HealthLink

Health and the Information Highway Division, Health Canada
October, 2003

Table of Contents

• 1.0 Introduction
• 2.0 Project Description
• 3.0 Achievements
  • 3.1 Goals Reached
  • 3.2 Additional Successes
  • 3.3 Unreached Goals
  • 3.4 Documents or Products Generated
• 4.0 Main Impact
  • 4.1 Human Resources Impact
  • 4.2 Privacy and Protection of Information
  • 4.3 Policy and Research Implications
• 5.0 The Future
• 6.0 Communications

1.0 Introduction

The HealthLink Project was originally based on a funding agreement between the former Okanagan Similkameen Health Region and Health Canada. In December of 2001 the government of British Columbia restructured health care delivery within the province and created five large health authorities. In the former OSHR - this meant the amalgamation of what had been 14 separate Community Health Councils and/or Health Regions into one health authority - Interior Health. The geographic area covered by the project grew from a modest 11 communities and a population of 300,000 to approximately 50 communities and a population of 720,000.

This organizational shift resulted in a total revamping of the original plan in order to maintain its deliverability during the remaining lifespan of the project. The original project description remains in this text with the updated version following in italics.

2.0 Project Description

Original:

The Okanagan Similkameen Health Region will develop a fully integrated information system designed to assist seniors and health professionals in raising awareness of existing community services and coordinating health services for seniors by providing toll free and local telephone numbers for seniors and their care providers. Callers will be linked to appropriate resources, assisted with accessing information on the Healthlink website, and provided with referrals to community care or linked directly to the needed resource. Beyond the CHIPP funding phase there are plans to add an electronic record containing data on clients using the information system. This record would be accessible to referring organizations subject to privacy and confidentiality policies.

Updated:

The HealthLink project has undergone a number of changes in the most part due to the change of the former Okanagan Similkameen Health Region to the new Interior Health Authority. As health care reforms get underway in our province the need for a service such as our web-based directory became more evident. The change in our region saw the project coverage area go from 11 communities scattered over a fairly small geographic area to some 52 communities spread over the lower 1/3 of the province. This change presented an exciting although daunting opportunity to take the original project's mandate and expand it to include this much larger population (from 300,000 to 720,000).

The original intent of the HealthLink project was to offer our population of seniors (which is currently the highest per capita in Canada) with the dual web-based, call-in directory of health care services located in their community. The original project would have established a 1-800 call centre staffed by two nurses on an after hours basis to compliment our existing community services.

The project, despite changes, has remained up-to-date and on time in comparison to the project schedule. Changes have occurred in almost every aspect of the original project starting with the elimination of the call centre. Listed below are the major "befores" and "afters" of the project plan.

Original:

The HealthLink team would establish a 1-800 call centre staffed by two nurses on an after-hours basis to provide our senior population with a "one-stop" place to call for health information and referral.

Updated:

The HealthLink team will assist our community health centres (one located in each of our Interior Health communities) to build their directory of services and use the HealthLink site as a referral source for phone-in, walk-in and while community health staff are on client visits.

Original:

The HealthLink call centre staff would access an on-line electronic health record to assess the client calling in order to make an appropriate referral. The record of the call would have been tracked and an internal referral could occur where appropriate.

Updated:

The HealthLink directory will provide each and every one of our intake points with an up-to-date listing of health service information in their home community as well as the neighbouring towns. Electronic health records do not currently exist at each of our sites although development work is underway to implement a record over the coming years.(see attached appendix on Interior Health and the future of the EHR.)

3.0 Achievements

3.1 Goals Reached

What elements in the originally approved work plan were achieved?

A number of the original elements were achieved:

• The creation of Interior Health's website was a fundamental building block of the project and was realized on time and on budget.
• The original "healthlink" directory was created and vastly improved by upgrading the database. It became a more dynamic, interactive directory better suited to the needs of our target populations.
• The idea of bringing more information to the public in a user-friendly, easy to access fashion was and continues to be improved due to the availability of the healthlink directory.

