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Transforming Healthcare Delivery Welcome to UHN’s SIMS (Shared Information Management Services) Improving the health system’s ability to provide quality patient care is at the heart of everything we do.
SIMS is committed to transforming the patient experience, providing health system leadership and enhancing customer service and quality. As one of the largest public sector health IT service delivery organizations in Canada, SIMS is a key player in leading information management and technology initiatives locally, regionally and provincially. It’s because our people are innovators who understand that information technology is not only an enabler of change, but can also be a driver. In a time when technology moves at rapid speeds and investing in
sustainable, long-term ehealth strategies matter, we know that we can never accept status quo. Our diverse and highly-skilled teams work collectively to face difficult challenges, overcome barriers, and develop practical and innovative solutions that matter to our patients and Ontarians. And so, I invite you to read stories of how our people and partners, who make our successes possible, are dedicating themselves every day to improving patient care, enhancing patient outcomes, and achieving transformative change in healthcare delivery.
Lydia Lee Senior Vice President & Chief Information Officer, University Health Network & Integrated Chief Information Officer, The SIMS Partnership
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SIMS is‌
4 Source: Staff survey from 2014 SIMS Conference
Our People
SIMS Staff at the 2014 e-Health Conference in Vancouver, BC
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Transforming Patient Care myUHN Patient Portal
Peter Gatzios is no stranger to the hospital. For over six years, he waited for a new kidney and received dialyses three times per week as an outpatient at Toronto General Hospital. Two and a half years ago, Peter received his second chance at life. He underwent a successful kidney transplant.
Peter Gatzios
“It wasn’t about interpreting the results or self-diagnosing. It was about building shared trust and opening the conversation up so I could gain a better understanding of my health...” -- Peter Gatzios, UHN Patient
What does myUHN Patient Portal mean for patients and staff? Click on the photo and watch the video to find out.
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During his time at the hospital, scheduling doctors’ appointments and anxiously awaiting test results became Peter’s ‘new’ normal. So when he was asked to participate in the pilot of a new e-health tool, myUHN Patient Portal, which would allow patients to have online access to their personal health information, he jumped at the chance. Not only would myUHN allow him to better prepare for his appointments, he would be able to access his health data in order to be better informed of his test results and ultimately, his care. “The biggest benefit of having real time access to my records is that I didn’t have to wait and stress out about my test results,” says Peter. “Instead, I could focus on what I needed to do. During my appointments, I started to spend more time asking questions and talking about my concerns.”
Empowering Patients as Partners in Care This May, Peter and patients from select clinics across UHN will have the opportunity to take a more active role in the management of their care. The myUHN Patient Portal will offer patients online access to their personal health information from UHN’s electronic patient record.
“Having information contributes to being informed, and decreases anxiety and the mental stress of waiting for tests results and reports. This is good for patients’ physical and mental health…” -- Patient, UHN
Once a patient has access to myUHN, they can see their UHN appointments, receive appointment reminders, see lab results and clinical documentation such as clinical notes, reports, assessments and discharge summaries. Early adopters of the portal, include: • Clinics/teams at Princess Margaret: Breast Cancer Survivorship, Leukemia, Endocrine, Testis • Clinics/teams at Toronto General: Red Blood Cell Disorders and Renal Management Clinic “Patient empowerment and patient engagement are at the heart of myUHN,” says Audrey Friedman, Director, UHN Patient and Family Education. “The portal will help patients feel better prepared for their appointments so they can have quality time with their healthcare providers.” For Peter, not only did myUHN improve his interactions with his healthcare providers, but he felt more satisfied with his care and overall experience at the hospital. “It wasn’t about interpreting the results or selfdiagnosing,” explains Peter. “It was about building shared trust and opening the conversation up so I could gain a better understanding of my health.”
Peter Gatzios at an event in Toronto with friends.
Working Together myUHN is a vital part of UHN’s strategic directions toward “patients as partners in care”. It builds upon best practices in providing exemplary patient care through timely access to information, education and tools that promote self-management. “At UHN, we provide patients with cutting edge clinical care and the critical education they need to manage their health,” says Nazek Abdelmutti, Manager, myUHN Patient Portal. “The launch of myUHN demonstrates our continued commitment to providing patients and families with tools that enable their participation as partners in their care.”
