All together now…

When the SARS virus hit Ontario in the spring of 2003, it wasn’t only patients and hospital staff that suffered through the crisis. The province’s healthcare information systems were put to the test as well — and they did not fare well.

With a multitude of providers using disparate information systems, it’s no wonder SARS proved to be an enormous challenge. The healthcare system includes hospitals, doctors’ offices, pharmacies, labs, home-care providers and other organizations, delivering services at 24,000 locations in the province, staffed by about a quarter of a million workers.

When the crisis hit, communications among these providers became vital. But at the hour of greatest need, it seemed that the clock had turned back ten years. Diskettes had to be hand-carried from one place to another because there were no interfaces between systems. Doctors and other healthcare workers had to send faxes back and forth, and waste precious time comparing faxed documents to determine differences.

And of course IT workers were in the thick of things as well. Many of them spent countless sleepless nights, transcribing information from one application to another. Recalled Linda Weaver, a healthcare IT manager at the time, “I had 35 of my people off on quarantine. It was the most painful ten days of my life because we had work to do and I couldn’t get the information to release them from quarantine. On top of that we were trying to help with the incredible stress experienced by our people who had been placed in quarantine. It was absolutely frustrating.”

When it came to IT, as with other aspects of the healthcare system, SARS was a huge eye-opener. Physicians, for example, had been asking for years, “Why do I need a network and email? Who am I going to talk to? Why do I need access to the Internet?” Suddenly the answer was clear. During the SARS crisis, at any hour of the day or night, physicians could have gone to a central Web site to get much-needed information, instead of hunting through mail and faxes and calling 1-800 numbers.

It was as if a light had been switched on. The importance of IT-enabled collaboration was apparent to everyone.

a remedy in the making

Even while the healthcare system was flunking its SARS test, work was already well under way to remedy the problems that became so evident during the crisis.

Long before SARS, many of the shortcomings of healthcare IT were already well understood, such as the lack of common security practices and lack of common ways to move information between the many thousands of IT systems in the province. It was apparent that there was a huge need to pull together a very large infrastructure incorporating the same kind of best-of-breed approaches that existed in the private sector.

Recognizing this, the Ontario government initiated a project in the late 1990s to find ways of addressing these problems. The project was initially staffed largely by contractors, but by 2003 it gained official agency status, and at that point the Smart Systems for Health Agency (SSHA) began transitioning about 60 percent of its contractors to full time staff.

Among them was Linda Weaver, whose involvement with the initiative dated back to 1997/98, when she was seconded to the project from the private sector for nine months to help develop the business case for the agency. In 2001 she came on board as a contractor, helping to build their network, and she has been there ever since. In January, 2004, she made the transition from contractor to Chief Technology Officer.

SSHA’s mandate was to go out and find the best players in the private sector, bring them together, and get them to work with each other to build the common infrastructure and start to deploy it.

“We spent two years, from 2001 to 2003, essentially doing that,” said Weaver. “Once we figured out what core services we’d provide and the requirements for them, we procured specific services from several key vendors. They came to the table with various sub-vendors and then we had to knit them all together in a large collaborative framework.”

The task was not an easy one.

managing the vendors

SSHA decided to provide seven core services: the network; the messaging system, based on email; a data-centre for hosting; a portal environment for common access; a registration and access management system; a shared directory service; and a PKI (public key encryption) system for security.

Delivery of the core services was to be undertaken by the main vendors and sub-vendors through a mutually supportive collaborative process. That was the theory, anyway. The reality turned out to be something quite different.

“We had a very na

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