Government & policy
Info key to Ontario’s healthcare
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
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
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
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
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
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