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Angela Davidson

Electronic Child Health Network (eCHN)

Executive Summary:

Andrew Szende, CEO of electronic Child Health Network (eCHN) must present to eCHN’s board of directors a clear plan that outlines a strategy for the Network’s growth. The eCHN Network is designed to provide both the public and registered health care providers with web-based access to children’s health information and services. It (eCHN) has been developed in partnership with the Hospital for Sick Children (HSC), IBM, and four member organizations. Szende believes that the eCHN could be an integral part of Ontario’s health care system. However, a major obstacle to overcome is to generate much needed financial support in order to facilitate its growth. I propose a comprehensive integrated strategy that will be implemented over three years to facilitate the growth of the eCHN Network.

Contributing Problems:

  1. Financial Support: The current financial situation of Ontario’s hospitals is such that they are struggling to provide higher quality health care at a lower cost. Budgets are being cut at all levels of health care. The Health Services Restructuring Committee (HSRC) anticipates that hospitals could avoid spending $900 million annually on acute care. This is evidence that it would be difficult to access the provincial government for financial support. Large and small institutions alike might be reluctant or unable to invest in a new system.
  1. Physician Support: Physicians need to be assured that eCHN does not take away from their power and independence. It is necessary to gain the support of the Ontario Medical Association (OMA) in order to facilitate eCHN’s growth. The OMA has considerable influence on the provincial government and over physicians since it is a self-regulating body. Once physicians have recognized eCHN as a necessary and valuable tool, support from the public will follow.
  1. Institutional Support: The growth of eCHN is also dependent on its utilization in hospitals, clinics, private practice and other facilities that focus on child health care. If eCHN does not have broad institutional support it will not be seen as a valuable tool in child healthcare and funding will be unjustified.

D.Future Structure of eCHN’s Network: During the early years of eCHN’s implementation, the Hospital For Sick Children (HSC) in Toronto is a practical “home base” for this network. However, eCHN’s goal is to be an integral part of the Ontario health care system, and its major partnership with HSC may not be everlasting. In order for the various stakeholders to invest in eCHN, it must be seen as more than an extended service of HSC.

Criteria:

I.Must be able to operate independent of health care professional and institution’s “personal agendas”: The operation of the eCHN Network must not favor the stronger stakeholders. All aspects of a child’s health care must be weighed equally in order to include the concerns of all facilities. All barriers to the involvement in this Network must be addressed.

II.Must be financially independent as to not impose a “burden” on the health care system or health care professionals: Any strategy for the growth of eCHN must not solely depend on “out-of-pocket” expenditure from health care facilities. The eCHN Network must not require an institution to cut costs in other departments to the extent that those department’s performance levels suffer.

III.Must be inclusive to all health care facilities that are concerned with the care of children: No health care facility that focuses on any aspect of the health care of children should be prevented from participation in the eCHN Network. Special arrangements should be made to assist any facility or group of facilities that cannot participate by their own means.

Alternatives:

  1. Do nothing, “survival of the fittest”: Once eCHN is implemented, it is in the “hands” of the institutions. Any institution or health care professional that can afford the cost of including eCHN in their practice can choose to implement it. Physicians and health care professionals will contribute to eCHN voluntarily.

Advantages: Does not require any facility to pay for something it cannot afford, does not require any provincial government participation and ensures that facilities that participate will use the service.

Disadvantages: Does not promote inclusion among health care facilities, depends on “out-of-pocket” expenditure regardless of whether or not an organization can afford it, will be controlled by the wealthier stakeholders, and assumes that health care professionals will contribute voluntarily.

  1. Lobby for federal and provincial financial support: Since eCHN is seen to become an integral part of the health care system, it is essential that both the federal and provincial governments provide full financial support. The ministry of health, (MOH), can allocated money to the provincial government to cover the extra cost of eCHN. Physician and patient use can be covered by OHIP and the provincial government can provide incentives (for physicians) to encourage eCHN’s use.

Advantages: Takes the financial burden off of already struggling health care facilities and includes all health care facilities.

Disadvantages: Complete provincial financial support is unrealistic, no way of ensuring that the service is valued and used correctly, funding in other areas of health care might be reduced, and the government would not take the risk of full support should the eCHN network fail.

  1. A comprehensive integrated strategy: This strategy would require the financial contributions from key stakeholders (i.e. OMA, government, and public to a certain degree). Regulation of the growing network would involve the OMA, provincial government, public, and health care facilities. Growth of the network will emphasize creating accessibility for all health care facilities. The eCHN network growth will occur in phases.

Advantages: Provides accessibility for all health care facilities (small and large), creates ownership and a teamwork approach, participation ensures support from stakeholders, does not place a financial burden on other aspects of health care, and allows room for innovative growth and evaluation through the phase system.

Disadvantages: Requires that the key stakeholders be convinced that the system is necessary and may delay immediate accessibility to all facilities.

Recommendations:

After careful consideration of the problems and review of the criteria I recommend alternative 3, a comprehensive integrated strategy.

The growth of the system will require 3 phases, which will be completed over 3 years.

Phase one:Growth of eCHN within large health care facilities in central locations across Ontario. This includes HSC, St. Joseph’s Health Centre, St. Elizabeth Health Care, Orillia Soldiers’ Memorial Hospital and Centenary Health Centre of the Rouge Valley Health System who agree on the $150 000 membership fee per institution.

Phase two:Establish consistent financial support from OHIP, OMA, and commercial resources. OHIP will contribute an individuals “user’s fee” each time a physician accesses “PROFOR” or a patient registers with “Your Child’s Health.” The OMA will be encouraged to make financial contributions, and in return, it will function as the major contributing regulatory body. Commercial resources will be utilized through paid advertisements on “Your Child’s Health.” These advertisements will only be posted once they have been evaluated and authorized by the eCHN board of directors.

Phase three:Relocation of the eCHN’s home base to a site separate from the HSC. Formation of a “interests’ committee.” This committee will include members from the government, OMA, various health care facilities, and the public. The committee will serve to address any issues concerning small and large stakeholders alike. Establishing a new base membership fee that is dependent on a) a facility’s operating budget, b) location within a region, c) estimated amount of use and d) funding from the provincial government at that present time. Recruiting members on a continuous basis either individually or operating from a shared location until the majority of the province is included.

The goal after three years is to have 90% of the health care facilities either as individual members or as shared members in a common location across Ontario. The majority of large health care facilities across Canada will be members as well. The membership of facilities outside of Ontario will promote the growth of eCHN nationally, which will lead the way to the international community.