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Government & policy

Info key to Ontario’s healthcare quality improvement

TORONTO – Having the right information, at the right time, is a critical part of Ontario’s goal of attaining the safest, highest quality health system in Canada by 2015.

So noted Adelsteinn Brown, Information Management Lead at the Health Results Team, part of Ontario’s Ministry of Health. Dr. Brown, who is also an Assistant Deputy Minister with the department, recently released an update on progress being made on information management in Ontario’s healthcare system.

He pointed to several initiatives aimed at producing better data, including the release of the 2005 Data Quality Report, which is referred to as the foundation for many of the initiatives.

The report was made available on the ministry’s web site in early spring. It can be downloaded at:

Said Dr. Brown: “We are already hard at work implementing some of the key recommendations contained in the report. I will briefly touch on a few ongoing initiatives…”

• Local Data Management Partnerships. Set up late last year, these are collaborative partnerships between healthcare providers, health information practitioners, LHINs, government agencies and health information associations.

Five data quality coordinators have been hired to support the partnerships. Their responsibilities will include providing education and training on data collection and reporting practices within LHINs, and promoting the new Communities of Practice for Health Information Management initiatives (see below).

• The Physician Documentation Expert Panel. Unfortunately, medical schools do not educate physicians on the importance of documentation and how to document effectively. Studies show that this can have negative consequences on the quality of patient health records.

Two studies that are part of the 2005 Data Quality Report raised concerns about incomplete patient charts and discrepancies in coding on charts. Both reports recommended that a Physician Documentation Expert Panel be set up to engage doctors and other stakeholders in the importance of accurate, complete and timely records.

To that end, a panel of physicians from across the province came together to examine ways to improve the quality and usefulness of information included in patient health records.

Under the lead of Dr. Ralph Kern, assistant professor at the University of Toronto and Neurology Program Director at Mount Sinai Hospital and the University Health Network, a guide was created to help physicians produce better documentation in a timely and effective manner.

A key component of the guide is a chart completion policy template. The panel reviewed existing chart completion policies at various hospitals and selected key elements to create a streamlined but comprehensive policy to provide guidelines for physicians and hospitals.

The information package will soon be distributed to physicians involved primarily in acute and ambulatory care through hospitals, the Family Health Teams and various medical organizations.

• Renewal of the Ontario Home Care Administrative System. A similar effort to close gaps in the home-care sector, coupled with the need to improve outdated technology, has led to the renewal of the Ontario Home Care Administrative System, and the introduction of a new data repository called the Home Care Database.

The new database will more efficiently collect and process information on clients being served by the home care sector. It replaces the Ontario Home Care Administrative System, which made use of obsolete technology and meant that errors in information were expensive to fix.

According to Dr. Brown, the new and improved system will offer: an expanded data dictionary better reflecting activities in all CCAC clients; inclusion of postal code to enable analysis by LHIN; a quarterly submission process that will reduce effort to reconcile data including electronic error reporting back to CCACS. Other improvements are also part of the new system.

The improved centralized home care database become operational at the beginning of June 2006.

• The Nursing Workload Measurement Project. For case costing hospitals, nursing workload data is the means by which costs are allocated. A simpler, easy-to-audit process will soon be put into place. Details about the new reporting rules for case costing hospitals will be made available by August 2006.

• Communities of Practice. The transfer of knowledge within the health information management community is key to supporting professional development. It also helps standardize data through the sharing of common practices.

In June, a Community of Practice (COP) web site was launched for all health information management professionals in Ontario. The URL is

The Community of Practice is made up of a number of communities. For example, there is a Hospital Health Information Management Community for all staff who code or have responsibility for data quality within a hospital.

There is a Community of Practice for hospital health management professionals for each of the 14 LHINs, as well as each Partnership.

• Professional Practice e-Learning and Assessment Tool. Improving coding practices is a key piece of the puzzle in the overall goal to enhance the quality of clinical data.

To this end, the Health Results Team, in collaboration with the Canadian Health Information Management Association (CHIMA) and the Ontario Health Information Management Association (OHIMA) has developed the Professional Practice e-Learning and Assessment Tool (PPeAT) to ensure coding competency of health information management professionals in Ontario.

PPeAT is a web-based tool that will provide targeted education and assessment of coding skills and knowledge at a core competency level to all hospital information professionals submitting data on the acute inpatient, day surgery and emergency care databases at the Canadian Institute for Health Information (CIHI).

PPeAT consists of nine modules, each with an e-learning and assessment component. The learning component is a refresher of coding concepts and standards. It can be accessed on the web as many times as a user would like. The assessment portion is completed only once and is timed. A coder is provided with a score following the assessment.

The aggregate results of PPeAT will be used by the ministry to identify education opportunities at a module, facility, LHIN and provincial level. Individual results will be known to the coder only. PPeAT assessments will be offered for coding professionals from August 2006 to October 2006.