Ontario health centres mobilize case management

There are a lot of hard-working people in Canada’s health-care sector, but at the Ontario Association of Community Care Access Centres, it’s amazing what Chris gets done.  

Besides maintaining all patient information and service plans across the province, Chris also handles intake and referrals, assessment tracking, service monitoring and even reporting on cases. Although some would probably say Chris’s approach to these tasks took some getting used to, it’s fairly safe to suggest that Chris will be a vital part of the OACCAC team for a long time.

Chris, of course, is not human. To Ontario’s 14 CCACs, Chris is really known as CHRIS, an acronym for the Client Health-Related Information System. Originally launched in 2008, the case management system is finally nearing the end of a long roll-out across various locations, with the last CCAC being brought on in November.

For Colin Zvaniga, however, the payback for CHRIS is only just beginning. In late August the CIO of the OACCAC announced a deal with Dell Canada that will involve the provision of more than 4,000 notebooks that will allow case managers to access client records from CHRIS wirelessly over 600 servers and VOIP capabilities.

“Being mobile is extremely important to them,” says Zvaniga, referring to the care coordinators and case workers that CHRIS is there to support. “We’ll be using the Dell equipment to go out to the home, access applications and assist citizens of Ontario right at their house.”

The CCACs, which across Ontario employ more than 7,000 people, provide a variety of services such as assisting 120,000 seniors with nursing and personal support at home and provide assistance to clients when they need to enter a long-term care facility. They also work with children suffering complex and chronic diseases, the terminally ill and many others. In total, the centres serve more than half a million people.  

Zvaniga says it’s important that while case managers can connect to CHRIS in the field, case managers won’t be paralyzed if they experience any outages.

“The dream is to have this where regardless of what function you’re doing in the system, you can get disconnected from the network and continue,” he says. “We’re not there on all of the components but we’ve hit the big pieces.”

The mobility options will be one more way to demonstrate the power of CHRIS, which Zvaniga says created considered change management hurdles during its creation and early deployment.

Before 2007, the CCACs were organized as 42 corporations. As the Ministry of Health aligned them into local integrated health networks, or LIHNs, they became 14 organizations, but the 42 ERP-style business systems running them remained. Many of them were still DOS-based, according to Zvaniga. The implementation of CHRIS also meant consolidating down to 14 data systems running on one application.

“I recall being in a CCAC once and sitting in front of 20-30 people and one of them said, ‘It’s so stressful – we’re just moving too fast. Can’t we slow down a little bit?’”

The answer was no. In fact, Zvaniga believes in what he calls “escape velocity,” to draw out the project champions who will influence the crowd.

“It’s like sending off a space shuttle – you need enough velocity that you can get the people to jump on board after,” he says. “We’ve been going at such a pace with the sector that the decision not to do it didn’t come into people’s minds.”

To describe the pace as quick would be putting it mildly. Zvaniga and his team had to deploy 42 ERP systems in 18 months. That’s on top of building CHRIS essentially from scratch because there was nothing on the market the OACCAC believed met its specific needs. Then there were the different processes and opinions of various CCACs, though that didn’t prove as trying as might be imagined.

“They’ve been very accommodating with each other, knowing where they want to go,” says Zvaniga. “We pushed the value proposition that there would be this one system, one set of processes, with local configuration/customization to enable certain differences. Those in the North might be different than in downtown Toronto. The demographics are quite different.”

The team created a governance structure that brought people into working groups and started doing long-term care placement processes. “We didn’t come in with a blank sheet,” he added. “We made edits and changes and had some wonderful discussions. We did it by the functional area of the system. They ended up giving us requirements.”

Once it came time to actually develop the software, Zvaniga’s team used a blend of approaches, from the traditional “Waterfall” methodology to the more rapid-fire Agile process. Along the way, the team encouraged participation at every level, including a “name the system” contest, which led to CHRIS.

The rollout began with two sites, and quickly evolved into something that could be adapted like a cookie-cutter across various CCACs.

“We built this as an ASP solution, almost a private cloud, so to speak,” he says. “Everyone comes in through the same mechanism. We gave out the required hardware on the server side as each of the 14 organizations needed it. Then we started on the functionality.”

In keeping with the shared service mentality, Zvaniga’s team tried to build feedback mechanisms into every stage. This included a ticketing system for the application that was provided to all CCACs, whether they had implemented CHRIS yet or not. Employees were not only able to report bugs but suggest enhancements in specific categories. So far, there have been 2,000 enhancements.

“People can see what they’re asking to do is actually occurring,” he says. Failure to do this could explain why so many similar projects – not just in health-care but in all sectors – end up disappointments. “People lose track of the significance of the changes to the end customer or end user. They sort of forget that these individuals are not independently a change agent.”

Besides the notebooks, the OACCAC will also be using Dell’s Compellent tiered storage products to deal with the 200,000 or more large files that might be sitting in CHRIS but inactive at a given time. This builds upon a more dynamic server environment that Dell helped the OACCAC set up as CHRIS deployment became more widespread, according to Dell Canada country manager Paul Cooper.

“We’re potentially getting them to a position to offer really intense virtualization, like a private cloud to support each of the CCACs,” he says. “They will be able to bring virtual machines online and manage the capacity that exists across their enterprise, as well as manage the workloads and the process around it. The over-arching framework is that it needs to be open, capable – it works – and affordable.”

Beyond these operational efficiencies, Zvaniga and his team are trying to boost the wider world of community agencies by offering them tools developed to integrate with CHRIS. This includes a the Residential Assessment Instrument, which checks patient conditions. It is being given out to agencies which would not otherwise have been able to afford it for pilot projects.

“We’re all working for the taxpayers of Ontario,” he points out. “We wanted to take economies of scales and bring it out where it’s appropriate to help enable them. These things are not inexpensive it’s a cap-ex.”

Although it contains a lot of patient information, it would be inaccurate to describe CHRIS as an electronic health record (EHR). That’s because the data is only available if the patient is receiving service from a CCAC. “If you went to your GP or to the hospital to get acute care, that data is not going to sit within CHRIS,” he says. However the OACCAC is planning to work with Ontario MDs, Infoway and others on how to most cost-effectively integrate into their system into the acute and primary sector.

That’s right: before too long, there’s going to be a lot more on CHRIS’s plate.

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