Terri Stuart-McEwan and Barry Rubin
Terri Stuart-McEwan and Barry Rubin are Co-Chairs of the UHN Health Information System (HIS) Implementation Committee. (Photo: UHN)

At UHN, our purpose is to transform lives and communities by elevating the way we deliver care, research and education. To support this ambition, UHN needs a new Health Information System (HIS).

As co-chairs of UHN's HIS Implementation Committee, working to drive decision-making throughout UHN's clinical transformation, Terri Stuart-McEwan and Barry Rubin see a day in the not so distant future when the HIS system fully supports the patients we serve at the centre of care.

"We often hear from our patient partners that their experiences at UHN are not seamless," says Terri, Executive Director Surgical Services at Toronto General, Toronto Western and Princess Margaret.

"This initiative is all about changing that."

The same is true for clinicians who are receiving patients for care or handing care over to colleagues in different areas of the hospital. Members of the clinical team can't always access a patient's complete care history using UHN's 30 year-old EPR, and are often asking multiple questions that have already been asked and answered by the patients many times.

Or, clinicians are dealing with misinformation that is repeated or doesn't get corrected.

"This can lead to an inefficient and potentially unsafe environment for our patients and practitioners, because we can't rely on the patient health information that is available to us," Terri says. "UHN's new HIS will resolve this issue, and will help us realize our vision of seamlessly integrated patient care."

What is a HIS?

HIS is a digital tool that allows hospitals to manage all aspects of their operations. Traditionally, HIS functionality integrates clinical and back office functions, helping organizations to centralize the management of information.

"At UHN, our focus will be on enhancing the patient experience by centralizing each patient's healthcare story," explains Dr. Rubin, Program Medical Director at the Peter Munk Cardiac Centre. "We will integrate and expand the functionality of the HIS in a way that will dramatically improve our ability to provide patient care, enhance medical education and support clinical research."

The new HIS will also make it easier for our clinicians to understand what is happening to our patients throughout their healthcare journey.

While UHN's HIS solution is intended to span the enterprise, it will not replace some of our other important systems, such as those used in finance and HR. And, core research systems that are currently in use won't be replaced, but will be linked to the new HIS to ensure the optimal exchange of information.

Why now?

Our current EPR, which was purchased in 1986, has seen its functionality expanded over the last three decades, including the introduction of new systems that support specialty areas of the hospital.

"When we talk about our current environment, we have a hybrid system with a mix of paper and best-of-breed digital solutions," says Terri.

Unfortunately this has created a less than optimal situation, where these solutions no longer meet our growing clinical and business needs; they provide a limited ability to incorporate emerging technological advances, cause duplication of effort and information, and sometimes yield varied sources of truth.

As a large-scale organization, UHN needs modern technology that supports our efforts to advance healthcare delivery and innovation.

"There has been a lot of work done from an IT perspective to stabilize our environment and put us in the best position for success," Terri says. "In addition, our CEO, Dr. Kevin Smith, and Board of Trustees are strongly supportive of this initiative."

A compass to guide the way

The primary focus of implementing a new HIS is improving patient care, while also improving the overall experience for patients and providers, and ultimately contributing to better health outcomes for our patients.

To help define the HIS project's scope, Barry and Terri, along with UHN's HIS Executive Steering Committee, established six guiding principles for the HIS project and implementation.

"TeamUHN understands that we are about to embark on a significant clinical transformation that will be challenging, and that will require a coordinated effort," Barry says. "When things become challenging we have to remember what our guiding principles are and why we're doing what we're doing."

These principles will guide all the decisions the team makes as they move forward with the implementation of the new HIS across UHN.

  1. Support UHN patient safety, quality of care and outcomes assessment initiatives.
  2. Promote the seamless flow of information and safe transitions of care between healthcare providers in the circle of care, UHN patients, clients and caregivers.
  3. Be the primary source of health information for all UHN patients, clients and caregivers.
  4. Further enhance the work experience and well-being of TeamUHN by integrating care, research and education.
  5. Enable high reliability workflows based on UHN appropriate use guidelines.
  6. Incorporate vendor product functionality that aligns with UHN's scope for this project.

Transformative times ahead

"We know that staff have lots of questions and are excited to learn more about our new HIS," Barry says. "As we are still in a procurement period, there is a limit to what we can share.

However, once we have a signed contract we commit to seamless, transparent communication throughout the project."

Terri likens the process to getting work done on your house.

"What we can say right now is that the work over the next two years will be very exciting, and like a home renovation project, it's likely going to get a bit messy," she says.

Over the next 18 to 24 months, the project team will be working closely with clinical teams to examine workflows at very granular levels in preparation for implementation.

"We're going to have to look at what we're currently doing, what we need to stop doing, and consider new ways of doing things to maximize value and ensure that our processes fit within the new system," Terri says. "This standardization work is really about building the foundation of our new house."

And while this transformation isn't being driven by technology, it is important to understand that the new system will shape our processes in ways we like and dislike.

"At the end of the day, implementing the new HIS will be a significant clinical change initiative that will create opportunities to standardize processes across our four sites," Barry says. "Ultimately, the new HIS will unleash the power of technology and innovation, and will drive the convergence of excellent care, research and education at UHN."

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