Related to this story: myUHN Patient Portal helps patients participate in their care
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Where Information Follows the Patient ConnectingGTA
Whether you work as a health care provider or have experienced the system as a patient, many of us have seen up close what works and what needs improvement.
ConnectingGTA, a hub for electronic health information in central Ontario, is striving to address some of the most common challenges expressed by patients: long waits for results, repeat tests, being asked for the same information multiple times, carrying medical records and medication to appointments.
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UHN’s SIMS team, under the direction of Lydia Lee, Senior Vice President and Chief Information Officer, University Health Network, is leading the development of a regional electronic health record (EHR) for health care organizations and clinicians across central Ontario that serves as a foundation for a province-wide EHR.
A Regional EHR “We started with a simple idea,” says Lydia. “Wouldn’t it be great if the information we needed to make care decisions was all in one place? Seeing this concept come to life, making information available at our clinician’s fingertips and having a real difference in the patient experience is amazing.” Funded by eHealth Ontario and Canada Health Infoway, ConnectingGTA integrates electronic health information so that clinicians can have a more comprehensive view of an individual’s health history. Starting with the information needed most by clinicians, the system captures critical information such as lab results, diagnostic imaging reports, discharge summaries and community assessments, and makes it available to clinicians across central Ontario. Up to 20,000 users are expected to be enrolled by the end of 2015. Dr. Peter Rossos, UHN’s Chief Medical Information Officer co-leads the ConnectingGTA Clinical Working Group, an interprofessional clinical team that determines the design, workflow and implementation priorities to best support regional care. “More than 200 clinicians were directly involved in the development process to best understand the needs of care providers and their patients,” says Dr. Rossos. “The clinical priorities were established in the early stages of the project. Our major efforts currently relate to alignment with existing technology, data quality and availability, privacy and governance policies." Dr. Rossos says the goal is to deliver a core solution that will allow all clinicians within Central Ontario to deliver better and safer care within their existing work environments.
What Clinicians are Saying Enhancing the ED experience “Connecting GTA will change the way we do business in the emergency department, currently we fax information to other hospitals and get it back much later. Now what we’ll do is access information electronically to make more timely care decisions.” - Dr. Asim Masood, Deputy Chief of Staff and Chief Medical Information Officer, William Osler Health System
Reducing repeat tests “I recently tended to a post-operative patient experiencing stomach pain who had recently been discharged from another hospital. Using ConnectingGTA, I accessed their test results from the other hospital, including a CAT scan from the previous evening, to determine a diagnosis and course of action without unnecessarily repeating the test.” -
Dr. Naresh Mohan, Chief of Staff, Rouge Valley Health System
More coordinated and integrated care in the community “Having access to ConnectingGTA allowed us to expedite discharges during this year’s flu outbreak. With discharge plans and discharge medication information we could maintain the patient’s continuity of care in the community and better anticipate additional support required to build on the follow-up care plan.” -
Anita Fast, Rapid Response Nurse, Toronto Central CCAC
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Enabling Patient-Centred Care UHN QIP Discharge Summaries
Every year at UHN, about 35,000 inpatients are discharged and 46,000 discharge summary reports are delivered to primary care providers. Patients' follow-up care relies on the quality, completion, and delivery of discharge reports. Over the past few months, UHN has been working on a quality improvement plan for discharge summaries. By focusing on standardization, quality improvements, and changes to clinical practices, UHN aims to support a more seamless care continuum and patient-centred care for its discharged patients.
To support this initiative, a physician group was established, including the VP Medical Affairs & Quality, Chiefs of Surgery & Medicine, and five additional physician leaders. Three expert panels have also been convened to identify and investigate all opportunities to improve the discharge summary process.
"Getting better at the discharge summary process and understanding its utility for patients and community care providers will strengthen connections between organizations and the patient." -- Dr. Charlie Chan, VP Medical Affairs and Quality
Residents and Physicians collaborating to complete a Discharge Summary at TGH General Internal Medicine.