What were the contributing key factors?

Despite staffing changes to the original work team - the vision, dedication and commitment of the team to seeing this project through to completion was a key factor in its success. During difficult times of shifting organizational priorities the work team assigned to this project kept the vision moving forward. The innovation of the team was key in successfully completing the directory in its current form. The original software platform chosen did not allow a dynamic user interface - the web analyst was able to research and implement a solution to allow for a more user-friendly, viable web directory.

What were the obstacles or challenges that had an impact on your achievements and how did you deal with them?

The huge changes facing the new health authority rendered this project a lower priority in the grand scheme of things. This meant that the project team had to move forward autonomously in order to meet the agreement with Health Canada. Some of the risk factors around staffing changes that the team initially identified came to fruition. Changing one of the key players mid-way through the project had a dual affect - first a steep learning curve to get up to speed with where the project was and where it was going and second it had the favourable affect of bringing a new lense through which to view the project. The result of this change is evident in the change of platform used to support the web directory.

There was an initial assumption that some of the supporting departments (IT, Finance) would offer "in-kind" support to the project. With the new responsibility of amalgamating and realigning priorities - this support was withdrawn. The team was able to compensate by taking on many of the tasks that would have been "in-kind.

3.2 Additional Successes

What elements were achieved beyond the originally approved work plan?

The directory was greatly expanded beyond the initial plan. Originally the plan was to have a listing of services for seniors in our 11 Okanagan Similkameen communities. The directory is now a comprehensive listing of ALL health services, affecting all our client population in all of our 52 communities through Interior Health. The directory is so comprehensive and successful that the other Health Authorities within the province are planning to adopt the format.

What were the contributing key factors?

The most important contributing factor was having staff on the project team with clearly assigned responsibilities and a clear plan for how to accomplish them. Collecting data for all of our communities could have been a daunting task - however, our team was able to pull existing information and, using directories such as the Telus yellow pages - were able to quickly assemble information for each of our communities. Expansion and correction of the directory information will be conducted on an ongoing basis by both users and the remaining HealthLink team members.

3.3 Unreached Goals

What elements from the originally approved work plan were not accomplished or sustained?

The concept of the call centre supporting the directory was not achieved. This would have involved a staff of nurses or nurse-practioners and would have served only the original Okanagan Similkameen Health Region area. In terms of ensuring best utilization of available dollars and the highest positive impact to our population - the change over to HealthLink becoming a directory supporting our existing points of contact was more feasible.

The province of British Columbia currently offers a 1-800 Nurse-Line service that accesses the BC HealthGuide on-line service. Meetings have been conducted with key staff of the BC Nurse-Line to pursue the opportunity of establishing a provincial directory of services that would support referral on a 24/7 basis.

What were the contributing key factors?

The key factor was the change over to a much larger organization - Interior Health.

What were the obstacles and how did that impact on you not being able to accomplish your objectives?

The largest obstacle was the amalgamation of existing services over a large area. The mergence of Interior Health from the former 14 Health Councils/Health Regions created an immediate need for a change in our most basic day-to-day business processes. The primary departments involved in this change over were Information and Technology, Finance and Human Resources. These departments would have been key in supporting the development and sustainability of a call centre. Shifting organizational priorities in light of political change presented our most challenging ongoing obstacles.

3.4 Documents or Products Generated

The chart below lists some of the tools we have developed.

(Please note that, as per the contribution agreement, Health Canada must receive a copy of any tools and products that were developed through CHIPP funding.)

