Before its EHR went in, Ontario Shores started over

For Ontario Shores Centre in Whitby, Ontario, the journey to its 2015 Davies Award started with preparation. A lot of preparation.

Ontario Shores went shopping for an electronic medical record system in 2007, selected Meditech's EMR system in 2008, and rolled it out in late 2010. Between the vendor selection and the go-live date, the institution had to completely rethink its processes.

“We were a purely paper organization—we didn't have any [electronic] clinical systems for documentation,” says Sanaz Riahi, the center's director of professional practice and clinical information. “But we realized we couldn't fit our paper workflows into this new technology.”

Entirely rethinking the organization's documentation processes and workflows was no small feat. A public teaching hospital near Toronto, Ontario Shores specializes in comprehensive mental health and addiction services for people who have complex, serious and persistent mental illness. With 15 specialized inpatient units and extensive outpatient and community services, the organization has 1,300 employees, 326 inpatients beds (with more than 115,000 patient days per year), and 60,000 annual outpatient visits.

From 2008 to 2010, more than a dozen people on a cross-functional team worked full-time on overhauling processes, rethinking workflows, and getting the technology in place. Then, well ahead of the tech rollout, Ontario Shores debuted the new processes.

“We went live with every document they'd see in Meditech, on paper, six months” before the EMR rollout, Riahi says. “Clinicians didn't have to get used to both new content and new technology.”

The preparation also included a lot of training, with superusers and physician champions recruited to ease the transition. The result, she says, has been successful and enthusiastic adoption, along with a number of successful programs built from the data in the EMR. Three case studies about Ontario Shores were highlighted by HIMSS for the Davies award:

• Clinical health guidelines: New, systematic clinical practice guidelines for schizophrenia patients, including alerts to clinicians regarding treatment, medication and referrals, delivered process improvements of as much as 74 percent.
• Infection prevention and control: Patients spend considerable time in common areas, which can make it difficult to prevent the spread of infectious disease. An electronic status board now leverages EMR data to track where illness is spreading, to better direct medical resources. Outbreak days dropped from 47 in the year prior to implementation to seven in the year after.
• Medication administration: Scanning patient IDs and medications before administering the drugs now has a 95 percent adherence rate, after some process adoption challenges. The system flags, and prevents, more than 600 medication errors per month that Riahi says could have gone unnoticed back when the facility operated with paper processes.

The data is kept in a Meditech database, housed in the center's Tier 3 data center. Backend and clinical data is all kept in the system, and analytics are run using Meditech applications.

Riahi says that new applications of the data come from multiple sources. For example, policies and practices related to medication are monitored on a monthly basis, so problems can be identified and addressed. Much of the time, a practitioner comes forward with a problem or a change request.

“A clinician will ask, 'Here's the gap—can we do something using technology?’ ” she says. “That's something that every single staff member can do.”