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A Valuable Tool for Care Providers Discharge summaries are useful tools for patients and their families to help them understand what happened during their stay at the hospital. Having this type of information enables patients to be partners in their own care. It allows them to have quality discussions with their care providers about their ongoing treatment. "It is critical that patients understand their follow-up instructions, and the letter allows this information to be presented in a written format. Overall, the discharge summary is a very valuable tool for the dissemination of information," says Meredith Linghorne, Nurse Practitioner at the Peter Munk Cardiac Centre. As a legal record of the information and counsel the care team has provided the patient, it's also a vital communication tool for care providers.
Did you know?
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Under the Ontario Public Hospitals Act, UHN is obligated to complete a discharge summary for each inpatient UHN can send a discharge summary to a primary care provider in just 30 minutes of it being completed According to the Ministry of Health and Long-Term Care, delayed discharge information provided to subsequent care providers is one of the factors contributing to 20 per cent of patients experiencing adverse events during the first several weeks after a hospital discharge The risk of re-hospitalization decreases when patients are assessed for follow-up by physicians who received a timely discharge summary
"It is your last chance to communicate with your patient about what they need to remember when they leave your care, and it also informs referring physicians with the information they need to continue the care continuum," says Marina Vainder, obstetrics and gynecology resident at TWH.
A sneak peek at upcoming changes UHN is committed to establishing a standard approach to documenting a discharge summary to: • Align with other Toronto Central Local Health Integration Network (LHIN) healthcare institutions • Complete a discharge summary within two days of the patient being discharged • Send a discharge summary to the referring/family physician within three days of completion • Ensure Most Responsible Provider (MRP) accountability for the accuracy of all completed discharge summaries
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Improving Patient Outcomes ACD Bariatric Assessment Notes
In a world full of technological advancements, gadgets and smartphones, UHN’s Dr. Allan Okrainec knows the advantage of technology goes far beyond video games and instant messaging. It has a valuable place in the medical field. It’s a place where technology is not only transforming the patient experience, but the way clinicians work.
‘A Major Milestone’
Dr. Allan Okrainec and Nurse Practitioner Sandra Robinson
“Pen to paper is a thing of the past. Incorporating mobile technology in our work can help create efficiencies so we can spend more time with our patients or potentially treat more patients. For the patient, it means waiting less for the care they need.” -- Dr. Allan Okrainec
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The Advanced Clinical Documentation Bariatric Assessment Notes is a synoptic documentation tool for clinicians. It highlights the potential of technological advancements in patient care. Using the iPad, clinicians and surgeons streamline their workflows, reduce errors and improve efficiencies so they can, ultimately, deliver better patient care.
“This initiative marks a major milestone in documenting patient care at the bedside using mobile technology,” said Okrainec. “But what’s truly exciting about this initiative is that we developed the program here at the hospital from the ground up.”
‘Real Magic’ The project involved an interdisciplinary team including nurses, social workers, dietitians, psychosocial, surgeons and SIMS’ project managers and developers. “The real magic of bringing this type of technology into the process of care is to make it work for the care providers – not making care providers work for the technology,” said Michael Caesar, Director of Information Management. “Having the right information at the right time throughout the entire continuum of care is essential, and the combination of this device and application has allowed the technology to take second stage,” he continued. “The focus remains on the patient and delivering the best possible outcomes.” Screenshot of the Bariatric iPad app
Setting a Standard As a result of the initiative, clinicians can input and access an extensive amount of patient data from the iPad, instead of having to refer to a number of separate charts, for example. Now, clinicians and surgeons have a better look into patients’ needs and medical histories, which translates into providing individualized and holistic care to patients before and after surgery.
In fact, as part of the bariatric patients’ journey, they are required to follow up with
their clinicians over a five-year period. With this new tool, not only are clinicians able to access patients’ medical histories, but they are also able to track and trend each patient’s recovery. “We’re transforming the way we capture data, and it’s exciting to see how this tool is helping UHN improve patient outcomes and enhance research,” said Okrainec. “There’s no doubt that all the work our team put into this will become a backbone for other programs at UHN.”