Document/Product Name	Available in Paper and/or Electronic Form	Licence Fee Required for use (Yes/No)	Previously Provided to Health Canada (Yes/No)	Appendix Name/Number
HealthLink Directory	Electronic	Yes	No	As per website
Evaluation Surveys	Both	No	No	Appendix A

4.0 Main Impact

The HealthLink project has what I refer to as an "evolutionary affect"......what I mean by this is that staff, clients, communities, etc. will begin to see the website as a more stable and reliable entity over a period of time. This will result, I believe, in an evolutionary process - a new way to to access and retrieve health information. A similar analogy - the way we went from using tellers at the bank to using ATM's to banking on-line. It is a change in expectations that needs to occur within our primary population. Recognizing that the upcoming generations will have an expectation to do "everything" on-line - it is the transitional generations that must make the shift. Electronic information and/or just the very amount of information we consider might consider as necessary to our day-to-day existence will continue to expand and shift.

The project is beginning to have a positive affect on staff in our health authority. Recent staff surveys indicate that while many of our 18,000 employees may not have seen or accessed HealthLink to date - many of those who are in direct service to the public have and are using the directory on an ongoing basis. Some of the comments received on our recent email survey of staff are listed below....

Administrative Coordinator, Kelowna:

"On numerous occasions I have directed callers to HealthLink......this resource as been invaluable for freeing up my time when queries related to care facilities cross my desk......thank you for providing this valuable tool".

Information Technologist/Security, Vernon:

"I was curious at first and was impressed at the ease in finding information. On a personal level I have a family member with some health issues and it was a good reference point for me.......gave some valuable information for my family to consider......"

Home & Community Care, Grand Forks:

"I find that I save a lot of time that normally I would have to make many phone calls......I get info right away......it is truly beneficial......"

What difference is your project making in your community or your region?

The HealthLink project is providing a vital link to health care information throughout our region. Having recently amalgamated a number of health councils and regions into one large area - the directory now provides staff easy access to what is available within the new Health Authority area.

What difference is your project making to your patients, to health care professionals, or to your organization's management and structure?

The impact of the website has been significant - it has allowed us to keep our staff, physicians and communities informed of changes as they happen.

What changes have you noted in the provision of services?

The spinoff of HealthLink should be more information, more easily retrievable by both the public and our staff. It is difficult - other than through staff surveys - to truly measure the changes at this point.

What findings from your project can potentially impact on the development of responsive health delivery policy and applied research agenda?

As we move more and more into a virtual world a directory such as HealthLink has potential to provide necessary health information to those in more remote areas. Access to information on the web is not limited by geography. Combined with the diagnostic, medical information available on the BC HealthGuide - the HealthLink directory has the potential to round out the information available to the public.

4.1 Human Resources Impact

Please indicate what short and long term impacts your project has had on human resources. Some things to think about are:

What new skills have staff/health care providers developed? Are these skills transferable to other jobs or situations?

We have been working with staff to increase their expectation of using the web as a reliable source of health referral information.

Have new positions been developed?

As a result of the construction of the website - we now have a full time web analyst reporting to our communications department.

Has the new technology increased demand on service providers? If so, how is it being managed?

The creation of a "one-stop" site to locate health care information should make it easier for our service providers to appropriatley refer clients to services in their community.

Has job satisfaction changed?

No impact.

Has productivity changed?

No impact.

Was there resistance to change?

It has been (as mentioned earlier) a bit of an evolutionary process to begin to change expectations of staff to use the website as their source of information. The staff are typically going to be our highest consumers of this service in reference to clients they serve. It will take time for staff and the public alike to become confident in the reliability of the information available via the HealthLink directory.

4.2 Privacy and Protection of Information

Have there been changes in the behaviour of health professionals/staff with respect to the protection of personal health information?

There is no impact to protection of personal health information on the HealthLink site.

Have changes been made to your policies and procedures?

Interior Health Authority has policies and procedures in place to deal with privacy. There has been no need or impact to change them as a result of the HealthLink directory.

Have you completed a Privacy Impact Assessment? If yes, what did it show? Did you change any policies or procedures as a result of the Privacy Impact Assessment?

It demonstrated no real impact in the area of privacy concerns.

Did you participate in the CHIPP Privacy and Security Survey conducted in August 2002? If yes, have you implemented the recommendations provided to you?

