Q&A: Lewis Hooper

Lewis Hooper is a busy man. A veteran of health care IT, Hooper was recently appointed regional CIO of five Toronto hospitals – Scarborough Hospital, Durham Access to Care, Lakeridge Health, Rouge Valley Health System and Scarborough Community Care Access Centre. The appointment is widely viewed as consistent with Health Minister George Smitherman’s call on Ontario hospitals to balance budgets and pool resources. How does he see his new role? Hooper recently spoke with Vanessa Ho of IT World Canada about his appointment.

Q. What do you bring to the job?

A. What I offer falls under three broad areas. Firstly, there’s my background in health care IT integration. I have worked with information systems in the past, helping hospitals integrate diverse systems. In the region of Durham, we linked five hospitals on a single information system. Secondly, I have actively participated in restructuring projects in Ontario and across the country … projects where groups of hospitals came together to figure out what they can do better. Finally, I have some consulting expertise. I know how to manage groups that are very keen to collaborate, but at the same time want to maintain their independence.

Q. What, in your view, are the main challenges confronting health care IT?

A. One challenge has to do with the urgent need to share information seamlessly at clinical levels – subject to patient consent, of course – and to create a single information repository. That’s definitely going to be one of my focus areas. We need to break down barriers to information sharing. Traditionally, it has been difficult to transfer information between sites, and that’s not helpful. It’s a single health care system, so from the patients’ perspective, moving from one site to another ought to be fairly easy. All their information should follow them within their local area. Unfortunately, this is not a reality … as yet.

I don’t think we completely grasp the importance of the health care information system – though we all rely on it, and experience it partially. Health care involves acquiring knowledge about a patient, sharing that knowledge among skilled practitioners (such as nurses and doctors) and doing so in way that allows somebody else in the chain to add more knowledge. Ultimately we need to be able to tell the patient: “you came here with these issues, here are our collective findings, and this is what we need to do together.” This recognition of health care as a knowledge transfer chain – acquiring knowledge, adding value to the knowledge, and transferring that knowledge to the next person in the chain – is the part that really excites me. Then there are lots of little things we can do to enhance the efficiency of systems and practitioners – such as avoiding duplication of services and getting redundant systems on a single platform.

Q. What are the advantages of having a single CIO for five sites?

A. For one, it allows us to adopt a consistent approach to health care technology and processes. It enables us to respond to fragmentation in health care IT – where in the past, various groups have created different programs and systems that don’t talk well with each other.

Information sharing is crucial to effective health care. We need to be able to move information simply and seamlessly across systems, while protecting patient confidentiality. We have to make it so when a patient shows up at a health care facility, their history, physical, latest lab test results, and everything the physician or nurse needs to treat the patient are available. This provides health care practitioners with a complete picture. That is key. Hospitals often have dissimilar procedures for information access and transmission. If we look closely at what each one is doing, select the best processes and apply them across the board – it could be a win-win situation for everybody.

That is why I think a regional CIO is so important. We develop things in silos and despite our best efforts have pockets of expertise and pockets of deficit. A regional CIO can identify areas of expertise in one health care facility and use them to correct deficits in others. In doing so, we can create a system that works more efficiently and effectively – one in which the whole is greater than the sum of the individual parts.

We should see ourselves as being part of one system. When this happens, our patients are the real winners, because it enhances the level of health care we are able to provide them.

Q. How close are we to achieving this goal of integrating health care?

A. Health care does not work as a system yet in Ontario. This position was created to break down barriers. Traditionally, it has been difficult to share information between sites. From the perspective of patients, it is one health care system. So moving from one site to another ought to be fairly easy, as all their information ought to follow them at least within their local area. This is not happening … as yet. That’s why the creation of the regional CIO post is such a significant step. It’s a recognition of the power of integration.

Q. What challenges and technology issues are you facing?

A. We have a bit of a bandwidth problem, but hopefully Smart Systems for Health (a Ministry of Health agency) will provide the connectivity between our various facilities. Three hospitals use the same major software vendor so there are some similarities. However, they have different databases – and from my perspective – that may cause some integration challenges. One workaround is a Web portal system that allows the doctor to come in and ask for information subject to patient consent. The user interface should be identical whether they are getting information from (say) Rouge Valley or from Scarborough General hospital. It would also be wonderful if we could get all the practitioners, family doctors, and specialists tied in too. They should have easy access to information we generate around the patient in the hospital and – on the flip side – be able to feed information to us as well.

Q. How will a common information system between multiple facilities improve health care?

A. It will enhance the patient’s experience. Today, when you come into a hospital you may give your personal and physical details to one person. Then a few days later if you go to a community care centre you have to provide the same details again. You visit your family doctor and do this yet again. While there is need for a certain amount of repetition in the health care system (practitioners may ask certain information over again to make sure they get a consistent picture), repeatedly providing details such as telephone, street address and so on can be tiresome. A common fault-tolerance system can also play a role in disaster recovery (DR). Right now, none of the five hospitals has a great DR program. While we have some contingency plans, it would be nice to set up a shared DR system so if a system goes down, its functionality is automatically transferred to one of the other sites.

And of course, sharing has great cost benefits that we still need to take advantage of.

A shared communications system is also being seriously considered. However, there are security factors. We can transmit information between the hospitals easily right now, but most of it goes over the Internet and we would rather have a more secure pipeline and greater bandwidth.