to form, we will make landfall as planned!

I look forward to celebrating successful landings with all of you.

Have a comment?
Contact me at Rodney@aohc.org

What is your Viral Factor?

With 4 million client records migrated – and 770 users trained on Nightingale on Demand – I feel safe to now declare that we’ve achieved critical mass.

To physicists, ‘critical mass’ is the smallest mass required to trigger a chain reaction leading to a big ka-boom! Or, if you’re a social media marketer, that’s the tipping point where your company’s website goes from “obscure” to “viral”.

Ok, we’re not planning big fireworks here (although a warming bonfire would be nice!) but you get the idea … With 20 member centres live on EMR and running at full tilt, we’ve reached a point where it’s time to shift focus a little – to move away from project planning to full-fledged operations oversight; and from implementation to true adoption.

I want to highlight the latter issue (i.e. user adoption) for one of two reasons.

1. Magic doesn’t happen just because you have gone live. Remember, having an EMR isn’t the same as using an EMR! The wand is just a wand, folks. You’ve got to give it a shake; maybe twirl it around for a bit before it starts performing wonders. I know some people are still feeling tentative, but think of NOD like any other computer program. The more you “practice” with it, the sooner you’ll come to own it.
2. Adoption does get easier now that we’ve got critical mass. It helps to know that another centre nearby is also on the same system. That’s more minds to consult; more notes to trade; more ways to learn.

So, how exactly do we spark this “user chain reaction”?

Going back to social media marketing … every website hoping to go viral has what is called a “viral or K-factor”. It is sometimes expressed as a formula:

K = i * c (where i is the number of invites and c is the percentage of conversion.)

The IMS team at AOHC has been working hard to boost the i part of this equation. To date, we have trained 770 users on EMR. Very soon, we will also be recruiting two new EMR Adoption Specialists. These two staff will provide extra support to users who may need additional guidance.  We have eHealth Ontario to thank for agreeing with our providing the additional funding to support this.

So the “invite” is out. 

What we now need is for you – the users – to accept our invitation. Stake your claim in the “c” column, because without your conversion, this equation will fall flat. In the interest of client-centred care, we are all obliged to ensure our clinical teams are using the EMR as effectively as possible.

It’s time to light the fire, folks. You have match sticks in hand. What are you waiting for?!

Have a comment?
Contact me at Rodney@aohc.org

The Power of Six

I recently read an interesting article on an Australian news portal titled, “The 6 Types of Friends Everyone Should Have”[1]. As I was reading it, I found myself nodding in agreement and thinking … wait a minute, this applies to our organization as well... The article says we need at least six different types of “friends” as each type serves a different purpose:

Type 1: The friend who is Cooler than you.
We can’t know everything. There are times when we must rely on those more knowledgeable than ourselves. Such “friends in the know” introduce us to better ways of doing things, or help expose us to new ideas. Sounds like a ECFAA ‘quality improvement’ approach…

Type 2: The friend who is up for anything.
When times are stressful and you feel lost, you need a friend who doesn’t require you to make an appointment. Here’s a go-to person you can call at the drop of a hat.

Type 3: The friend who you aspire to be.
This is your role model, someone who challenges you to be better than your current self or state.

Type 4: The friend who doesn’t know any of your other friends.
This flies in the face of the “birds of the same feather...” theory. But sometimes, you need a friend who is able to give a different perspective, or offer objective advice without being vested.

Type 5: The friend who is painfully honest.
Here’s a friend who gives feedback the way feedback is meant to be given – without any sugarcoating. He/she lets you know exactly what you’ve done right – or wrong.

Type 6: The friend you’ve known longer than you’ve known yourself.
And finally, these are friends who know (and share) your values as their own.

Now, don’t you think this rings true for organizations like ours, too? Here at the AOHC, we have many different types of members – CHCs, AHACs, NPLCs and CHFTs. We also have many professional groups – clinical staff, data management coordinators, information technology staff, managers, executive directors, etc.

Surely, we’ve got at least one of every “friend” type within our membership!

As we move forward with our work, there will be times when we need to call upon one another to guide or teach; to be peer leaders (friend type #1); to provide critical feedback or work out lessons learnt (friend type #5).

We will need members to give of their time; to serve on committees; to stand up and volunteer their centres for being a pilot site; (friend types # 2 and 3); to provide independent counsel (friend type 4); to constantly and consistently advocate for our Model of Care (friend type 6).

To whom shall we look to for all these if not within our own members?

2013 has started at a run. It will be another mind-boggling year of successes and challenges. Let us move through it with confidence, knowing (thank goodness) that we have friends enough to help keep us all on track.

Here’s to our “friendship” and collective success.

Happy New Year, folks!

________________________
1. http://www.news.com.au/lifestyle/relationships/the-six-different-friends-everyone-should-have/story-fnet0he2-1226505482113

 

One Anothering ... Are you doing it yet?

Christmas is coming and I was browsing an ebook store one day for suitable gifts when a strange-sounding title caught my eye – One Anothering. Not exactly a term our English teachers would endorse I’ll bet, but it is a captivating concept nonetheless – i.e. the idea of a community of people nourishing and enriching one another through fellowship; sharing experiences and growing in the process.

While the book itself has a Christian theme, its key concept isn’t all that new. In fact, I was almost certain the idea is one our aboriginal friends would be vastly familiar with. So when De dwa da dehs nye>s became the first Aboriginal Health Access Centre (AHAC) to go live on 30 November, I decided to find out a little more ..

Well, guess what? - De dwa da dehs nye>s translates to: “We’re taking care of each other amongst ourselves”. It speaks to the same concept, only in different words.

As the centre familiarizes itself with Nightingale on Demand, its staff will be gathering important information about how electronic databases can better serve our aboriginal communities, and they will have ample opportunities to practice “one anothering”.

I will be looking to Executive Director Constance McKnight and her very capable team at De dwa da dehs nye>s to lead the way for her fellow AHACs as they explore uncharted territories – new ways to document spiritual healing or more efficient ways to deliver care services, for example.

They will grow champions in their midst, I’m sure, and I am very excited just thinking about what this can do for their entire community. Many First Nations people believe that all things are connected. Every point connects to the next – and the next – until the circle is complete. That’s what we’re doing with each milestone we achieve. We’re moving closer to meeting our common objectives, one of which is equal access to health care for every single community.

Which brings me to this book by Richard Wilkinson: The Spirit Level: Why More Equal Societies Almost Always Do Better. It’s something to think about this festive season. As the year draws quickly to a close, maybe there’s time to sit back (with a beer in hand, of course) and take stock – of how far we’ve come, and how much further we need to go.

Before I sign off the blog for the year, I wish to thank everyone for their cooperation and hard work. Chi Miigwetch.

Happy holidays, folks, and happy one anothering.

 

Have a comment?
Contact me at Rodney@aohc.org

 

Take the Lead, Bring Home the Bacon …

Last week, I was reminded of what it means to be leaderful – the willingness to serve as a leader in a collective manner.

At AOHC’s two-day Knowledge Management event and the proceeding data management coordinator (DMC) Leadership Day, I was humbled and privileged to see how many of our colleagues stand ready to accept and share the joys and challenges of moving the sector forward.

To be leaderful, you don’t need to be chair or president of a committee, and you most definitely don’t need an ED or CIO title after your name. What is needed, however, is a spirit of collaboration, to know one’s strengths – and weaknesses - and the readiness to step up to the plate.