No impact.

Did you receive any patient views/concerns/compliments on the handling and use of their personal information?

We are not using personal information of our clients - however we are listing physicians and other community service providers. The feedback has been positive on these listings - no concern regarding privacy issues.

Did any of your privacy/confidentiality rules/guidelines help or hinder your health care providers (all staff) to provide patient service?

No impact.

Was patient privacy raised as an issue in any way during the trial?

Not applicable.

What tools were used for obtaining and managing patient consent?
(electronic/paper/combination) Not applicable.

Were there instances where patients refused consent and, if yes, what were the reasons given?

Not applicable.

Will you be conducting regular Privacy Impact Assessments? If not done routinely, under what circumstances will revised Privacy Impact Assessments be conducted?

Not applicable.

Have you participated in discussions with representatives of provincial health infostructure networks on privacy and protection of personal health information?

Not applicable.

Do you feel your project has influenced privacy policy and process development in your jurisdiction? If yes, in what way?

Not applicable.

4.3 Policy and Research Implications

Major finding #1:

The HealthLink directory for Interior Health could be used as a "shell" to create a provincial directory of services. The availability of a "referral" type directory such as HealthLink would enhance existing services such as the BC Nurse Line. Currently the BC Nurse Line is limited to giving diagnostic, medical type advice and cannot provide community contact information to clients who call in.

The province would have to establish a process for updating and/or sharing valid, reliable community based information with the public.

5.0 The Future

Our plans for maintaining our HealthLink project once the CHIPP funding ends:

What are the key barriers to ensuring your project is sustainable beyond the CHIPP funding period?

Ongoing funding will be the primary barrier - in times of conflicting priorities and a considered view to reducing and/or streamlining health care costs - it is difficult to demonstrate the value of a product such as the directory. During the period of time it will take to really educate our staff and the public about the advantages to an on-line directory - there will be competing priorities.

Do you have funding for the next stage of your project?

Currently there is only minimal funding on an "in-kind" basis available to maintain the directory. We are exploring, however, an option of using an "e-Commerce" site. This would allow Interior Health to charge "for-profit" agencies and persons listing on our directory. It would like be no more than a cost recovery endeavour however may prove to be enough to maintain the directory.

How will the project be funded?

Potentially through use of an "e-Commerce" site.

Do you intend to expand your project? If so, can you provide Health Canada with an overview of your future plans?

This project has tremendous potential to be developed into a provincial tool. There are no hard and fast plans at this time to do so. Chief Information Officers of the neighbouring Health Authorities have requested more information at this time.

If you are not planning an expansion, what are the key reasons for not proceeding?

We will continue to maintain the HealthLink directory - expansion is dependent on a number of things - not the least of which is funding.

In your planning, have you considered such matters as:

• Your ongoing vision and mission
• Governance and leadership
• Human resources needs
• Communications
• Needs of health care professionals
• Technical development plans
• Funding requirements
• Interoperability with other projects and systems

All of the above have been considered and reviewed - potentially an e-Commerce site may provide the solution to many of the current barriers to expansion or sustainaibility of this project.

We are currently operating four specific pilot sites although the directory is currently available in all of our communities. It would be beneficial if the BC Nurse Line (BC HealthGuide) would access the directory for our area and provide the critical feedback needed to support the expansion to a provincial directory.

6.0 Communications

Methods/tools used to communicate with our stakeholders:

Methods or Tools	Date	Targeted Audience	Documents or Presentations Produced	Appendix Name/Number
Conference	Oct 2001 Oct 2002	Seniors	Two stage presentations, bookmarks, pamphets	Appendix B
Media Events	Oct 2001 Oct 2002	Kelowna Community	Talk-show interviews - radio and television
Publications	Current	Communities/Staff	Newsletters Brochures Bookmarks	Appendix B
Website (please provide the Website address)	Current	Communities of Interior Health & Staff	www.interiorhealth.ca/healthlink