Grey Bruce Health Services: Rob Croft, Chief Information Officer

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Maintaining continuity of IT systems is a challenge under the best of conditions. The task becomes even more of a challenge when the sites in the network are more diverse and scattered.

That’s the situation Rob Croft faced as CIO of Grey Bruce Health Services (GBHS), an amalgamation of hospitals serving Grey and Bruce counties in Ontario, Canada. While the main facility is located in Owen Sound, the network also includes rural hospitals in Lion’s Head, Markdale, Meaford, Southampton and Wiarton. In addition to supporting six hospitals on one network, the system includes South Bruce Grey Health Centre and Hanover and District Hospital, bringing the total to 11 separate sites on one database. Croft, who has been with GBHS for 30 years, currently runs the I.T.  platform for the patient care systems as well as a number of other applications.

Croft says, “The biggest challenge for an organization like ours is the criteria used to match patients, as we need to share information with a multitude of systems some provincial and some local. They all have a different ways of matching patients and when we factor in the complexity of 12 sites this problem grows exponentially. With the amount of information we’re sending out to these repositories, we have to question the risk involved when the information doesn’t match.”

During his seven years as CIO, Croft was involved with the negotiations with Hanover and District Hospital and South Bruce Grey Health Centre to bring their IT services in-house. Those partnership arrangements have gone extremely well, he said, bringing together support from the other organizations and the commonality of moving a system forward for the overall population.

“We are unique in our partnership arrangement in that we run the front and back-end of most applications for all those sites,” he said. “Our sites have taken ownership over the design decisions and have ended up with a unified single system. This has allowed flexibility and standardization of our approach of care for the overall population.”

HIS Responsibilities

Croft has direct responsibility for the HIS department, as well as clinical records area, telecommunications, biomedical engineering, switchboard and library functionality.

One major project on Croft’s plate right now is the integration of a number of family physician offices in the community where GBHS sends live interface messages back to the different office software vendors. Currently, 100 physicians receive electronic information from GBHS’ servers. This information transfer includes lab results, admission and discharge summaries and radiology results, sent directly to physicians’ offices rather than gathered through a portal. The next phase of this project involves including a medication reconciliation that would be sent to family physicians at the time of a patient’s discharge from the hospital. “On discharge, the patient’s current medication list is automatically sent to their practitioner,” Croft said. “The on-line availability of the list should go a long way toward solving a lot of the medication problems that patients present with in our emergency departments.”

Croft also spends time working with the South West Community Care Access Centre (the region’s primary provider of home health care services), ensuring that automatic referrals are being sent for patients who qualify for care through the CCAC. This work has moved beyond the automatic referral processes and is moving towards the capacity to provide CCACs with advanced notice of pending admissions to prevent hospital visits or alert CCAC that a home evaluation is required for patients preoperative.  This decreases system slowdowns when transitioning a patient from acute care to home care.

Process Planning

A challenge Croft faces in IT services involves process and change management, as well as involving the right people to make those change management decisions that reflect on the technology that is being introduced. To assist with that process, Croft and his staff are completing the necessary workflow mapping, then building the system to support what they want to achieve with that workflow.

“We’ve had hundreds of years to perfect the paper world, and now we’re being asked to move that world into an electronic world,” he said. “It’s going to take a number of years to perfect it. As we work our way down this road, we’re starting to see applications mature, and we are now able to tweak them to the point where we’re getting some real benefit out of them now.”

Healthcare IT Trends

A healthcare trend that Croft sees spilling over into the IT world is the need for patients today to have access to their medical records. Patients are much more informed today and as a result the desire is to have as much information as possible when it comes to their healthcare history and current medical conditions. While printed materials might be acceptable for now, eventually, patients will want that information in an electronic format.

“The IT community is going to have to get its head around understanding that demand from an IT perspective,” he said. “How do you populate personal health records? How will all that come together? Will there be portal solutions? It’s just a matter of time before this issue becomes a key focus of our work. ”

With this trend, as with any new healthcare-related technology, come financial concerns on the part of the institution providing the service. Croft notes that as healthcare budgets tighten, keeping up with the latest technology becomes an issue.

“You want to run the latest and greatest while at the same time get the most use out of your existing systems,” he said. “It’s a tough juggling act for our organizations. It’s costly to remain on old systems, as maintenance fees increase, but it’s also tough for organizations to afford new technology.”

When Croft first joined GBHS, the trend was more about staying current with the latest technology because that was perceived as the right thing to do. While he doesn’t go so far as to say it was a matter of technology for technology’s sake, he does see a movement toward more of the philosophy behind getting value out of the technology. He believes it’s more about looking at the technology differently, to feed repositories or not to duplicate data entry, with the ultimate goal of making the end-user’s experience better.

“Having the expertise of being in a healthcare facility for 30 years and understanding how the organization works at all different levels has given me a huge advantage,” he said. “We’ve been able to blend our technology to make sure that it covers a number of different departmental needs and we’ve built solutions that cover all sectors of the healthcare system. This integrated approach is what has made us successful.”

-by Kathy Knaub-Hardy

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