It’s quite like how ants go about their tasks. If you’ve ever dropped a sliver of bacon while barbequing out back, watch and learn… one ant will come along, then another, and another. Pretty soon, you get ants on every side, dragging the crumb slowly along in unison, seemingly all of one mind, all leaderful, all engrossed in navigating the pitfalls together. Not a single ant broke rank. It’s a beautiful sight, really, and that’s how it should be. That’s why such tiny creatures can carry upon their collective shoulders the weight of giants.

And that’s why I’m so pleased with how last week’s events turned out. To all the folks who attended, a big ‘thank you’. Whether you volunteered – or were volun-told – you actively and enthusiastically participated in the sessions. From discussing the fundamentals of data quality, to privacy, to data migration lessons learnt, to those incredibly important soft skills around change management - you owned the day and for this I applaud you. It spoke volumes about your desire to be the change you want to see in the sector.

Those that support the role of DMC often serve as change management agents within their organizations. Especially in this time of sector-wide change, with the implementation of information management systems and the enhanced capabilities of the community health sector in performance management, the role of the DMC is integral. This was a chance for DMCs to share their leadership experiences and maximize best practices in system implementations, and they nailed it!

We have loads to do going forward, folks, and I am much heartened to see that our sector has more than A Few Good Men – and Women who are up to the task.  Just imagine what our organizations and our sector will look like when we are done.  It’s time to up the Ant(e)!

Have a comment?
Contact me at Rodney@aohc.org

Breaking New Ground… in a New Pair of Shoes

I love my shoes. I’ve made great strides in them. They’ve walked me down long and easy roads, as well as slippery slopes down mud trails and dirt tracks. Old, leathery comfort…

A few weeks ago, I noticed they were starting to fall apart. The soles were wearing very thin; and the recent storm did them no favors. I realized, with some agitation, that I needed new shoes. 

New shoes! Now, I know a few people who think Saturdays are best spent on a shoe hunt, but not I. The idea of trading in a snug fit for corns and calluses did not appeal to me, but the options were limited – don my hiking boots, or get a new pair of dress shoes. 

It’s a little like the new EMR, come to think of it. Here you are, trading in your old, familiar systems for a brand new “something”. Will it fit your needs? How long before it becomes a part of your daily routine?

Well, the truth is, as with every new pair of shoes, there is an intense – but thankfully short – breaking-in period. The initial steps may be awkward, painful even. But you know for a fact that the old familiar feeling will return. So please, try it on for size. Walk circles in it; run with it if that’s what you normally do. Comfort comes with constant use. And while familiarity is an important factor, there are other qualities in a product – any product – to look for when making a purchase. For example, value-for-money; return-on-investment; advanced features and embedded technology; performance and durability. 

By all accounts, our sector has made an informed purchase. At the recently concluded ED Network meeting in Niagara-On-The-Lake, several of our early adoption sites shared important lessons learnt going live on Nightingale on Demand (NOD). They had been asked to take the difficult first steps into new territory, and I commend them for it.

Now that they have set a trail, the rest of us can follow suit, mindful that with each forward step, we learn something useful, and grow more comfortable in our new shoes. Before long, we’d be walking – actually in our world – running many miles in them – getting to where we need to be and looking good along the way!

 

Have a comment?
Contact me at Rodney@aohc.org

What’s in a word?

I’m not really one for text-book definitions, but when I last checked the dictionary, the meaning of the term “align” seems to describe very well what we’re trying to do here at the AOHC.

a•lign, verb. - To be parallel; to adjust; to ally.

What does it mean, anyway, to be aligned with provincial priorities? What are these priorities and how are we lining up? Well, many of you would already have heard about the sector’s Information Management Strategy, or IMS. To sum it up short and sweet, this strategy’s primary goal is to help our member centres provide “the right care, at the right place, at the right time”. 

In essence, IMS runs parallel to the declared goal of the Local Health Integration Networks (LHINs), the Health Ministry and eHealth Ontario – i.e. to create a sustainable primary healthcare system that revolves around the individual.

Ontario’s vision for healthcare – as outlined in the Ontario Action Plan – calls upon us to undertake “transformation activities” that will lead to accelerated change in multiple areas of care. As a sector, we have responded to this call. The new EMR solution that we’re currently deploying (Nightingale on Demand) is one such transformation enabler.

en•abler, noun. - One that provides the means for another to achieve an end.

By end-October, we will have successfully deployed NOD in at least a dozen centres. Come 2014, every member centre will be equipped with all necessary tools to reap the benefits of eHealth alignment. These include: Ready access to new eHealth offerings such as electronic access to hospital reports; more client information captured and managed according to accepted standards; lower system costs and improved data quality over time.

Going “e” (for electronic) opens up many possibilities. It lets us adjust to new realities faster, and give us the means to do behind-the-scene work more efficient, so that we can devote more time to actual client care.

Just this week, our IMS team alerted that all CHCs are now able to produce their MSAA reports for Q2 reporting using BIRT – a program that has been in development for many months. Small win, perhaps, but a crucial win nonetheless.

From my vantage point, things are starting to line up. Transformation takes time and patience. With a little of both (and some luck for good measure), we will achieve our stated vision of a primary healthcare system that is equitable, accessible and aligned.

trans•for•ma•tion, noun. - An act, process, or instance of being changed.

So, there you have it: Align. Enable. Transform. Three simple words that carry so much hope for a better tomorrow!

Have a comment?
Contact me at Rodney@aohc.org

 

Client Confidential – Be Safe, Not Sorry

When it comes to confidential information, I tend to take a “lock, stock and barrel” approach.

Remember that fiasco a few months back involving a leak of voter information? (See The Canadian Press, July 2012 – 4 million Ontario voters warned of ‘unprecedented privacy breach). That was one nightmare scenario I hope I never have to deal with, which begs the question of why I’m talking about this now.

Before you start worrying … we do not a security breach on our hands. But what we do have is a disaster waiting to happen if we are not vigilant. Let me explain.

So far, eight sites have gone live on the new EMR solution (NOD). We have reached critical mass, sharing information every step of the way. What’s more, we are now wading (up to our elbows, really) into the hugely complicated world of data migration, where we will most certainly be dealing with some very confidential client information.

Such information (e.g. detailed medical histories, status reports, illness registries, etc.) should be accessed strictly on a need-to-know basis.

How does this translate for you and me? What can we all do to make sure we keep confidential information really confidential? For what it’s worth, here’s my 10-point security checklist:

1. Shred all documents you no longer need. Don’t leave it around for all to see.
2. Use a privacy screen on your computer if you work with confidential information.
3. If you are communicating member ‘stories’, make sure the information do not identify individual clients.
4. Use encryption! This is a most useful tool.
5. Guard your passwords jealously – do not share passwords unnecessarily, particularly if these are passwords to confidential data files – and change them frequently
6. Do not try to access information you have no permission to. Curiosity is no defence – and that includes looking at your own information in the EMR
7. Periodically evaluate your privacy training needs and discuss this with your supervisor/colleagues.
8. Keep chatter away from issues or concerns surrounding clients.  Have these client discussions behind closed doors where being overheard is minimized.
9. Do not bring work home if ‘work’ is of a confidential nature.
10. Do not think you’re infallible – we all best intentioned, but we all make mistakes or suffer misfortunes that can lead to a privacy breach – even for the best-intentioned.

The AOHC is upgrading its privacy program because it is the right thing to do.  We want our members to be confident in our ability to protect confidential, personal, and personal health information that we have access to.

If you have any privacy tips to add/share, I’ll be happy to hear them. In the meantime, be Safe, not Sorry!

