Project: Laval integrated network information system (SI-RIL)

2005
Canada health infostructure partnerships program (CHIPP)

Synopsis

The Programmation régionale de services ambulatoires (PRSA) [regional programming of ambulatory care services] pilot project is an integrated physical and mental health services network supported by a technological infrastructure that is on the leading edge in Quebec and Canada. Deployed under the name "Système d'information du réseau intégré de Laval" (SI-RIL) [Laval integrated network information system], this technological infrastructure is also supporting a shared care and services approach involving all the workers in a territory. The Système d'information de la programmation régionale des services intégrés[1] (SI-PRSI) [regional integrated services programming information system] and the Clinique médicale virtuelle (CMV) [virtual medical clinic] are computerized systems designed to provide secure exchange of clinical data among the various institutions, with a view to regional co-ordination of care. The main interest of the SI-PRSI project lies in three major aspects of the development of this project: the designing of the information system, the establishment of the regional technological infrastructure and the issue of privacy. Implementation of the CMV was motivated by the desire to share clinical information and improve the circulation and dissemination of that information.

Outcomes

N.B.: Owing to the time constraints for implementation of this project, the proponents were unable to describe the measurable effects when preparing the final report. For an update on the outcomes and impacts, please contact the resource person mentioned at the end of this summary.

The PRSA project yielded a number of outcomes, despite external factors that caused a major slowdown.

In connection with the SI-PRSI, exchange of clinical information through a regional clinical record is being successfully supported. There are three main components:

• A reference tool that was developed, called the "Demande de services interétablissement" [request for interinstitution services] and known by the acronym "DSIE."
• A set of provincial evaluation tools that was created (the "Court term" [short term], the "Multiclientèle" [multiclientele], which includes the "Système de mesure de l'autonomie fonctionnelle" (SMAF) [functional independence measurement system], the "Profil évolutif" [evolving profile], and the intervention and services allocation plan.)
• A set of clinical forms that were standardized by various professional committees from the institutions in the Laval network.

In connection with the CMV:[2]

• The Cité de la Santé people and some general practitioners set out to identify a potential supplier for a requisitions and results system.
• Analysis of the needs of 40 medical clinics in the region made it possible to chart the current work processes and establish practical and measurable evaluation criteria.

Policy Implications

• Compliance with legislation was a major challenge. The Act respecting health services and social services, the Act respecting protection of personal information in the private sector (particularly with respect to the CMV component), the Act respecting access to documents held by public bodies and the protection of personal information and the Act to establish a legal framework for information technology were disregarded and solutions were developed by specialists in the form of service or partnership contracts and agreements, supported by legal opinions.
• A multidisciplinary working group was formed to meet the specific challenge of managing consent for the virtual medical clinic component. Two types of consent were managed by the CMV system: one-time consent and prospective consent for family physicians or the vulnerable clientele. In addition, other documents with a legal connotation were developed: the pamphlet "Information sur votre participation au projet SI-RIL" [information on your participation in the SI-RIL project][3] and the information document "Avis de retrait de votre participation au projet informatisé intitulé SI-RIL"[4] [notice of withdrawal of your participation in the SI-RIL computerized information system].

Research Implications

• Development of a network approach supported by a coherent technological infrastructure had many impacts on the organizational structure for delivery of regional services programs and on development of skills by the people working in the clinical and technological fields. It has been observed that the impacts among the workers are on productivity and work satisfaction.
• Deployment of the SI-RIL has reminded us how important it is to maintain the focus on designing and delivering clinical solutions for patients and that regional integration of informational, technological, real property, human and financial resources is necessary.

Lessons Learned

Many lessons were learned through the PRSA project. The following is a summary of some of those lessons:

• Do not underestimate the resources that need to be allocated to management of change. It has been observed that the resources allocated are not always sufficient, that analysis and understanding of the impacts of change on individuals and work processes are sometimes incomplete, that communication initiatives are not targeted and are unidirectional, that the training program put in place does not allow for acquisition of all the skills needed to enable individuals to absorb change well, and that evaluation of psychological impact on individuals in terms of stress and anxiety, which is often the source of resistance, is simply skipped.
• Make the designing and delivery of clinical solutions for clinicians and patients the primary focus. At the start, the SI-RIL project was aimed at developing innovative clinical solutions and making them available to health professionals, to help them do their job. The purposes of the project were clinical, above all; the solutions sought were meant to benefit practitioners and patients. Technology, vital to a project such as this, was always used as a lever, but was never a goal in itself.
• Ensure regional integration and co-ordination of informational, technological, real property, human and financial resources. The health system in Quebec is complex, owing to the large number of managers, the many decision-making levels involved, and the various roles and responsibilities that have devolved to the various public and private organizations in the network. In connection with the SI-RIL project, the regional integration plan was an essential tool for ensuring that the necessary resources were available and put in place in a timely fashion.

