Joy Tetlock Raj Thethy Rhonda Ross

1. “Building Relationships to Improve the Patient JourneyEMR partnership between the Northern Health Region and the Opaskwayak Cree Nation Health Authority. Joy Tetlock Raj Thethy Rhonda Ross

2. Northern Health Region

3. Opaskwayak Cree Nation • OCN is one of eight communities in the Swampy Cree Tribal Council area, and is one of the larger employers in the area • Total membership of OCN is approximately 5,600 with 56% of the members living on OCN land • OCN is governed by a Chief and eight (8) Councilors • In addition to many community services, OCN operates its own commercial enterprises like the OCN Blizzard, the Otineka Mall, the Kikiwak Inn and the OCN Shell; as well two schools, the Joe A. Ross School and the Oscar Lathlin Collegiate

4. Opaskwayak Health Authority • In 2000, the OHA was established by way of a by-law enacted under section 81 of the Indian Act • OHA is governed by a Board of Directors consisting of one Elder, two Portfolio Councilors and five community members appointed by Council • OHA is responsible for the administration and provision of health programs and services to community members • OHA is located in the Beatrice Wilson Health Centre; a 11,553 sq. ft. facility constructed in 2011; Accredited with Commendation in July 2013 • OHA operates a satellite clinic to the RHA; also as a MB Tele-health site; an eChart site as well as a partner community in the Community EMR Mustimuhw Project

5. Overview of The Pas & OCN • Two communities adjacent to one another; once considered separated but through a change in thinking, now considered connected by that same Northern Saskatchewan River • NHR provides health services in The Pas with limited access on OCN • OHA provides community health services on OCN • Residents of OCN access Acute Care and Primary Care services at The Pas Health Complex

6. The Partnership • In 2011, OHA invited the Northern Health Region (NHR) to a joint planning meeting; for many their first time on OCN • An opportunity to create an understanding of different ways of doing things; and to build a working relationship by getting to know one another andsharing common opportunities • Established the goal of addressing the continuity of care for the residents of Opaskwayak Cree Nation • NHR became a stakeholder partner in the OHA Health Services Integration Project

7. Initial Drivers • Community Readiness • OCN wanted improved access to health services for residents living at OCN and for those in neighbouring communities • OCN wanted a physician working at OHA with full access to timely and accurate patient information • Invited NHR to the table for joint meeting to discuss opportunities for partnerships • Shared Resources • OHA’s new Beatrice Wilson Health Centre provided space for the region to place a physician on OCN • Physician provides Primary Care services through the Health Centre but is a contract physician with the Health Region • Plan moving forward is to add an additional Physician once resources become available

8. Initial Drivers • NOR-MAN Review • Provided recommendations and a business case on how to move forward • Amalgamation • Provided NHR with the opportunity to look at an electronic solution • NHR acquired resources through amalgamation to assist with the implementation of an EMR • Was the opportune time to add OHA due to a change in EMR provider on the Western Campus of the Region

9. Moving toward a Shared EMR

10. The Infrastructure Set Up • Install a point to point wireless radio system, from OHA to the hospital • Install new computers, switches, printers & scanners to the clinic • Configure OHA staff onto RHA active directory servers for appropriate access • This provides OHA with a true turnkey solution

11. Privacy Impact Assessment • We understood the necessity of having a PIA developed for this partnership • It was challenging to design at first because this has never been approached before • Privacy Officers from the NHR, OHA and MB eHealth provided recommendations to the PIA • OCN Chief and Council supported the Regional EMR Project and the PIA through Band Council Resolution; a process similar to what was required with the Assembly of Manitoba Chiefs in the cEMR Mustimuhw Project

12. Timeline

13. Implementation • We are in mutual agreement that a shared letterhead would show our partnership to the public • Computers needed to be located side by side, one has cEMR & the other has our EMR installed • Privacy and access to personal health information is a concern for both parties Opaskwayak Health Authority P.O. Box 10280 Opaskwayak, MB R0B 2J0 PH: 204-627-7410 Fax: 204-623-1491 Regional Office 84 Church St Flin Flon, MB R8A 1L8 PH: 204-687-1300 Fax: 204-687-6405

14. Challenges • OCN had a slow PDN link to Winnipeg. We had to find a way for them to communicate with our EMR securely • They have a cEMR (Mustimuhw) at present in use that will continue to be used. How or will the two applications work with one another? • What will IT support services look like? What types of agreements or Memorandum of Understanding needs to be in place? • A PIA had to be agreed upon and signed, since this is the first time for a joint venture, it was unclear how to proceed at first • How were we to audit usage of the EMR

15. Challenges • Connect remote location to our system (issue is site is over bridge and continuing costs) • Provide proper access to our system while also protecting the network and systems

16. Key Learnings • Require full commitment from both partners • Opportunities exist for interoperability between the two EMR systems; NHR and Mustimuhw • Provider access auditing considerations may be different • Implement access to more of the systems required to provide the best health care possible. These include RIS/PACS etc

17. From NHR Perspective • Ability to improve clinical outcomes • Ability to decrease unnecessary tests • Improve timeliness of care • Ensure team members are aware of where the patient is at in their health care journey • Ability to have a common care plan with consistent goals • Patient does not have to tell their story over again as information will be available where they access care

18. From OHA Perspective

20. Questions?