Have a comment?
Contact me at Rodney@aohc.org

 

Congratulations, Davenport-Perth CHC

Finally, a good night’s sleep – after weeks turning and tossing at the edge of my bed!

Davenport-Perth Community Health Centre went ‘live’ as planned this week, and I’m feeling like a very proud (and much relieved) parent whose precious kid finally made it through the first day at a new school.

This is a really big milestone for us, folks. Not to take anything away from the seven “trail-blazing” member centres that have gone ‘live’ on Nightingale on Demand (NOD) before, but Davenport-Perth was the first data migration site for us – and many, many people worked round the clock to make sure we stayed on target.

For this, I wish to express my thanks to: Kim Fraser, Executive Director of Davenport-Perth for the support and understanding; the data management team and staff at the centre for their receptiveness and exceptional work preparing for this deployment; the training team for their patience; and my own AOHC team for their stamina, dedication and belief in this project!

Congratulations aside, I want to stress how crucial Davenport-Perth’s experience is in the greater scheme of things. They are the first in a long line of member centres that require very meticulous back-end work prior to deploying the new EMR. The data migration process is a hugely complicated one. To prepare for the transition, all data had to be cleaned up and subsequently validated – four times! Add to this the steep learning curve for all providers and what you get is a massively stressful situation for everyone. And, they relocated offices over the same weekend. How’s that for being superstars?!

Were there any lessons learnt from this experience? Of course there are. With every ‘go live’, we learn something new and apply the lessons learnt towards the next deployment. That way, we get better and better at what we do, and the process becomes smoother. Our EMR transition team will share these lessons learnt once we’ve had the chance to catch our breath – and get some shut eye.   

Until then, channeling legendary broadcaster Edward Murrow, Good Night and Good Luck!

Have a comment?
Contact me at Rodney@aohc.org

 

My Blog, in Perspective

Not all blogs are created equal. 

I started the CIO Blog as a way for me to share my thoughts on pertinent issues and give voice to some of the things happening at work and beyond.

It is a way for me to engage my colleagues in the sector. While I strive to meet with as many people as I possibly can “in person” – at conferences and during regional user groups or ED network meetings – the fact remains that there is only one physical “me” and just so much time I can devote to travelling in the region. Hence, this blog.

It lets me reach out, share my thinking and explain my vision. In three short months, I’ve posted more than a dozen pieces with topics ranging from EMR to data migration to community initiatives, amongst others.

But there’s potential yet. I believe that this blog can “mirror” normal conversations. 

We can make the CIO Blog a two-way dialogue – with your help. What piques your interest?  What affects you? What confounds you? And, more importantly, what can I blog about that will help you?

The CIO Blog can only be as engaging as we – you and I – make it to be.

We don’t always have to talk about the IMS program. (I’m neither a nag nor a broken record ... honestly) After all, the bigger picture informs our work, too. There’s more “out there” that affects us than just the four IMS work streams.

For example, issues like refugee health coverage, or provincial and federal policies, rising health care costs, surgical wait times, food bank programs, breaking medical news or research, community anti-violence programs, etc.

These are topics that inform our work and are equally worthy of discussion, because our Model of Care defines health care in non-traditional terms. As such, I’ve tried to blog about some of these things. 

Overall, I’ve had great feedback from the sector and for this, I want to say, Thank You. Cheers for reading and for sharing your views. I hope my two cents’ worth has given you pause and made you ponder. If so, I consider that a small success.

This week, I invite you to help me take this blog initiative a step further.

What’s your “wish list” of topics? What can I speak to that will have you nodding (or shaking) your heads vigorously? Is there anything happening in your neck of the woods that’s worth sharing? For that matter, have you a joke or story to share that’ll give us all one very precious albeit fleeting moment of relief from our insane pace of work?!

Would you like to pen a guest post – or “volunteer” anyone you know (or dislike - kidding!) to do so?
Go ahead, make my blog yours - and let’s keep talking!

Have a comment?
Contact me at Rodney@aohc.org

Citius, Altius, Fortius

If we strip the recently concluded Olympics of all its pomp and ceremony, we get to see the Games for what it really is – for what it was intended to be – a celebration of our desire to consistently out-perform ourselves.

Pleased to say, I actually managed to catch a game or two this time around. The event that took my fancy was taekwondo and I watched Canada’s matches with interest. In particular, Karine Sergerie’s and Francois Coulombe-Fortier’s quarter-final fights. Both of them fought with heart, but lost to opponents who were faster, bigger, stronger.

Citius, Altius, Fortius.


Long years of sweat and tears, and all for a split-second, all-or-nothing, performance. That, to me, speaks of dedication. Of course, gaining the podium would have been a bonus, but I haven’t the slightest doubt that each and every one of our athletes will get right back up, take in the lessons learnt, and do pretty much as they did before – train for the next big game, race or challenge.  Success is nothing more than getting up one more time than you fall down.

Next time, they will all swim faster, jump higher, be stronger.

I applaud our Canadian team for having a collective dream, and thank them for reminding me that dreams take stamina and immense effort to fulfill. It’s a good and timely reminder, given that we’re now at the crossroads of some of our major projects – EMR and BIRT especially.

We are subscribed to the dream of getting electronic – being able to share data, facilitate collaboration and promote efficiencies. It’s a simple, but not simplistic, dream. To my mind, our “race” can be likened to a long-distance swim. (Inset: Congrats to Richard Weinberger for taking Bronze in the open water 10-km race!) We have no control over tides or currents, but we are in a good position to achieve our goal, even if it takes two years!

So folks, we’ve prepped for this “event” since 2003. We’re well past the mark now, having crossed the first few milestones … now’s the time to build momentum. Keep steady, one stroke, and then another … towards the finish line.

Lǎozi, an ancient Chinese philosopher, summed this up most poignantly: “A journey of a thousand miles begins with the first step.”

And while we’re at it, always thinking - Citius, Altius, Fortius.

Have a comment?
Contact me at Rodney@aohc.org

 

Privacy Matters

The topic of privacy has always been a delicate issue for me. So when the news broke recently that Elections Ontario discovered a privacy breach involving the personal information of several million voters, I shivered – for two reasons.

One, because I am a voter and I’m loathe to think that my personal data may be lost somewhere out there, in the hands of God-knows-who ... and two, because I dread to think what the fallout would be if such a breach ever happens to us in the primary health care sector.

Knock on wood, but now that we’re moving into the digitalized world of electronic medical records, we must ensure that we never drop the ball when it comes to privacy matters. Technology exists today that will enable us to audit, log and otherwise secure all information for purposes of accountability.  We can much more effectively prevent, monitor, detect and mitigate privacy breaches with today’s technology than we could with paper health records.

Many of our clients see their health records as highly confidential information, and rightly so. They share such information with their health care providers, trusting that it will be safely stored. We cannot afford to betray that trust, not even on the off-chance.

Given today’s I.T. super highway and the speed at which information travels, even a small leak anywhere in the system could very quickly develop into something we cannot possibly hope to control. (If you’ve ever tried to fix a leak in your basement, you’ll know what I mean. An undetected drip can turn into a flood overnight).

So what precautions are we taking?

Well, for starters, we need to recognize that nightmares can and do happen. We must acknowledge that privacy can be breached and that any work done towards its prevention and detection is time and effort well spent.

