Central East Local Health Integration Network
CEO Report to the Board
September 28, 2016
Table of Contents
Transformational Leadership...................................................................................................................................... 2
Health Service and System Integration ...................................................................................................................... 3
Quality and Safety ........................................................................................................................................................ 5
IHSP Strategic Aims..................................................................................................................................................... 8
Seniors ........................................................................................................................................................................................................... 8
Vascular ......................................................................................................................................................................................................... 9
Mental Health and Addictions ...................................................................................................................................................................... 12
Palliative Care .............................................................................................................................................................................................. 13
Indigenous Services .................................................................................................................................................. 15
French Language Services ....................................................................................................................................... 16
Enablers ...................................................................................................................................................................... 18
Improving Access to Primary Care .............................................................................................................................................................. 18
Transitions in Care & Electronic Health Information Management .............................................................................................................. 18
Fiscal Responsibility ................................................................................................................................................. 22
Hospital Sector ............................................................................................................................................................................................. 22
Community Sector: Community Support Services (CSS), Community Health Centre (CHC), and Community Mental Health & Addictions
(CMHA) ........................................................................................................................................................................................................ 26
Long-Term Care Sector ............................................................................................................................................................................... 28
Multi-Sector Updates ................................................................................................................................................................................... 29
Ministry-LHIN Performance Agreement Performance Indicators: ......................................................................... 30
Community Engagement ........................................................................................................................................... 32
Operations .................................................................................................................................................................. 35
Other Announcements .............................................................................................................................................. 37
Living Healthier at Home
Keeping at the forefront, the health care needs of our current and future local residents,
changing demographics, fiscal realities, Ontario’s Action Plan for Health and the LHIN Mission
and Vision, the overarching Central East LHIN Integrated Health Services Plan (IHSP) and its
strategic aims can be described as ‘Living Healthier at Home’. The following is a compilation
of some of the major activities/events undertaken during July, August and September in
support of the Central East LHIN’s Strategic Directions;
Transformational Leadership: The Central East LHIN Board will continue to lead the
transformation of the health care system into a culture of interdependence.
Quality and Safety: The Central East LHIN Board defines health care as being person-centred, safe and
of high quality.
Health Service and System Integration: The Central East LHIN Board will work with all partners to
integrate the health care delivery system to better meet the current and future needs of patients,
caregivers and communities.
Fiscal Responsibility: Resource investments made by the Central East LHIN board will put people and
patients first.
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Central East Local Health Integration Network
CEO Report to the Board
September 28, 2016
The Central East LHIN is working towards achievement of the Strategic Aims of the 2016-2019 Integrated Health
Service Plan;
1. Continue to support frail order adults to live healthier at home by spending 20,000 fewer days in hospital and
reducing Alternate Level of Care days for people age 75+ by 20% by 2019.
2. Continue to improve the vascular health of people to live healthier at home by spending 6,000 fewer days in
hospital and reducing hospital readmissions for vascular conditions by 11% by 2019.
3. Continue to support people to achieve an optimal level of mental health and live healthier at home by spending
15,000 fewer days in hospital and reducing repeat unscheduled emergency department visits for reasons of
mental health or addictions by 13% by 2019.
4. Continue to support palliative patients to die at home by choice and spend 15,000 fewer days in hospital by
increasing the number of people discharged home with support by 17% by 2019.
Transformational Leadership
The Central East LHIN Board will continue to lead the transformation of the health care system into a culture of
interdependence.
Housing and Homelessness Framework:
Central East LHIN staff continue to meet with the Service Managers and develop the relationship between the LHIN
and municipalities in aligning our planning and implementation work as it relates to Supportive Living Environments.
The group meets on a bi-monthly basis and last met on August 11th. We would like to extend our congratulations to
Mary Menzies who has retired from the Region of Durham after a long and prestigious career as Director of Housing
Services. Mary was instrumental in establishing the working relationship between the LHIN and the Region. Central
East LHIN staff look forward to working with John Connelly, who has replaced Mary in this same position.
LHIN staff met with municipal staff in Northumberland County and the City of Toronto to collaborate around the
determination of common priorities and potential municipal/LHIN collaborations.
The LHIN’s relationship with the City of Toronto has taken a major step forward as the result of several meetings over
the summer. This has led to the creation of a specific planning table, “The Resilient Tenancy and Services Working
Group” that includes the GTA LHINs and is chaired by Andrea Austen, Lead for the City of Toronto’s Seniors Strategy.
Central East LHIN staff are working with City of Toronto staff to align resources around the new Seniors Shelter that is
planned to open in Scarborough in Fiscal Year (FY) 17/18. This Shelter is the first of its kind in Canada and will provide
services to homeless older adults that are intended to support them in achieving stable housing. Central East LHIN
staff are very pleased to be working with the City of Toronto on this project which will align both existing and planned
Central East LHIN resources with this exciting new service that will serve the most vulnerable older adults in the Central
East LHIN.
Central East LHIN staff were pleased to participate in a series of cross-Ministry consultations regarding the creation of
a Supportive Housing Framework and Best Practice Guide for the province. This integration of policy across Ministries
is very exciting and will provide a common framework for Supportive Living Environments across sectors and ministries.
The Framework and Guide are presently out for more public consultations prior to being finalized later this year.
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Central East LHIN staff have been supporting the current Ministry of Health and Long-Term Care’s transformation of
the Homes for Special Care Strategy. This work will be completed this Fiscal Year (FY), with anticipated program
changes to be implemented in FY 17/18.
Central East LHIN staff attended the opening of a new Supportive Housing Program in Whitby with Ministry of Health
staff. It is the result of a collaboration between Ontario Shores (OS) and the Canadian Mental Health Association,
Durham Branch, (CMHA-D). This new program is a repurposing of Homes for Special Care (HSC) resources that will
serve the needs of long time patients currently ready to leave OS, but who are in need of intensive community supports
to achieve the transition. This well-appointed and comfortable home has been renovated and is in close proximity to
OS. Congratulations to both OS and CMHA-D for their initiative in putting this important supportive program in place.
Health Service and System Integration
The Central East LHIN Board defines health care as being person-centred, safe and of high quality.
Maternal Child Health – Special Needs Strategy:
The four service delivery areas in the Central East LHIN (Durham, Haliburton/Peterborough/City of Kawartha Lakes
(HPCKL), Hastings/Prince Edward/Northumberland (HPEN), and Toronto) continue to meet to develop implementation
strategies for Integrated Delivery of Rehabilitation Services for approval by the ministries in the Fall 2016. Following
the development of formal Steering Committees, each area has been planning for operational changes required to
support the new service delivery model.
Health Links:
Coordinated Care Management
Health Link Network organizations within the six initiated Central East Health Links (Scarborough North, Scarborough
South, Durham North East, Peterborough, Haliburton County and City of Kawartha Lakes and Northumberland County)
continue to complete Coordinated Care Plans (CCPs) in accordance with the Central East Health Links Coordinated
Care Planning Framework.
A total of 416 CCPs were completed in Q1 with regional programs such as the Geriatric Assessment Intervention
Network (GAIN) Hospital and Community Teams and Palliative Care Community Teams (PCCTs) leading the creation
of CCPs within the six initiated Health Links. In Q1, GAIN Teams completed a total of 85 CCPs. The Central East LHIN
has also specified that the provincial Coordinated Care Tool is to be used as the care planning document in all Central
East LHIN PCCTs.
The following provides a breakdown of the number of CCPs completed by each Central East Health Link in Q1:
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Scarborough North: 167
Scarborough South: 114
Durham North East: 36
Peterborough: 34
Haliburton County and City of Kawartha Lakes: 11
Northumberland County: 54
In total, 1,685 new basic CCPs have been initiated for patients in the Central East LHIN since Q3 of the 2013/14 funding
year.
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Durham West Health Link
The initial Kick-off meeting of the Durham West Health Link was held on August 31st, which focused on collecting and
collating information for the Readiness Assessment and Business Plan. A draft of both the Durham West Readiness
Assessment and Business Plan have been completed and the Readiness Assessment has been submitted to the
Central East LHIN’s Senior Team for review and submission to the Ministry of Health and Long-Term Care (MOHLTC).
Initial areas of focus for the Durham West Health Link include Primary Care Engagement and the identification of how
to expedite outcomes, including the completion of CCPs, within the Durham West Health Link as many Durham West
Health Link Network partners participate in the Durham North East and Scarborough South Health Links.
Primary Care Physician Leads in Local Communities
Recruitment of Primary Care Physician Leads in Local Communities continues. Targeted outreach has been completed
to solicit candidates from the Durham North East, Durham West and Northumberland County Health Links. To date,
six of the seven Primary Care Physician Leads in Local Communities have been contracted. An Orientation Session
for the Primary Care Leads in Local Communities is scheduled for October 14, 2016.
Recruitment for the Primary Care Physician Lead in Local Communities for the Northumberland County Health Link
community continues.
Client Health and Related Information System (CHRIS)/ Health Partner Gateway (HPG) Interim Electronic Solution
With two of the Central East Health Links (Durham North East and Peterborough) participating in the provincial Orion
Health CCT Proof of Concept, it has become evident that the remaining five Health Links (Scarborough North,
Scarborough South, Northumberland County, Haliburton County and City of Kawartha Lakes, and Durham West)
require an electronic solution to facilitate the completion of CCPs.
A decision was made, and supported by the MOHLTC to leverage the Client Health and Related Information System
(CHRIS) and Health Partner Gateway (HPG) system to allow for the joint editing and storage of CCPs. The initial build
of the enhancements to the CHRIS/HPG system is complete. A CHRIS/HPG CCT Interim Electronic Solution Steering
Committee has been developed to plan for the implementation of the Tool to the Central East Health Links not
participating in the provincial Proof of Concept.
To facilitate the implementation of the Interim Electronic Solution, a Readiness Assessment (RA) was distributed to the
Scarborough North, Scarborough South, Haliburton County and City of Kawartha Lakes and Northumberland County
Health Links to determine each Health Link's preparedness to implement the Tool. Based on evaluation of the RAs,
the Scarborough North Health Link will be first to implement the Interim Electronic Solution followed by a phased
implementation in the Scarborough South, Northumberland County, Haliburton County and City of Kawartha Lakes
and Durham West Health Links. Members of the Scarborough North Health Link will be joining the CHRIS/HPG CCT
Interim Electronic Solution Steering Committee.
Orion Health Coordinated Care Tool (CCT) Proof of Concept
Orion Health has recently made changes to the Orion Health Coordinated Care Tool (CCT) Proof of Concept to allow
for joint authoring and editing of Coordinated Care Plans (CCPs) by Health Link Network organizations. These changes
require Health Link Network organizations participating in the provincial Proof of Concept to sign a new Data Sharing
Agreement (DSA). Several participating partners in the Durham North East and Peterborough Health Links have yet
to sign the DSA as there are concerns regarding language contained within the DSA and lack of clarity surrounding
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the issues of collection, use, and disclosure of personal health information. Without the signing of the DSA by all
Durham North East and Peterborough Health Link Network partners, the release of the new CCT Proof of Concept
authoring model has been delayed locally in the Durham North East and Peterborough Health Links, and also
provincially.
In order to facilitate the signing of the DSA, the Health Links Project Management Office has facilitated teleconferences
between the Privacy Officers of Lakeridge Health (LH), Peterborough Regional Health Centre (PRHC), and the Central
East Community Care Access Centre (CECCAC), along with their legal counsel, the Central East LHIN, Orion Health,
CCIM, and the Ministry of Health and Long-Term Care to answer questions Health Link Network organizations have
raised regarding the DSA.
Upon unsuccessfully mitigating these concerns and questions via the teleconferences, the Central East LHIN has
drafted an Addendum to the Orion Health CCT Proof of Concept DSA to facilitate the signing of the DSA and has also
asked that the above listed organizations work collaboratively to draft suggested edits to the DSA that would ensure
their sign-off. LH, PRHC and the CECCAC have additionally requested that the DSA be reviewed by the Information
and Privacy Commissioner of Ontario. The Central East LHIN and Health Links Project Management Office are awaiting
further direction from the MOHLTC.
