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Government & policy

N.S. to address health IT after operational review

HALIFAX – Nova Scotia is taking action on recommendations from a provincial health system operational review to make its healthcare system more effective and sustainable, the government said.

Of note, the review recommends the creation of a centralized business office to manage services on a common platform. It references the Plexxus organization in Toronto, where 13 hospitals have created a business office to manage administrative functions and to coordinate group purchasing.

The review advises the Ministry of Health to standardize all district health authorities on a single administrative platform. Currently, the government make use of SAP, while the Capital District Health Authority uses PeopleSoft and IWK Health Centre employs Meditech Magic. It would make sense, the review says, to use one such solution throughout the healthcare system.

The Nova Scotia government announced that all 103 recommendations made by Corpus Sanchez International in the report titled, “Changing Nova Scotia’s Health Care System: Creating Sustainability Through Transformation”, have been accepted and will begin to be implemented over the next three years.

The Provincial Health Services Operational Review, an executive summary of the report, the province’s response document and fact sheets about Nova Scotia’s healthcare system are available online at

“A thriving healthcare system is critical to the future of Nova Scotia,” said Premier Rodney MacDonald. “With the information in this report, we are ready to chart a path that will ensure our healthcare system is safe, accessible appropriate, effective and efficient for generations to come.”

The recommendations outlined in the report cover every aspect of the healthcare system. It notes Nova Scotia’s system is heavily focused hospital-based care, which is the most expensive way to deliver healthcare services. It recommends a focus on community-based care, and restructuring across the system.

“Nova Scotians need and deserve a healthcare system that supports all of their healthcare needs, whether it is staying healthy, living with chronic disease, or end of life care,” said Health Minister Chris d’Entremont.

The report was developed with input from thousands of healthcare providers and interested groups, from every hospital across the province. It notes factors such as an aging population, poor health status of Nova Scotians, increasing demand for health services, health human resource challenges, and the cost of maintaining the system as reasons why the system must change to continue to meet the changing health needs of Nova Scotians.

“As health system leaders, we support the vision of transformation that focuses on quality and safety. In order for the healthcare system to be truly sustainable, we must broaden our focus from the treatment of illness, to include maintaining and improving health, in partnership with our citizens,” said Dr. Brendan Carr, vice-president of medicine, Capital District Health Authority.

In its response to the report, the province has outlined actions for four key areas: helping people stay healthy; addressing changing needs of seniors; supporting health professionals; and investing for better results. Specific initiatives include establishing a selfcare/telecare phone line for 24/7 health advice, establishing a health human resource strategy, reviewing pharmacy and laboratory services, improving the flow of patients throughout the hospital system, and the use of non-clinical support services.

“I am particularly excited to note that we will be engaging citizens in consultation on the development of a rural health strategy for the province, which will include addressing the issue of emergency health care,” said Mr. d’Entrement. “As patients, caregivers and taxpayers, we all have a role to play in ensuring we have the best healthcare system possible – not only for ourselves, but for generations of Nova Scotians.”

The Provincial Health Services Operational Review, an executive summary of the report, the province’s response document and fact sheets about Nova Scotia’s healthcare system are available online at

An excerpt from the operational review (infrastructure section):

Business Office Consolidation

Many healthcare jurisdictions across North America use centralized business office models. These involve transaction processing functions, to manage all services on a single platform. In turn, this allows local organizations to use their resources for decision support, financial analysis and strategic management functions, rather than day-to-day administrative applications.

One such initiative is occurring in Toronto where 13 hospitals have formed a business office corporation – Plexxus. Plexxus is expected to produce the following benefits:

• Achieve economies of scale, through the standardization and integration of processes and through group purchasing.

• Integrate common systems to pool savings and make affordable the investments required in IT infrastructure.

• Drive continuous process improvements through standardization and introduction of performance indicators.

• Reduce operating costs of administrative services for all participants, allowing them to invest more in direct patient care and improved access to services.

• Deliver timely and relevant information to hospital managers to enable better decision-making.

• Take advantage of leading practices, e.g., pay on receipt practices, web-engaged employee and manager self-serve HR, among others.

Nova Scotia is well-positioned to leverage technology to enable a transition such as the one envisioned by Plexxus in Ontario. The Province’s decisions to purchase SAP, and to support group purchasing, are good first steps. Taking the concept further suggests the same benefits to Plexxus for Nova Scotia and would allow the province to deliver administrative services within or closer to benchmark levels.

The national benchmark (as defined through the CIHI/Hay national benchmarking study) is 6.53% of costs expended on administrative services. Actual experience in Nova Scotia suggests that only one DHA (CBDHA) currently operates at or below that benchmark.

Moving to a model that enables efficiency would allow DHAs to redeploy resources to critical operations support functions, without the need to redirect additional or new resources outside of patient care delivery. High level analysis suggests that a 0.5% overall reduction in administrative costs (e.g., 7.5% of total costs versus 8%), would yield savings of approximately $8 million across the health system. These savings should be pursued for reinvestment in the system.

Multiple options for moving forward exist. Nova Scotia has experience with Information Technology (HITS-NS) using a host organization model. The alternative for consolidated business office functions is the Toronto model, i.e., establishing a separate organization that is owned by all parties.


That the Department of Health work with the DHAs/IWK to undertake a feasibility study on business office consolidation, to determine if there is a business case for proceeding with this concept and, if so, the legal model to be implemented, i.e., separate corporation owned by all DHAs/IWK, or a host DHA.

For a business services platform, the Province has committed to pursuing implementation of SAP as the preferred system and has launched the Health Administration System Project (HASP) to implement the system. CDHA uses PeopleSoft and the IWK currently uses Meditech Magic. From CDHA’sperspective, the primary rationale for rolling out PeopleSoft is that the system is in place and could be rolled out Province-wide much more quickly. On the other hand, the SAP model has the benefit that the rest of government is on the platform. The IWK believes that it will lose functionality if it abandons the Meditech platform.

It was beyond the scope of PHSOR to comment of which system should be selected, but it is not beyond our scope to comment on whether or not one system should be in place. While architecture solutions exist to bridge between systems, the PHSOR Team is of the opinion that one system should be selected and pursued. From a government perspective, that decision has been made, with SAP the choice.

The PHSOR Team also acknowledges that PeopleSoft is a very good system, but one that is likely too expensive for an organization the size of Capital Health. DHA 9 should require not more than three FTEs to support the system, yet the current PeopleSoft staffing is 10 FTEs. The DHA acknowledges that some reduction in staff may be possible and will explore these opportunities as appropriate. An alternative is to leverage PeopleSoft across other DHAs, thereby spreading the ongoing operating costs over a larger base and making the system more affordable in the process.


That the DOH select either PeopleSoft or SAP for DHA-wide implementation, in order to proceed with the DHA-wide roll-out as soon as possible. Once selected, all DHAs/IWK should re-confirm their commitment to the single platform.