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It Started with an Idea… SIMS Innovation Challenge
Blair Witzel understands how innovation and technology can transform the way healthcare is delivered. But when Blair’s mother was admitted to a longterm health care facility in Saskatoon, it took on a much more personal meaning.
The Problem Although most of his family resides in the area, Blair lives in Toronto which means he is not always kept up to speed on his mothers health status or treatments. “It’s hard to get the big picture,” says Blair. I may speak with my siblings or multiple care providers, but still not understand what my mom’s (L-R) Blair Witzel and the Family Link team: long-term treatment plan is. Adrelle Lewis, Ahmed Nasir, Emily Yuen, and Ardian Shtylla Even getting the context of her test results can be challenging.” “I would prefer to get concise updates from a care provider who can help me understand what I can do to support her care.” When a patient is admitted to the hospital the family members often experience anxiety, worry and fear. This is compounded when there is a lack of information and education regarding the patient’s status. Although family members are often the care providers and support team for the patient, there are not many tools or means to assist the family members in supporting the patient. “I know technology can’t solve the problem on its own, but there’s got to be a way for it to help facilitate conversations between care providers and a patient’s family member.” 14
The Solution: Family Link Family Link is attempting to lower the amount of anxiety and fear that the family members experience by increasing the amount of information and education we deliver to them. By leveraging innovative technology, Family Link hopes to help inform and educate family members about the patient’s journey from admission to discharge. By including family members as partners in care, it can develop positive interactions with care providers, and improve the patient’s experience.
About the Challenge The annual SIMS Innovation Challenge is an opportunity for staff to flex their creative muscle by designing an innovative solution to a healthcare problem. Pitch ideas
Form teams
On December 15, 2014, the Family Link team presented their solution to a panel of judges and over 240 SIMS staff at the first annual SIMS Conference and Innovation Challenge. The team won the Innovation Challenge and has started their investigation to develop a solution.
Design solutions Present @ SIMS Conference
‘An Amazing Experience’ At SIMS, we have the opportunity to work on exciting projects that are transforming the landscape of health care in Ontario. Nevertheless, it’s always invigorating to create your own idea and see it come to fruition. The SIMS Innovation Challenge was an opportunity to pitch an idea that solved a healthcare problem and aligned with the SIMS Roadmap. There was one caveat: we had to build a team with people from at least 3 different SIMS teams. This encouraged everyone to get out of their comfort zone and work with new people. As teams were formed we were given one day to design our product and create a presentation. The time pressure forced us to focus on the core problem we were trying to solve. Finally came the SIMS Conference, the day where we had to present to the impressive panel of judges and over 240 SIMS colleagues! Each team had great ideas and when it came time for us to present it went by so fast; it’s all a blur now! At the end of the conference they announced the winners and we were extremely surprised to hear our name called. The SIMS Innovation Challenge was an amazing experience. We got a chance to create and work on our own project and best of all meet and work with some of the amazing people that we have here at SIMS. Can’t wait 'till next year! -- The Family Link Team
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Senior Leadership Lydia Lee SVP & CIO, UHN & Integrated CIO, SIMS
Dr. Peter Rossos
Jim Forbes
Dr. Joe Cafazzo
Chief Medical Information Officer
Chief Technology Officer
Sr. Director, Medical Engineering & Human Factors Engineering
Medical Informatics Telehealth
Project Capability Office Information Security SIMS Education and Learning & Performance Support Business Operations
Penny HackenbrookRogers Director, Application Product Management & Health Records & Transcription Health Records & Transcription Department & Enterprise Scheduling Applications (DESA) Patient Care Management Systems (PCMS)
Slaven Rakic Director, System Engineering and Enterprise Architecture
System Engineering & Integration Corporate Intranet Database Management Enterprise Architecture
Duska Kennedy Director, Technology Services & Business Engagement
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End User Solutions Infrastructure Solutions Education, LPSP Network & Voice Solutions Telecommunications IT Managed Services West Park
