Delivering the digital backbone for integrated care in Ontario, Canada

Introduction: In Ontario, Canada’s most populated province, significant progress has been made in digital health, however silos of personal health information continue to contribute to a fragmented system and experience. Representing more than 13 million individuals, Ontario had the opportunity to further transform the care experience by unleashing the power of integrated data that is both unique in volume and variety compared to other jurisdictions in the world.


Introduction:
In Ontario, Canada's most populated province, significant progress has been made in digital health, however silos of personal health information continue to contribute to a fragmented system and experience. Representing more than 13 million individuals, Ontario had the opportunity to further transform the care experience by unleashing the power of integrated data that is both unique in volume and variety compared to other jurisdictions in the world.
Practice Change Implemented: In 2015, University Health Network, Canada's largest academic research hospital, led the delivery of Ontario's digital blueprint with the implementation of ConnectingGTA -the backbone for digital health innovation in Ontario. ConnectingGTA electronically integrates patient information from across the care continuum making it available at the point of care to improve the patient and clinician experience.
This large-scale change initiative enabled a fundamental shift in the way data is used, digital health tools are leveraged, and how clinicians collaborate, contributing to the advancement of integrated care in Ontario.

Theory of Change:
The ConnectingGTA program developed a change approach aligned with Prosci and a nationally recognized change management framework, to guide end-to-end adoption activities and scale up implementation efforts. ConnectingGTA directly engaged stakeholders at all levels, and was designed by clinicians for clinicians -having direct clinical leadership and involvement throughout the solution design, program development, and implementation.
ConnectingGTA grew from involving two initial clinician champions to directly engaging over 200 clinicians in the design and development that resulted in 40,000 users within the first year of implementation.

Impact & Outcomes:
This approach gave clinicians access to priority clinical data that they identified as important to support the delivery of integrated patient care. As a result, there have been significant improvements to transitions in care as sectors across the continuum have timely access to critical patient information.
With the implementation of ConnectingGTA, patients receive better, faster, more coordinated care, and providers can share information more effectively. Additionally, clinicians have noted that there is improved productivity, more timely treatment, and a reduction in duplicate tests, saving both time and resources across the continuum.

Sustainability & Transferability:
The success of ConnectingGTA led to the rollout of the provincial electronic health record, which continues to grow today improving the integration of care for the province of Ontario. ConnectingGTA now provides access to more than 70,000 health care providers and has progressively grown its active user base to 10,000 -a true mark of sustainability as clinicians have now made ConnectingGTA a part of their daily workflow.
ConnectingGTA continues to expand, adding additional clinical data types such as laboratory and drug information, as well as spreading access across the care continuum to sectors such as primary care and mental health and additions.

Conclusions & Lessons Learned:
ConnectingGTA has transformed the digital health landscape by changing the way data is used, how tools are leveraged, and how collaboration occurs across the care continuum. This sets the foundation for continued opportunities to make advancements towards the delivery of integrated care moving forward in Ontario.
Keywords: electronic health record; change management; digital health; transformation; integrated care