2.3. Determinaci´on de los par´ametros astrof´ısicos
2.3.3. Composici´on qu´ımica
(): Indicates higher value for a given option (=): Indicates value is the same across both options
The below table summarizes the evaluation of options against five key criteria. Each criteria was considered independent of one another. While both options provide value, the analysis suggests a common solution provides greater value. Details of the evaluation of options against each criteria has been provided in the subsequent pages.
Note: Evaluation of options reviewed by LHIN and ILC.
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4.5 Options Analysis: Value for Patients
Criteria Common HIS ModelMixed Notes
Provides better access to information
• While both options will integrate with and utilize provincial assets like cGTA to access information across patient care settings, a common solution offers a greater likelihood that access to patient information will be consistent across the region.
Enables patient self-management (e.g. self-scheduling, ability to view
results online etc.)
=
=
• Either option will only lay the foundation for patient engagement. A common solution may simplify access points, while local solutions may tailor how patients can interact with the system to meet needs. Ensures patients and families do not
have to tell “my story” or provide patient information multiple times
=
=
• While both options will integrate with and utilize provincial assets to tell the whole patient story, a common solution provides more granular access to information within a system as opposed to just integrated access.
Note: When patients move across LHINs or other HSPs (outside of hospitals), either option will require similar strategies to meet this need. Enables improved communication
across care providers
• While both options will integrate with and utilize provincial assets to communicate across patient care providers, the “transactional system” workflow functionality such as alerts enabled through a common solution allows for a more seamless experience and access to real-time
information for providers where there are patients shared across hospitals within the LHIN.
• In either option, connectivity to other care collaboration tools, portals, etc. will be required.
Increases patient safety and quality of care
• While both options would support improving patient safety, a common solution offers higher degree of standardization and lays the foundation to ensure hospitals work towards standard workflows.
• A common solution supports seamless delivery for regional programs.
Core to this project is value for patients. The current and long-term demands of patients have been carefully considered throughout this analysis. The analysis suggests a common solution will provide greatest value for patients because it lays a stronger foundation for patient engagement, ensures a consistent patient experience and enables the region to collectively meet patient demands to have greater access to information and play an increasing role in managing their own care.
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4.5 Options Analysis: Value for Providers
Criteria Common HIS Mixed Model Notes
Provides real-time information electronically to providers (i.e. from
health tracking apps, etc.)
=
=
• In either option, the HIS will not do this directly. In theory, it may be easier to integrate this once to a common solution, but this may limit the flexibility of how information is integrated.
Increases patient safety and quality of care1,2
• While both options would support improving patient safety, a common solution offers a higher degree of standardization and streamlined clinical information exchange laying the foundation to ensure hospitals drive towards standard workflows.
Note: this is more the case as it pertains to providers who have patients who move across hospitals in the LHIN (i.e. through regional programs). Enables improved communication
with patients/family
members/caregivers
=
=
• Both options would support improved communication with patients due to improved access to information and both will integrate with and utilize provincial assets to communicate across care providers.
Enables easy sharing of information across the continuum of care
=
=
• Both options would support improving sharing of information and will integrate with and utilize provincial assets for access to information across patient care settings. Either option eases providers use through fewer integration points.
The needs and demands of providers as it relates to IT-enabled patient care have been considered throughout the analysis. This analysis suggests that both options provide relatively the same value. The value to providers is in the implementation of a modern HIS either through a common or mixed solution enabling access to information and improved communication with patients.
(): Indicates higher value for a given option (=): Indicates value is the same across both options
1In Central Finland Health Care District, the common HIS system has led to a reduction in time spent on signing in to multiple systems and maintaining disparate patient information – the time freed up contributes directly to improved quality of patient care. It is estimated that doctors’ efficiency has improved by 10% as a result of integration.
2In the Lower Mainland Consolidation (BC), it was recognized that the development of a shared electronic health record improved the quality of patient care and reduced medical errors for patients. Please refer to Appendix H for additional details.
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4.5 Options Analysis: Value for the Health System
Criteria Common HIS ModelMixed Notes
Improved decision support and use of information to support patient
care and program decision making1
• While both options would improve decision making, a common solution has a greater likelihood for facilitating provincial and regional reporting. Improved health outcomes
=
=
• Both options create the ability to maximize patient outcomes through information sharing and inter-operability.
Improved communication of health information between HSPs (beyond just hospitals)
=
• While both options will integrate with and utilize provincial assets to communicate beyond hospital providers, a common solution helps to ensure seamless communication of information between HSPs in the LHIN.
