Guest Editorial – Learn – Share – Evolve

I am honoured to be the guest editorial for this very important issue – The HealthAchive Issue. The theme of the conference is Learn – Share – Evolve. From my perspective, having just completed my 3 year public sector tour of duty as CIO of the South West & Waterloo Wellington LHINs and as eHealth Cluster Lead for South Western Ontario (SWO), as well as from my past roles with the Federal Government and with some amazing private sector companies, I wanted to convey some insights, thoughts and ideas as to how we could approach things moving forward in Ontario.

What did I learn?
Culture and teamwork are key. You have to continually reinforce a culture of driving results, with a winning attitude emphasizing a high performing culture where opinions are accepted from everyone, strengths are leveraged and stakeholders involved. You have to set the tone from the top, leverage those around you and practice what you preach. I also learned that it’s not all about the technology. It’s about scale and approach. In Ontario, we’ve created the “cluster model” that is guided by core principles including leveraging current investments and moving beyond technology to create innovation around the governance, delivery and sustainability of ehealth.

What can I share?
Of the many things that I could share, there is one thing in particular. Taking on a CIO role in Southwestern Ontario was challenging; especially in a LHIN – a relatively new structure in Ontario; focused on eHealth – an industry facing brand issues after the summer of 2009. Instrumental in guiding my approach was my experience from the private sector mixed with ten years military service.

The approach?
Simple at first: conduct a current state assessment, create a strategic plan, set up a framework with operating standards, implement the tactics, create contingencies, create alliances, have good intelligence, use communication as a key tool, act with integrity, and be consistent and fair. Then things got complicated given how Ontario is structured. In such a complex landscape, the basic principles saw us through. Stay on task – don’t get discouraged or sidetracked. Focus on governance and delivery structures – not on technology. Keep a positive attitude through the team and stakeholders.

How do we share?
We have to continually break down barriers and cross boundaries. Start by leveraging our local initiatives, support new ways of thinking and new thinkers like those involved in emerging apps challenges and hackathons, and foster private-public sector collaboration such as the Vendor Friday events in SWO. In addition to those, continue to broaden through provincial and national conferences to ensure that we share not only within our province but across Canada, like at key events including Health Achieve and COACH’s National eHealth Conferences.

When I was at GE, we called it being “Boundaryless”. Finally, share by ongoing communication, including social media.

How do we Evolve?
It’s not so much about the technology. We need to transform our delivery models, create a coherent policy framework and operating standards for ehealth across Ontario. Its about the people and process. Given that, we need to create good governance and one point of accountability so that the current goal of an integrated EHR is achieved and then we can build upon that to put technologies in the home, promote ehealth to support wellness, and public health, put individuals at the centre of their care as partners, not as patients, transform traditional office visits beyond office walls and hours, and incorporate the rapid use of data so that prescriptive and predictive modelling becomes a tool used daily for the system and for the individual.

cSWO – Project to Program!
CSWO started as one of the three EHR projects in Ontario and evolved into an ehealth governance and delivery program that changed the way we work, how we deliver, and how we govern. In SWO, ehealth is governed through three key parties: the LHINs, a large regional hospital, in this case, LHSC, and four service delivery partners – one partner per LHIN. The service delivery partners are accountable to the four LHINs in SWO and to LHSC, thereby pulling the partners together.

This sharing of system governance, allows the LHIN to be accountable for local ehealth via it’s local delivery partner, and to influence the cluster EHR project, where LHSC is accountable. As such, all four delivery partners are working together, with common goals, and with a common framework and standard operating procedures. This approach to governance balances the myriad of organizations currently delivering care in Ontario and has removed the LHIN from playing the middleman between health service organizations and the MOHLTC with respect to ehealth.

In SWO, ehealth has evolved from a project to a program and is now in a position to enhance the quality of care and be aligned with government policy at the provincial and local levels. It is in a position to support LHIN IHSPs, the Excellent Care for All Act, and new models of care including Health Links as well as be a ready partner for OTN, CCO, OntarioMD, OACCAC, HQO and the many other provincial organizations that now have a strategy to plug into. This lays the ground work for realizing cost-effective health solutions with measurable outcomes based on a common quality methodology and framework.

In conclusion,
Ontario has a very complex healthcare system. There are no easy or straightforward answers but we can learn from our successes, share them widely and evolve the way stakeholders work together. I am optimistic that successes such as cSWO can be emulated not only to other ehealth clusters, but also for other programs such as those arising out of Health Quality Ontario (HQO).

This will only lead to better alignment, enabling us to solve the business problems of today, and do so within months and even weeks and not in years, as that is no longer acceptable. I encourage each of you to make a difference, to challenge the current way of doing things, leverage each other, and contribute your individual leadership strengths to help us all…

Learn – Share – Evolve.

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