Community Health Services (CHS) Integration Strategy – Phase II:
Discussions continue on how to effectively interface the Personal Support Service (PSS) Policy Implementation with
the CHS Integration Strategy - Phase II as well as to further interface both initiatives with Patients First: A Roadmap to
Strengthen Home and Community Care. This will mean in part determining how best to advance important PSS
standardization respecting: Intake, Assessment, Care and Service Planning, Care Coordination, Service Delivery and
Wait Listing Management across all Community Support Service (CSS) organizations and services.
Quality and Safety
The Central East LHIN Board defines health care as being person-centred, safe and of high
quality.
Behavioural Supports Ontario (BSO) – Long-Term Care (LTC) Program:
The Central East LHIN was pleased to learn that the province will be providing further investments in the BSO program
that will both sustain and spread these important services throughout the LHIN. The Central East LHIN will receive
$78,334 in stabilization funding to be applied to existing long-term care investments. An additional amount of $568,279
will be provided to support additional investments in long-term care, while an amount of $243,548 is available for
allocation to providers across the health care system. Central East LHIN staff have been working with the Seniors Care
Network and the Central East LHIN Behavioural Supports Ontario Lead to develop the plan for these investments that
will be presented at the September Board of Directors meeting. LHIN BSO investment plans are to be submitted to
the Ministry by September 28, 2016.
Emergency Care Steering Committee (ECSC):
The Central East LHIN has established the Emergency Care Steering Committee (ECSC) and held its first meeting on
July 14th. The meeting was well attended and included Central East LHIN hospital representation - both Emergency
Department (ED) Physician Leads and Senior Administration. The ECSC will be meeting on bi-monthly basis.The
ECSC will provide oversight to the Pay-for-Results (P4R) program and drive the best emergency care in the Central
East LHIN through:
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Patient Experience: Ensure excellent patient experience in the delivery of patient and family-centred care in
Emergency Department (ED) services;
Clinical Leadership: Provide clinical leadership, knowledge, and understanding of the key regional and local
issues as they relate to emergency care in the Central East LHIN;
Education: Promote and share information and/or educational opportunities to Central East LHIN EDs; and
Quality Improvement: Enable the exchange of research, information, and emerging practices across Central
East LHIN EDs for the purposes of standardization, quality, and improvement of ED performance.
The focus of the July 2016 meeting was to review and approve the Terms of Reference, review the P4R program and
review Central East LHIN Hospital Health Human Resources Challenges. The group will meet again on September
29, 2016.
Pay-for-Results (P4R):
Planning for the P4R program continues as the Central East LHIN and P4R hospitals await funding from the Ministry
of Health and Long-Term Care. In August 2016, the Central East LHIN kicked off the first of three P4R Working Group
sessions, with the remaining two sessions having occurred in early September 2016. As part of the scope of the P4R
Working Group, the focus was to review, evaluate and select Shared Projects for endorsement by the ECSC and
approval by the Central East LHIN Senior Team. The group leveraged Expert Choice, an electronic decision-making
tool, to evaluate and score each proposed Shared Project.
In addition to the Share Projects, the working group began developing an evaluation framework for determining the
success of all P4R approved projects (hospital-specific and Shared Projects). The evaluation framework will be used
to guide subsequent P4R planning as it relates to installment funding and fiscal year 2017/18 funding.
Next steps include:
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Recommend Shared Projects for endorsement by the ECSC and approval by Central East LHIN Senior Team;
Finalize performance evaluation framework for all P4R projects, including hospital-specific and Share
Projects; and
Continue to develop reporting requirements for the P4R metrics (including linkages to Health Links and
Primary Care) and project performance.
Critical Care - Life or Limb Policy:
On August 3rd, the Critical Care Services Ontario (CCSO) provided an update on the progress of the Life or Limb Policy
and Repatriation for the 2015/16 fiscal year within Central East LHIN. The CCSO and CritiCall Ontario continue to
monitor Life or Limb Policy performance by reviewing cases that did not meet the policy criteria due to the following
reasons:
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No response from on call physician in 20 minutes;
The physician declined to provide consultation for a declared life or limb case;
No MD on call for a specific service; and
The physician provided consultation but declined the transfer.
For April 1, 2015 to March 31, 2016, the Central East LHIN had a total of two such cases (of the 193 total declared Life
or Limb cases for which Central East provided consultation). CritiCall Ontario sent letters to the relevant hospital Chiefs
of Staff to bring these cases to their attention. Overall, the Central East LHIN successfully facilitated 99.0% of Life or
Limb cases for the fiscal year 2015/16.
CCSO has also started to provide LHINs with a preliminary view of Repatriation activity. In 2015/16, based on data
entered by hospitals into CritiCall Ontario’s PHRS Repatriation Tool:
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40.0% of repatriations sent by the Central East LHIN were repatriated within 48 hours by receiving hospitals;
58.4% of repatriations received by the Central East LHIN were repatriated within 48 hours; and
66.9% of all repatriations in Ontario were repatriated within 48 hours.
According to the Provincial Life or Limb Policy, patients will be repatriated within a best effort window of 48 hours once
a patient is deemed medically stable and suitable for transfer to ensure the system can provide timely access to Life
or Limb patients. Repatriation will be a key focus at the CCSO Town Hall on October 20, 2016 including a review of
hospital repatriation activities, focusing on ways to improve data quality and patient flow.
CCSO will also be taking a look at “over-declaration” in the Provincial Life or Limb Policy by discussing data trends at
the LHIN level and translating these into opportunities for program improvements. CCSO hopes that this will generate
significant discussion between hospitals within the Central East LHIN (and across LHINs) and opportunities for
improving patient access and flow. On August 23rd, the Central East LHIN Critical Care Network (CE-LCCN) at its
quarterly meeting discussed the need to develop a critical care quality reporting framework for the LHIN as well as for
all Intensive Care Units (ICUs) in the Central East LHIN.
Long-Term Care (LTC) Capacity Planning in the Greater Toronto Area:
As reported in June 2016, the Central East and Toronto Central LHINs are working together with a consulting firm to
develop a LTC Capacity Plan. The Plan will assess and recommend on the LTC capacity required in the Scarborough
area of Central East LHIN and across Toronto Central LHIN in both the scope and types of services necessary to
appropriately serve LTC residents today and in the future.
The expected outcome of the project is a better understanding of the “right place of care” options, based on the profile
of patients and clients requiring care and services in the context of LTC Beds, Complex Continuing Care Beds,
Rehabilitation Beds, Assisted Living / Supportive Housing sites, and In-Home services in Scarborough and the Toronto
Central LHIN. In addition to the initial capacity planning work, this phase will provide advice on LTC Decant Space
needed to support the Enhanced LTC Renewal Strategy in Scarborough and Toronto Central LHIN.
An Advisory Committee has been established to provide expert advice and input to this project and inform the
recommendations. The Interim Report was released on July 17th for review and feedback. The final report is expected
for October 31, 2016. The next Advisory Committee meeting has been scheduled for September 9, 2016.
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IHSP Strategic Aims
Seniors
Nurse Practitioners Supporting Teams Averting Transfers (NPSTAT):
Consistent with the Q1 objective, all 68 Long-Term Care (LTC) Homes are now engaged with the program. NPSTAT
service in the final two Homes will complement existing Nurse Practitioner (NP) resources funded through the Home’s
own nursing and personal care envelopes.
ED Aversion Metrics
Through 1,410 face-to-face patient visits in Long-Term Care Homes in the first quarter of Fiscal Year (FY) 2016/17,
NPSTAT NPs directly assessed 1,072 unique patients while providing telephone consultation and support to 378 more.
Only 1.5% of face-to-face patients were transferred to hospital potentially saving almost 5,900 hours of time across
Central East LHIN hospitals and approximately $1.18 million in patient care costs. Consistent with expectation, most
intervention occurred early in the disease process with 68.4% of patients ranked at low acuity using the Canadian
Triage and Acuity Scale 4 and 5 scoring levels.
Repatriation
NPSTAT engaged with 54 LTC patients in hospital to support timely discharge and facilitated earlier discharge for 14
unique hospitalized patients with varying lengths of stay. Repatriation efforts resulted in potential savings of 122
hospital inpatient days and $155,000 in direct patient costs. NPSTAT has committed to more detailed monitoring of
this metric through FY 2016/17.
Geriatric Assessment and Intervention Network (GAIN):
Specialized Geriatric Services (SGS) programs have identified goal based care planning for frail seniors as an area
requiring development across all programs. GAIN is leading this work, with a comprehensive implementation plan for
this new model to be finalized towards the end of 2016.
At the close of Q1, GAIN team cumulatively reported a surplus, largely the result of unfilled staff positions. Recruitment
is underway for remaining vacancies. The GAIN Regional Office will work with the teams to develop relevant proposals
for consideration by the Central East LHIN for the use of surplus funds to advance the work plan of GAIN in FY 2016/17.
Geriatric Emergency Management (GEM):
GEM nurses work in hospital emergency departments, conducting assessments to provide support to older adults
experiencing acute health concerns, with a focus on trying to reduce unnecessary hospital admissions. The Central
East LHIN has nine operational GEM positions.
GEM nurses from the six reporting sites collectively assessed 958 patients through the first quarter of 2016/17, 88.4%
of whom were new patients. The majority of patients are seen in the emergency department prior to an admission
decision. GEM demographics show a consistent range of patients, the majority over the age of 85. Patient assessed
by GEM nurses were discharged home 77.3% of the time.
Dementia Strategy:
The Action Plan for Dementia Care in the Central East LHIN was submitted to Central East LHIN staff in June 2016 by
the three partners: Ontario Shores Centre for Mental Health Sciences (OS), Seniors Care Network (SCN) and the
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Alzheimer Society of Durham Region. The report and accompanying recommendations were presented to the Central
East LHIN Board of Directors during the June 2016 meeting.
The Central East LHIN Board of Directors requested a report outlining a prioritization of the recommendations detailed
in the submitted Action Plan for Dementia Care in the Central East LHIN. This prioritization was received by Central
East LHIN staff in August 2016. Central East LHIN staff are currently performing a review of the document. These
results will be reviewed by the Central East LHIN Senior Team when they are presented in the form of an Action Plan.
Once approved, these materials will come forward to the Central East LHIN Board of Directors for consideration.
Physiotherapy Reform – Exercise and Falls Prevention:
The Central East LHIN, supported by the nine Lead Agencies, continue to finalize the implementation of exercise and
falls prevention classes targeting specific populations. This work involves the development of classes targeting the
Francophone population, which are anticipated to begin in September 2016. (Additional details included in the French
Language Services section).
Assess and Restore:
In collaboration with the SCN, Central East LHIN staff conducted an evaluation to determine recommended projects
for 2016/17. As per the Ministry of Health and Long-Term Care (MOHLTC) process, proposed 2016/17 projects were
reviewed by the MOHLTC in May 2016, and were subsequently approved by the Central East LHIN Board of Directors
in July 2016. The funding letters are in the process of being finalized and will specify the organization-specific
performance metrics related to this initiative (i.e. number of incremental attendances/visits; number of frail seniors
served; % unplanned readmission to hospital within 30 days of discharge from hospital, as well as unique organizationspecific metrics).
The following are additional reporting requirements for 2016/17 for each initiative:
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% of patients with evidence of discharge documentation sent to primary care physician and/or next rehab
care provider;
% of clients discharged home that were home prior to admission;
Demonstration of Health Link involvement (i.e. participation in Health Link care conferencing, number of
completed Coordinated Care Plans, etc.); and
Functional outcome measure change as per Rehabilitation Care Alliance - Frail Senior Medically Complex
Compendium.
Vascular
Vascular Health Strategic Coalition:
The Vascular Health Strategic Aim Coalition (VHSAC) met on June 30th. The Ontario Stroke Network (OSN) presented
on the key finding of the 2014/15 Central East LHIN Stroke Report Card and Stroke Progress Report Card.
The Stroke Report Card compares performance of Central East LHIN to other LHINs and ranks performance to
provincial benchmarks (if available). The Stroke Progress Report compares Central East LHIN’s performance to its
own average performance in the previous three years.
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Key findings from these reports were as follows:
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Central East LHIN was a high performer provincially on three indicators;
There was significant improvement on 7 of 16 indicators in comparison to past (2011/12-2013/14)
performance; and
There are opportunities for system level planning to optimize acute care (i.e. stroke unit care) and community
model of care post discharge from hospital.
