Health care in Ontario is an enormously complex system that depends on information. At the most fundamental level, it is used by doctors to decide on the best possible treatment options for their patients. At a system level, where decisions about the management and delivery of health care services are made, the data that health care providers across the province collect about patients is studied and analyzed to identify trends in population health, such as the incidence of stroke and obesity. This evidence is then used to plan for and make decisions about which health care services will be provided where.

Over the last decade, advances in technology have dramatically increased our capacity to collect, store and analyze a large volume of health-related data. The reality is that collecting all this data is placing a considerable burden on many health care providers. With close to 100 separate health information databases in operation, health care planners, researchers and analysts are finding it more and more difficult to access the information they need. At the end of the day, when system planners and managers are looking to evaluate how the system is performing, the data itself is coming up short. Key pieces of information are missing to evaluate basic things like the quality of care overall in the province are missing.

The Ontario government has committed to breaking the cycle of ever-escalating health care costs by instilling a culture of accountability and improved outcomes – one that is tied to results. It needs accurate and comprehensive information to measure performance and provide a clear indication of the health system's performance overall. Despite having more than 2,000 indicators in Ontario, many of these are of limited use because they are either difficult to interpret or they do not relate to the government's health priorities.

Additionally, through major government initiatives, such as the Wait Times Strategy and the E-Health Strategy, new patient-level data is being generated and collected to track wait times and to enable the creation of electronic patient records. This data will need to be integrated into the provincial information management system. With the creation of Local Health Integration Networks (LHINs) and the Ontario Health Quality Council (OHQC), new information needs are emerging.

The Ontario Government is committed to putting in place an information management framework to improve our ability to collect more accurate and up-to-date information and to track and monitor how the health care system serves the public.

Adalsteinn (Steini) Brown, an Assistant Professor in the Department of Health Policy Management and Evaluation at the University of Toronto and the principal investigator for the Hospital Report Research Collaborative, was appointed Lead for Information Management for the government's Health Results Team in September 2004 and is spearheading this province-wide effort.

The Information Management Strategy is focused on producing better data, supporting accountability and quality improvement through performance measurement, and supporting evidence-based decision-making.

The goal of the strategy is to build a system that people can count on – one that is more efficient, effective and accountable. A system that provides objective, timely and accurate information is the basis for sound decisions that are in the best interest of patients. With better information and through enhanced information management, the government will be able to accurately measure and track how the system is performing, so that people can assess its quality and progress.

In its first year, as part of the effort to produce better data, the Information Management team documented all the data that the Ministry of Health and Long-Term Care had by identifying:

• Where and how data is collected and by whom
• Where the data is stored, and how the data flows between the various databases and data warehouses
• Who has access to what information
• Who makes decisions based on that information.

The end result is the Ontario Health Planning Data Guide, the first comprehensive index of all healthplanning data. This guide is available on the Ministry of Health and Long-Term Care’s web site as a resource for health system planners and researchers.

The team is lessening the burden for Community Care Access Centres to report on the services they deliver, so that the focus can be on the management of care instead of on the production of documents. Three metric tonnes of paper have been eliminated as a result, which has freed up 20,000 person hours.

In collaboration with the Institute for Clinical Evaluative Sciences, the Hospital Report Research Collaborative, the Canadian Institute for Health Information, and the Joint Policy and Planning Committee, the Information Management team completed the first-ever clinical-data blitz with Ontario hospitals.

This entailed province-wide sessions designed to improve the quality of the acute inpatient and ambulatory care data submitted to CIHI by all Ontario hospitals. This resulted in the voluntary correction of more than 1,400 abstracts, thereby demonstrating a concrete example of the system working to produce better data.

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