Evolving hospice care within Ontario
It has been said that necessity is the mother of invention, and so it has proven to be in Ontario. The sunsetting of one system resulted in a shared regional instance of Cerner Millennium® being introduced at a local hospice, smoothing the journey for patients approaching the end of their lives, as well as those who are caring for them.
When Hospice of Windsor & Essex County’s legacy registration and documentation system was being sunset, the facility was able to use its existing relationship with Windsor Regional Cancer Program (WRCP) to join its instance of the Oracle Health electronic health record (EHR). This was possible because WRCP being a part of the e-VOLVE program, which is managed by TransForm Shared Service Organization (TSSO).
"The integration of Oracle Health EHR into our hospital system has been a game-changer for our community palliative care services. Our team can now access vital patient information at the touch of a button, facilitating timely and safe care for patients and their families. The seamless transition of care from acute to hospice care has improved patient safety, and our collaboration with TSSO has allowed us to tailor the Cerner Millennium platform to meet the unique needs of our healthcare team, patients, and caregivers. This is truly a step forward in delivering exceptional patient-centred care." Sheri Bergeron MD, CCFP (PC), FRCPC Palliative Physician and Medical director Hospice of Windsor & Essex County Inc.
TSSO senior business analyst, Ben Parent, believes the benefits of a single, accessible patient record are “obvious”: “For palliative care doctors who work both in the hospitals acute, sub-acute and ambulatory settings, most of them also serve as doctors that work at Hospice. And so, for them to see all the history of the patients journey from diagnosis through treatment and their final palliative stage, they are better able to address their needs and support the continuity of care without having to rewrite any of the history”.
Fellow TSSO senior business analyst , Christine Brignall, explains a simple logistical reason for Hospice making the switch: “Prior to going live, they had about 20,000 paper faxes in 2018 to 2019 from the hospitals in the region. And these faxes, because they'd have to be organized, would sit on the fax machine, or not get to the nurse completing that triage, for a number of hours. That delayed patient care and – especially for patients who are transitioning to palliative care – every second counts.”
A great deal of collaboration was required between TSSO and Oracle Health to roll out the instance of Cerner Millennium into Hospice. This included treating the facility as an ambulatory service of Windsor Regional Hospital and adapting existing workflows to make them suitable, but without adding a multitude of extra screens for providers using the system. By working with the staff that would ultimately use the EHR, they gathered all documentation requirements and designed integrated workflows so the user experience could stay as streamlined as possible.
Healthcare providers aren’t the only beneficiaries, with patients enjoying faster, better connected care, as Christine explains: “There was a patient that was discharged from hospital after hours, and didn't have an appointment at Hospice until after the weekend. They were planning on seeing a palliative care physician, but were not given pain management medications over the weekend. If that patient wasn't able to access a palliative physician or nurse after hours, they would have likely gone to the ED as a result of not having those pain medications.”
“But because they were able to call Hospice, which was able to access their inpatient record, they already knew the medications that they were using for pain management, so they were able to prescribe some medications that would get that patient through the weekend until they were going to be seen again at Hospice.” She adds, “It's really helpful to have a shared record so that that patient doesn't have to tell their story over and over again.”
Integrating health data with external health team partners isn’t easy, but sharing the instance of Cerner Millennium through the e-VOLVE program facilitated a shared EHR, but there were some challenges. Coding workflows needed to be modified to accommodate the different venue requirements. In some cases, faxes are still required for external nursing agencies, and there are limitations when it comes to scanning. However, these have all been recognized, with Ben noting, “There's always continuous improvements we can make.”
He continues, “In my mind – and within TransForm – other people are thinking, ‘what other community nonprofit services can we include?’ There are other people in other organizations that the hospitals work very closely with, including another hospice in the Chatham Kent area. Why can't we also build them in?”
With greater collaboration, an increase on the number of subject matter experts, and building scalable templates being planned, the evolution of care in Ontario will continue to be an ongoing process.