The VHSAC members were also asked to review the Terms of Reference (ToR) for their own supporting committees
to ensure that the ToRs’ have wording regarding the relationship to the Vascular Health Strategic Aim Coalition, and
that the objectives of the groups support the achievement of the Vascular Aim.
Telehomecare:
At the end of July, there were 115 patients with Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart
Failure (CHF) (or both) that were enrolled in Telehomecare, with 82 patients continuing to provide daily monitoring data
from the communities of Haliburton, Kawartha Lakes, Durham and Northumberland.
The Central East CCAC Telehomecare program is entering its 6 month of operation; therefore the first group of patients
is nearing discharge from the program. The discharge process involves ensuring that patients are confident in
managing their symptoms independently as well as providing resources to patients so that they might continue to
access appropriate community resources beyond discharge from Telehomecare.
Telehomecare has been met with enthusiasm by the hospital partners, owing to the program’s potential to help
hospitals meet their Strategic Goals and Quality Improvement Plans by reducing Emergency Department visits and
admissions for patients with COPD and CHF. Rouge Valley Health System has embedded Telehomecare into its Order
Sets for both COPD and CHF, and Northumberland Hills Hospital has committed to do the same in the near future.
Stroke:
The Cross –LHIN Planning: Community Based Stroke Rehabilitation was held on July 13th with representation from the
Central East, Central and Toronto Central East LHINs. The group discussed the overarching question: How can we
implement best practice stroke care to align with QBPs across three LHINS that have interdependencies and some of
which have unique needs (e.g., rurality)?
The meeting also included time to review resource mapping across the three LHINs - What exists, what are the options
for filling gaps, what are the options for community based rehab and implications? The group agreed on next steps,
including recommendations to senior leaders, stakeholder engagement and possible change process.
Outcomes of the meeting included establishing commitments to ongoing cross-LHIN planning for stroke with focus on
community sector. There was agreement that stroke could be leveraged to inform regional and sub-regional planning.
The group discussed the Integration of the Forward Sortation Areas (FSA) data in the LHIN maps to support more
robust modelling. The next meeting of this group is at the end of September with a plan to update the LHIN CEOs
subsequent to the September meeting.
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Governance and strategic planning for the integration of the Ontario Stroke Network and Cardiac Care Network have
been initiated. Stakeholder input is being gathered relative to the role and function of this new organization in vascular
health.
Centralized Diabetes Intake (CDI):
In Q1 there were a total of 478 referrals assessed by the CDI Care Coordinators with 117 referrals forwarded to CCDC
sites and 361 to DEP sites across the LHIN. Primary Care Providers are the largest referral source and referred 276
patients to CDI in Q1. In July, 2016 a total of 169 referrals were assessed and processed by CDI. Of those referrals,
112 were sent to DEPs across the Central East LHIN. CDI is currently achieving their targets.
Diabetes Education Centres (DEPs):
The MOHLTC is aligning the Ontario Diabetes Strategy, previously part of the Implementation Branch, to the Home
and Community Care Branch as it is implementing the Roadmap to Strengthen Home and Community Care. As part
of the implementation, they have divested the Centre for Complex Diabetes Care (CCCD) and Self-Management
Programs to the LHINs. The outcomes of these divestments include: improved coordination and integration of care for
individuals living with diabetes and chronic diseases; streamlined services and accountability; and alignment with LHIN
Renewal. The divestment was completed by July 1, 2016. DEPs Q1 and Q2 program reporting is due to the LHIN on
November 4, 2016.
Centre for Complex Diabetes Care (CCDC):
In July, 2016, there were a total of 57 referrals assessed by Centralized Diabetes Intake (CDI) and forwarded to the
CCDC care delivery sites. The breakdown of these 57 referrals is as follows: Lakeridge Health received 13 referrals,
Peterborough Regional Health Centre received 21 and The Scarborough Hospital received 23 referrals. The three sites
combined are working with approximately 545 active CCDC patients. All CCDC sites are currently achieving targets.
Ontario Renal Network (ORN):
The Ontario Renal Network is an important planning partner in the Central East LHIN and has representation on the
Vascular Health Strategic Aim Coalition.
Capacity
 Peterborough Regional Health Centre (PRHC) needs to re-locate their in-centre dialysis to another location within
PRHC. This is due to the need to do drainage remediation work in the hemodialysis area. No patients are at risk.
Currently, the planning for new space does not reduce any capacity for PRHC, and will not affect patients’ access
to dialysis. PRHC has struck an incident management team to work through this process. The expected
construction on the area is anticipated to take 12 weeks. Northumberland Hills Hospital (NHH) has three stations
available, if required and there is also capacity at the Peterborough Dialysis Management Clinic, as needed.
Ontario Renal Network (ORN) Regional Leads continue to monitor this with PRHC leadership.
 ORN and Regional Leads continue to work with The Scarborough Hospital (TSH) to address capacity needs.
Several options are being considered and worked through, including further minor expansion within TSH, and a
smaller station start-up at the Centenary site of Rouge Valley. Consideration is also being given to the status of
the Independent Health Facilities (IHF) in Ajax Pickering, Markham and a review of a potential re-location of
another IHF from Hamilton, to the Scarborough region.
 Lakeridge Health (LH) has been approved for an additional three station expansion at the Whitby site, increasing
the stations in the new pod, from six to nine. This will result in a total of 21 stations at Whitby. LH will be able to
support TSH in their capacity needs, assuming that some patients are able to travel to LH-Whitby.
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As LH completes the integration with Ajax Pickering, there will be the opportunity to assess if any dialysis patients
presenting at Rouge Valley Health System (RVHS) – Ajax/Pickering (and living within the catchment area) who
may have been transferred to TSH, have a new opportunity to receive care closer to home.
Ministry approved Case Manor to offer peritoneal dialysis in collaboration with Peterborough Regional Health
Centre. However, unfortunately, Case Manor is currently unable to provide this service. Discussions are currently
underway with the Administrators, ORN and Ministry.
Ontario Renal Plan II Goals:
Goal #1: Empower and support patients and family members to be active in their care
 All programs pursuing their work and initiatives for Patient Engagement and an updated plan is due into the
ORN on September 30th.
Goal #2: Integrate patient care throughout the kidney care journey
Pre- and Post-Kidney Transplant Care
 Work continues at the ORN to further define and review pre- and post-transplant needs and issues.
Primary Care Engagement
 All programs submitted their primary care engagement plans June 30th, and now continue to pursue their
initiatives.
Palliative Care
 All programs continue on their journey to progress their work in Palliative care.
Goal #3: Improve patients' access to kidney care
Home and Community Care and Access
 Work continues with both ORN and Regional programs to review increased referrals for home or independent
dialysis options.
Emergency Management Planning
 All programs are now commencing the final step of completing their Emergency Management Plans, due in
to the ORN in March 2017. These will be reviewed, discussed at the regional meeting and work will proceed
as opportunities for standardization are assessed.
Mental Health and Addictions
Implementation Strategy for the Central East LHIN’s Mental Health and Addiction Strategic Aim:
Central East LHIN Mental Health and Addictions Physician Lead
Ontario Shores (OS) is in the process of selecting their new Chief. Once this process has been concluded, the Central
East LHIN will initiate the selection process for a new Mental Health and Addictions Physician Lead. Waiting for OS to
conclude their process ensures that the physician selected will have the opportunity to apply for the Central East LHIN
Lead position.
Community Crisis Review Priority Project:
This project completed its second phase with the submission of their final report on June 30, 2016. Central East LHIN
staff analysis will be completed in mid-September as the next steps for this priority project are determined.
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Assertive Community Treatment Team (ACTT) Value Stream Mapping (VSM):
The ACTT VSM Project has now completed its second year of implementation with their report submitted on June 30th.
The project is now entering its third and final year with a full project report to be submitted as of June 30, 2017. As of
March 31, 2016, 74 clients transitioned to Stepped Care and the number of ACTT Clients discharged had increased
from 64 in FY 14/15 to 71 as of March 31st.
Home First @ Ontario Shores:
The Ontario Shores Home First table has not consistently met over the summer due to vacations. Despite that the
strategy has continued, with the plan to resume regular meetings in September. The pressing need continues to be
patients requiring Long-Term Care for whom no suitable placement can be found.
Rent Supplements and Intensive Case Management Supports:
Although the Ministry of Health and Long-Term Care has confirmed the Central East LHIN allocation of Rent
Supplements and attached Case Management supports for Year 3 of the Housing Strategy, these resources have not
been released. The expected release date is not known at this time.
Palliative Care
Ontario Palliative Care Network/ Central East Hospice Palliative Care (CEHPC) Network:
With its launch in March 2016, the Ontario Palliative Care Network (OPCN) committed to enhancing current Palliative
Care Networks and clinical leadership across the province. One of the first deliverables of the OPCN is the development
of 14 Regional Palliative Care Programs (1 per LHIN) across the province.
To support Regional Palliative Care Networks across the province, the OPCN provided a draft terms of reference for
renewal of current LHIN Palliative Care Networks. To support the renewal of the CEHPC Network, a refreshed Terms
of Reference have been developed with joint accountability to the Central East LHIN CEO and the Central East
Regional Cancer Program Regional Vice President (RVP). The new Regional Network will be chaired by the Central
East LHIN CEO and RVP and will align with provincial, Central East LHIN, and Central East Regional Cancer Program
direction. The existing CEHPCN will cease to function and a call for membership will be issued in fall 2016.
Palliative Care Community Teams:
In December 2014, the Central East LHIN Board of Directors approved funding to support the development of three
(Phase 1) Palliative Care Community Teams (PCCT). These three Phase 1 PCCTs are currently functional in
Scarborough, City of Kawartha Lakes and Haliburton. To support delivery across all Central East LHIN Sub-Regions,
the Central East LHIN Board of Directors approved funding for three (3) new PCCTs (phase 2). In June 2016, to support
PCCT delivery across all LHIN sub-regions, the Central East LHIN sent out a targeted Request for Business Case to
the following communities:
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

Durham
Peterborough
Northumberland/Campbellford
A lead health service provider in each of Durham, Peterborough and Northumberland/Campbellford have submitted a
Business Case to the LHIN detailing PCCT implementation in their community. A Review Committee including Central
East LHIN staff and external partners was created to review the Business Cases. Upon satisfactory alignment with the
Central East LHIN PCCT Model of Care document and agreement on the details proposed in the Business Cases
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between the Review Committee and the health service providers, funding will flow to support the implementation of the
three (3) Teams.
Palliative Care Education:
The Central East LHIN, in partnership with its health service providers funded to provide palliative education, have
developed a LHIN-wide Education Plan. The Education Plan includes formalized education programs (i.e.
Fundamentals, Fundamentals Enhanced, Comprehensive Advanced Palliative Care Education (CAPCE) and
educational opportunities provided by Central East LHIN Palliative Pain and Symptom Management Consultants
(PPSMC). This Education Plan will increase access to specialized palliative care education and training opportunities
across all settings, including community and long-term care.
Palliative Physician Education:
The first of three Learning Essential Approached to Palliative and End of Life Care (LEAP) training sessions was held
on June 17-18th in the Scarborough-cluster at The Scarborough Hospital (TSH). The two-day course was facilitated by
Dr. Rahim Abdulhussein from TSH and co-facilitated by Franzis Henke from the CECCAC, with 19 participants joining
the session.
Planning is also underway for the Durham-cluster LEAP training session (the second of three sessions), scheduled for
September 30-October 1, 2016 at the CECCAC offices. The course will be facilitated by Dr. Osborne, Central East
LHIN Physician Lead and Franzis Henke from the CECCAC. Registration details have been sent out to all interested
participants, with 15 participants enrolled so far.
Residential Hospice:
In July 2016, the Central East LHIN released its Residential Hospice Strategy. The purpose of this document is to
provide a framework for stakeholders who are interested in the planning, development and implementation of
residential hospice in the Central East LHIN. The Strategy includes a Residential Hospice Strategic Aim:
To expand options available to palliative patients in the Central East LHIN by increasing the number of operational
residential hospice beds to 56 by 2019, by:



Pursuing development of beds across LHIN sub-regions;
Advancing collaborative multi-sector partnerships to make best use of public investment; and
Recognizing residential hospice as a key element to advancing Hospice as Hubs strategy.
