Showcase Ontario - Move to include First Nations in public health initiative

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Ontario's Integrated Public Health Information System (iPHIS) is being heralded as hugely successful in co-ordinating the province's previously disparate outbreak reporting mechanisms, but the system may have overlooked thousands within the province’s Aboriginal community.

Ontario’s First Nation communities have to be linked to the province-wide contagious diseases management system and database before another outbreak similar to the Severe Acute Respiratory Syndrome (SARS) epidemic hits the province, says a policy advisor at the Ontario Secretariat for Aboriginal Affairs (OSAA).

"We have to get First Nations communities involved in iPHIS before disaster strikes," said Barry Silver, senior policy advisor at OSAA. Silver was one of the attendees at a presentation on the iPHIS program yesterday. The presentation was part of at the 2006 Showcase Ontario conference being held in the city.

Currently on in Toronto, Showcase Ontario is Canada's largest information and information technology education conference and exhibition. The iPHIS presentation by the Ontario Ministry of Health was titled Government of the Future. It highlighted how technology is being used to improve government services.

The Aboriginal affairs secretariat, Silver said, is taking part in the Ontario Avian Influenza Working Group that's preparing contingency plans on handling a possible bird flu outbreak. "This is the best time to find out how native communities can be included in iPHIS, before we have an outbreak."

Marie Muir, manager of business improvement and knowledge management at the Ministry of Health Long Term Care agrees with Silver. "One of painful lesson we learned during the SARS crisis is that you cannot change a system in a crisis when external conditions are already changing it for you."

During her group’s presentation titled SARS Wars: How iPHIS is Winning the Battle Against Infectious Disease, Muir said at the height of the SARS outbreak in 2003, they attempted, but failed to change Ontario’s contagious disease reporting system.

Muir said at that time, the Public Health Agency of Canada approached her department and offered to help them deploy iPHIS which was then being used in British Columbia. "We managed to install the system in 10 days, but we couldn’t get any contact and quarantine management capability to the people in the frontlines," said Muir.

She said at one time public health units were keeping tabs on some 10,000 people who were quarantined in own homes by calling these families three times a day and "keeping track of the situation using sticky notes."

Muir said Ontario’s health units operated different reporting systems that made it difficult for workers to make sense of data being gathered. "We might think we did things the same way, but when we sat down to talk it over we found we had our own unique twist on the matter." The SARS outbreak later claimed 44 lives, rendered thousands of people in the Greater Toronto Area (GTA) ill and cost $600 million in health expenses and more that $1.2 billion in loss revenues to businesses in the province.

Catalina Trevizan, senior manager of systems development and maintenance at the Ontario Ministry of Health said, after the crisis, the government took immediate steps to deploy iPHIS.

The project was launched in the fall of 2003 and deployed by December 2005.

The system is a central database that enables health units to collect and manage information on communicable diseases. It is deployed across Ontario’s health districts and linked to the province-wide IT network set up by Smart Systems for Health Agency (SSHA), affiliated to the Ontario Ministry of Health.

SSHA electronically connects 95 per cent of Ontario’s hospitals and provides access to vital information and resources to more than 150,000 health care workers.

"The system allows health workers to gain a province-wide view of an outbreak and get a better idea of how it is progressing across the area," said Trevizan.

The system helps avoid the chaos that prevailed during the SARS outbreak when health units had no means of sharing data real time or of eliminating redundant reporting.

The use of iPHIS in recent outbreaks of salmonella, Legionnaire’s disease and rubella in the province has proven very effective, Muir said. "The real power of the system is in helping detect trends and link cases to risk exposures."

These are the capabilities that Silver hopes Aboriginal communities across the province will have access to.

He said health information coverage over reserves and other First Nation communities is patchy. "Some communities are linked to an automated health database and some are not."

Silver said OSAA would like to discuss with the Health Ministry how these communities can be linked to the iPHIS.

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