Using Canadian Health Outcomes for Better Information and Care (C-HOBIC) thousands of nurses in Ontario, Manitoba, and Saskatchewan have been collecting standardized information for a patients’ electronic health record (EHR) to support nursing care and improve health system efficiency.
C-HOBIC not only provides nurses with information about how their patients are benefiting from care, but also tells administrators how well their organization is preparing patients for discharge, and offers a broad-based view of how the system is working. This information is valuable in helping to improve health system planning and resource allocation, as well as performance measurement and research.
Sponsored by the Canadian Nurses Association in partnership with the health ministries of Ontario, Prince Edward Island, and Saskatchewan, the project was launched in 2007. A year later Manitoba, represented by Winnipeg Regional Health Authority, joined the C-HOBIC initiative. The project is made possible through an investment by Infoway as part of its Innovation and Adoption program.
The idea for developing the C-HOBIC project grew out of the success of Ontario’s HOBIC program, an initiative of the province’s Ministry of Health and Long-Term Care. Kathryn Hannah, executive project leader for C-HOBIC and health informatics advisor to the CNA, sees the project as an important development, enabling nurses to improve patient-focused care and practice. “This is the first time nurses are getting something back from an electronic system that will actually help them in their practice,” she says.
Peggy White, the project’s national director, says moving the program beyond Ontario is an opportunity to improve health outcomes across Canada.
“If we want to use information to improve outcomes, we need to standardize the information so we can compare outcomes over time and across organizations,” says White. “Currently, when a patient is admitted and the initial assessment is completed, that information is paper-based and in narrative form.” This makes it difficult to provide feedback to clinicians about outcomes, to improve care and practice.
“Nurses are passionate about health care,” White says. “They went into nursing to help people. They don’t want to take care of a computer system. But they want access to information that will help them improve their practice, and C-HOBIC gives them that.”
White gave the example of a patient with chronic obstructive pulmonary disease; on intake, the patient rates her shortness of breath on a scale from one to four. As she moves from acute care to home care, the use of systematic, structured language and standardized measures to describe her condition means clinicians can evaluate her health outcomes across disciplines.
“If I am a home-care nurse, I can look at this standardized information and see what the patients’ functional level is now and where it was at discharge,” says White. C-HOBIC’s goal is to get information back to clinicians so they can evaluate patients over time. Ultimately, improved continuity of care means patients will experience better health outcomes.
White notes an unanticipated benefit of Ontario’s HOBIC has been the extent to which it allows patients’ families to become more involved in their loved one’s care, through access to status updates from a real-time database.
The effectiveness of equipping clinicians with computer and Internet access has inspired the C-HOBIC team, along with Infoway, to advocate for the more widespread investment in the electronic infrastructure to support such systems.
“If nurses have to run to a desk down the hall to find out about a patient’s medications and pain-management plan, it won’t support their work,” says White. Hands-on learning will help busy health care professionals experience the practical day-to-day benefits of integrating computers—and programs like C-HOBIC—into their practices.
C-HOBIC has enabled clinicians to more fully understand the value of standardizing health outcomes. What’s more, the information gathered in C-HOBIC can become part of a patient’s EHR, and that’s valuable in helping with planning across the continuum of care.