In June 2016, the Ministry of Health and Long-Term Care (Ministry) announced additional operating funding for
residential hospice beds in the province. Operational funding increased from $90,000/adult bed annually to
$105,000/adult bed annually. In August 2016, the Ministry provided new operational funding to the Bridge Hospice, a
3-bed residential hospice located in Warkworth. The Ministry will be provided $315,000 annually to help support the
operation of the Bridge Hospice, making this the first operational residential hospice to receive Ministry funding in the
Central East LHIN.
Palliative Care Leadership:
To work in partnership with Dr. Osborne, Central East LHIN Palliative Care Physician Lead, a Central East Palliative
Care Clinical Co-Lead (PALCC) (non-physician) is being hired to provide clinical leadership across Central East LHIN
championing both provincial and local strategies within the Central East context. The PALCC will collaborate with local
partners to improve palliative care across all patient populations, illness trajectories and health care settings.
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Working as a member of the Central East Palliative Care Community Team (PCCT) leadership group, the PALCC will
provide clinical guidance, expert consultation and project management support to the region’s six PCCTs. In doing so,
this individual will promote, refine and implement a Central East PCCT standardized Model of Care for all Teams.
Medical Assistance in Dying (MAID):
In February 2015, The Supreme Court of Canada unanimously struck down the Criminal Code prohibition against
physician-assisted dying to the extent that they prohibited physician-assisted dying. In June 2016, assisted dying
became legal in Canada and Bill C-14 received Royal Assent. To support Medical Assistance in Dying (MAID) in the
Central East LHIN, a Central East MAID Working Group has been established and is chaired by Dr. Bert Lauwers,
CEO from Ross Memorial Hospital.
The purpose of the Working Group is:
To plan for seamless, integrated, patient-centred provision of MAID through the development of a regional plan
that promotes equity and access for the patient, resident or client in any organization in the Central East LHIN.
Membership includes representation from the following sectors/services:











Hospital
CCAC
Primary Care
Palliative Care
Long-Term Care
Community Health Centre
Indigenous Population
Hospice
Retirement Home
Pharmacy
CCAC Contracted Service Provider
A Terms of Reference has been created with the deliverable of the Working Group being “A Regional Plan for the
provision of MAID services in Central East LHIN.” The Regional Plan will provide processes and pathways to be
implemented within each sub-region ensuring access to MAID for all patients regardless of geography. The Regional
Plan will support the Central East LHIN IHSP and integrated systems of care.
Given the need for a clinician to provide MAID, a key deliverable will be processes and pathways to support clinicians
to utilize their local networks for conscientious objection or those who require a second opinion.
Indigenous Services
Central East LHIN Indigenous Peoples Strategy:
Each Circle has appointed representatives to the planning committee for the upcoming Annual Joint Circle meeting to
be held at the Curve Lake First Nation on October 28, 2016.
Both Circles have reviewed and finalized their Terms of Reference.
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First Nations Health Advisory Circle:
The Central East LHIN First Nations Health Advisory Circle met on July 21st at the Alderville First Nation. The
discussions included an update from Cancer Care Ontario, updates on the Cultural Safety Training across the LHIN
and health issues in each community. A full planning day to determine a work plan has been scheduled to take place
on September 30, 2016. The next meeting of the Central East LHIN First Nations Health Advisory Circle is scheduled
to take place on September 29, 2016 at the Hiawatha First Nation.
Métis, Inuit and Indigenous Peoples Advisory Circle:
The Central East LHN Métis, Indigenous Peoples and Inuit Health Advisory Circle meeting took place on July 3rd at the
Central East LHIN. The meeting was well attended with many new members and included updates from Cancer Care
Ontario and from the communities themselves. The Central East LHIN Métis, Indigenous Peoples and Inuit Health
Advisory Circle will meet on September 23, 2016 for a full day planning session to develop a work plan.
The next regular meeting of the Central East LHIN Métis, Indigenous Peoples and Inuit Health Advisory Circle will take
place on October 19, 2016 at the Friendship Centre in Peterborough.
French Language Services
FLS Primary Care:
A meeting took place with TAIBU in June to highlight that the Nurse Practitioner (NP) should be hired in the long term,
and flag that TAIBU Executive Director should clarify this issue with the Physician at the beginning of his contract, in
order to avoid conflict with the Ministry of Health & Long-Term Care (MOHLTC) role regarding Physician
appointment/contract.
The Bilingual Physician started providing primary care services in French at TAIBU, in the first week of July. Entité #4
and the Central East LHIN continue to support the promotion of this service. In less than one month, approximately 20
Francophones have received primary care in French in Scarborough. TAIBU Community Health Centre (CHC) has
secured funding over two years from the MOHLTC to maintain the Bilingual Health Promoter position that will support
the work of the Bilingual Physician.
Identification of TAIBU as FLS Provider:
The Central East LHIN has met with TAIBU CHC to review progress the HSP has done toward its identification to offer
services in French in the Scarborough cluster. This engagement included the review of the Identification Process Guide,
active offer of services in French in place at TAIBU, and the HSP preparation for identification. As TAIBU CHC has met
the minimum requirement with the above and the HSP will continue to improve active offers of services in French.
Francophone Community Table on Health-Durham Region (FCTHDR):
With the support of the Entité #4, CMHA-Durham will support TAIBU CHC in providing MHA First Aid in French to the
Scarborough Francophone community. Planning engagement is underway between the two partners to provide this
course as of Q3.
Falls Prevention in September through the ADP (partnership OSCC/CAH):
In the month of June, the Oshawa Senior Citizen Centre (OSCC) and the Centres d’Accueil Heritage (CAH) have
started a partnership engagement to explore opportunities to provide Falls Prevention classes to French-speaking
seniors in Durham region. As a result of this partnership, the OSCC has accepted to support the CAH by converting
one of its Falls Prevention class into French that will be offered to Francophone seniors through the FLS Adult Day
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Program (ADP) in Oshawa. Classes will start in September and based on performance of the FLS classes, the Central
East LHIN, OSCC and the CAH, and Community Care Durham (CCD) will work together to leverage opportunity to
continue providing Falls Prevention in French in ongoing basis.
Joint Action Plan:
The FLS Planner and the Entité 4 staff have worked together to develop a joint FLS work plan to achieve the goals of
the Joint Action Plan, throughout the Central East LHIN Strategic Aims and priorities.
Mental Health and Addictions (MH&A):
The Central East LHIN and two LHINs partners including Central and Toronto Central LHINs are working in partnership
to support a MH&A proposal submitted through Entité #4 by HSPs in the GTA. This proposal aims to support a MH&A
Navigation and Coordinated Access to Community MH&A services, for Francophones to have access to linguistically
and culturally appropriate MH&A. The objective is to maximize the use of existing French language capacity and
support the delivery of culturally appropriate MH&A services in French, and to maximize awareness of, and the use of,
the centralized access programs (Access Point Streamline) by referral sources.
Mental Health Leads and FLS Lead of the LHINs partners have been engaged on discussion to leverage the best way
to support this initiative through a Pan-LHIN funding. As it appears complex for them to support this proposal together
through Pan-LHIN funding, each LHIN will support its respective HSPs separately. The Central East LHIN will work
with the Entité 4 to support CMHA-Durham to work with MH&A HSPs of all Central East LHIN clusters, including
Durham, Scarborough and North-East, to submit an H-SIP directly to support Francophone MH&A in the Central East
LHIN. The FLS MH&A project will also focus on Health Equity by targeting Francophone immigrant population and the
overall Francophone community of the above three LHINs partners.
Francophone Seniors:
The implementation of the FLS Seniors Aim is being planned through a FLS Cognitive Health Project across the Greater
Toronto Area (GTA), with the support of French-speaking stakeholders and planning partners of across sectors,
including the two French Language Health Planning Entities (Entité 4 and Reflet Salveo), 5 LHIN partners, including
TC LHIN, Central LHIN, Central West LHIN, Mississauga Halton and the Central East LHIN. The goal of the FLS
Cognitive Health Project is to meet the growing needs of the aging Francophone population of the GTA.
An FLS Consultant, has been appointed to develop options for service models for memory services, including a memory
clinic focusing on very early detection and intervention for mild cognitive impairment, and that will also address the
need for referrals for those with more severe dementia. These models will include the creation of prevention and
treatment tools, and will align with LHIN priorities set out in the 2016-19 Integrated Health Service Plan (IHSP), the
Central East LHIN action plan for Dementia, and the province’s Dementia Strategy and Patients First Initiatives.
Several engagements have been organized with Central East LHIN HSPs and community stakeholders, including
Seniors Care Network, the Alzheimer Society, Ontario Shores, etc. to learn more about their approach and vision and
their programs and services for both patients and their caregivers/families regarding the continuum from healthy aging
memories, and to explore potential synergies on how they can support the Francophone community, including their
capacity to provide dementia services in French.
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FLS Palliative Care:
In July 13, 2016, the Entité 4 has submitted the FLS Palliative Environmental Scan to the Central East LHIN, with
accompanying recommendations. Further revisions are being incorporated by the Entite and discussions will follow to
explore opportunities to incorporate appropriate FLS Palliative Care strategies into the Central East LHIN Palliative
Care Plan.
Enablers
Improving Access to Primary Care
Primary Health Care Advisory Committee (PHCAC):
Health Link Physician Leads
Health Link Physician Leads: The contracting of seven Health Link and System Transformation Primary Care Physician
Leads (one per LHIN Sub-Region) has been completed, with the exception of Northumberland County Sub-Region.
Targeted outreach will continue in this area. Dr. Caulford, Central East LHIN Primary Care Lead and the Central East
LHIN staff hosted a first touch-base with Leads on September 7th. With the Central East LHIN and Dr. Caulford’s
support their initial activity is to engage with their peers and begin participation in their assigned Sub-Regions. An
orientation session for the Primary Care Leads in Local Communities is scheduled for October 14, 2016.
The LHIN Sub- Region Primary Care Physician Leads will work with Dr. Paul Caulford, to build networks through
engagement of primary care physicians and Nurse Practitioners across the Central East LHIN in the advancement of
integrated systems of care within each LHIN Sub-Region. The next meeting date is scheduled for Wednesday,
September 21, 2016.
Transitions in Care & Electronic Health Information Management
Connecting Ontario:
ConnectingOntario is the provincial initiative that leverages provincial assets (such as the Ontario Laboratory
Information System – OLIS) and assimilates the contribution from hospitals, CCACs, Long Term Care and other
organizations to build the electronic health record (EHR) to improve patient care and clinical efficiencies and provide a
viewer for clinicians. The initiative currently is connecting the three regional initiatives of the GTA, the Southwest and
the Northeast.
The new delivery partner, Sunnybrook Health Sciences Centre has undertaken a re-engagement with the organizations
identified as contributors and viewers for the next wave of implementation. Confirmation has been received that Ross
Memorial Hospital and Haliburton Highlands Health Services are part of this project wave as a viewer. Contribution
and viewing work continues for Peterborough Regional Health Centre, Northumberland Hills Hospital and Campbellford
Memorial Hospital. Ontario Shores Centre for Mental Health Sciences is looking to the rescheduling of their viewing
and then contribution to align with their Meditech Upgrade and in conjunction with their partner Waypoint.
Over the summer, presentations were provided by the Sunnybrook project team on the CGTA system to various smaller
groups in the LHIN including the Seniors Care Network. A preparation package for Family Health Teams, or other
smaller organizations to become viewers has been developed if they wish to gain access to the system through ONEID.
This will be more broadly communicated in the fall.
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Hospital Report Manager (HRM)/ Timely Discharge Summary Information System (TDIS):
A provincial initiative to provide discharge and consult reports from hospitals directly into the EMR of physicians that
will inform providers and improve access to more timely information to improve the delivery of care.
Eight of the nine Central East LHIN hospitals are currently contributing to the HRM system and Ontario Shores Centre
for Mental Health Sciences is expected to go live in the Fall 2016. There continues to be physicians who are working
with Ontario MD and completing the agreements and technology testing to receive reports and the region has over 700
physicians now live on the system, with another 100 having signed agreements. Funding for the last contribution
implementation (for Ontario Shores Centre for Mental Health Sciences) was no longer available and the LHIN has
requested to Ontario MD and to eHealth to provide equitable funding for all hospitals..
