Project: Integrated clinical information management network (RIGIC)

2005
Canada health infostructure partnerships program (CHIPP)

Synopsis

The main purpose of the Réseau intégré de gestion de l'information clinique (RIGIC) [integrated clinical information management network] project was to develop an integrated system for creating, storing and exchanging secure health data in support of the regional co-ordination and delivery of clinical care and services in the oncology continuum. The project was also aimed at facilitating patients' access to a wider range of services in a network, while optimizing information sharing and resource use. RIGIC is the result of collaboration between the Régie de la santé et des services sociaux de la Mauricie et du Centre-du-Québec [Mauricie and Centre-du-Québec regional health and social services board], the Centre hospitalier régional de Trois-Rivières (CHRTR) [Trois-Rivières regional hospital centre], and the Centre hospitalier du Centre-de-la-Mauricie (CHCM) [Centre-de-la-Mauricie hospital centre], in partnership with MediSolution Ltd.

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 RIGIC project yielded a number of outcomes. The three major areas in the care and services continuum in which there were significant impacts were: dynamic information sharing; access to critical data on an expanded canvas, with a maximal data set and a minimal data set; and use of real-time access as a lever to aid medico-clinical decision making.

• Achievement of increased effectiveness in everything relating to administration of care, giving physicians, nurses and other workers user-friendly tools enabling them at any time to input pertinent clinical data in electronic form when they are obtained, and to consult the clinical data needed for optimum administration of care.
• Strict control over access to confidential health information, through implementation of mechanisms to make access to the information secure. Strict control in management of confidentiality and privacy resulted in establishment of interinstitutional policies and procedures that go beyond mere computerized management of those data.
• Identification of certain population trends through analysis of health information in comprehensive databases. Analysis of the data in the repositories created in connection with the project could not be started within the current timeframe. Putting in place solutions and making them operational were activities that were carried out on a priority basis, to ensure the feeding of records into the clinical data repositories.
• Creation of data repositories facilitating research, analysis and evaluation. The data repositories have been set up and they manage standardized information, insofar as the information is managed using unified dictionaries. However, use of this information has not begun, since the pace of deployments has not made it possible to put in place mechanisms for identifying the elements to be extracted and used.

Policy Implications

• The arrival of the RIGIC project made the professionals aware of the importance of protecting personal information, given the ease with which they can access the information, once they get past the access codes and passwords barrier. To support this new approach, new policies and procedures had to be developed to communicate to people what they were expected to do and to provide a framework for the new practices flowing from implementation of the project.
• A consent management system requires prior authorization in writing by the patient, so a form for consent to interhospital access to the information in paper format was developed.

Research Implicatons

• RIGIC changed the way health care and services are delivered in the Mauricie region. Greater accessibility of information must not compromised the security of critical information. However, it inevitably leads to a reorganization of practices, in which consensus must be reached and which must generate new approaches to collaboration among the network partners.
• The people involved in the project daily saw their understanding grow over time, enhanced through multidisciplinary exchanges: clinical, administrative and technological.
• Management of change was a major challenge and continues to be one to this day. It has been observed that the participants developed highly valuable expertise.

Lessons Learned

• Management of change is a fundamental element for success. There was experience on a day-to-day basis with the extent to which management of change remains a concern that can quickly topple the best software solutions.
• The clear defining of the objectives constantly served to inform the decisions made by the project managers when a strategic direction had to be chosen.
• A critical lever is the partners' synergy in the establishment of shared service objectives. The workers established a collaboration model to ensure co-operation and co-ordination at each stage, with a view to making the computer-based solutions operational.
• The strength that lies in complementary skills is the most important thing learned in connection with RIGIC. The contribution of each of the people involved guaranteed a better understanding of the organizational issues that emerged as the project moved along.

The Future

This pilot project reflects the regional vision for information technologies supporting delivery of services in the context of a continuum and network of integrated services to the population.

Some issues may be obstacles to the sustainability of the project. Assurance of recurrent funding and putting in place winning conditions for management of change and mechanisms for the users' taking ownership are essential factors in integration of technologies with regular service delivery activities.

The subsequent stages of the RIGIC project will be the subject of consultation with the partners, to ensure a shared vision and understanding of the regional part of the project. Development of a project organization manual will be the favoured tool supporting the consultation. This manual will define the determining elements for the carrying out of the project.

Annex A: Documents or Products Generated

Name of document/material	Description	Reference
Final reports	In accordance with the guidelines issued by Health Canada: Final report - Health Canada Evaluation report - GRIS Financial report Outside auditor's report	Paper documents attached Electronic copy on CD - "Rapports" (reports) directory
Software applications involved	Master patient index Clinical data repository Requests and results system Care plan system Appointments system Interface engine Intake and registration system	MédiIndex MédiData MédiRésult MédiPlan MédiVisit MédiConnect MédiPatient
User's guides	For the software involved	Will be provided on request, with prior confidentiality agreement
Training guides	For the software involved	Will be provided on request, with prior confidentiality agreement
Demonstration video	Tools for training in and dissemination of information on the new functionalities	Electronic copy on CD - "Exécutables" (executables) directory
Confidentiality and privacy	Policy on interhospital access to information Consent form Access procedure Logging procedure	Electronic copy on CD - "Sécurité et confidentialité" (security and confidentiality) directory
Standard contracts (with suppliers)	Private firm, AGTI, for repositioning the project Contract on software and professional services with MediSolution Contract with the Groupe de recherche interdisciplinaire en santé (GRIS) [interdisciplinary health research group] for evaluation	Paper documents Electronic copy on CD - "autres documents" (other documents) directory

For further information, please contact:

Jacinthe Marchand, at 819-697-3333, ext. 53558, or via jacinthe_marchand@ssss.gouv.gc.ca