The next step is to build a picture of our collective privacy needs and opportunities. To this end, AOHC has initiated a Privacy Project to develop a roadmap that will guide the sector’s practices on all privacy-related issues.  Our goal is to help members build privacy best practices into all ehealth solutions.  We will align with the approach laid out by the Information Privacy Commissioner’s Office known as ‘Privacy by Design’, and take advantage of the knowledge and experience of our members.

To kick off this project, my team has designed a short survey that will gather feedback on members’ present capacity to manage privacy protection. We would like to know what privacy risks and opportunities our member centres have experienced or anticipate; and how the AOHC may help.  An anonymous summary report will be made available to members for their own use in due course.

I sincerely hope that all EDs will assist in our efforts, by encouraging participation from their respective privacy officers. The survey will be opened till August 22 and can be found Here .  

Let’s put our heads together to make doubly sure we protect ourselves; our health care practitioners, and most importantly, the clients we all serve.

If you have a strong privacy staff in your organization, do let us know.  We will try our best to share expertise, knowledge and tools across the membership.

And lastly, please don’t hesitate to share this message with your staff – this important work should not be kept private!  

Have a comment?
Contact me at Rodney@aohc.org

 

                                                                                                        

The Unnecessary Evil

How do you explain a six-year-old being gunned down in a movie theatre, or a teenager being shot dead at a BBQ social, or a kid being hit while having a meal at the food court?

These children could be mine, or yours.

As a parent, I am worried, and I am angry. I am worried because gang/youth/gun violence is getting to be a bit too much of an everyday occurrence. And I am angry because most of this is preventable.

Recall what Nelson Mandela said a decade ago (2002, World Report on Violence and Health), 

“Violence can be prevented. We owe it to our children, the most vulnerable citizens in our society, a life free from violence and fear. In order to insure this, we must be tireless in our efforts … we must address the roots of violence.”

While Ontarians struggle to make sense of the recent spate of fatal shootings, I believe – and I’ll risk speaking for every allied health professional here – that youth violence is primarily a public health issue. At its core, youth violence is strongly shaped by the social determinants of health. It stems from frustrations born out of a lack of educational and employment opportunities, poverty, social exclusion, racism and inadequate housing.

Let me give you an analogy. How do you grow a healthy plant? You have to water and fertilize from the roots up. You provide a conducive environment and add support structures to guide its growth. You watch for destructive weeds and prune away diseased leaves. In essence, you provide care for every single aspect of the plant’s health.

That’s how it should be for community health, too.

The good news is that we in the community health sector recognize the issue for what it is and we are taking active steps to do our part.

We know, for example, that poor academic performance is often correlated to school dropout rates. We understand the importance of keeping kids in school (where there are positive role models) and keeping them off the streets and away from the influence of gangs.

For this reasons, several Community Health Centres such as Regent Park and Rexdale CHCs offer youth programs like Pathways to Education. Pathways offers tuition and coaching to ensure youths will successfully complete high school. Such community-based initiatives help break the vicious cycle and it is this ‘break’ that will critically alter the fabric of society for the better.

This is why the Association of Ontario Health Centres (AOHC) advocates tirelessly for a broader vision of primary health care – because without a healthy and inclusive community, no one can safely say that he/she will never be touched by violence.

Make no mistake, folks, what we’re witnessing in Toronto these past weeks is a call for help from the most marginalized quarters within our communities. Answering this call for help demands that we send in teachers, health promoters, counselors, nutritionists, etc – not just squad cars and ambulances.

Have a comment?
Contact me at Rodney@aohc.org

 

In Dreams Begin Responsibilities

A book editor once told me that her publisher never minded if she made a few errors in a 300-page novel, so long as she makes up for it with an excellent title. You see, in the world of book publishing, flawless copy does not sell books. Arresting titles do.

Of course, in an ideal world, nothing ever goes wrong; nobody ever makes mistakes; and we would never miss a step. Fact is, in an ideal world, I’d be sipping wine onboard my own 150-foot yacht docked at an island bearing my good name - but I digress…

What I’m really trying to say is this – there is no shame in minor infractions or small imperfections, as long as we diligently pick up on the lessons learnt.

In my last post, I pledged to give a regular account of things and keep matters transparent – the good; the not-so-good, and the downright nasty. So here goes:

The good is always a joy to share. We have successfully implemented Nightingale on Demand (NOD) at all four “paper sites” and this is a milestone worth celebrating. Our first Nurse Practitioner-led Clinic (NPLC) – Huronia – has also gone ‘live’, while French River and Health Zone NPLCs are on track to be ‘live’ this summer.

The not-so-good? EMR implementation hit a couple of bumps on the issue of training and post-live support. However, we have taken active steps to address the issue and deployment down the line will go a lot smoother, thanks to all involved who have taken these important early lessons to heart and put the spirit of continuous improvement into the project.

Oh, speaking of books … I recently came across a short story by an American essayist and poet entitled, “In dreams begin responsibilities”. I think that’s something we should keep in mind as we start the IMS program year (i.e. which runs from July 1, 2012 to June 30 next year).

A flexible, functional, responsive EMR is something we’ve all dreamt of for so long. Now that it’s here, the time has come for us to own some of the responsibilities that come with just such a dream:

For me, as for members of the Information Management Committee (IMC), we have the responsibility of informing our stakeholders if anything – however small – doesn’t go exactly according to plan. It is also our responsibility to actively seek your counsel on next steps and future directions.

For individual Executive Directors, you have the responsibility of making sure project-critical information gets passed down to the appropriate level of staff, so that knowledge is shared in advanced of actual implementation.

For Data Management Coordinators (DMCs), you hold the keys to facilitating the actual data migration, to ensure that daily operations do not stall unnecessarily. I depend on you. We all do.

For clinicians and other health care professionals, you must claim responsibility for the EMR’s usage. The entire IMS platform was built to support you - our front-line colleagues. “Technology” is only so many letters strung together if it is not utilized to its fullest potential. For this reason, I strongly encourage all clinicians to have a go at the new EMR and explore its functionalities.

And last but not least, to every member of my IMS Team, to you falls the ultimate responsibility. You are the standard bearers; the drummers; the foot soldiers; believers, all. I assure you, your tireless efforts will not be in vain when all is said and done.

We all need to remember that plans are usually based on best-case scenarios.  They don’t usually describe reality – with all its inherent blemishes. As we learn more and gain experience, we need to ensure the broader collective is effectively kept up-to-date.  This is much easier said than done.  There are many communications reaching out to those involved or touched by our IM Strategy.  Unfortunately, it is all too easy for the recipients of these to miss or lose track of these messages in a sea of competing emails, voice mails, newsletters, meetings, vacations and day-to-day work activities.

Another challenge we have to manage is the “promise of potential” as I like to call it.  A vision is often very compelling and can help bring people together under a common banner.  It rarely addresses the challenges of how to reach that vision – or the reasonableness of how close we can actually get to that.  The reality is that what is achieved is often less than the theoretical potential – for a whole lot of valid reasons.

As the saying goes, “the grass appears greener on the other side of the fence”.  We need to do our individual parts to ensure that when we collectively get to the other side of the fence, the vibrant green of lush grass hasn’t lost too much of its luster. This all said, I firmly believe we are all in agreement on the need for maintaining common understanding. I am more resolved than ever to do my part to help ensure everyone has access to the right information at the right time. 

Like Nik Wallenda who recently crossed the Niagara Falls on a tight rope, our challenge is a perpetual effort to find the right balance between too much information and not enough – and successfully making it through the challenges surrounding such an endeavour to get the message successfully to the other side.

All this is to say that we take this stuff seriously.