Lakeridge Health, as host to the TDIS system, distributed notices to the over 500 TDIS agreement holders to formally
terminate their Service Level Agreements as of November 30, 2016. TDIS subscribers not yet live with HRM are being
contacted via telephone to ensure they are aware of the plans to shut down TDIS, and to determine their intent. Those
expressing interest in HRM are identified to OntarioMD for immediate follow-up.
Clinicians without OMD certified EMRs will be required to provide current fax number information in preparation for the
switch to fax delivery of their reports November 30, 2016. All of the Central East LHIN hospitals have participated in
a planning session to prepare for the cutover and some have begun their own communications to TDIS subscribers in
their catchment.
E-Consult:
A provincial initiative using the OTN system to provide text based pre-referral information between primary care and
specialists to support a determination on next steps in treatment.
E-Consult was identified as part of a research initiative to be used by clinicians in the Central East LHIN in February of
2016. As part of the initiative, we are able to expand and work with Ontario MD to increase adoption. Over the summer
ETI has met with the regional groups to determine the viability and need for e-consult. The focus on the planning is
now with Seniors Care Network, Vascular Network and Mental Health Network.
The Palliative teams see value, but there is concern around the timeliness of response for this sector, and will look at
conferencing as a better alternative. The next step will be training and implementation for the physician leads, and
identification of clinicians in these groups that would like to participate both primary care and specialties.
In September, the provincial project has agreed to allow primary care providers in the seven (7) remaining LHINs to
join the systems in order to increase adoption. Current metrics show that approximately 25% of registered users are
active.
E-Notification:
The e-notification solution is an enhancement of the Hospital Report Manager and adds notification of admissions (to
Emergency or Inpatient) within a hospital and passes the information from the hospitals through the CCAC CHRIS
system (to add information if the patient has services by CCAC) and through the HRM system into the EMR of the
physician. The project is implemented and managed through CCAC and the provincial association OACCAC.
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The request to implement the e-notification solution was made to the CCAC and we are awaiting confirmation of
scheduling the initiative.
Hospital Information Systems (HIS) Renewal:
Hospital Information Systems (HIS) work by the ministry-initiated committees provides guidelines and
recommendations on hospital information system renewal (including procurement, collaboration and standards).
The recommendations and guidelines were released as part of eHealth 2.0 on HIS renewal in August to the LHINs and
Hospital stakeholders. It identifies recommendations and proposes that the Advisory Group continue and further
develop implementation plans.
Pan-LHIN Ontario MD (OMD) Referral Initiative – Primary care to Specialists:
The agency supporting physicians’ technology has been tasked by the Ministry of Health and Long-Term Care to
develop a business case to support referrals of primary care to specialists.
As many of the LHINs have undertaken referral management, they have been asked to work with the project team at
OMD to develop the business case for a solution that will minimize duplication of systems, and ease of use for clinicians.
The LHIN stakeholders have now been expanded from those with referral systems to all LHINs and participation in the
August meeting brought all members up to speed on the criteria and planning. The current proposal is to leverage the
OTN system as the central infrastructure between all referral systems and the clinician’s electronic systems (EMRs).
Coordinated Care Tool (CCT) Provincial Evaluation Committee:
The Ministry of Health and Long-Term Care have formed a committee to provide input to a consultant team in
development of an evaluation framework and completion of the evaluation of six (6) interim solutions to electronic
Coordinated Care Plans in the province and their comparison to the Provincial CCT (ORION).
The evaluation committee has met monthly over the summer and have confirmed the evaluation framework to review
the six (6) solutions currently available in the province to electronically create and manage coordinated care plans:
CCT (ORION), Client Health Related Information System (CHRIS) / Health Partner Gateway (HPG), Southeast Health
Integrated Information Portal (SHIIP), Chatham Kent Solution, Relay Health, Northumberland Partners Advancing
Transitions in Healthcare (PATH).
The framework and approach will be approved at the September meeting and the consultant will then undertake the
engagement with stakeholders using the tools to gather the information and inform the report to complete the work.
Order Sets for Quality Based Procedures – Provincial Initiative:
The province is supporting an initiative to fund and implement quality-based procedure order sets in hospitals to 2018
in order to develop more standardized care and provide supporting metrics provincially.
The Central East LHIN engaged with the project team based at St. Joseph’s in Hamilton to provide information sessions
to hospital leadership over the summer. The result is that seven (7) of the hospitals in the LHIN have signed on to the
project to implement the electronic order sets through the vendor, Think Research. Ontario Shores already has
electronic order sets built into their HIS system (Meditech) and is ineligible for the funded program; and Haliburton
Highlands Health Services and Peterborough Regional Health Centre have declined at this time.
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The project team held their kick-off session with the hospitals on August 26, 2016 and team members for the working
groups of clinicians, project leadership and technology were led through information and planning sessions by project
team members from Think Research and St. Joseph’s. The next steps will be for each organization’s planning and
working groups to begin meeting. There will be regional update sessions held every eight (8) weeks to share information
between organizations.
CERRI – Common Electronic Regional Referral and Intake:
The Novari system is being developed as a regional platform for referrals of all types and pathways to support clinicians
one stop access to referrals and provide a ‘no door is the wrong door’ option for providers and patients. In the first
phase, there are three pathways being implemented: Acute to Rehabilitation and Continuing Complex Care, Diabetes
and Cardio Rehabilitation, as well as the integration to registries and other systems for ease of use.
Over the summer, the vendor has made the additional enhancements requested by the providers prior to full go live of
the system. In addition, to support the automation of the Cardio-Rehab information system use of the referral system,
scoping of the integration has been undertaken to determine need and costs and is expected to be implemented before
the full use of their pathway is undertaken.
Provincial Registries – Patient Registry (EMPI) Contribution:
Provincial Registries exist for patients (demographics) and providers to support validation of the right person. Hospitals
and other large organizations have been contributing to the systems for many years, and in the last three years, the
systems were updated by eHealth Ontario for additional use. Campbellford Memorial Hospital and Haliburton
Highlands Health Services are the only two remaining hospitals to complete contribution to the registries which will be
a foundation for electronic integration and care delivery solutions.
Both Haliburton and Campbellford have completed the agreements and infrastructure changes and are currently
completing the Site Security Assessments. Campbellford has successfully connected to the conformance environment
and message quality testing is in progress in order to process them correctly and for the vendor to apply any changes
required. A change to the IP addresses is required for Haliburton data to be processed, and once completed, the
conformance testing for this hospital can begin.
Health System Improvement Plan – Process Improvement and Electronic Development:
To automate and improve the process of funding and change requests by health service providers to the LHIN and
improvements in the tracking and decision making process internally in the LHIN. This project will eventually integrate
with funding approvals, project management and performance systems.
The changes to the process, including the automation based on the Sharepoint platform, have been reviewed by the
Senior Team. An updated implementation schedule and input of all the current HSIP requests are being done in
September. Webinars to provide the overview and training will be provided to staff and then to providers along with
the communication that provides access to the organizations. The system will be tested for six (6) months and a review
will be undertaken in February 2017 based on the use and feedback by internal and external stakeholders.
Eclipse – Portfolio Project Management:
The electronic application that supports the project management and reporting for projects to be used by the LHIN
staff, as well as the Central Ontario Cluster eHealth programs.
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Over the summer, work through the project management committee in the LHIN have reviewed the solution and selflearning modules have been developed to support the learning and adoption of the tool. The first four modules will
include the overview of project management and purpose of the tool, through access and navigation to more advanced
use of creating and managing projects and reports within the solution. There are an additional four (4) modules
including administration of the system that will be set as curriculum but provided through the vendor training.
Fiscal Responsibility
Resource Investments in the Central East Local Health Integration Network will be fiscally
responsible and prudent.
Hospital Sector
Hospital Funding and Allocations:
The following Hospitals received one-time funding through Urgent Priorities Funding (UPF):
1.
2.
3.
Ross Memorial Hospital (RMH) - $30,253 in support of Cardiac Rehab services for 275 Cardiac Rehabilitation cases;
Rouge Valley Health System (RVHS) - $1,001,418 in support of the Cardiovascular Rehabilitation Program; and
Lakeridge Health (LH) - $67,875 to support a 0.5 Full-Time Equivalent (FTE) Nurse Practitioner (NP) Lead.
The following hospitals will receive one-time funding for additional Magnetic Resonance Imaging (MRI) hours at a
rate of $215 per hour:
1.
2.
3.
4.
5.
6.
LH - $111,800 for 520 additional MRI hours;
RMH - $40,205 for 187 additional MRI hours;
Northumberland Hills Hospital (NHH) - $29,885 for 139 additional MRI hours;
PRHC - $37,840 for 176 additional MRI hours;
RVHS – $109,005 for 507 additional MRI hours; and
The Scarborough Hospital (TSH) - $79,120 for 368 additional MRI hours.
The following hospitals received prior-year (2015/16) one-time Cardiac Services funding related to 3rd Quarter inyear adjustments:
1.
2.
Peterborough Regional Health Centre (PRHC) - $120,400; and
RVHS - $1,037,900.
Hospital Capital Status:
In June 2008, the Ministry of Health and Long Term-Care (MOHLTC) approved TSH’s Diagnostic Imaging Fit-up
concourse project at the general site for up a total amount of up to $8,100,100 with a provincial grant of up to
$6,520,000. TSH is now ready to begin the process of obtaining a contractor to complete the project. With the changes
and increase of costs that have occurred over the years, TSH has been requested to submit a revised Stage 2
Functional Plan to the MOHLTC.
Hospital Service Accountability Agreement (2008-16 HSAA):
In May 2016, the nine (9) public hospitals and one private hospital in the Central East LHIN were notified of the
proposed extension of the current Hospital Service Accountability Agreement (HSAA)/Private Hospital Service
Accountability Agreement (PHSAA) from June 30, 2016, to March 31, 2017. Hospitals were provided with a written
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agreement and sign-off of the 2016/17 extended agreement, which were accompanied by pre-populated schedules for
the entire 2016/17 fiscal year as at March 31, 2016.
The Central East LHIN will follow its standard practice of refreshing HSAA/PHSAA Schedules, and conducting quarterly
performance reviews during 2016/17. Work is underway to develop a more consistent approach to the performance
reviews.
There has been no formal correspondence to date regarding the details of the provincial 2017/18 HSAA process.
For several years, Bellwood Health Services Inc. (BHSI) has been in discussions with the Central East LHIN and the
MOHLTC regarding its intention to relocate its operations, including the 12-bed in-patient alcohol rehabilitation unit
funded by the Central East LHIN, to another location outside of the Central East LHIN.
Bellwood Hospital, a Division of BHSI, serves men and women, aged 19 and older, with alcohol addiction/dependency.
The Central East LHIN provides annual operating funding to BHSI of $1,666,900, which delivers a program for the
treatment of alcohol addiction through a private hospital license for 12 inpatient beds. This inpatient program addresses
all aspects of the addiction, including physical/medical health issues, psychological issues, and social issues. This
program is staffed with an inter-disciplinary team, is accredited with exemplary standing by Accreditation Canada, and
is a provincial resource for Ontario residents.
On June 30, 2016, the Central East LHIN received formal notification from BHSI that it intended to move its operations
from its current location on 1020 McNicoll Avenue in Scarborough (within the Central East LHIN) to 175 Brentcliffe
Road (within the Toronto Central LHIN) at the end of September 2016. This date has subsequently been adjusted to
early November and the adjustment will be brought forward to the Board on September 28th for further discussion. In
the meantime, the Toronto Central LHIN and the Central East LHIN are working together on a formal agreement which
will operationalize the transfer.
Hospital Risks:
At the beginning of the 1st Quarter of 2016/17, two Central East LHIN hospitals faced known risks. One risk first arose
in 2014/15, when several hospitals identified funding misalignments where funding documentation issued by Cancer
Care Ontario (CCO) and the MOHLTC was not in agreement. The majority of these identified risks were resolved during
the course of 2015/16. Despite progress being made to resolve the matter, another funding misalignment has occurred
in 2016/17 and continues to affect TSH. Both the MOHLTC and CCO are aware of the issue and its impact on the Base
Funded Expense calculation. The identified risk is approximately $138K, which potentially impacts the overall Health
Based Allocation Model (HBAM) funding to TSH. Further discussions to resolve this issue were held in mid-June and
mid-August. The MOHLTC met with representatives of the Senior Team, Central East LHIN staff and TSH. The
MOHLTC has now indicated that it will expedite resolution of this issue, over the next few weeks.