Healthcare Human Factors eHealth Innovation Personal Health Information Technology Quality Systems
David Gretzinger Director, Medical Engineering Electromedical – UHN, MSH & TR Surgical – UHN Medical Imaging Support – UHN, MSH, WCH & TR
SIMS Finance & Procurement Communications SIMS General Counsel Employee Relations Special Projects
Shiran Isaacksz
Michael Caesar
Sr. Director, Information Management
Sr. Director, Information Management
ConnectingGTA (cGTA) GTA West Diagnostic Imaging Repository (DI-r) Resource Matching & Referral Toronto Central CCAC Strategic Delivery Partnerships
UHN Site Managers
Kamini Milnes
Karen Martin
Director, Information Management/ Information Technology, TC-CCAC
Sr. Director, Clinical Practice Transformation
Stephanie SaullMcCaig
Jackie KwongLeung
Director, Information Management, RM&R
Project Director
Sonali Kohli
Paul Santaguida
Program Director, GTA West DI-r & cGTA
Program Director, Health Quality Programs
Wing-Si Luk
ISAEC Program NS-QIP Program
Program Director, cGTA Implementation & Adoption
Nimira Remtulla Program Director, cGTA Solution Delivery
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Our People
What We Do
530+
359
employees
students since 2005
Project Management Strategic Planning Technology Solutions
40%
60%
male
female
27%
Architecture Privacy & Security
6-10
43%
11%
11-15
Years of Service
16-20
Application Product Management
Medical Engineering
5%
21+
13%
0-5
Provide operational & project management support
Our Certifications*
to transform the patient and clinician experience at UHN
Work with healthcare organizations across the continuum of care to share and provide IT resources
Work with regional, provincial, federal, and international stakeholders to provide leadership in developing systemwide IT solutions
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* Data collected from staff during 2014 SIMS Conference
What We Manage
Our History
1,000,000+ messages exchanged per day between 80+ UHN systems
2003 Real-time electronic patient information is shared across 5 hospitals when SIMS launches PRO (Patient Results Online)
25,000+ health records requests processed last year
18,000+ users supported
2004 UHN and Toronto Central CCAC establish The SIMS Partnership
2006
19,500+
Patient safety at UHN improves with the implementation of computerized provider order entry: major ordering and transcription errors drop by 42%
email accounts
12,600+ phones
9,500+
2007 Toronto Central CCAC care coordinators start using a comprehensive, fully integrated electronic case management system designed and built by SIMS
desktops & laptops
2010 Adolescent patients are better able to self-manage their Type 1 diabetes with the release of bant, a mobile app
850+ servers
Our Partners Members
Funders
2011 UHN/SIMS shares expertise with Kuwait Ministry of Health to support the development of cancer treatment services
2014 Integrated electronic patient health information is shared across GTA hospitals and CCACs through ConnectingGTA
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SIMS In a Year
SIMS Education Classes
Service Desk calls
Health Records processed
Gigabytes of data moves across UHN network
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1,300
175,000
25,000
6.5 million
Telecom support requests a year
5,300
Telehealth videoconferences a year
4,300
42,000
1.7 million
156 million
800
1.3 million
250
Password resets
Minutes of dictation transcribed
SPAM messages blocked
Change Requests to EPR
Calls to Switchboard a year
Devices replaced a year
Beyond UHN
5,000 SIMS and Toronto Central CCAC, through Resource Matching and Referral (RM&R), facilitated the placement of 5000 patients in Toronto Central LHIN’s Long-term Care Homes
3,000,000 SIMS, eHealth Ontario and Canada Health Infoway have jointly developed the largest of the four provincial diagnostic imaging repositories in Ontario. GTA West DI-r stores approximately 3 million diagnostic images and reports a year.
15,300 SIMS, eHealth Ontario and Canada Health Infoway have developed central Ontario’s Clinical Data Repository, ConnectingGTA. It is currently accessible to approximately 15,300 users across 40 organizations.
86 SIMS and Toronto Central LHIN have collaborated to develop the Emergency Management Communication Tool (EMCT). To date 86 organizations use the application to coordinate emergency management activities.
500,000 SIMS supports Toronto Central LHIN’s Alternate Level of Care referral application, Resource Matching & Referral (RM&R). Since going live in 2008, 500,000 referrals have been sent and accepted in RM&R.
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SIMS Roadmap Our Vision, Mission, Focus Areas, and Values
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