Thanks to an integrated information system of seven hospitals in the Niagara Peninsula, Ontario, Canada, patients there have the advantage of moving from one hospital site to another seamlessly to receive care with the assurance that their medical records will be available to their health professionals.

Douglas Memorial in Fort Erie, Greater Niagara General in Niagara Falls, Niagara-on-the-Lake, Ontario Street in St. Catharines, Port Colborne, St. Catharines and Welland — are integrated by a comprehensive Information Technology strategy, under the leadership of Bala Kathiresan, CIO of Niagara Health System.

As an amalgamated system, NHS patients can seek care at any of its seven hospital sites without having to worry about transferring their medical records. They can complete tests in one hospital and go to another for further care without having to repeat the tests. The IT system in place allows care providers to access patient information when they go to any NHS hospitals.

With a mission to promote working within an integrated system for a healthier Niagara, the NHS philosophy is focused on integration, with the understanding that integration is not possible with just information without IT support. A patient who visits one of the hospitals for initial care should subsequently be able to go to other hospitals for the same care. “If the information does not flow with the patient, we cannot really provide a seamless care,” says Kathiresan.

IT brings in systemic changes. For those systemic and workflow changes to be effective, a corporate philosophy that supports this vision plays a key role. But Kathiresan adds just vision is not enough. “The way I approach IT planning is with pragmatic idealism.

Idealism in itself can get us into trouble if it is not rooted in reality. In other words the vision has to deliver the value,” he adds.

The NHS caters to 411,000 residents across the 12 municipalities of the Regional Municipality of Niagara. It is the largest amalgamated hospital system in the Province of Ontario, with an annual operating budget of about $332 million Canadian dollars and approximately 4,200 employees. Upon amalgamation in 2000, each hospital’s independent system had to be integrated into a seamless information system.

“At the outset, we were dealing with multiple organizations that had multiple systems with differing IT philosophies. Creating the strategic plan to integrate the individual systems into one integrated system was an extremely detailed and complex undertaking as implementation of the plan would have to be done while supporting existing health-care delivery at each of the hospitals,” says Kathiresan.

For the IT heads at the hospitals this was a new reality; care was going to be delivered in an integrated fashion at each hospital site, and IT had to support this new integrated approach. “The IT staff understood the idea of delivering value meant taking an integrated approach,” Kathiresan says.

When considering the challenges he faced, Kathiresan says buy in from all health partners within the hospitals is crucial to realize its full value. Physician adoption, for example, is a key issue he sees today. “We have provided electronic access to patient information, they have embraced it with enthusiasm, seen the benefit of it, but going beyond just access and having to do order entry and be more interactive with the system is still a challenge,” he reflects.

The electronic patient information is not only available to the care provider and the surgeon at a hospital, but the same information is also available to physicians at their offices, when patients visit them enabling continuum of care.

At the NHS, Kathiresan is in the process of implementing IP telephony. For the first time in Canada across multiple hospital campuses, patients can access services available in seven sites by dialing one number using the IP telephony technology. “This is remarkable for the patients, as they will not have to incur long distant call charges,” he notes.

About critics who call such automation to cause more errors than create efficiency, and to those care providers who see such technological changes as taking them away from patient care, Kathiresan responds, “During the transition period this is probably true in some instances, people are used to a certain workflow. When that changes it can be confusing.” He also adds once the systemic benefits are realized it will be well embraced.

Implementing the integrated information system has resulted in a number of administrative efficiencies at NHS. “In the area of finance implementing integrated information system has enabled us to achieve a 22 percent staff reduction while providing improved information access to managers to effectively manage their departments,” say Kathiresan. However, it is hard to put a dollar value to the systemic benefits that are realized in clinical areas and patient care. “With systemic benefits such as avoiding duplicate test and adverse drug reactions, it is difficult to put a dollar value to the clinical efficiencies gained through the initiative,” he adds.

Leading a team of 31 members with a budget just over $9 million Canadian dollars annually, he acknowledges that resources are a huge challenge in a public institution.

“Having a good team and getting the involvement of the key stakeholders, and having the corporate support for IT initiative in my mind are some of the key factors for successful implementation,” he opines.

Kathiresan and his team are in the process of implementing the Picture Archiving and Communication System, used to archive and retrieve diagnostic images such as X-Rays, CTs and MRIs online. He says such systems have enabled care providers in bettering their efficiencies.

Kathiresan was recently appointed to lead the development of an eHealth plan for all hospitals located within the Hamilton, Niagara, Haldimand and Brant Local Health Integration Network as the Integrated Vice President and Chief Information Officer. “The fundamental focus of the LHIN is to integrate care delivery not just within the hospital but beyond the hospital boundaries and make the publicly funded healthcare system patient-focused, results-driven, integrated and sustainable,” Kathiresan adds.

The challenge this time revolves around working with 11 different governing structures overseeing dozens of hospital sites all of which combined operates at $1.3 billion Canadian dollars. Given Kathiresan’s success for optimizing with available resources and bringing legacy systems together, this could just be another seamless unison.