OPOR Areas of Impact
One Person One Record (OPOR) will have a broad impact on a variety of services and processes throughout the healthcare system. These areas include a combination of health services and vendor supplied modules for both adult and pediatric patients. For clinicians, allied health professionals, or physicians who care for patients in many of these settings, the ability to practice and document within all areas required will be well supported.
Acute Care
Acute Care is the active care a patient receives for short-term treatment for a severe injury, an episode of illness, an urgent medical condition, or during recovery from surgery.
Acute care settings may include emergency departments, intensive care, surgical, obstetrics, and other areas where patients are acutely unwell and require treatment.
Acute care services are provided by a range of medical and surgical specialties.
OPOR’s Clinical Information System (CIS) will assist in the standardization of provincial order sets, plans of care, and structured templates for documentation.
All entered information by the acute care team will be visible and automatically populated to support patient discharge or transfer to other departments or sites.
OPOR’s HIE (Provider Portal) solution will functionally replace SHARE with a more user-friendly design and efficient user access protocols.
Ambulatory Care
Ambulatory Care, also known as Outpatient Care, is medical care provided on a non-admission basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services.
This care encompasses specialist clinic visits, some general medicine care, and advanced medical technology and procedures provided outside the hospital setting.
OPOR will assist in the standardization of provincial order sets, plans of care, and structured document standards which will improve the process for patient intake, treatment, and discharge.
OPOR’s CIS and integrated applications will enable time-efficient access to electronic medication reconciliation, bedside charting, shared health records, and clinical decision support for providers.
Continuing Care
Continuing Care supports people who require clinical care at home, community care services, and long-term care.
This clinical area focuses on the assessment of patient and family needs and works with them in finding the right support to help them live safely at home for as long as possible.
OPOR will enable access to real-time patient information to support the identification of resources matching patient and family needs.
This access will facilitate improved communication and collaboration among healthcare providers across the province.
Critical Care
Critical Care provides intensive care for patients with critical conditions or injuries in an Intensive Care Unit (ICU). Patients in these units are heavily monitored for any changes in condition or vital signs via an interdisciplinary team requiring specialized equipment and technology.
This care is provided in the ICU, pediatric ICU (PICU), and neonatal ICU (NICU) across the IWK and Nova Scotia Health facilities. Some units specialize in certain areas, such as the Cardiac Care Unit (CCU) or post-operative cardiac surgery management in the Cardiovascular Intensive Care Unit (CVICU). Many of these patients are transferred to and from the IWK or QEII hospitals across the Maritimes via EHS LifeFlight.
OPOR will enable consistent methodology in the admission, assessment, and order of treatment for patients in ICUs across the province. All documentation obtained in an Emergency Department (ED) and Inpatient Unit will be accessible and will auto-populate into the patient’s critical care documentation and history.
Diagnostic Imaging
Diagnostic Imaging (DI) refers to various tests presenting internal body parts.
Services available vary by site and include Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound, General Radiography (X-ray), Nuclear Medicine, Fluoroscopy, Angiography, and Interventional Radiography.
These services are provided in 42 sites across Nova Scotia, ranging from tertiary care facilities to community outpatient clinics.
OPOR will enable a single log-in to access the patient radiology health records, orders, and results across the province.
The Enterprise Imaging (PACS) software, as well as the voice recognition software (PowerScribe) will remain in place and seamlessly integrate with OPOR’s Clinical Information System (CIS).
OPOR will also assist clinical standardization at a provincial level throughout its implementation to host new, standardized provincial order catalogues, patient preparations for DI exams, and protocols for scheduling.
Emergency
Emergency Medicine is the provision of urgent care to patients with various conditions and injuries in an Emergency Department (ED). These patients can directly present to the ED in critical condition or become transferred to this department as an inpatient.
The ED uses specialized monitors and technology to manage patients as well as the flow of patients in and out of the department.
Trauma patients can present to their local emergency departments; however, major trauma patients are typically transferred to the IWK or QEII via EHS LifeFlight. ED clinicians have a close working relationship with their colleagues at EHS, who provide pre-hospital care and support transfer between hospital sites.
Emergency Medicine will be supported with a much more comprehensive patient history entered across NSH and the IWK.
OPOR will assist in the standardization of order sets, plans of care, and structured document standards to enable a consistent manner of documentation, ordering, and monitoring across the province.
OPOR’s Clinical Information System (CIS) will enable access to technology supporting patient flow through the department. The CIS will also integrate the EHS Electronic Medical Record for access to patient information regarding the pre-hospital and transfer periods.
Health Information Services (HIS)
Healthcare Information Services encompasses electronic systems designed to manage healthcare data. It involves the collection, storage, management, protection, and transmission of patient health information. This area includes Person Identification and Encounter Management (PIEM), patient and provider identification, patient registration and scheduling, as well as switchboard services.
