CIOIN

Executive summary

Back in the 1970s, US Secretary of State Henry Kissinger, frustrated with the baffling multiplicity of people to consult, grumbled: "When I want to speak to Europe, who do I call?" A similar state of affairs prevailed until recently in the healthcare sector of Ontario. Organized in sectoral silos, there was no central entity concerned with common interests.

"It wasn't clear who to call, so everyone would be called," says Hy Eliasoph, CEO of the Central LHIN (Local Health Integration Network) in northern Toronto, Canada. "Things got replicated over and over." This made it difficult to take e-health initiatives forward across the continuum of healthcare providers. Decisions made in isolation created fragmented IT environments lacking interoperability, says Eliasoph. As a consequence, Ontario lags behind other provinces in developing a unified healthcare system.

Shifting from a vertical to a horizontal regional model is a major change for Ontario. Now over two years into reorganization along regional lines, the 14 fledgling LHINs must learn to speak with one voice and their systems must talk to one another. Their impact is being felt in many areas.

A milestone was reached recently when the 14 LHINs assumed responsibility for funding healthcare organizations within their regions. Recognizing that the province can't continue to micro-manage this enormous area, the Ontario Ministry of Health and Long-Term Care transferred about Rs 94,500 crore of the Rs 159,300-crore operation into LHIN hands.

"Over time, we're thinking of a different funding model for hospitals and other organizations. IT funding will come with strings attached, which will be this: you can't just do whatever you think is right for your organization - there's a broader health system to consider." Funding is a central issue. More money would give LHINs more wiggle room to help fulfil their e-health integration mandates, says Anderson.

Projections of diabetes, for example, are making headlines. With an increasingly aging population, about 10 percent of Ontarians will be diagnosed with the disease by 2010. "IT will be the investment required to support diabetes management.

"The biggest challenge the LHINs face from an IT perspective is dollars: inadequate funds to move on the e-health agenda," he says. Other provinces fund IT projects separately from administrative budgets. Ontario alone lumps these together, he says. "You need to spend more money on IT today to get savings down the road.

System integration will need to be done within the context of privacy and security legislation. Another major issue is how to create interoperability out of disparate proprietary systems, and how to handle legacy systems. Decisions will need to be made by LHINs about whether to invest further in extending existing systems or replacing them outright.

To avoid creating 14 new silos, an e-health leads council has been established to provide IT governance for the regionalization effort in Ontario as a whole. Consisting of a leading CIO from each LHIN, the council meets regularly with the ministry and Smart Systems. Counterparts in other provinces further along in their regionalization efforts are frequently consulted.

The larger projects that come with regionalization give LHINs greater purchasing power and a market influence in areas that have been overlooked in the past, suggests David Thomas, vicepresident of Montrealbased Emergis. Historically, hospitals have been the biggest purchasers of healthcare IT products and services, so vendors catered to these key customers, he explains. "The market wasn't nursing homes, access clinics and so on. Although these are major components of the healthcare system, they were too small individually to warrant attention. This left them bereft of choices and competition." Folding them into larger structures like LHINs gives them more purchasing clout, and they are now getting more attention and product options, he says.