See you on the other side of the gorge!

Have a comment?
Contact me at Rodney@aohc.org

 

Bimaadiziwin (The Good Life)

   












Believe it or not, I’m actually going to make time for a short vacation this summer. For all of one week this June, I shall endeavor to live “the good life”, catching up with friends and family over a barbeque or two.

Sounds mundane enough, but take it from me, if you’ve been driving on high gear for months on end, a little mundane is actually a good thing!

Merry-making aside, when I think of the good life now, I am reminded of an aboriginal word. Two weeks ago at the Primary Health Care Conference 2012, James Carpenter, a respected traditional healer from Anishnawbe Health Toronto, mentioned the term, Bimaadiziwin (which literally translates to ‘the good life’).

To aboriginal people, Bimaadiziwin is a way of living that promotes the art of sharing – the constant exchange of experiences, knowledge, viewpoints, visions, greetings, etc. At its heart, the concept encourages people to come together in a gathering of peers, to listen and to learn; to support one another in the pursuit of dignity and wellness, not just at the individual level, but at the communal level too.  

It’s a beautiful philosophy, one that reminds us of why we are committed members of the same association (i.e. AOHC). As a community of like-minded professionals, we have a duty to one another - an unspoken pledge to help our fellow communities achieve Bimaadiziwin by leveraging our individual strengths and skills.

So let’s get the ball rolling, shall we? I’ll start with my personal pledge - and I hope you will all join in with your own. From each according to his/her own abilities, yes?

Here goes …In my capacity as CIO of AOHC, I pledge to be guided by the principles of Bimaadiziwin, and contribute to our collective vision by:

1. Sharing the ‘big picture’ and strategic plans at every level of organization – from giving semi-annual presentations at Regional ED Networks, to touching base with both front-line and back-end staff of member centres during Regional User Group meetings and other forums;
   
2. Listening to your concerns and keeping an open mind to all your suggestions for improvement;
   
3. Learning about your organization’s unique challenges; and
   
4. Supporting you in your efforts to overcome barriers and make person-centred care a reality in your community through the adoption of innovative Information Technology.

Now, your turn!

Have a comment?
Contact me at Rodney@aohc.org

People-centred Care: Are we there yet?

Back in the early 1970s, there was a major mindset shift with what was then called the “patient empowerment movement”. It was a turning point that changed the physician-client relationship, making health care more participatory. People wanted a greater say in their treatment options. Better-informed clients began questioning if medicine can be complimentary with other options.

Fast-forward 20 years. Another significant development took shape. It led to a shift in emphasis from disease management to disease prevention. Avoiding the disease in the first place was better than managing it after the fact - from all stakeholders’ perspectives.  It has resulted in people taking proactive steps to improve their own health status.

With the explosion of technology and the advent of sophisticated consumer health gadgetry, we are now witnessing yet another revolution. Today, anyone with an iPhone can download applications – or – “apps” as my kids tell me - to monitor heart rate, track blood pressure, document stress levels; even scrutinize their own x-rays – and make this information available to health care providers of their choosing.

People want to know what’s going on with their health – and they want the information now. Knowledge is power – cliché, but true. They are no longer content to leave the decisions solely in their doctors’ hands. Increasingly, they want to be a part of the ongoing conversation; “nothing about me without me”.

Should health care professionals worry?

In the grand scheme of things, I feel we are definitely moving in the right direction. It is a good thing that people are seeking answers over the Internet; questioning their physicians; demanding to be involved. More involved/interested clients than less so, I say.  I certainly espouse the former rather than the latter for myself and my family.

As was discussed at AOHC’s Primary Health Care Conference 2012, our ultimate goal – or challenge – is true people-centred care, i.e. how to make the “person” the focal point of all health care efforts – in every sense of the word. According to the World Health Organization (WHO), people-centred care is about building several core values into our health care system:

• Empowerment
• Participation
• The central role of the family and community in any process of development, and
• An end to gender and all other forms of discrimination.

As the Honourable Minister Deb Mathews noted, if we’re taking a check-list approach to this, it is obvious that we’re not there - yet. There is still some ways to go before we can declare ourselves a model of people-centred health care.  The profound achievements in people-centred care of the NUKA model in Alaska are encouraging and a testament of the work ahead of us.

As Dr. Rick Glazier noted in reviewing the ICES study data, we’re moving towards it – and that’s something worth celebrating!

‘You can’t manage what you [don’t] measure’.  This is where our information management strategy will help.  Manual measurement can be costly in time, expertise required and training.  By making eHealth tools available that make data capture efficient, we can help improve decision-making and involvement as we collectively continue to pursue people-centred care.

This was my first AOHC Annual Conference – and it certainly won’t be my last.  I found it informative and affirming that as a sector, we are on the right track.  I want to thank all of you for attending – and more importantly, participating in – our annual conference. In these very busy and demanding times, your very presence speaks volumes. It says to me, “We believe in people-centred care. We share the vision. We are part of this dialogue.”

What a powerful affirmation! This is progress towards creating a more equitable and holistic health system that addresses all the social determinants of health. My team has their eye on this goal and we will provide the tools that help our clinicians and leaders make the right decisions in partnership with those that we serve.

Together, we can make people-centred care happen – one person at a time. Maybe not in the next year or two, but certainly, it will happen in the foreseeable future if we work together for change – “Hoza”!

Have a comment?
Contact me at Rodney@aohc.org
 

We’re moving the Cheese, Folks

 

 

There are probably very few people out there who would aspire to be like rats. I, too, used to see these creatures as pests, but a friend who keeps them as pets opened my eyes – and raised my brows – recently.

According to her, rats are highly adaptable animals that are somehow hot-wired to always think positively. They like routine but aren’t adverse to change. Highly inquisitive, they are always happy to sniff out fresh opportunities when introduced to a new environment.

And that got me thinking … Perhaps it’s time we open our minds to learning from these humble creatures. Who knows, they could teach us a thing or two about adaptability, willingness to go with the flow, and ultimately, a “get-up-and-go!” attitude.

Remember that phenomenal business tale and top-selling book, Who Moved my Cheese? For those unfamiliar with the tale, here’s a quick summary:

2 rats and 2 humans woke up one day to find their all-important “cheese” missing. The rats didn’t mind being suddenly placed in a new situation and quickly set off to explore the new terrain, confident that “new and improved” is almost always better than “old and tired”. The 2 humans, on the other hand, were horrified. Not daring to cast their eyes on the far horizon, they feared a “maze” of unknowns. So they opted to stay within their comfort zones and starve. Eventually, hunger got the better of one of them. My guess is he got tired of dieting.. Anyway, he weighed the risks and decided to venture out. To his surprise, he found new cheese – and learnt that the 2 rats had been enjoying the bounty all along!

(A video presentation could be found here: http://youtu.be/4C0M2CL9TJE)

All right, my friends. What is the take-away lesson for us?

We are now at major crossroads. We have to decide if we are going to be like the rats and embrace the changes to come, or hunker down with the humans in a corner of the maze; to indulge our fears and doubts – and be left behind.

I urge you to trust to the rodents’ instincts! Yes, the MAZE is scary. Together, we have scouted and mapped out a way forward. I bid you follow.

We will strive to make this maze as transparent as possible, so that the journey feels a stroll in the park. No walking blindly into hedges here. You will not get lost. Pardon the pun, but it will be an a-mazing journey!

At the recent ED Network meeting on May 12, I confirmed our commitment to be transparent all the way. Every step, every move, every sideward look and turn – I will clearly signpost them all. We have built strategic vantage points all throughout this maze – and we will survey the lay of the land on a regular basis.

