Health integration calls for more collaboration

The establishment of Local Health Integration Networks (LHINs) offers significant potential to improve the delivery of health services to Ontarians, including reduced wait-times.

In essence, through the LHIN structure, health care delivery in Ontario transitions from loosely coupled service delivery silos to integrated service delivery environments organized by geography.

By illustration, the Kirby Report on Ontario’s Wait Times Information System cited a recent initiative in the Champlain LHIN to develop a coordinated model for cancer surgery.

When fully implemented, this initiative should allow patients to be assessed through a common multi-disciplinary site and then allocated to those centres within the region that have the capacity and ability to perform the required surgery, even if the patients were first referred into the system through another site.

A major distinction between Ontario and some of the other provinces is that LHINs are being established as management or coordinating entities, while in various other provinces the regional health authorities have taken more direct control of the service delivery organizations. Ontario’s Bill 36 restricts LHINs from becoming direct providers of clinical services.

Achieving the integrated LHIN service delivery model is a journey that will require significant focus on business transformation, supported by information management and technology change in both the clinical and administrative environments.

The ability to provide access and securely deliver the right information – at the right time, to the appropriate users, regardless of location and, for management purposes (program and administrative), provide an enterprise view – are fundamental requirements for the effective operation of an integrated service delivery model.

While it is too early to tell whether Ontario’s approach to integration through LHINs has significant advantages in comparison to the regionalization approaches used by other provinces, it does place an even greater emphasis on collaboration, consultation and organizational change management.

The LHIN transformation initiatives will need to respect the expertise, individuality and culture of each of the health facilities, while providing the necessary support to collaboratively achieve an integrated environment.

The IM-IT transformation must be tightly integrated as a key enabler of the business transformation, supporting the process changes and diverse information requirements. From a CIO perspective, the LHIN environment, integrating as well with the provincial iEHR initiatives, has significant implications:

– increased system complexity, diversity and interoperability needs
– systems transition from important to being mission-critical
– data explosion: risk of information overload for business users
– increasing emphasis and reliance on meaningful information – how we derive it, what we do with it, how we use it – to help drive outcomes
– change in service perspective from individual facilities to a regional view that delivers consistently to all health delivery within the LHIN

The role of CIO is essential to successful transformation: being the executive champions for sustained alignment of the IM environment with enterprise strategic direction, ensuring relevant information is available to support the diverse and changing requirements of the health enterprise.

Some key considerations in effectively managing the increasingly complex IM-IT environment include:

Focus on areas of strategic importance:
– Enterprise architecture and alignment with strategic direction
– Transform “data” into “useful information” that becomes an asset to the health enterprise
– Establish IM-IT as an enabler of collaboration and clinical transformation
– Primary emphasis on process and business functionality
– Data management and business intelligence: data warehousing, common clinical syntax, business rules engines and pattern recognition basis

Develop an ‘agile’ information environment:
– Simplify infrastructure
– Emphasize open standards and interfaces; XML, HL7, SOA
– Simplify application mix
– Establish some fundamental foundations: strong IP network (wired and wireless); centralize storage and servers; portals for clinical and non-clinical information
– Find incremental projects that lead towards the outcome

– Access third-party capabilities and expertise – procure core technology as a service – outcomes, cost and SLA-driven
– Shared services environments for non-core functions
– Finance and admin, HR and payroll, supply chain
– Lessons learned in other jurisdictions and industries
– Common interests and capabilities between LHINs

In Canada and internationally, there is broad recognition of the benefits (improved service delivery, reduced wait-times, improved resource utilization) that can be achieved through integrated health systems such as those mandated with the establishment of LHINs. Universally, enabling IM-IT environments are integral to their success.

Integration requires collaboration, driving the need for transformation and secure accessibility to meaningful information at the right time, to the appropriate users. For health CIOs in Ontario, the expanded mission for LHINs means broader perspective, requirements and opportunities, emphasizing the strategic role they have in the successful transition to integrated health systems.

Wolfgang Baun is vice-president, Canada Health Care, at EDS Canada. He can be reached at

Related content:

Provincial health care blocks clamour for credibility

Leveraging analytics to maximize e-health records

Regionalization creates organisms from isolated cells

State of the union: Health care regions across Canada

Regional networks offer wider access to information

Infoway upbeat on EHR progress

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