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PARTNERSHIP BETWEEN MANITOBA & BRITISH COLUMBIA FIRST NATIONS
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PARTNERSHIP BETWEEN MANITOBA & BRITISH COLUMBIA FIRST NATIONS
MUSTIMUHW
( pronounced Moose tee mook )
Name Mustimuhw cEMR
Vendor Cowichan Tribes
Location Duncan, British Columbia
Installations BC, SK, MB
Platform Runs on Windows
Architecture Client Server or ASP model
Licensing Annual/per userNot for profit business model
A computerized medical record created specifically for First Nation community based health organizations
Integrated use amongst multi-disciplinary & para-professional care teamsCommunity, family & cultural focus Enabling client participation & empowermentSupporting the specific range of programs, services & workflow in FNs community based organizations
Mustimuhw meets the electronic charting needs of First Nation health centres and service providersDesigned by First Nations for First NationsCharting designed for nursesModules for First Nation health specific programsReports designed to meet the funding requirements of Health Canada/INAC/P&T
Community Health NursingMaternal Child HealthImmunizationsChronic Disease ManagementChild Oral Health InitiativeMental Health CounselingHome and Community CarePatient Travel/Medical Transportation
Desktop application that runs under WindowsLocally installed, orremote server versionDesigned to support
multi-site practice groupsremote locations mobile workers
Customizable charting templatesFull disconnected use capabilityLab result interfaces in British ColumbiaHome Care reporting interface for Health CanadaFuture integrations planned with Panorama and VIHA Pathways
Culturally appropriate, and strength-based, programs that address social determinants of health, are more successful in a FN contextMustimuhw cEMR provides a comprehensive record that members can relate to
includes community teachings & sayingsincorporates culturally appropriate language
Contextualizes member records within their family & extended-family contextAboriginal – Status – On-Reserve/Off-Reserve classification
Service cultural of Members (clients) being part of health care teamGoal-setting & Success monitoring tools for MembersMember specific print-outs & summaries of various aspects of chart they can take awayProviders record charting notes in conjunction with members
Helps instill ownership over own health, & provide knowledge transfer & “words” to have in navigating broader health care system
Telehealth, EHRs & EMRs, PanoramaMustimuhw Pilot projectInterim eHealth Advisory Partnership MFNs ICT InventoryMFNs Technology Council
Building the MFNs Network CommitteeYouth ICT CommitteeTechnology Development Committee
Manitoba First Nations ICT Training Initiatives Inc.HISAP Readiness AssessmentsAFN National eHealth Advisory Committee (NeHAC) & AFN ICT Working Group
63 First Nations in Manitoba125,000 plus registered Manitoba First Nation members62% live on reserve60% are under 30 yrs6 of the 20 largest First Nation communities in Canada are located in Manitoba
50% (32) of Manitoba First Nations are northern and/or isolated communities
36% (23) are not accessible by all-weather roads
Dene
Cree
OjiCree
Ojibway
Dakota
The goal of the MFNPWTG project was to reduce the significant impacts of foot ulcers & amputations through the development of a wait time guarantee for the prevention, care & treatment of diabetic foot ulcers in Manitoba First Nations (MFNs) communities. http://www.fnwaittimesguarantee.com/
The MFNPWTG project researched options & invested in hardware & software for 6 pilot sites. The initial goal was to implement in 8 sites, however jurisdictional issues led to 2 sites being eliminated.
INPUTS
Funding
• Health Canada- wait times envelope national office• Separate envelope, not FN envelope• Sustainability funding from 2008 to current from FNIH MB
Stakeholder partnership
• MFNs• AMC• Federal Government• Provincial Government• Clear Concepts• Saint Elizabeth Health Care• Cowichan Tribes
ACTIVITIES
IT infrastructure- Connectivity- Hardware- SoftwarePreplanning visitMaking Mustimuhw Your OwnCommunity level trainingTechnical and Mustimuhw support
OUTPUTS
IT equipment purchased based on needs Preplanning visit & AssessmentCustomization, privacy policy & other information issues addressedCapacity building carried out at the community level to build competency in software usage
On-going technical and Mustimuhw support made available to the communities
SHORT-TERM OUTCOMES
Health Canada reports at the touch of a buttonCompliance with reporting requirementsEasy scheduling & trackingCan add current health forms directly into the cEMROn-line charting and easy access to growth chartsScreening people with diabetes for risk of foot complicationsStores digital photographs of woundsRight information at right time
LONG-TERM OUTCOMES
Integrated case mgmt & holistic careVaccine preventable communicable disease controlCommunity empowermentPortabilityAccountability & efficiencyUseful tool for health care providers to help improve health status of FNs Increased job satisfaction among nurses & healthcare providersSafe, reliable, quality care
AMC acquired financial contributions from FNIH-MB for Fiscal Years 2008-2011 to aid with project management, administration, communication & collaboration with MFNs, Cowichan Tribes, etc.
In March 2008 AMC took the Systems Champions to Cowichan to show their commitment to the partnership, as they continued to take Mustimuhw to its next level of functionality, security, implementation & support.
AMC continues to develop a business model & funding plan to allow for all interested MFNs to implement Mustimuhw.
A Mustimuhw Evaluation Plan was undertaken by AMC as part of Health Infostructure funding, to collaborate lessons learned & validate the upcoming business plan.