Health Information Management (HIM) involves the overall management of health records including scanning, release of information, chart deficiency, and record retention. This area is also responsible for medical coding and abstracting, medical transcription, and clinical forms management.
OPOR will enable HIS to standardize how it collects and manages personal health information by replacing a variety of hospital information systems with a single clinical information system with one Master Patient Index (MPI) and provider database.
A single MPI will help ensure accuracy of identification and limit data quality issues related to duplicate patient entries and overlay of patient information. Accurate person identification is required to ensure providers have timely access of patient medical history.
Medical Device Integration
Medical devices are used by many clinicians to support patient care across the province. These devices range from a basic vital sign monitor found in clinics to complex diagnostic and therapeutic systems used in critical care and operating rooms.
The OPOR Bedside Medical Device Integration (BMDI) team works with all clinical areas to evaluate, prioritize, and implement the wide range of medical devices found in the OPOR ecosystem.
Monitors and specialized equipment- including tools such as Cardiac Catheterization suites and dialysis units- will be integrated and populate real-time data via the Clinical Information System (CIS).
This will improve clinical workflows, data quality, clinical-decision support, and patient safety in acute care, ambulatory, and inpatient settings across NSH and the IWK.
Medical Specialties
Medical specialties include General Medicine and numerous subspecialties practicing in various possible settings.
Some subspecialties, such as Cardiology and Nephrology, often use advanced technologies and equipment benefitting from integration to an electronic medical record.
OPOR will assist in the standardization of provincial order sets, plans of care, and structured documents. These will enable consistent and standardized admission processes, orders, consults, referrals, as well as transfer and discharge tools via the Clinical Information System (CIS).
The CIS will enable clinicians to access patient information from any previous NSH or IWK department admission or visit across the province. One-stop-shop access to previous documentation will enable streamlining patient transfers across hospitals for efficient transitions and a more comprehensive picture of the patient care journey.
Mental Health & Addictions
The Mental Health and Addictions Program (MHAP) provides support to those experiencing mental disorders and addictions through services aimed at helping people manage their conditions and work toward recovery.
OPOR will support MHAP providers in the provision of specialized, evidence-informed treatment and care through standardized clinical practices, workflows, order sets, clinical decision support, and plans of care that are based on the latest clinical evidence.
OPOR will also improve access to patient information and communication for providers and partners through real-time electronic clinical documentation, medication management, and results information.
Obstetrics & Gynecology
Obstetrical, Maternity, and Midwifery Care is a specialized field dedicated to providing comprehensive and inclusive support to birthing parents, the developing fetus, and their families throughout the entire journey of pregnancy, labour, and the immediate postpartum period.
In Nova Scotia, compassionate healthcare professionals and experienced midwives working prioritize the physical, emotional, and cultural needs of individuals and their families, ensuring personalized care that embraces diversity and promotes a positive, empowering birth experience for all involved.
Gynecological health care comprehensively addresses the reproductive health requirements for individuals with female reproductive systems through preventive care, diagnosis, treatment, and management of various conditions intending to promote optimal reproductive health and personalized care throughout different life stages
Switching from paper-based records to an Electronic Health Record (EHR) system will revolutionize patient care by improving access to information, enhancing coordination and communication among healthcare providers, reducing medical errors, and increasing overall efficiency. With instant and centralized access to comprehensive patient data, healthcare providers can make informed decisions, avoid duplicate tests, and deliver more personalized and effective treatments. EHRs enable seamless information exchange, promoting continuity of care and faster referrals or consultations. Ultimately, the transition to EHRs transforms healthcare delivery, improving outcomes, greater safety, and an enhanced patient experience.
Oncology
Oncology care delivery will be designed provincially through a partnership between the Oncology Transformation Project and One Person One Record.
Cancer Care Transformation
Pathology and Laboratory Medicine
This area is responsible for the provision of diagnostic laboratory testing for prescribers and patients in Nova Scotia.
Additional services provided include specialized and referral testing, diagnostic consultation, and environmental testing on non-clinical specimens.
OPOR will introduce a single instance of the laboratory information system. Users will no longer log in to multiple sites as they do today, and patient pathology and lab health records will include orders and results from across the province. Lab analyzers across the province will integrate to the new information system through the iBus interface.
OPOR will initiate the use of new and standardized provincial order catalogs, standardized care sets, and the integration with LOINC coding. Cerner Millennium will expand out to all areas of the province for lab, and additional modules will be introduced for the genomics and HLA labs.
Pediatrics & Neonatal
Newborn and neonatal care refers to the specialized healthcare provided to infants during the early stages of life, encompassing the period from birth to the first 28 days. This comprehensive approach focuses on meeting the unique needs of newborns, including monitoring vital signs, ensuring proper nutrition, addressing medical conditions, promoting developmental milestones, and providing emotional support to infants and their families.
Highly skilled professionals and caregivers collaborate to optimize the health, well-being, and growth of these vulnerable newborns, setting the foundation for a healthy and thriving future.