Process transparency is important. It means being able to monitor, control and manage developments at every turn, to be able to sniff out opportunities and dangers 10 feet ahead.

The AOHC has been empowered by you – our valued constituents – to take the lead in negotiating and procuring solutions that meet our members’ unique setup. We have succeeded.

Now, as we move into the Operational Phase of our projects, it is vital that everyone – from health promoter to physician to data coordinator to executive director – understands every inch on the proverbial ‘yellow brick road’.

So going forward, my team will be sharing with you the finer details of our processes, from finances to implementations to lessons learnt. Please, don’t be overwhelmed. 

Whatever issue or detail you’re not sure of, or wish to clarify, feel free to flag them – and we’ll do our best to answer.

My point really is this: I believe we have established a good line of sight within the maze. I am offering you my shoulders to stand on – to help lift you clear of any lingering doubt or fear you may have.  

Only … please … not all of you at once. My knees might buckle!

Have a comment?
Contact me at Rodney@aohc.org

Staying the Course

I recently watched a TV trailer for the 2012 Summer Olympics in London, titled “Believe”.

And it got me thinking of that champion amongst champions, Greg Louganis, a legendary diver whose feats mesmerized the world during the 1988 Summer Olympic Games in Seoul, Korea.

Louganis was then neck-and-neck with his competitor when he cracked his head hard on the springboard while performing a difficult reverse dive. Despite requiring five stitches and clearly in pain, he went right back to the competition and turned in a superb performance that won him the Gold medal.

That, to me, is the Olympian spirit. Louganis showed the world what is meant by the term, perseverance.

I myself have learned a thing or two from the world of sports. As a 2^nd Dan black belt holder in Taekwondo – a Korean martial art form and an Olympic sport – I’ve come to deeply appreciate some of the values central to the sporting world – values such as fair play, discipline and perseverance – i.e. the ability and willingness to hold on to your goal regardless of obstacles, challenges or even criticism.

And perseverance – one of five tenets of Taekwondo – is my topic today.

My waist line will tell you I’m no aspiring Olympian, but I am championing a cause no less worthy, and flying high our flag in my own way. 

What is this cause I’m supporting? Why, eHealth, of course. Just as our athletes strive to bring honor to this country, I, too, am working hard to showcase our member centres as leaders in the use of Information Technology. By extension, I hope to position this province as an innovator in the world of health informatics.

Together with the rest of our team, we have put in place a strategy that will take us round the next lap or 10. We have already established an eHealth framework comprising the new Electronic Medical Record (EMR) system and invested in a powerful solution called BIRT (Business Intelligence and Reporting Tool).

BIRT is a “solution” because it was created precisely for that purpose – to address the problem of gaps in the information sharing process. The current information management environment within the CHC sector is highly complex, comprising many core systems that facilitate clinical management, health promotion & education, accounting, HR and community development activities, amongst others. By and large, these individual systems do not communicate with each other, since data is entered into multiple programs for different reporting purposes. The lack of a common solution means that some organizations operate as many as 50 unique systems capturing valuable data that can’t be easily shared across the sector.

Why am I revisiting this now?

Simple – to remind us of why we’re investing so much time, energy and money in BIRT.

This is a solution we all agreed on; to solve a problem we all admit exists.

With BIRT, we will be better placed to gather data in a holistic manner for robust analysis, which will in turn facilitate strategic decisions that help drive quality improvements in the sector. If we can help clinicians and business leaders make effective decisions, it will free up limited resources for other needed programs and services. Now, surely this is something worth working up a sweat for?

The road to success is almost never straight and narrow. As my famous namesake, Robert Burns, puts it, the best-laid schemes sometimes gang aft agley (i.e. go awry). But the common thread that runs through each and every champion’s program is perseverance.

BIRT is not a 50 meter dash across the pool. It’s a long distance swim – up river, against the current in cold waters. Think of the Salmon ...

We need to build rhythm with every stroke, and it doesn’t matter who’s first off the blocks. What matters is that we keep at it, slowly at first, then steadily after.

Yes, we got off a little wobbly. There were more issues than we anticipated and working these out took more time than originally planned. But when faced with unexpected challenges, we proved by our actions that we were not the quitting kind. On the contrary, we re-doubled our efforts and stayed the course.

My friends, we are now one step closer to achieving automated operations with BIRT!

I am happy to report that the processing of accumulated backlog files in BIRT Phase I will soon be completed (by end-May, 2012). We will then be able to resume regular, weekly submission and processing of CHC data using the scheduler and extraction tool.

The next step is having BIRT Coordinators access the BIRT Portal routinely to review data submission status and error reports to resolve data quality issues.

I want to take this opportunity to thank you for your support, and urge you to continue working with us on this solution, so that together, we can make Ontario’s eHealth vision a reality.

As the TV trailer asks, “Do you believe?” 

I hope we can all answer in unison with a resounding “Yes”.

Have a comment?
Contact me at Rodney@aohc.org

Dollars & Sense ...

        VERSUS             

It’s that time of the year again, when the days get warmer and sleek, über-cool sports cars come out to play. Inevitably, stopping at the traffic lights next to one of these chic machines makes me wonder if I should trade in my trusty old Ford Focus for a new, open-top Mercedes SLK. Now, wouldn’t  that be something, eh?

The question is, do the dollars make sense – and will the wife agree? I already know the answer to the second part, so let’s just consider the first.

What are my options? Should I get a work horse like the Honda Accord, with its excellent fuel economy, value-for-money and record reliability; or should I splurge on a luxury make that will turn my daily commute from Barrie to Toronto into pure pleasure? The Honda will get me to the same place a Mercedes would, with a fair bit of change left over for servicing and maintenance.

I’m sure most people would agree with me, especially when we’re talking big-ticket items like cars, houses or the new electronic medical record (EMR) system, that the main thing to consider is ROI – Return on Investment.

In these belt-tightening times, it is important that we ask ourselves 3 questions:

• Will this purchase help save me some change in the long-term?
• Will its upkeep and maintenance be affordable?
• Will it offer me a good ROI and yet be perfectly reliable?

With Honda - as with Nightingale on Demand - the answer is yes, yes, and yes.

True, there is a wad of dollar bills to put down, but if your car is running old and starting to show signs of wear, you really only have two choices:  (1) buy a new car now while the dealer is offering good incentives; or (2) push your old car to the max and pray it doesn’t stall on the 400 during peak hour traffic.

Imagery and analogy aside, that is exactly the situation we’re facing now, my friends. Should we keep our old computer systems, or transition to the new electronic solution? Do we want to wait for the existing systems to completely break down at the most crucial moment, or would we rather strike a deal while the iron is hot?

I know - paying in cash scares you.

But I encourage you to look beyond the initial capital outlay and see the value that this investment will bring – to your organizations; to your health care providers and ultimately, to your clients.

This new EMR we’re purchasing isn’t a Mercedes. It’s a Honda.

We’re not buying into pomp and posh here; we’re investing in reliability and high efficiency at a decent price, with a huge subsidy to boot. With new technology and new functionalities, our new solution will allow us the breadth and depth of scope needed to move confidently forward into the next decade.

The face of health care in Canada is changing, trending the rest of the world. From the Middle East to Southeast Asia to the Big Apple across Lake Ontario, health care organizations are putting in place the necessary infrastructure that will take medical services to the next level. Do we want to lead the pack, or are we content to lag behind other provinces and/or countries?