The Future

The Agence de développement de réseaux locaux de services de santé et de services sociaux de Laval [Laval local health and social services network development agency] already has written confirmation from the Ministère de la Santé et des Services sociaux du Québec [Quebec health and social services department] that it will receive the funding needed to maintain the regional infrastructure and the SI-PRSA in public institutions. Future developments that are envisaged will make it possible to consolidate implementation of the basic components regionally. Eventually, development of the SI-RIL will make it possible to further support its integrated services network. The expertise developed in Laval with respect to management of clinical and organizational change in connection with implementation of secure information systems that respect protection of personal information is also an asset to be preserved and strengthened. The SI-RIL project gives the Laval region the technological infrastructure that is at the heart of the integrated services network. That infrastructure is open and flexible. Its main benefit is that it matches needs for information access and availability[5], and integrates inter- and intra-institutional applications to create an information clearinghouse capable of reaching all health and social services workers in the Laval region.

Annex A: Document and Products Generated

Title of Document or Material	Name of Electronic File ou "Paper Document" Notation	Licence Fees (Yes / No)
Avis de retrait de votre participation au projet informatisé intitulé Système d'information du réseau intégré de Laval (SI-RIL) [notice of withdrawal of your participation in the SI-RIL (Laval integrated network information system) computerized information system]	AVIS retrait du projet SI-RIL avec cliniques.doc	No
Avis de retrait de votre participation au projet informatisé intitulé Système d'information du réseau intégré de Laval (SI-RIL) [notice of withdrawal of your participation in the SI-RIL (Laval integrated network information system) computerized information system]	AVIS retrait du projet SI-RIL.doc	No
Cadre global de gestion sur la sécurité des actifs informationnels du réseau de la santé et des services sociaux [comprehensive framework for managing the security of informational assets in the health and social services network] Version 4.3, May 2001	Cadre securite actifs informationnels.pdf	Yes
Projet SI-RIL - Système d'information - Réseau Intégré de Laval - Présentation au comité de programme néphrologie [SI-RIL project - information system - Laval integrated network - presentation to nephrology program committee]	Comité de programme néphrologie 2002-04-02.ppt	No
Liste des membres des comités et des sous-comités de programme (par programme) [list of committee and subcommittee members (by program)]	Comités et sous-comités PRSA au 2002-01-07.doc	No
Convention de partenariat [partnership agreement]	Convention de partenariat 2002-05-09 version 2.doc	No
Convention de confidentialité [confidentiality agreement]	convention_confidentialite4 OMNI-MED et IBM.doc	No
Informations sur votre participation au projet SI-RIL [information on your participation in the SI-RIL project]	Dépliant d'information SI-RIL.doc	No
Formulaire d'engagement à la protection des renseignements personnels et à la sécurité des actifs informationnels [form for undertaking to protect personal information and the security of informational assets]	Engagement020715.pdf	No
Protocole d'entente de collaboration relativement à la transmission des résultats de laboratoire de MDS aux médecins participant au Système d'information du réseau intégré de Laval (SI-RIL) coordonné par la Régie régionale de la santé et des services sociaux de Laval [memorandum of understanding regarding collaboration with respect to transmission of the MDS laboratory results to physicians participating in the Laval integrated network information system (SI-RIL) co-ordinated by the Laval regional health and social services board]	Entente Laboratoires MDS	No
Entente de services - volet administratif [service agreement - administrative component]	Entente MODELE Volet administratif Version 2002-09-19.doc	No
Entente de services - volet clinique [service agreement - clinical component]	Entente MODELE Volet clinique Version 2002-09-19.doc	No
Convention de confidentialité [confidentiality agreement]	Ententes de confidentialité.doc	No
Analyse de l'architecture du projet SI-RIL [SI-RIL project architecture analysis]	Évaluation Gartner.ppt	No
Formation Lotus Notes - principes de base [Lotus Notes training - basic principles]	Formation Lotus Notes.ppt	No
Identification du médecin de famille - Clientèle vulnérable et examen médical périodique des enfants entre 0 et 5 ans inclusivement [identification of family physician - vulnerable clientele and periodic medical examination of children between 0 and 5 years of age inclusively]	Formulaire consentement Clientèle vulnérable Version 2003-07-04.doc	No
Formulaire de consentement - médecin de famille [consent form - family physician]	Formulaire consentement Médecin de famille Version 2003-07-04.doc	No
Formulaire de consentement ponctuel [one-time consent form]	Formulaire consentement ponctuel Version 2003-07-04.doc	No
Liste de vérifications simples à faire par le support de premier niveau [list of simple checks to be done by those at the first level of support]	Guide support de 1er niveau.doc	No
SI-RIL - Guide d'utilisation [SI-RIL users' guide] Version 1.5	Guide Utilisateur Formation - Novembre 2002.doc	No