The introduction of a Clinical Information System (CIS) in Pediatric and Neonatal teams will have a profound impact on healthcare.
This system will enhance efficiency and communication among healthcare providers, enabling more coordinated and holistic care for young patients. It will streamline data management, leading to better patient safety and care quality by reducing errors and facilitating data-driven decision-making.
Additionally, the CIS’s data-rich environment will support research and quality improvement initiatives, ultimately advancing pediatric and neonatal medicine.
Overall, this digital transformation promises to empower healthcare professionals, optimize resource utilization, and improve the well-being of pediatric and neonatal patients.
Perioperative Services
Perioperative (Surgical) Services are provided at 17 Nova Scotia and IWK Health facilities across the province. This includes pre-operative care, outpatient clinics, Day Surgery (DS), Same Day Admit (SDA), Operating Rooms (OR), Post Anesthesia Care Units (PACU), inpatient surgical units, Medical Device Reprocessing (MDR) Service and the Perioperative Service Network. Surgical procedures include elective, urgent and emergency operations. The Perioperative Service Network ensures quality, system performance, policy, planning and the facilitation of research and innovation related to all aspects of perioperative and surgical care.
OPOR will assist provincial clinical standardization via various solutions. Notably, we will enable single-entry access to surgical services to help improve surgical wait times, and support provincially-standardized perioperative documentation, in addition to governance supported by predefined policies, guidelines, and standards. This includes enhanced patient tracking to increase Operating Room efficiencies and access to high-quality, reliable data to optimize patient care. Additionally, the Clinical Information System (CIS) will enable access to more comprehensive patient history and enhance the transfer of care process while minimizing documentation inefficiencies. OPOR is also supporting other IM/IT initiatives such as e-Referral, to enhance its functionality in providing digitized referrals across the province.
Pharmacy & Medication Management
Pharmacy services include the provision of pharmaceutical care, medication reconciliation, dispensing, drug inventory maintenance, drug monitoring, patient drug assessment, antimicrobial stewardship, practice-based research and support, drug information, drug use evaluation, educational programs, and performance improvement.
Medication Management involves medication reconciliation, prescription, procurement, storage, selection, preparation, administration, and documentation of medications. The process is designed collaboratively by physicians, pharmacists, pharmacy practice assistants, nurses, and other healthcare providers to ensure drug therapies are safe, effective, and appropriate.
OPOR implementation will introduce the Closed Loop Medication Management (CLMM) system. CLMM uses technology throughout the medication management process. All steps in the process are electronically documented, from ordering to barcode administration of medications. Pharmacy will have ready access to patient electronic health records, including medication administration records, results of investigations, and progress notes to review the clinical appropriateness of an order.
Physician Documentation
Nova Scotia physicians have been burdened with an unnecessary amount of documentation largely due to systemic inefficiencies. OPOR, led by the CMIO and their Physician Support Team, will provide several systemic solutions to minimize time spent on high-quality physician documentation.
OPOR will provide Physician Order Entry (CPOE), allowing physicians to send orders and request consults in a paperless, partially auto-populated, and expedited process to other NSH or IWK medical specialists and allied health professions via the Clinical Information System (CIS). Additionally, OPOR will assist in the standardization of provincial order sets and structured templates supporting auto-population and dictation to minimize time spent during documentation. The integration of monitors and specialized medical devices will allow real-time documentation of various clinical data.
Primary Care
Primary healthcare is a multidimensional system that organizes services for people across the continuum of care and works with partners to improve the health of communities. This approach to healthcare acknowledges the determinants of health and the vital importance of healthy individuals and communities.
Determinants of health include socioeconomic factors such as residence, education, relationships, and income levels, in addition to genetic and environmental factors. It also includes the continuum of care from pre-conception to end-of-life care, emphasizing health promotion, disease and injury prevention, health maintenance, and supporting patients and families as partners in overall healthcare.
OPOR will replace the SHARE portal with the HIE (Provider Portal) to enable more efficient access to clinical data. Provider Portal provides the same functionalities and integrations in addition to a more user-friendly design and an enhanced user access process. This solution will be accessible to any primary care provider across the province- regardless of their affiliation with NSH or the IWK. OPOR will also provide primary care providers in Collaborative Practice Teams with access to the Clinical Information System (CIS) to document and access comprehensive patient records across the province. Additionally, OPOR is currently supporting other IM/IT initiatives, such as e-Referral, to enhance its functionality in providing digitized referrals across the province.
Rehab
Rehabilitation services involves post-acute care, where providers typically treat patients requiring additional care after hospital treatment. Patients recovering from debilitating injury, illness, surgery, or other chronic conditions may receive care through rehabilitation services.
OPOR’s Clinical Information System (CIS) will enable access to comprehensive patient medical records pertaining to their previous treatment in any hospital across the province. Additionally, OPOR will assist in the standardization of provincial order sets, care plans, and structured templates to improve the provision of care and optimize documentation efficiency.