The second risk is a continuation of the effects of the performance factors affecting NHH. While the Hospital is approved
to implement its Hospital Improvement Plan (HIP), it faces significant challenges in terms of its operating and working
funds deficits, neither of which appear to be on track (to be eliminated in 2016/17).
A new risk, arising from the disclosure of 2016/17 Health System Funding Reform allocations early in the current fiscal
year, affects both NHH and RMH. In August, the MOHLTC met with representatives of the Senior Team, Central East
LHIN staff, NHH and RMH. The potential issue of medium-sized large community hospitals being affected by funding
23
volatility was discussed. The MOHLTC is now exploring options to establish and, if necessary, mitigate the potential
risk.
Finally, as a result of the acceptance by the MOHLTC of the Report of the Scarborough/West Durham Panel on
April 28, 2016, LHIN staff have begun to identify emerging financial risks related to transitional and restructuring
expenses that may be incurred by RVHS, TSH, and LH. The materiality of these potential risks will be brought forward
as the affected hospitals continue their work with the Ministry-appointed Special Advisor, Mark Rochon.
The initial integration business cases were submitted to the Central East LHIN on July 25, 2016. Both proposals
provided a high-level profile of anticipated challenges and risks related to the facilitated integrations, including impacts
on Human Resources, Financials, Community Engagement and Communications Plans, and identification of
immediate next steps. As disclosed to the LHIN Board at its meeting in August 2016, the proposed integration of RVHS
Centenary integration with TSH would potentially realize a new corporation. This business case identified between $1M
and $1.8M in annual savings, and a one-time investment of up to $25.1M over three years, to achieve a successful
integration and stabilization.
The proposed RVHS Ajax/Pickering integration with LH identified $0.3M in savings annually, and a one-time investment
of up to $18.8M over three years, to achieve a successful integration and stabilization. The LHIN Board approved the
further development of the business cases on the understanding the facilitated integrations would come into effect on
November 1, 2016.
Hospital Performance:
In 2015/16, the MOHLTC worked with all LHINs to revise a range of targets that are now included in the 2015-18
Ministry-LHIN Accountability Agreement (MLAA). Based on local experience in 2016/17, attaining a number of these
targets continues to pose a moderate to significant challenge for hospitals. The most significant challenge relates to
the Magnetic Resonance Imaging (MRI) target. Whereas the target at the beginning of 2015/16 related to the percent
of priority IV cases completed within the access target of 28 days, and was set at 50%, from August 2015 onwards,
the target relates to the percent of priority II, II, and IV cases completed within the access target of 28 days, and has
been set at 90%.
LHIN staff believe attaining this target will require transitional strategic planning and comprehensive action on the part
of the affected hospitals. The Central East LHIN, as well as other LHINs, have adopted a transitional MRI target to
encourage performance improvement in order to ultimately achieve the provincial target. The transitional target for the
Central East LHIN is 70% in 2016/17. All affected hospitals are currently experiencing growing wait lists for patients
requiring MRI services. As a result, wait time days have been impacted.
The Central East LHIN has identified the need to provide ongoing support for a strategic operational plan that will now
include an interim investment of an additional 1,900 MRI operating hours in order to meet the patient demand and
ensure timely access, moving towards both the 70% transitional target and ultimately achieving the 90% provincial
target.
Orthopaedic Quality Scorecard (OQS):
In July 2016, the Central East LHIN received the 3rd Quarter 2015/16 performance results. All HSPs have met or
exceeded the respective performance targets.
24
Hospital Sector Working Groups & Committees:
Diagnostic Imaging Working Group (DIWG)
The DIWG met on July 15, 2016. Members reviewed the DI Efficiencies Report which addressed a number of metrics
including wait times for each of the priority level procedures (reference the WTSWG section below). The Dates Affecting
Readiness to Treat (DART) report is also reviewed monthly, and there has been noted improvement in the data capture
of DARTs.
Recently, in July 2016, Health Quality Ontario released a report and recommendations related to the modernizing of
Ontario’s Radiation Protection Legislation. Technology advancements have now presented challenges within the
context of the existing Act. There is also a need to advance the conceptualization of quality within the initially identified
dimensions - safe, effective, patient-centred, timely, efficient, and equitable. Next steps would include the
establishment of a taskforce to develop regulations and standards. There was no scheduled meeting of the DIWG in
August 2016.
Finance Leadership Group (formerly Hospital/Community Care Access Centre Financial Leadership Group (HCFLG))
The HCFLG met on June 19, 2016. Members discussed the implications of the alignment in 2015/16 of funding and
performance with respect to regional programs. Year-end reporting concluded on June 7, 2016 whereby the use of all
paymaster accounts in practice and in the Self-Reporting Initiative templates had ceased, with the exception of
MOHLTC- or Cancer Care Ontario-approved arrangements.
Members inquired as to the status of the 2016/17 Quality Based Procedure (QBP) Volume Management Instructions.
This document outlines the process related to the reconciliation process of QBPs for each fiscal period, which may be
modified from year to year. As at June 2016, the 2016/17 QBP Volume Management Instructions (VMIs) had not been
released.
The HCFLG met again on July 15, 2016. Members reviewed the Terms of Reference for the working group. There
were some minor revisions incorporated into the existing document and it was adopted by consensus. The name of
the group was revised to reflect anticipated changes in the overall membership over the course of the year. The group
will now simply be called the Finance Leadership Group (FLG).
Members recommended that a sub-group of the FLG be initiated, where the HSP leads of HSFR as well as staff from
the Central East LHIN would provide recommendations to the FLG on HSFR-related matters. Each HSP would have
up to two representatives from both Finance and Decision Support who are familiar with the HSFR methodology and
detailed components of the overall funding model. The recommendation was supported by the group. The inaugural
meeting was planned for August 2016.
The FLG meeting scheduled for August 2016 was cancelled due to lack of membership availability.
Wait Time Strategy Working Group (WTSWG)
The WTSWG met on June 23, 2016, and there was concern expressed regarding MRI Operating Hours where MRI
machines are not currently funded to maximize utilization of capacity operating hours. HSPs provided annualized
capacity operating hours. The Central East LHIN has now secured some funding, and an investment has been made
regarding additional operating hours. Affected HSPs were formally notified on July 4, 2016.
25
HSPs provide a monthly report via the Hospital Status Survey. The overall intent of this survey is to identify risks and
opportunities related to Wait Times for both Surgery and Diagnostic Imaging (DI). Historically, there has been a need
to reallocate funded volumes for surgery. Usually, this would occur at the end of the 3rd Quarter. In some instances,
the reallocation is triggered due to historical funded base volumes which may not reflect current practice within each
surgical modality. In late 2015/16, incremental funded volumes were moved to base.
As a result, members suggested that this may be an opportunity to permanently reallocate both base and funded
volumes to better reflect current reality. In July 2016, the MOHLTC agreed that this reallocation process would be
supported within the confines of existing overall Wait Time funding. HSPs were requested by the LHIN to investigate
potential reallocations and provide recommendations which would be discussed at the September WTSWG meeting.
Members also agreed to investigate additional strategies to be deployed in 2016/17 regarding performance
improvements related to both Surgery and DI. Focus group meetings are to be organized by HSPs to brainstorm options
to advance performance improvement initiatives in Surgery and DI. An additional consideration of other impacts on
performance might include Radiologist Reporting turn-around-time.
There was some initial discussion regarding performance relative to target - DI. The discussion included specific
recommendations, including using two technicians per machine to improve throughput and encouraging booking
procedures over the midnight shift to allow more flexibility and better utilization.
An abbreviated meeting and agenda occurred on July 25, 2016, where members discussed the consolidated results
for year-to-date June. There was a slight decline in performance for some surgical modalities where it was identified
that follow-up with surgeons was warranted. There was also a noted decline in performance related to DI. In part, the
decline is a continuation of data capture issues that arose from the Wait Time Expansion project, and HSPs are working
through data stabilization issues on an ongoing basis with Access to Care.
Hospital Sector Initiatives:
Wait Time Strategy Working Group (WTSWG) Expansion
As indicated in both the WTSWG and the DIWG report, the WTS Expansion Project has resulted in the perceived
decline in performance which is a continuation of data capture issues that arose from the Wait Time Expansion project
implementation in March 2016, and HSPs are working through data stabilization issues on an ongoing basis with
Access to Care.
Community Sector: Community Support Services (CSS), Community Health Centre (CHC), and
Community Mental Health & Addictions (CMHA)
Community Sector Funding and Allocations:
The following reallocation of funding related to Human Services and Justice Coordinating Committee was completed:
1.
2.
3.
Campbellford Memorial Hospital (CMH) – ($7,000);
Haliburton Highland Health Services (HHHS) – ($7,000); and
Canadian Mental Health Association – Haliburton, Kawartha, Pine Ridge (CMHA-HKPR) - $14,000.
The following reallocation of funding related to Assertive Community Treatment Team (ACTT) Stepped Care was
completed:
1. Ontario Shores Centre for Mental Health Sciences (OSCMHS) – ($223,126); and
26
2. Canadian Mental Health Association – Toronto (CMHA-T) - $223,126.
3. The Canadian National Institute for Blind received base funding to support operations at both of its branches
as follows:
4. Canadian National Institute for Blind – Durham (CNIB-D) - $39,870; and
5. Canadian National Institute for Blind – Haliburton, Kawartha, Pine Ridge (CNIB-HKPR) - $93,030.
The Central East Community Care Access Centre (CECCAC) received prior-year (2015/16), one-time funding totaling
$200,000 in support of Health Links.
The CECCAC received one-time funding of $12,000 from UPF to provide one-time Personal Support Services (PSS)
to address unique, short-term client needs.
Momiji Health Care Society (MHCS) received $174,418 in UPF to support Assisted Living Services (ALS)
enhancements.
The following HSPs received Year 3 PSS Wage Enhancement funding:
1.
2.
3.
CECCAC - $3,134,300;
CMH - $4,529;
Carefirst Seniors & Community Services
Association (CSCSA) - $39,348;
4. Community Care City of Kawartha Lakes (CCCKL) $34,609;
5. Community Care Durham (CCD) - $70,524;
6. Curve Lake First Nation (CLFN) - $3,589; and
7. Four Counties Brain Injury Association (FCBIA) $1,667;
8. Haliburton Highlands Health Services (HHHS) $14,619;
9. Kawartha Participation Projects (KPP) - $17,800;
10. Les Centres d'Accueil Heritage (CAH) - $131;
11. March of Dimes Canada (MDC) - $4,223;
12. Momiji Health Care Society (MHCS) -$32,393;
13. Scarborough Centre for Healthy Communities
(SCHC) - $1,468;
14. St. John's Retirement Homes Inc. (SJRHI) $22,032;
15. St. Paul's L'Amoreaux Centre (SPLC) - $69,806;
16. The Canadian Red Cross Society (TCRSC) $8,231;
17. TransCare Community Support Services (TCSS) $62,032 ;
18. Victorian Order of Nurses for Canada - Ontario
Branch (VONCO) - $75,601; and
19. Yee Hong Centre for Geriatric Care (YHCGC) $8,098
Carefirst Seniors & Community Services Association also received additional Year 3 PSS Wage Enhancement funding
from UPF totaling $54,549.
2016/17 Community Investments and 2015/16 4th Quarter SRI Reports:
Central East LHIN staff are currently engaging with community HSPs regarding specific reporting and performance
challenges related to 2015/16 4th Quarter Self-Reporting Initiative (SRI) reports. In August, the Central East LHIN
determined and finalized the first tier of Community Investments for community sector HSPs. All HSPs were informed
of their eligibility for these investments based on a series of evaluations of each community provider’s performance
and its compliance with conditions in the Multi-Sector Service Accountability Agreement (MSAA). Central East LHIN
staff continue to evaluate providers’ eligibility for additional 2016/17 Community Investments. These investments will
focus on strengthening the system through providing additional funding for strong performance and increased
performance targets (where applicable) and on delivering more direct service to the residents of the Central East LHIN,
particularly for services such as adult day programs, assisted living services for high risk seniors, vascular disease,
and palliative care.