Advancing the health system is an important consideration of this analysis. The analysis suggests a common solution lays the foundation to build out other areas like regional decision support and care coordination. With fewer integration points, a common solution also lays the foundation to easily adopt provincial solutions as they emerge.
(): Indicates higher value for a given option (=): Indicates value is the same across both options
1Canada Health Infoway states the interconnected health information systems allow healthcare providers access to information when and where it is needed, allowing HSPs to ‘make informed decisions in a timely manner, avoiding delays in treatment and care planning’.
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4.5 Options Analysis: Cost Effectiveness (LHIN-Level)
The below graph illustrates the 5 and 10 year Total Cost of Ownership (TCO)1 for each option. To note, the model developed to calculate TCO for each option includes several assumptions (please refer to Appendix E) that procurement, design and build of an HIS has lower costs for a mixed model than baseline, and further savings over the long-term for a common HIS. The model does not predict or include the variances of unknowns such as the specific HIS system, or changes to implementation costs and is a model to understand the financial implications of each option.
• Baseline: refers to hospitals pursing incremental investment in the current composition of shared and independent models. This includes: PRHC, CMH, & NHH sharing an instance, LH & RVHS sharing an instance, and the remaining 4 hospitals remaining independent
• Common HIS: refers to all hospitals sharing an instance
• Mixed Model: refers to the “current future state” plans where OS, TSH and RVHS remain independent, the four smallest hospitals join with LH to form a common HIS on a single instance, while PRHC joins a separate common HIS with London Health Science Centre (LHSC)
While there is no financial benefit to a common solution in the short-term, the analysis suggests there is a modest financial advantage at the LHIN-level for a common solution over 10 years to achieve HIMSS Stage 6.
Key Notes:
• Over 10 years, the efficiencies gained from integrating HIS functionalities were found to be greater than the costs of collaboration for a common solution.
Source: Hospital and LHIN provided data and assumptions as listed in Appendix E.
1Total Cost of Ownership refers to the full cost of implementing the HIS. TCO calculations outlined in this analysis include costs related to the direct IT costs (i.e. software, hardware etc.) as well as training, change management, and IT support. For clarity, TCO for the common HIS factors in efficiencies for back office functions. 254 485 234 391 209 423 0 100 200 300 400 500 600
5 Year TCO 10 Year TCO
5 & 10 Year Estimated TCO Comparisons (in $ M)
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4.5 Options Analysis: Cost Effectiveness (Hospital-Level)
At a hospital-level, the value proposition for each individual hospital may be perceived to be lower while the value proposition is focused at the health system level.
5 & 10 Year Estimated TCO Detailed Comparisons (in $ Millions)
Hospital
Baseline (continued incremental investment)
Common HIS Mixed Model Single Instance Current Future State
5 Year 10 Year 5 Year 10 Year 5 Year 10 Year
CMH 4.1 7.2 3.1 5.2 3.8 6.5 HHHS 1.2 2.5 1.3 2.2 1.6 2.9 LH 70.0 125.9 54.0 88.8 63.8 110.7 NHH 12.1 21.3 9.2 15.2 11.2 19.3 OS 17.4 42.7 32.4 52.3 17.4 42.7 PRHC 40.6 73.5 31.5 53.2 29.1 64.6 RMH 14.2 29.1 16.3 27.5 20.0 35.0 RVHS 62.5 114.2 47.1 79.3 30.8 72.2 TSH 31.8 69.0 38.9 67.3 31.8 69.0 Total 254.0 485.4 233.9 391.1 209.5 422.9 Key Notes:
• Over 10 years, the efficiencies gained from integrating HIS functionalities were found to be greater than the costs of collaboration for a common solution.
Source: Hospital and LHIN provided data and assumptions as listed in Appendix E.
• Baseline: refers to hospitals pursing incremental investment in the current composition of shared and independent models. This includes: PRHC, CMH, & NHH sharing an instance, LH & RVHS sharing an instance, and the remaining 4 hospitals remaining independent
• Common HIS: refers to all hospitals sharing an instance
• Mixed Model: refers to the “current future state” plans where OS, TSH and RVHS remain independent, the four smallest hospitals join with LH to form a common HIS on a single instance, while PRHC joins a separate common HIS with London Health Science Centre (LHSC)
52 0 100 200 300 400 500 600
Baseline Common HIS Mixed Model
10 Year Estimated TCO Comparisons (in $M)
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
0 100 200 300 400 500 600
Baseline Common HIS Mixed Model
5 Year Estimated TCO Comparisons (in $M)
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7