Northwest Territories Virtual Care Action Plan

1. Overview of areas of focus

The Northwest Territories (NWT) has one of the highest costs per capita to deliver health services in Canada. Factors related to the demographics of our population, geography, chronic disease and population health characteristics pose a real challenge to sustainability.

The Government of the Northwest Territories (GNWT) has several core systems that facilitate territorial health records. Primary care and specialist outpatient services are documented in the Electronic Medical Record (EMR), a digital patient chart that provides a foundation for NWT virtual care services. The Diagnostic Imaging platform shares information to regional centres across the territory. Reducing patient and provider travel not only saves time and money, it allows patients to be cared for closer to home and to their support systems. Virtual care allows patients to be cared for by the same provider between in-person visits, enabling relationship-based care, which is foundational to culturally safe and effective care. This contributes to improved access to care, equity, timeliess, safety and outcomes.

In response to the COVID-19 pandemic, the NWT health and social services' system significantly increased the use of virtual care by expanding the use of the tools we had, working closely with our care teams, Indigenous governments, and virtual locums. We were able to reduce gaps in secure messaging, file transfer and video conferencing.

While this allowed us to meet the immediate virtual care demands, we recognized limitations to our ability to expand services. The GNWT has an inventory of aging technology solutions, with multiple systems rapidly approaching retirement. Building on the successes of previous territorial rollouts, we will guide the investments of new technologies to enable a comprehensive health care record.

2. Bilateral agreement initiative: HSS EHR strategy and system modernization

The GNWT must approach the replacement of its information systems, as a foundational step towards a more wholesome client record and to meet the future information needs that will support virtual care delivery. The territorial systems are key components of the NWT patient record. However, due to the age and upcoming retirements, there are limitations with connecting to new virtual care technologies, or to other systems being used in other patient care areas. While systems are enabled for territorial use, client health records are not linked across all NWT patient services, and data is captured and updated differently across various technologies. The funding from this agreement will support planning and procurement of new solutions to addresses these challenges.

With program areas looking to fill information gaps exposed by the pandemic, we must plan for new technologies to consider all services as we work towards a comprehensive care record. Patients need to receive care wherever they seek services, and health information systems must work together to keep patient information safe, available to care providers, and to allow providers to find information more quickly and use it to make informed decisions. This means that for patients who have long-term illnesses like diabetes or cancer, a shared patient chart will be able to connect different providers who are all delivering services and will be able to show them patient progress over time. For example, if a patient needs to go from a fly-in community to Yellowknife to get an X-Ray, the clinic in the patient's home community will be able to get all the images and specialist's notes.

At the same time, recognizing the critical need to ensure patient confidentiality and privacy, new digital solutions will support providers to collect the right information at the right time, reducing the need for patients to provide information more than once, while also limiting provider to provider sharing as appropriate. Throughout the services, residents will be enabled to see their personal health information and records, and request copies of it.

To prepare for strategic replacement of solutions in the NWT, federal funds will be used to support development of an overarching Electronic Health Record (EHR) Strategy.

Development of HSS information framework

Currently the HSS electronic systems are independent islands of data. To improve the way we use data to support care, we need to bridge these information streams. We are exploring ways to make data more accessible to patients and care providers to support the continuum of patient care, and to HSS system decision makers to enable evidence based decision making.

This work will support improvements in services and expand opportunities for timely equitable access to care for all northerners by providing a framework of connected information services across all care areas. There will be a more complete patient record supporting seamless care for providers, partners and patients by enabling the right information to be accessed to make the best care decisions.

Program areas that have identified the need to digitize paper records and processes include community counselling, mental health programs, and health information exchange with Alberta and Nunavut for patient continuity of care.

To accomplish this, GNWT will complete coordinated assessments of in-flight or proposed initiatives that touch a patient care record. We will create an information management framework to document available data and establish a governance structure for ongoing effort and governance.

Patient Care Record (Core Patient Record Systems and supports for provider workflow)

Over the course of the pandemic, the GNWT has undertaken several initiatives to support process improvements. It is important to find the balance between resolving urgent operational needs while maintaining the path towards an EHR.

Patient and provider information workflows will continue to be reviewed and optimized across the territory in order to establish territorial standards that work well within the needs of individual communities. Impact assessments will be ongoing to maintain public health service levels while supporting improvement efforts.

We will seek partnerships to support making data more accessible for decision-making. Partnerships could include for example, other GNWT departments, research organizations and researchers, other governments, as well as 3rd party funding.

We are beginning to identify data quality improvements necessary to ensure data is captured in a consistent manner on the front lines of patient care, and that it can be consistently used across the continuum to support providers in the delivery of high quality care by providing data on patient history (e.g. preferences for traditional indigenous healing approaches, chronic conditions, allergies, etc.) regardless of location (i.e. from regional centres to fly-in communities).This will also support health system planning.

These funds will support in obtaining resources to support these efforts, procurement of tools and technologies as required, as well as ongoing engagement opportunities with providers and patients.

Data centre proof of concept

It is not easy to access data for continuity of care between providers who are not using a particular information system. Additionally, it is not easy to access data for broader system-wide decision making, such as to understand a population health status or risk.

For example: the percentage of people with up-to-date immunizations, or the number of people who require diabetes follow-up so clinical staffing levels can be predicted.

This data would normally be pulled from identified information systems and put into a data warehouse. Health and Social Services does not have a data warehouse.

These funds will support in obtaining resources to support these efforts, procurement of tools and technologies as required, as well as ongoing engagement opportunities with providers and patients.

This effort will be coordinated with the initiatives being completed through the Canada Health Infoway Virtual Care Funding. Both streams of work which also aid in enhancing access for providers, standards for data security and privacy controls, and provide a better basis for health information exchange with other jurisdictions and national partners. Improved management of NWT information assets will support proactive decision making such as resource allocations when we have a coordinated technology portfolio with improved analytics capabilities.

3. Funding allocation table

4. Performance measurement and expected results

• The GNWT will collaborate with CIHI to identify a set of pan-Canadian indicators and where possible, provide jurisdiction specific baseline data that will be used by CIHI to measure progress on virtual care implementation.