27
Total 2016/17 Community Investment funding for providers other than the CCAC approved to-date: $1,040,476, of
which $291,001 is deemed one-time and $749,475 is deemed base operating funding.
Community Sector Capital Update:
The LHIN Board reviewed the programs and services elements of Community Care of the City of Kawartha Lakes’
(CCCKL) combined/modified Stage 1 and 2 submission related to its Community Health Centre New Build Project.
Based on an assessment of CCCKL’s plan, updated information related to its actual and projected services and
program delivery, and assurances that its performance will improve further upon its entry into the New Build, staff
recommended the Board endorse the submission, this approval was obtained at the meeting of the Board on August
24, 2016.
Performance and Risks:
Central East Community Care Access Centre (CECCAC)
The CECCAC anticipates a balanced budget position at March 31, 2017. Base funding adjustments in 2016/17 will
allow the mitigation of growth pressures, the provision of services to the higher needs waitlisted patients, and support
to caregivers. The base funding adjustments include the following:




$ 2,358,900 for 2016/17 and 2017/18 and then annually from 2018/19 onward;
$4,353,000 for HSFR, when fully implemented;
$10,322,700 base funds for expanding service to high-needs clients; and
$ 2,580,700 for enhanced respite services.
The current rate of growth in patient complexity, patient numbers and related service volumes is factored into the
CCAC’s projection of a balanced position at year-end. Growth is closely monitored to allow sufficient time to implement
mitigation strategies if an increase in the rate of growth is seen. The already low costs per patient for Central East
CCAC patients, compared to other CCACs across the province, does, however, impede CECCAC’s ability to realize
further significant savings without increasing patient risk and potentially increasing hospital ED visits.
Despite the new proposed base funding adjustments, the Central East CCAC will continue to implement organizational
and administrative efficiencies to maximize the funding available for patient services.
The table below illustrates the growth in waitlists in August, 2016. Service to higher needs waitlisted patients are
expected to begin in September, 2016.
Central East CCAC Waitlists
Adult Therapy Services
Enhanced Personal Support
Personal Support
April 1, 2016
July 1, 2016
247
1,053
2,304
286
1,233
2,451
Long-Term Care Sector
LTC Sector Funding and Allocations:
Strathaven Lifecare Centre received $735,384 top-up funding for 15 convalescent care beds through UPF.
LTCH Redevelopment:
On August 15, 2016, the Central East LHIN hosted a meeting with the Director, Long-Term Care Home Renewal
Branch, her staff and a representative from the Capital Branch. The delegation first met with the Central East LHIN
28
Senior Team to provide any updates on the Central East LHIN programs and on the developments with the overall
process. Following the meeting, Central East LHIN staff travelled to two Long-Term Care and Retirement Home
locations. The purpose of the visit was to review the physical layout for potential temporary sites to utilize as
redevelopment projects evolve and LTCH beds become unavailable in the short-term.
Long-Term Care Home (LTCH) Service Accountability Agreement (LSAA) 2016-19:
Work has been done at the Pan-LHIN LSAA Advisory Committee, Planning and Schedules Work Group (PSWG) and
Indicator Working Group (IWG) to prepare for the 2017/18 LSAA. The intent is to minimize workload for the LHINs and
the HSPs for this refresh and focus only on essential changes (i.e., licensing changes or schedule updates). LHINs do
not currently plan as a group to introduce new indicators or requirements for 2017/18.
Multi-Sector Updates
Health System Funding Reform (HSFR) Local Health Integration Network (LHIN) Advisory Committee (AC):
The HSFR LHIN AC has been very active over the summer months. In June, the MOHLTC advised the HSFR LHIN
AC of proposed HSFR methodology revisions that may need to occur for both 2016/17 and 2017/18. Revisions under
consideration include a revised Volume Planning and Management Methodology whereby volume allocations for
2017/18 may incorporate a population-based approach; mitigation options are being considered for HSFR fundingrelated issues. Based on feedback from the field, it was identified that there was a need for additional focus and
attention regarding Communication, Education and Knowledge Translation.
Educational sessions were scheduled during the months of August and September, where each LHIN would host a
session focusing on the HSFR Forecasting Tool. The Central East session was held on August 15, 2016, which was
well attended by representatives from all six HSFR-affected HSPs. The adoption and in-depth understanding of each
of the components of HSFR was also highlighted. Quality Based Procedures require support in advancing best practice
and quality outcomes.
The Advancing Quality Sub-Group provided an updated strategy where the originally conducted QBP survey which
occurred in 2014 would now be re-issued to provide a gap analysis and current QBP implementation status update.
The 2016 QBP survey will be circulated for response in early September. The timing of the survey aligns well with other
provincial work being undertaken. A QBP sub-group has been tasked with a comprehensive review of the current QBPs
and, in fact, whether they should actually remain QBPs. Some QBPs, due to the very nature of the disease, are
challenging in terms of clinical management and best practice as often times these patients present with multiple comorbid conditions.
The provincial HSFR Advisory Committee tasked the Communications, Education and Knowledge Translation SubGroup to provide an analysis of the current state of LHIN Local Partnerships (LP) and develop recommendations on
the evolution of the LHIN LPs and to leverage advancement of the implementation of HSFR. Recommendations would
potentially include expanded accountabilities related to standardized work plans, agendas and a more robust Terms of
Reference. This work began in April 2016, and the culmination of the recommendations will be brought forward in early
September.
Integrated funding models continue to be explored. Initial findings would suggest that some QBPs are more conducive
to an integrated funding model across the continuum of care and involving multiple health care sectors.
Health System Funding Reform Local Partnership (HSFR LP):
The HSFR LP has not met over the summer months as the provincial work associated with the future of LPs was
undertaken.
29
Quarterly Report Highlights – Ministry of Health and Long-Term Care (MOHLTC):
The 2nd Quarter 2016/17 report from the LHIN to the MOHLTC is in progress and will be submitted by September 30,
2106. This report includes the LHIN forecast to year-end March 31, 2017, for Operations and TPA (Transfer payment
Agency) funding, risk analysis, and detailed descriptions of programs currently underway at the Central East LHIN.
Self-Reporting Initiative (SRI):
4th Quarter SRI reports for the Community and Hospital sector were due June 7, 2016, and June 9, 2016, respectively.
85% of the Community sector and 70% of the Hospital sector submitted the SRI reports on or before the due date.
SFPM staff reviewed the SRI reports and followed up with HSPs as required.
Ministry-LHIN Performance Agreement Performance Indicators:
The table below summarizes the MLAA indicators for the month of July 2016. Central East LHIN did not meet its
monthly MLAA target for the following indicators:
•
•
•
90th Percentile Wait Time from community for CCAC In-Home Services: Application from community setting to first
CCAC service (excluding case management);
90th Percentile Emergency Department (ED) Length of Stay for Complex Patients; and
Percent of Priority 2, 3, and 4 Cases Completed Within Access Target for MRI Scan.
For those indicators that are reported quarterly through Stocktake, Central East LHIN did not meet the Percent ALC
Days (Q4 2015/16) and ALC Rate targets (Q1 2016/17). The Central East LHIN is working with all Health Service
Providers to develop further mechanisms to reduce ALC. Improvement plans with actionable items are being devised
to help achieve targets within local HL communities.
Central East LHIN did not meet the target for Repeat Emergency Visits within 30 Days for Mental Health Conditions
but did meet the target for Substance Abuse Conditions in Q4 2015/16. Central East LHIN is working closely with
Health Service Providers to improve LHIN performance. Specifically these strategies include: Hospital to Home
Strategy throughout the LHIN Schedule 1 Hospitals; Implementation of Crisis Bed Program; Expansion of Peer Support
throughout the LHIN; CE LHIN Dementia Strategy and Child and Adolescent Hospital based services project; and an
anticipated investment in Behavioural Supports Ontario, (BSO) should have a positive effect on this indicator.
Central East LHIN did not meet the target for Readmissions within 30 days for selected HIG conditions in Q3 2015/16.
Hospitals across the Central East LHIN have identified strategies in their Hospital Quality Improvement Plans (QIPs)
to reduce readmission rates for patients with Pneumonia, CHF and COPD.
30
CENTRAL EAST LHIN
MLAA PERFORMANCE INDICATOR DASHBOARD
Performance effective as of:
July 2016
Table 1: Performance Indicators
Current Data
Status Source
Reporting
Period
Provi nci al
Target
LHIN
Actual
Percentage of Home Care Clients with Complex Needs who received their
Personal Support Visit within 5 Days of the date that they were authorized for
Personal Support Services
95%
88.2%
DoN
2015/16 Q3
Percentage of Home Care Clients who received their nursing visit within 5 days
of the date they were authorized for Nursing Services
95%
94.3%
DoN
2015/16 Q3
90th Percentile Wait Time from community for CCAC In-Home Services:
Application from community setting to first CCAC service (excluding case
management)
21 days
38
DoN
2015/16 Q3
90th Percentile Emergency Department (ED) Length of Stay for Complex Patients
8 hours
9.8
DoN
Jul-16
90th Percentile ED Length of Stay for Minor/Uncomplicated Patients
4 hours
4.10
DoN
Jul-16
90%
46.3%
ATC
Jul-16
90%
92.0%
ATC
Jul-16
90%
92.8%
ATC
Jul-16
90%
93.0%
ATC
Jul-16
Percentage of Alternate Level of Care (ALC) Days
9.46%
13.57%
ATC
2015/16 Q3
ALC Rate
12.70%
17.85%
ATC
2015/16 Q4
16.30%
18.90%
DoN
2015/16 Q3
22.40%
27.29%
DoN
2015/16 Q3
15.50%
16.66%
DoN
2015/16 Q2
91%
ATC
Jul-16
98%
ATC
Jul-16
21
DoN
2015/16 Q2
10
DoN
2015/16 Q2
3.7
DoN
2015/16 Q3
80.9
DoN
2015/16 Q3
45.9%
DoN
2015/16 Q2
Percent of Priority 2, 3, and 4 Cases Completed Within Access Target for MRI
Scan
Percent of Priority 2, 3, and 4 Cases Completed Within Access Target for
Diagnostic CT Scan
Percent of Priority 2, 3 and 4 Cases Completed Within Access Targets for Hip
Replacement
Percent of Priority 2, 3 and 4 Cases Completed Within Access Target for Knee
Replacement
Repeat Unscheduled Emergency Visits within 30 days for Mental Health
Conditions
Repeat Unscheduled Emergency Visits within 30 days for Substance Abuse
Conditions
Readmissions within 30 days for Selected HIG Conditions
Table 2: Monitoring Indicators
Percent of Priority 2, 3 and 4 Cases Completed Within Access Target for Cancer
Surgery 1
Percent of Priority 2, 3 and 4 Cases Completed Within Access Target for Cataract
Surgery 1
CCAC Wait times from Application to Eligibility Determination for Long-Term
Care Home Placement: From community setting 1
CCAC Wait times from Application to Eligibility Determination for Long-Term
Care Home Placement: From acute-care setting 1
Rate of emergency visits for conditions best managed elsewhere
N/A
1
Hospitalization rate for ambulatory care sensitive conditions 1
Percent of Acute Care Patients who have had a follow-up with a physician
within 7 days of discharge 1
1 No established Target; monitoring indicator only
Current Status legend
Indicator has met or exceeded it's target
Indicator has not met it's target but is within a 10% corridor
Indicator has not met it's target and is not within a 10% corridor
31
Community Engagement
Community Engagement is the foundation of all activity at the Central East LHIN. Being more responsive to local
needs and opportunities requires ongoing dialogue and planning with those who use and deliver health services.
Engagement with a wide range of stakeholders can be conducted at various levels including informing and educating;
gathering input; consulting; involving and empowering.
Calendar of Events:
To assist us in tracking our Community Engagement activities, an ongoing Calendar of Events is kept up to date and
shared with staff. It documents all engagement activities with a wide range of stakeholders. Many of these events are
also posted on the Central East LHIN website: www.centraleastlhin.on.ca/showcalender.aspx.
