Written by Carol Adam, CHIM
Ontario Chapter Chair

I had the pleasure of speaking to Diamond Watson-Hill, Director of Health Information Management and HIM lead on the One THP Project with Trillium Health Partners. We talked about the activities, changes, and impact that the COVID-19 pandemic has had on the HIM teams at Trillium Health Partners in Mississauga, Ontario. This piece summarizes the information she shared with me.

It is important to note that all organizations were learning about COVID-19 activities at the beginning of the pandemic. The information provided in this interview represents the experiences of Trillium Health Partners and have evolved over time, as most of the health system has.

Does Trillium Health Partners have a hybrid records system, and how did this impact the HIM team during the pandemic? Did procedures and processes need to be changed or updated?

Diamond shared that Trillium has a hybrid record, in addition to having two separate versions of MEDITECH’s patient care system. The process for managing the paper-based chart within their organizations was the first area that needed to be reviewed due to staff anxiety on how to handle the paper. In addition, there were concerns about picking up paper charts in new areas of the organization, such as the COVID assessment centres. The IPAC (Infection Prevention and Control) team was consulted and spoke directly to the HIM team to build a process that would ensure that staff were safe and to answer questions to relieve anxiety as much as possible.

It was confirmed that documentation on paper-based records is only completed in “clean” areas of the nursing units; therefore, the risk of transmission is very low. Masks are worn when picking up charts anywhere within the organization, though gloves were deemed unnecessary, as the wearing of gloves can be high risk if not managed correctly. Full-hand hygiene must be followed before and after visiting clinical areas.

Diamond was very happy to report that the HIM team managed this process very well and has remained healthy throughout this time period.

Trillium was well into the planning for their EPIC HIS and expected to go live in July of this year when the COVID pandemic happened. The project was put ‘on pause’ in March to redeploy the project team to COVID priority initiatives, but planning is currently underway to bring the team back together to work toward a new go-live date to be announced in the near future.

One of the activities that Trillium engaged in during their EPIC implementation was resiliency training to help their organization manage this huge change initiative. This training has proven useful for their teams during the current situation.

One positive effect of the planning for EPIC was the clinical teams’ understanding of the potential patient outcome/patient safety improvements that electronic documentation in a single electronic system in a multi-site environment can support. Some have hypothesized that some of the COVID activities might have been managed in a more streamlined way had EPIC already been implemented, so that is something to look forward to.

How did you manage your team in relation to working on site versus working from home? Did you have to adjust hours or move teams off site?

Diamond noted that the HIM coders already work from home, so there was no change in their work location. A few Trillium team members alternate working from home and on site, as some of their tasks are manual and must be completed on site—but the majority of other team members, including leadership, have remained on site throughout this time period.

Early in the COVID situation, the HIM team spent time organizing the workspaces to ensure appropriate distancing. They actually measured between all stations to ensure there was a least six feet of separation, and in some cases moved small furniture to ensure appropriate separation and that staff felt safe.

What has been the impact on release of information (ROI) processes, specifically around the public entering the ROI workspace?

In the early days of COVID affecting hospital operations generally, Diamond said it became clear that they would need to close the ROI workspace to the public. Some members of the public had masks while others did not, and it became a safety risk for staff.

The process for the ROI team became electronic through email and telephone to ensure that requests were being met appropriately with the correct authorization. Trillium updated their website with revised ROI procedures and informed screeners at public access doors to the hospital. Requestors are required to photocopy their picture identification with signature, which is matched to the signature on the consent.

Diamond shared that although request volumes are lower than usual, the new process is somewhat less efficient due to processes that remain paper based (e.g., printing the requested documentation from various source systems, scanning it, then ‘zipping’ it into an encrypted file that is sent electronically to the requestor). These processes are required to ensure PHIPA compliance and will be reviewed and revised as they move toward EPIC implementation. 

Have any of the HIM team members had to move into more direct care locations in order to support the organization through COVID-19?

Diamond shared that she is proud of the HIM team for stepping up and helping out as needed. Members of the HIM team have contributed to the organization through redeployment since the beginning of the pandemic period. A small group of HIM staff was redeployed as screeners prior to the organization specifically hiring for these positions. Some team members were deployed to help build face shields that were received in pieces. Like many organizations, they received a large volume of donations for staff from the community, and HIM staff helped to organize packages of the donated goods for the THP staff. Others were trained in the N95 mask fit testing procedure and worked various shifts (including nights) to ensure tests were completed for all staff requiring them.

Anything else you would like to share?

The HIM leadership was involved in aligning HIM practices as changes were made in clinical areas related to preparing for the expected capacity issues related to treating COVID-19 patients. Ambulatory care locations were moved to new sites to make room for a new 100-bed inpatient unit. In addition, the organization built an 80-bed portable pandemic response unit. All of these clinical changes made it necessary to ensure that patients were registered at the appropriate site and that documentation (including dictation) was also done for the correct site (as our systems are currently separate). A key component was communicating to clinicians the importance of documentation in the appropriate system to match the patient registration to ensure the availability of timely and accurate information.

Currently, Diamond says, the HIM leadership team is reviewing processes that have been ‘quickly implemented’ over the last few months to ensure that they can be sustained going forward. The increase in virtual patient visits will be continuously monitored to ensure that these visits are captured correctly, as it is expected that virtual visits will continue even after the pandemic comes to a close.

In addition, they are currently looking at physical changes in the ROI area once the public is back on site, such as installing plexiglass or other barriers to ensure the safety of the ROI team.

It was a pleasure to have Diamond share the experiences of her HIM team during this current situation.