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Marafioti, Hooper discuss eHealth at ITAC Ontario

TORONTO High-profile hospital CIOs Lewis Hooper and Sam Marafioti  (pictured here, L to R) gave talks at a December meeting of ITAC Ontario (the Information Technology Association of Ontario – Speaking in his role as Vice-chairman of the Ontario Hospital e-Health Council, Marafioti outlined the council’s views on improving the workings of the healthcare system through computerization.

Marafioti is also Vice President and CIO at Sunnybrook & Women’s College Health Sciences Centre, in Toronto.

Hooper summarized the initiatives being taken by his facilities – he is Regional CIO for eight hospitals and four long-term care organizations in eastern Toronto. They’re part of Local Health Information Network 9, which stretches “from Victoria Park to Algonquin Park,” quipped Hooper.

Offering a strategic direction for hospitals in Ontario, Marafioti spoke in favour of grass-roots projects rather than large, top-down solutions. “Megaprojects are projects of the past,” he said. “The future will be based on [smaller] building blocks.”

As well, in order to gain favour with the public, the benefits of e-health projects must be made known. “We need to demonstrate the efficacy of the investments,” said Marafioti.

Computerized solutions have tremendous potential for improving the healthcare system, but need to become a higher priority on the political agenda. “eHealth isn’t yet a government priority,” said Marafioti. “It’s a ministry priority, but we haven’t heard the message come from the Premier.”

By contrast, Marafioti observed that British Prime Minister Tony Blair has spoken out on the need for electronic medical records. He said high-level politicians in Canada must also promote electronic solutions as a way of modernizing the healthcare system in Canada.

Marafioti said there must be increased financing of eHealth in hospitals and the healthcare system in general. “Funding of 1.8 percent [of hospital operating budgets] won’t cut it.”

(Recent surveys by Canadian Healthcare Technology have found that hospital CIOs across Canada feel 4 percent of operating budgets would be needed to adequately finance eHealth in hospitals. Trillium Health, a two-hospital organization in Toronto, announced earlier this year that it would boost IT spending to 5 percent of its operating budget to deploy Project THINK, which uses IT to re-engineer the organization.)

On a related front, Marafioti asserted that more work must be done on eHealth standards: “They need to be much more precise, and we must identify them in a more timely fashion.”

He mentioned that a recent Ontario Hospital Association survey identified the capabilities of organizations across the province. There are wide variations in this respect, he said.

Smaller hospitals, for example, are facing challenges in the area of human resources and IT skills. As one solution, said Marafioti, “we’re looking at the concept of [IT] SWAT teams that can move around the province.”

For his part, Hooper outlined the major eHealth inititatives under way in eastern Toronto. Of the 12 organizations he heads as regional CIO (including the Scarborough Hospital, Lakeridge Health and Rouge Valley Health), seven are using Meditech systems. However, Hooper commented that even so, integration among the different Meditech versions and components is no easy task.

Complicating the equation are the various types of long-term care systems currently in use. Financial systems across the region include Meditech, Infinium, Ormed and Great Plains. Overall, 53 sites are being supported using a total of 294 applications.

Hooper noted that the eight hospitals and four CCACs for which he serves as regional CIO together spend $25 million on IT, or about 2.1 percent of the total operating budget.

Top tier projects include a regional Electronic Health Record, a clinical portal, standards, disaster recovery planning, an enterprise master patient index (EMPI), privacy and governance. As well, there is a help desk initiative under way (Hooper observed it’s an area that’s been “notoriously under-funded,” and that hospital staff sometimes refer to it as the “helpless desk”.)

Other projects and technologies that are being implemented in the eastern Toronto area include Microsoft SharePoint as a collaborative tool. There’s also an effort to consolidate decision support tools, and to develop an integrated system for smoothing the paperwork that’s done when patients are transferred from hospital to long-term care. In this area alone, noted Hooper, great productivity and performance gains will be made.

Citing information from a study conducted in Kitchener-Waterloo, he noted that up to 60 percent of patient data is manually re-entered when patients leave hospitals and enter the continuing care sector; using integrated systems, that data could be automatically transferred from one organization to another.

Improving data flows could also result in earlier discharges from hospital, as well. He noted that patients who are ready to be discharged often remain in hospital because the relevant paperwork hasn’t been completed. Reducing this cycle time would result in faster discharges, saving beds and improving hospital efficiency.

Hooper emphasized that technology is important, but that its purpose is to support the transfer of knowledge in the healthcare system, knowledge that ultimately leads to better patient care.