Below are listings of recent activities that involved Central East LHIN staff:
On June 17, Deborah Hammons attended the grand opening celebration of the new Carefirst One-Stop Multi-Services
Centre in Scarborough. This new hub provides access to services for seniors and others in the community under one
roof. The event was well attended by local community members, donors and local elected officials.
Staff provided a presentation to local seniors about LHIN’s and specific health care services for seniors available in
Durham Region at MPP Lorne Coe’s two Seniors Fairs held on June 23rd and June 24th.
On November 1, 2015 Oshawa Community Health Centre (OCHC) and The Youth Centre (TYC) amalgamated into a
single Community Health Centre. At the Annual General Meeting on June 27th, 2016 that was attended by Deb
Hammons, “Carea Community Health Centre” was revealed as the new organization’s name.
The Central East LHIN supported MPP Lou Rinaldi on July 7th with budget announcements at Campbellford Memorial
Hospital and Northumberland Hills Hospital. These events were well attended by hospital board and staff, local elected
officials and the media.
Along with MPP Jeff Leal, the Central East LHIN was happy to participate in the Ministry of Health announcement on
July 25th, regarding the increase to annual funding to Hospice Peterborough to $1.05 million when the community’s
new hospice palliative care hub is complete. Construction is expected to begin soon and open in early 2018.
Parliamentary Assistant John Fraser visited the future site of Glen Hill Terrace in Whitby on July 27th to announce new
investments the province is making in long-term care homes. Glen Hill Terrace proposes to build a new 160-bed home
on 1.8 acres in Whitby.
Karen O’Brien attended the Association of Municipalities of Ontario (AMO) annual conference on August 14-17th. It
was a good opportunity to engage many of the Municipal leaders from within the Central East LHIN, as well as many
of our 13 MPPs.
Engagement Tables and Communication Support:
As noted previously in this report, Central East LHIN staff continue to engage with stakeholders on a regular basis to
manage the local health care system. For more information on these engagement tables see
http://www.centraleastlhin.on.ca/communityengagement.aspx.
32
Media Relations/Tell a Story:
Engaging with our media partners includes the development and distribution of news stories either through Central
East LHIN news releases or repurposing information shared by our health service providers or the Ministry of Health.
The goal is to share information that supports the LHIN’s Strategic Aims. See
http://www.centraleastlhin.on.ca/newsandevents.aspx
Website:
The Central East LHIN website continued to be the primary vehicle for both communication and engagement with our
stakeholders. The beginning of the summer saw an ever increasing number of visits and pages viewed and volumes
remained high in the summer.
Month
June
July
August
Visits by unique visitors
4,604
3,942
3,984
Pages Viewed
16,660
14,100
13,825
% of visitors – New vs. Returning
57.6%/42.4%
55.4%/44.6%
58.9%/41.1%
In June, July and August, 17,117 or 96.16% of the sessions were by users in Ontario with the careers pages continuing
to have the highest number of hits as a landing page after the home page, closely followed by “About Us”, “Contact
Us”, “Goals and Achievements” and “Board and Governance. The goal of the website is to continue to support
colleagues in the Central East LHIN and in other LHINs by posting information that supports the goal of advancing
integrated systems of care and actively promoting engagement opportunities to patients and other stakeholders.
The communications department participated in Google Analytics training over the summer. With this training we can
now determine the referral sources for visitors to the Central East LHIN website, tracking where visitors are going on
the website and where they drop off.
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Social Media:
Communications staff continue to use Twitter to generate awareness of LHIN initiatives and have recently added a link
between the LHIN’s Twitter and Facebook accounts so that Facebook is updated automatically.
As of the middle of September the number of Central East LHIN followers now stands at 2,625 and we are following
700 accounts.
A 28 day summary (mid-August to mid-September) shows an increase in tweets and followers and a decrease in
impressions, visits and mentions:
Additionally, a summary of engagement activity over the past 90 days shows the following:
Impressions: Times a user is served a Tweet in timeline or search results
Engagements: Total number of times a user interacted with a Tweet.
Clicks anywhere on the Tweet, including Retweets, replies, follows, likes,
links, cards, hashtags, embedded media, username, profile photo, or
Tweet expansion
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Operations
Finance:
The first quarter LHIN Balance Sheet and Operations Financial Forecast Report were completed and submitted to the
Ministry of Health and Long-Term Care on June 30, 2016 which includes actual spending from April to May and
projections for the remainder of the 2016/17 fiscal year.
Q1 expenses for Board members were posted on the Central East LHIN website on July 31, 2016. This practice is in
alignment with the Minister of Health’s request to make this information publicly available. The second quarter LHIN
Balance Sheet and Operations Financial Forecast Report will be completed and submitted to the Ministry on September
30, 2016 which includes spending from July through to September 2016 (Q2).
Batch #1 (Finance and Human Resources) of the Operations Policy Manual will be brought forward for a bi-annual
review to the Audit and Finance Committee on October 12, 2016. The second batch will include policies from the
Information Technology and Operations sections and will be brought forward to the Audit and Finance Committee on
January 11, 2017.
Administration:
The Customer Relationship Management (CRM) Funding Module Project has achieved the target deliverables of
governance development, process flow and staff training for the Health Service Provider (HSP) funding letter process.
In June, the project increased its scope to include the CRM Reports feature. This decision was based on building a
robust and sustainable system for current and future use. The CRM database transitioned to a system that would track
and report on HSP funding by sector, program and location. Modified process flows were created and staff training was
provided to meet the target go-live date in September. Both the Yellow Brick process and the new CRM Funding letter
process will run concurrently until the end of the year to ensure the new process meets all necessary requirements.
The CRM Performance Management Module Project was approved for roll-out in July. The Performance and Risk
Management module will serve as a central location to track by HSP, the LHIN’s efforts in meeting its accountabilities
with respect to monitoring HSP performance. The project committee will develop process flows and create automated
reports to provide key stakeholders with information required for decision making. The expected implementation date
for this project is September 2016.
The Archives and Recordkeeping Act Provincial Working Group (ARAPWG) met in July to discuss and plan for the
implementation of the approved LHIN Records Retention Schedules. Records Retention Schedules are date driven,
utilizing the end of calendar years and fiscal years for record series retention periods. LHINs will be tasked individually
to develop authorized disposition processes that are in compliance with the Archives and Recordkeeping Act.
Provisions are underway to supply training sessions and resources to all LHINs this fall.
The LHINs received training in August on the Accessibility for Ontarians with Disabilities Act (AODA). The webinar
examined each of the 38 Success Criteria including the compliance schedule for the Broader Public Sector (BPS). The
LHIN Shared Services Office will provide additional training sessions on Creating Accessible PDF Documents with
Adobe Acrobat and Microsoft Word.
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Human Resources Update:
The following staff members from the Project Management Office were transitioned to the Central East LHIN office –

Marley Budreau is the CECCAC Senior Manager, Quality Improvement LHIN Initiatives and will be
providing leadership to the Health Link Project Management Office. Her official start date was July 11,
2016, Marley is familiar with both the LHIN and the CCAC as her past roles include being a Consultant
at the LHIN and a Project Manager at the CCAC.

Maria Grant is a new Project Manager with the Central East Health Links Team supporting the North and
South Scarborough Health Links. Prior to joining the team, Maria was the Provincial Program Manager
for Cancer Care Ontario's Survivorship Program for six (6) years and focused on implementing models
of follow-up care for survivors of cancer. Maria is no stranger to the Central East region having been a
Health Planner with the Central East LHIN with the System Design and Integration Team in 2008.

Andrea Smith is a Project Manager supporting the Durham North East, Northumberland County and
Haliburton County and City of Kawartha Lakes Health Links. Andrea is also leading the implementation
of the Ministry’s Care Coordination Tool Proof of Concept in Durham North East. Andrea has been
Project Manager since July 2015 and joined the Health Links team in July 2014, in both the Quality
Improvement Facilitator and Communications Coordinator positions. Prior to Health Links, Andrea was a
Senior Programs and Standards Advisor at the Ministry of Health and Long-Term Care and supported
the development of a provincial performance management strategy and implementation for the 36 Public
Health Units. Andrea will be transitioning the Durham North East files shortly to the newest Project
Manager.

Dan Harren graduated from Trent University with a Bachelors in Psychology, with his honours year
specializing in memory and cognition. Dan has years of experience managing clinical programs and
serving patients suffering with mental illness, acquired brain injury, addictions, chronic pain, and spinal
cord injury in hospital, rehabilitation, and community settings. He has a Graduate Certificate in Conflict
Management, and is also experienced in behaviour management/programming.

Rachel Long is the Communications Coordinator with the Central East LHIN Initiatives. Rachel comes
with over six (6) years of experience from Community Care Durham coordinating mental health and
specialized geriatric programs across Durham Region including the launch of Home First, Psychogeriatric
Community Supports and the integration of assisted living and exercise/falls prevention programs. With
additional experience as a Publications Assistant in non-profit and Communications Coordinator in
hospital foundations, Rachel is pleased to work with the LHIN team to support Health Links, Behavioural
Supports Ontario and the Self-Management Program. Rachel has an educational background in Public
Relations, Fundamentals of Mental Health, Healthcare Innovation and Digital Health Promotion.
The Central East LHIN welcomed Samiah Khan to the SFPM unit, her first day was on June 13, 2016 and she has
joined as the Coordinator, SFPM. Samiah’s most recent experience has been at the Canadian Red Cross, Ontario
Region where she held positions as a Project Coordinator, Program Associate and Executive Assistant to the Director
General. She is currently working on her second Masters in Health Evaluation and has attained her Master of Arts
from Carlton University and Bachelor of Arts from York University.
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For our CRM Funding Module Project – Gloria Smith has been working with the CRM group to help with developing
the work processes and training manuals. She was the lead for the implementation of the CRM module for the South
West LHIN.
Matthew Tenney completed a contract with the Central East LHIN working with the Decision Support unit on
Geographic Information System (GIS) mapping. Matt is from ESRI Canada Inc. as a research fellow.
Tunde Igli joined the SFPM unit as a Senior Consultant, System Finance & Risk Management on September 6, 2016.
Tunde has been with the Ministry of Finance for a number years and has held roles such as an auditor/inspector,
specialist, manager and senior policy and legislative designer. She is a Certified Management Accountant, attained a
Master’s in Business Administration from Wilfrid Laurier University and is working on a Canadian Risk Management
Designation.
It is with excitement to announce that Irem Ali has successfully attained the role of Senior Analyst SFPM, his official
start date was September 5, 2016. Irem first arrived at our LHIN in December on contract, prior to coming to the Central
East, Irem worked at the Waterloo Wellington LHIN.
Other Announcements
CareFirst is Internationally Recognized: The below link has been posted to our YouTube channel on the extremely
innovative Carefirst One-Stop Multi-Services Centre located in our LHIN in the Scarborough cluster https://www.youtube.com/watch?v=cgTEATj2nbU. Carefirst has already been internationally recognized for the design
of this facility which allows an integrated group of providers to wrap primary and community-based services around
seniors so that they can live healthier at home. These include Adult Day programs, a Geriatric Assessment and
Intervention Network (GAIN) clinic, computer classes, PSW education facilities and so much more. With a Family
Health Team located on one of the floors, the facility also houses transitional care beds for patients requiring respite
or care that can be better delivered outside the hospital, thus supporting our hospitals with their ALC challenges. Other
tenants include a pharmacy with more allied services to come.
Haliburton Highlands Appoints President and Chief Executive Officer: The Board of Directors at Haliburton
Highlands Health Services announced on July 7, 2016 that Ms. Carolyn Plummer, RN, MHSc was being appointed as
President and Chief Executive Officer. Ms. Plummer was originally hired as the hospital’s Director of Patient Care and
Chief Nursing Executive and had been serving as Interim President and CEO since December 2015.
Lakeridge Health Appoints President and Chief Executive Officer: Lakeridge Health announced on August 25,
2016, that Matthew Anderson was the new President and CEO of the hospital. Mr. Anderson has been serving as the
President and CEO of William Osler Health System in Etobicoke since 2010 and will become Lakeridge’s new CEO in
November.
Respectfully Submitted,
ORIGINAL SIGNED BY
Deborah Hammons
Chief Executive Officer
Central East Local Health Integration Network
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