Ontario Perinatal Surveillance System An Authoritative Perinatal Information System APHEO AGM, Nov. 20, 2008 Toronto, Ontario
Agenda Agenda � Overview and of OPSS � Current and Future status � Where do the Niday Databases fit? � GTA PH-EPI group � Opportunity for Public Health – Access – Standards – Technology 2
Surveillance in Canada Surveillance in Canada Image courtesy of CPSS 3 Historical omissions from Ontario due to “Data quality Concerns”
Overview � Provincial committee struck to provide guidance for perinatal surveillance in Ontario � Evolved from ON Perinatal Partnership Program (OP 3) � Funded initially to support Niday Perinatal Database � MoHLTC direction of develop linkages/partnerships with other provincial data initiatives
OPSS Overview OPSS Overview � Collaboration of programs collecting maternal/ newborn data, including: – Niday Perinatal Database – Fetal Alert Network – Midwifery Program – Newborn Screening – ON Maternal Multiple Markers Screening � To develop an integrated web portal that provides a common repository for all perinatal information � Objective is to contribute towards achieving optimal health of mother, baby & families 5
6 Data Continuum Data Continuum
Data Status Data Status � Current perinatal/neonatal data status in ON: – Many disparate data repositories across continuum. – None inclusive of the entire reproductive population – There is duplicate data collection – Misaligned data element definitions misaligned – There are few appropriate and timely health system planning and accountability measures – There is little data linkage and therefore unfulfilled value and lost potential 7
OPSS rationale Integration Perinatal/Neonatal to ensure a comprehensive data solution that will effectively support the activities and goals of the emerging MoHLTC maternal-newborn- child- youth strategy � Inclusive of all pregnancies and births � Allows relational analysis across the continuum � Provides population and health service surveillance � Meets principles of information management
Niday/Midwife 9 Fetal Alert MSS OPSS Databases OPSS Databases Screening Newborn
OPSS Data Vision OPSS Data Vision OPSS Web Portal One stop shopping Users are given privileges to access certain components of portal Data transfer occurs seamlessly to appropriate organizations Common data fields ie. demographics Maternal Newborn Serum Niday Midwifery FAN Screening Screening Privilege-based data retrieval 10
OPSS Objectives OPSS Objectives � Provide high quality data that supports innovative health planning and health system management / evaluation � Support evidence-based strategy development and implementation � Eliminate redundancies and enhance efficiency in data collection � Mandate data standards � Improve linkages between data holdings � Track individuals through the “continuum of care” � Support research and innovation 11
OPSS Data Uses OPSS Data Uses The challenge is to reach a practical balance between the improvement of health, the effectiveness of the health care services, and the right to privacy and confidentiality of personal health information. √ Towards this effort, OPSS has: – Developed a new data architecture model for an integrated perinatal/neonatal information system – Established a new governance model – Apply for Registry status designation (or equivalent) to support OPSS objectives, collect, use and disclose personal health information in accordance with privacy legislation and data system standards 12
Secondary Uses Secondary Uses � Enhanced ability to manage programs and services, while also allowing the Ministry, LHINs and Public Health Units to: – develop responsive policies – improve evaluation and accountability in the system – support quality patient-centered care through service delivery improvements – promote health and healthy behaviours – support maternal and newborn disease prevention – inform human resources planning, and – create powerful hypothesis-generating research and innovation initiatives 13
Challenges Challenges � Before completing integration, important to evaluate risk of proposed OPSS system � Various types of risk – Usability for end users (clinicians, hospitals, planners, etc) – Data quality – Technology – Privacy assurance 14
Field of Dreams Field of Dreams “Build it, and they will come” � Many unanticipated partners and potential usages � Important to ensure robust yet flexible system, able to respond to new demands in the future 15
Nomenclature Nomenclature � Niday database : collection and reporting tool � OPSS : term used to designate broader perinatal surveillance system of the future � OPSS Committee : 11 member committee to provide guidance and expertise � OPSS Exec Committee : 5 program leads + staff to establish data convergence principles and work plan – current focus of all OPSS work
Niday Perinatal Database Niday Perinatal Database • Developed in Eastern Ontario, by PPPESO, at CHEO • Web-based database • Captures 97% of births in Ontario • “Real-time” perinatal data • Partnership with hospitals, midwives, public health units, LHINS, MOHLTC, and other stakeholders • Program management, benchmarking, CQI, planning, evaluation and research 17
Niday Database Niday Database Risk factors and conditions influencing birth outcome •age Indicator Framework Indicator Framework •smoking •multiple pregnancy •presentation •age Infant health •health problems •Feeding Birth outcome •previous CS •congenital anomaly •group B strep •gestation •neonatal •reproductive assistance •birthweight •death •APGAR 1, 5, 10 •hearing •stillbirth •health problems Intrapartum interventions •resuscitation •jaundice •Hypoxia •monitoring •head •induction circumference •epidural •surgery •forceps/vacuum •SNAPS, TRIPS •episiotomy, laceration •augmentation of labour Health service factors •induction •first trimester visit •cesarean •prenatal classes •complications •care provider •steroid use •birth in appropriate setting •antibiotics •length of stay in hospital •transfer •duration of second stage 18
Niday “ “Readiness Readiness” ” Activities Activities Niday � Complete provincial implementation of Niday (136,944 records in 07/08) � Evaluation and data quality initiatives � Development of integrated perinatal and neonatal system � Data Workgroup: aligning and standardizing data elements within OPSS data holdings
GTA- -PH PH- -EPI EPI GTA � Support in implementation of Niday � Initial data quality initiatives � Participation in the CHN Annual Statistical Report 20
Access to OPSS � Membership on OPSS Steering committee � Support PH access provincially � Support PH standards � Technology to support reporting requirements � Influence data collected
22 Thank – You! Getting there!
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