Canada is a first rate country and I’d like to think that Ontario is a first rate province. Our vision of a single, harmonized and coherent Information Management Strategy depends upon everyone’s active participation. Only then can we deliver a comprehensive, secure and client-focused electronic system that will improve the way our clients receive care.

Do we show by our united effort that our sector comprises innovators and change facilitators, or are we ostriches with heads firmly buried in the sand, afraid to take calculated risks?

Either way, my friends, a tidal wave of change in health care is coming, in fact, it is here. Call it the Excellent Care for All Act (ECFAA) or Drummond or Walker reports – change is the only constant today.

It will be transformational. A sea change, if you will.

And when this huge wave breaks, I don’t want to be caught out on a stalled engine.

Do you?

Have a comment?
Contact me at Rodney@aohc.org

 

The World of Rubber Bands

Lately, I’ve been hearing things. Don’t raise your eyebrows, it’s not what you think...

I’ve been hearing about how a handful of people are stressed, tentative, worried or otherwise uncertain about all the new changes going on. I’ve heard questions about how we’re going to smoothly transition to a new electronic medical records (EMR) platform; migrate, manage and integrate data; how we can ensure zero glitches; how best to guide, teach, hand-hold, so that people won’t get splashed stepping from the dock to the boat.


At the heart of it all, the question behind all these questions is simply this: How do I intend to manage these Changes – with the capital “C”?

Sure, change management theories abound. The biggest companies the world over have mulled over this issue in countless boardroom meetings. CEOs have spent sleepless nights thinking up ways to “Manage Change”.

And me? What do I think of change management?

Well, it got me thinking of the humble rubber band ...

People, to me, are like rubber bands. Yes, rubber can wear out; they can become brittle and they can snap. As with all materials. But rubber can also s-t-r-e-t-c-h. Therein lies its beauty – and its innate strength.

Like rubber bands, we all come in different colours, different sizes and shapes. Some of us stretch better than others. Some of us are more (or less) “stretch-resistant”. But we all have the common ability to expand our minds, our worldviews. We have it in us to change the way we work, upgrade, do better, etc.

Sometimes, we have more capacity to deal with change, i.e. we are more resilient. At other times, under certain circumstances, we are less willing to be pulled in six different directions. And perhaps, once or twice in our lives, we just feel we have no more stretch left in us.

I get it. I understand.

But let’s face it, we’re rubber bands, and it’s in our nature to stretch ourselves.

I’m not here to force change down your throats. I’m here to help you strengthen your own internal rubber band, and help you (and your organization) stretch to your fullest potential.

Do we know for certain – are we 110% sure – that our Information Management Strategy is fail-proof?

Can we say for certain there will be zero glitches along the way?

Is there a way to anesthesize the slightest hint of pain in the adoption of new health care technologies?

Alas, no, no, and no.

Change comes at a stretch.

We can’t promise our inner rubber bands won’t break, but here’s the thing: There’s less chance of a snap if we stretch a bunch of rubber bands together (as opposed to stretching a single one).

Consider the bungee cord, which is composed of several elastic strands twisted together to form a solid core. Many folks have staked their lives when they bunjee-jump off a bridge head first – yet live to tell the tale! This just goes to show the amount of “load” we can safely place on ourselves if our core is strong and flexible.

Tongue-in-cheek, I often describe health service delivery as highly competent professionals often stretched to the point of incompetence. Unfortunately, reactions to this have often been nodding agreement. But it doesn’t have to be!

We’re all in this together – you and I.

It is my belief that we can make Change happen – even if it comes at a stretch. All that’s needed is for us to band together; to contribute our individual tensile strength to the AOHC core; to become a bungee cord that will hold against every tug, drag or pull.

So when it comes your turn to face the new EMR, or the new CI Tool, or any other new project for that matter, remember that you’re not alone.

If you ever feel a snap coming, give me a shout – and I will stretch out my hand to you. I promise.

Have a comment?
Contact me at Rodney@aohc.org

 

Data Migration

Have you ever moved house?

The last time that happened to me, I remember feeling both excited and anxious.

I didn’t really mind the packing up (at least, not as much as the unpacking!) But what nagged me most were these questions: Did I overlook anything important? Did I accidentally throw out something precious in my haste to meet the mover’s deadline? If I mislabel a package, will I ever find it again?

I can imagine that this is exactly what data migration folks would be feeling right about now. What if some data get left behind?

Now, wouldn’t that be the end of the world!

The truth is, data migration is a complex operation. It is a complicated process.

I’m not trying to scare anyone here. I’m just saying this is something worth thinking about. The best thing for us now is to do all we can before the migration journey actually starts. This will ensure we retain as much control over the process as possible.

So for what it’s worth, here are my take-away tips for the data “warriors”:

1. Identify the person/team who will oversee the operation.
   
   You may roll your eyes now, but take it from me, when the floodgates open, it is best you know who holds the key. Someone must assume overall responsibility during the data transfer process – and everyone should know beforehand who that “someone” is.

2. Invest time to improve data quality.
   
   You don’t wait for your car to stall before you check your engine oil. Just so, I’ll advise you to start looking at your data log and ask yourselves if any data cleansing is required. Too often, the back-hand refrain of “Oh, our data’s good enough” will lead to delays down the road.

3. Expect the unexpected.
   
   Is there a scenario where there is absolutely zero data rejection? Would you believe it even if I tell you “yes”? Let’s face it, we’re dealing with a huge amount of data here. Inevitably, there may be hiccups. Hopefully these will be minor, but to discount them altogether would be a mistake. I’ll give you this much though – we have an expert team at hand, and I promise, we will walk you through the thick and thin of it from beginning to end.

4. Acknowledge this as a strategic opportunity to change for the better.
   
   Data migration is more than just a tactical or necessary move. It is an opportunity for an organization to get re-acquainted with its store of valuable information. Your data sets are high assets and if we do this right, the data migration outcome will increase the value of such assets exponentially.

5. Remember to breathe …
   
   Please, don’t hold your breath. As much as this is unchartered territory for many people, we have been planning for this event for many, many months now, so relax. Here at the AOHC, we have adopted a methodology designed to ensure that the integrity of data quality is preserved during and after the transfer. Our #1 priority is to minimize the impact this migration will have on end-users.

So just continue doing what you do best – and leave the heavy lifting to us. Moving house doesn’t have to be stressful. You just have to hire a professional mover.

(And yes, the guys we’re using to move your data are professionals!)

Have a comment?
Contact me at Rodney@aohc.org

 

   CARE, defined

“Take care.” – It’s something we say or hear often, but what does it actually mean?

It is such a simple yet empowering term. If you ask me, I would tell you that the word CARE stands for Clients Are Really Everything.

And they are.
 
They are the primary reason why our member centres exist. They are at the heart of what we do. And “they” are you – and me.

That’s right. I, too, am a client. For some time now, I’ve been a client at Barrie Community Health Centre (CHC) and I’ve benefited  greatly from their Diabetes Program. I’ve also seen first-hand how community initiatives (CI) can improve a community’s health status. For example, Barrie CHC organizes a monthly “grocery store tour” that teaches clients how to grocery shop and make healthy food choices. It is educational and fun. You get to walk down the (supermarket) aisles and say I do - to a better diet!

CIs are an integral part of our health care system. They are community need-driven, and community-focused. Their activities are custom-fitted to the communities they serve and – here’s the best part – everyone is welcome. It matters not if you are a CIO or unemployed; a citizen or new immigrant. These socio-economic indicators are not (and must never be) the criteria for care in this great country.