Lettre d'intention - Volet administratif [letter of intent - administrative component]	Lettre d'intention modèle volet administratif.doc	No
Lettre d'intention - Volet clinique [letter of intent - clinical component]	Lettre d'intention modèle volet clinique.doc	No
Les orientations technologiques du réseau sociosanitaire - pour un accès intégré et sécurisé à l'information [technological directions of the public health network - for integrated and secure access to information]	Orientations technologiques MSSS.pdf	No
Implantation d'un système régional d'information clinique à l'intention des omnipraticiens - Présentation aux fournisseurs [implementation of a regional clinical information system for general practitioners- presentation to suppliers] January 24, 2002	Présentation Appel de partenariat 2002-01-24.ppt	No
Projet réseau SI-RIL - Rencontre clinique médicale Laval Ouest [SI-RIL network project - Laval West medical clinical meeting] December 4, 2001	Présentation Tournée des cliniques.ppt	No
Projet SI-RIL - Système d'information - Réseau Intégré de Laval - Présentation au présidents des comités des programmes [SI-RIL project - information system - Laval integrated network - presentation to program committee chairs]	Présentation Comité des présidents 2002-01-30.ppt	No
Rapports des comités de programmation régionale des soins et des services de courte durée - Diabète [reports of regional acute care and services programming committees - diabetes]	Progr DIA- Rapport CSSAL Janvier 1998.DOC	No
Rapports des comités de programmation régionale des soins et des services de courte durée - Gériatrie [reports of regional acute care and services programming committees - geriatrics]	Progr GER- Rapport CSSAL Janvier 1998.DOC	No
Rapports des comités de programmation régionale des soins et des services de courte durée - Obstétrique [reports of regional acute care and services programming committees - obstetrics]	Progr OBS- Rapport CSSAL Janvier 1998.DOC	No
Rapports des comités de programmation régionale des soins et des services de courte durée - Oncologie [reports of regional acute care and services programming committees - oncology]	Progr ONC- Rapport CSSAL Janvier 1998.DOC	No
Rapports des comités de programmation régionale des soins et des services de courte durée - Pédiatrie [reports of regional acute care and services programming committees - pediatrics]	Progr Pédiatrie- Rapport CSSAL Janvier 1998.DOC	No
Rapports des comités de programmation régionale des soins et des services de courte durée - Système cardiovasculaire [reports of regional acute care and services programming committees - cardiovascular system]	Progr SCV- Rapport CSSAL Janvier 1998.DOC	No
Rapports des comités de programmation régionale des soins et des services de courte durée - Santé des femmes [reports of regional acute care and services programming committees - women's health]	Progr SDF- Rapport CSSAL Janvier 1998.DOC	No
Rapports des comités de programmation régionale des soins et des services de courte durée - Système digestif [reports of regional acute care and services programming committee - digestive system]	Progr SDI- Rapport CSSAL Janvier 1998.DOC	No
Rapports des comités de programmation régionale des soins et des services de courte durée - Système génito-urinaire [reports of regional acute care and services programming committees - urogenital system]	Progr SGU- Rapport CSSAL Janvier 1998.DOC	No
Rapports des comités de programmation régionale des soins et des services de courte durée - Santé mentale [reports of regional acute care and services programming committees - mental health]	Progr SME- Rapport CSSAL Janvier 1998.DOC	No
Rapports des comités de programmation régionale des soins et des services de courte durée - Système nerveux et musculo-squelettique [reports of regional acute care and services programming committees - nervous and musculoskeletal system]	Progr SNM- Rapport CSSAL Janvier 1998.DOC	No
Rapports des comités de programmation régionale des soins et des services de courte durée - Ophtalmologie [reports of regional acute care and services programming committees - ophthalmology]	Progr Syst ORL et OPH- Rapport CSSAL Janvier 1998.DOC	No
Rapports des comités de programmation régionale des soins et des services de courte durée - Système respiratoire [reports of regional acute care and services regional programming committees - respiratory system]	Progr Syst Respiratoire- Rapport CSSAL Janvier 1998.doc	No
No title	Projet de IBM 2002-11-20.DOC	No
Suite du rapport d'évaluation du système d'information soutenant la programmation régionale des soins ambulatoires de la région de Laval - Commentaires du plan de suivi des recommandations de la Commission d'accès à l'information [continuation of report on evaluation of the information system supporting Laval region ambulatory care programming - comments from the plan for follow-up on the recommendations of the information access commission]	Rapport final Evaluation SI-PRSA 2003-06-12.pdf	No
Protocole de prêt de local, de serveur et de personnel [premises, server and personnel loan protocol]	SI_RIL entente Cite de la Sante.doc	No
Entente de services - Volet administratif [service agreement - administrative component]	SI_RIL entente Clinique volet administratif.2.doc	No
Entente de services - Volet clinique [service agreement - clinical component]	SI_RIL entente Clinique volet clinique.2.doc	No

For further information, please contact :

Mr. Jean Fratelli, at 450-978-2053 or via jean_fratelli@ssss.gouv.gc.ca