For this reason, I think CARE could also stand for Community Action Resulting in greater health Equity.

And that in a “nutshell” is why CIs are so critical to our mission and vision here at the Association of Ontario Health Centres. As the cartoon illustrates, inequality is a tough nut to crack but with good policy-making and concerted community action, it is an achievable goal. I believe that CIs are a great approach towards leveling the playing field for everyone living in Ontario, at least as far as health care is concerned.

To make this happen, each community organization must be able and willing to share their experiences, discuss lessons learnt and communicate milestones, so that the success achieved in one community can be replicated in another 100 miles away.

The good news is we can now do this with minimal effort. With the CI Tool, every member organization can now log their CIs in detail, noting what works and what needs improving. With both inventory and evaluative components, the CI Tool is a great platform for learning and sharing. I highly recommend you make full use of it.

The CI Tool was designed for you – the provider – to demonstrate and celebrate your commitment to community health care. As one of the four streams of our Information Management Strategy, the CI Tool represents a unique strategic area of development.  It captures the aspects of the CHC sector that make it unique. 

The Ministry of Health and Long-Term Care, as well as the research and academic communities have all expressed interest in understanding the impact that CI programming has on community health status.

It is our version of the proverbial nutcracker. With it, I am confident we can bring to fruition our common vision of a more equitable health system.

Community initiatives work and they are much appreciated!

Have a comment?
Contact me at Rodney@aohc.org

 

The Gathering Place

Chigamik Community Health Centre (CHC) just happened to be the first member organization to implement Nightingale on Demand – the latest electronic medical record (EMR) system available in Ontario.

Don’t get me wrong now, the scheduling was not done haphazardly. As a matter of fact, a lot of hair-pulling (and probably some choice language) went into planning the implementation line-up. But now that I think about it, there is deep meaning to Chigamik being the first.

Quite apart from the fact that Chigamik is a paper site which made initial deployment less complicated, it is fitting – poignant, almost - that the fist go-live site for a system meant to serve the entire community be at Chigamik which, in aboriginal language, means “the gathering place” or “the people’s place”.

I mean, that’s why we’re all here doing this great work, because everyone matters.

We are here to provide quality health care for everyone, regardless of their socio-economic, cultural, linguistic or other differences. Every individual. Every community. No discrimination. Equal access at every gathering place in Ontario.

All our projects and programs; all the late nights and the long hours; all the hard work and the sweat – all so that we can empower each and every provider to harness the latest in information technology in service of our clients.

We are in the thick of creating a system – housed in many different “gathering places” – that puts us in the best possible position to facilitate better care, by arming every health care professional with the right tools to do the important work of tending to other’s well-being.

There is an ancient African proverb from the Igbo and Yoruba regions of Nigeria: “It takes a whole village to raise a child.”

It has indeed taken a small village to make this crucial first EMR project a success! No fewer than 29 staff were involved – the Chigamik team; the AOHC team and the Nightingale team.

As a parent, I know only too well that raising a child is both a joy and a challenge. So will it be with our EMR project.

We have made all necessary provisions to ensure this “baby” grows up well. We have given it every possible advantage to secure its future.

But like a toddler who wobbles at his first few steps, there may be new challenges in store as we move to Regent Park – our first beta site to require data migration.

It will take patience, flexibility and good faith. But it will be worth it!

We have a vision. Now, let’s all take a deep breath and channel our energies into making the vision a reality.

Congrats, Chigamik, we’re elated at this progress and I’m sure every other member organization will be looking to replicate your successful EMR implementation.

And Chi Miigwetch, Chigamik – thank you for being such a wonderful partner.

Here’s a toast – to the health of all our communities. We have one success – and 85 more successes to go!

Have a comment?
Contact me at Rodney@aohc.org

 

“Nurse, I need an Upgrade.”

That 19^th Century American humorist we all know as Mark Twain once commented: “Be careful about reading health books. You may die of a misprint.”

Mr. Twain did not have the luxury (or the bane) of Google Search at his fingertips but he’s spot on about the ridiculous amount of information bombarding us every which way.

As the inaugural Chief Information Officer at the Association of Ontario Health Centres, I share the following impressions and musings, and I welcome an open dialogue about my thoughts below. 

Why am I starting this blog? – Because I feel it is important for us to get to know each other; to exchange ideas in less formal settings. (No, I’m not having a mid-life crisis and I’m not trying to compete with my teenaged children to win the coveted “Blogger of the Year” award.)  

My wife tells me that good relationships are key to everything – they are easy to aspire to but tough to achieve. I agree – I always agree with the wife. Kidding aside, I truly believe that we will be able to work successfully together if we understand each other, so I’m laying bare my mind.

The world today is vastly different from the one just 20 years ago. This is a rapidly changing environment. Take health care, for example. Every day, there is word of new diseases, new drugs, new research, new clinical trials, new operational procedures, new standards, new policies, new this and new that.

Personally, I can effectively manage about half a dozen unrelated issues before the proverbial balls start to hit the ground.  How do health care professionals handle the barrage of information while tending to dozens of clients, keeping multiple records and writing numerous reports? How do they separate the spurious from the critical; weigh market claims against the full set of evidence; call up complicated family health histories in aid of diagnostics; distill, extract and otherwise analyze the gazillion gigabytes of information confronting them – and manage to improve health outcomes?

(Literature suggests that physicians would have to read nearly two dozen peer-reviewed clinical journal articles – every day - just to remain current in their fields.  Managing demands on time and making the correct decisions given all this is a daunting challenge no doubt.)

In an era of automation and technology, the relative explosion of new information has further complicated this challenge as professionals try to sift through the ‘noise’ to get to those nuggets of information that will inform their decision-making.  Many are turning to technology to help push back the onslaught of data – and rightly so.

The question, then, becomes – what kind of technology do you rely on?

With the world moving at break-neck speed, where Apple puts out an i-something or other every few weeks, that trusty, old, Generation X computer still sitting in so many of our clinics -or hanging off our belts - just won’t do anymore. Not if we want to up the ante on quality health care.

It’s time for an upgrade.

So, how exactly do we do this? – By tapping into the latest electronic medical record (EMR) system currently on the market; by investing in an information warehouse system that allows our health care practitioners to catalogue, store, share and clearly flag any data set(s) they want for easy, immediate retrieval and analysis.

Given the recent provincial focus on primary health services, opportunities abound. This is an exciting time for the primary health care sector. We are in the midst of profound systemic change. The information management strategy provides tools to do more with less time and less effort.  The challenge before us is to work together closely to ensure the solutions we are moving to do, in fact, help us improve the health status of those we serve.

With considerable involvement from all corners of our membership, we have collectively developed an information management strategy that will establish best practices in the sharing and management of administrative and clinical data; promote quality improvement at the local, regional and provincial levels; encourage clinical collaboration, and improve client outcomes.

At the end of the day, we are changing lives for the better – hundred and thousands of lives.

Clearly, this type of profound transformation doesn’t happen on its own and not without involvement by those that are most affected by it. 

And it doesn’t happen overnight. 

We have a plan. We have exceptional teams engaged. We are in the initial implementation stages and we have begun to realize major milestones.

Call me an optimist but I’m excited by the prospects.

It won’t be long before we are able to announce successful eHealth implementations among our members.

I am ready to own this challenge and I look forward to working with each of you to realize the possibilities!

Stay tuned for more …

Have a comment?
Contact me at Rodney@aohc.org