Pilot evaluation helped inform our future efforts
Evaluation input from 5 of the six FNs
Difficulty / Complexity for end-user:
The majority (77%) of Health Centre end-users found it a friendly and easy to use application.
Key positive outcomes identified by Health Centre respondents:
Access to Information
Time-saver
Easier reporting
Increased information security / confidentiality
Interoperability = ability of electronic medical systems to interface, or connect, to “talk to each other”
GOAL of project = develop & demonstrate interoperability between Mustimuhw (cEMR) & a primary care clinical information system (EMR), i.e. within same community or with primary care service providers outside the community, but who provide service to the on-reserve population.
MUSTIMUHW cEMR II PROPOSAL“Developing Interoperability for Manitoba First
Nations”
Expansion of Mustimuhw cEMR to 3 MFN communities
Community Selections & Readiness Assessments
Project Advisory Committee CTFoH
Project management team
Project Liaison, ICT Network Liaison, Interoperability Team
housed at Manitoba eHealth & AMC eHealth report directly to AMC eHealth = Project Management Office
CANADA HEALTH INFOWAY
Mustimuhw cEMR Phase II Project
Application principles:Improve patient wait times & healthcare through technology Prevent disease & its complications, in particular Diabetes
Outcomes:Contribute to meeting the objectives of the MFNTC Resolution & contribute to building the future Centre of ExcellenceIncrease ICT capacity in communities & community level decision-making, including business opportunities
Deliverables-based funding: receive $$ after completion & approval of documents, for example:
Project Charter & Project Procurement Plan Project Sponsorship & Advisory Committees Formation Master Project Plan & Change Management Plan Community Site Selection & Engagement Reports Service Delivery Model: Current & Future
The 1st FNs in Canada to receive funding from Infoway for community EMRs!
June 2011Proposal Submitted
January 2012Legal Agreement complete
Project Commencement
February 2012 Staff Procurement
January 2012Press conference announcing project
June 2013Project end
Community InfoCommunity Info
Largest First Nation community in Manitoba, with a population of approximately 9042 people of Ojibway & Cree descent.
Located 190 km north of Winnipeg, MB, and has an area of 75,749.2 acres.
With the support of MFN PWTG Pilot Project we were given tools to enhance our current diabetes program:
Mustimuhw install
Training, foot care instruments, dremels, doppler, printer and a digital camera to help enhance our community program
Medical Transportation ProgramVisiting Mental Health TherapistsGeneral Dentist - Dental Therapist &COHIHome and Community Care ProgramAboriginal Diabetes Initiative ProgramWater Quality ProgramTraditional Healing ProgramNNADAP ProgramPublic Health – Baby Clinic - ImmunizationsFootcare ProgramHealth & Wellness ProgramMaternal Child HealthVision Care ProgramCanadian Prenatal Nutrition Program
Benefits to ClientsEnhanced internal case-management & communication – continuity of care with follow upsStandardized templates for service encounter charting
Benefits to StaffJob satisfactionAutomatic data collection for reporting (efficiency)Client wait times are decreased through faster charting
Benefits to ManagementFacilitates compliance with reporting requirementsFacilitates quality assuranceFacilitates employee activity monitoringIncreased capacity for changeData collection
evidence-based programmingevaluationadvocacy
“The Mustimuhw program makes charting much more easy and efficientto use. It decreases a lot of time charting in between clients, improving the level of service.” Home and Community Care Program
“I find the use of the program extremely beneficial in that it cuts the time for charting. The reports function make the month end reports a lot more easyto compile. I like that the system gives reminders for certain activities, Ie: foot screening, etc. The spell check function also makes for an easiertask, an I will continue to use the program.” Public Health Nurse
Community InfoCommunity Info
Current Leadership 2012-14 – Chief Frank Brown, Councillor Mervin Demas, Councillor Gerald Sandy
1877 - Canupawakpa Dakota Nation, non-TreatyLocated in southwestern ManitobaOne of 5 Dakota Bands in ManitobaPopulation of 600+, on reserve 300+Language spoken – Dakota
Community Health Promotion & Injury/Illness Prevention, Public Health Protection Communicable Disease Control & Management, Home & Community Care
CHNs, HCCNs, Health Care Aides, In Home Care Support, CHRs, Community Diabetes Worker, Visiting Dietician, Foot Care Nurse, Nurse Practitioner
Medical Transportation
Community WellnessAddictions & Solvent Abuse, Mental Health, Crisis Intervention, Parenting Skills, Injury Prevention, Healthy Babies & Child Development,
“The Mustimuhw Program has been great for our Community. The nurses can provide better continuity of care. The Mustimuhw program is excellent for case management, you can easily see which programs have been involved with the client. I can’t imagine running my program without it.”
Shelley Kirkup, HCCNM
“The Mustimuhw program is member focused, he/she can monitor their own strength of wellness.”
Mental Health Coordinator
“We wish our health centre had the program, Sioux Valley considers CDN to be very fortunate to have the program.” Neighboring
community, Sioux Valley Nurses
Continue the partnership & collaboration with all project partners
Establish a linkage to the Manitoba Regional Health Authorities electronic health systems.
Establish linkage to FNIH’s other electronic programs, e.g. CRW’s program – Medical Transportation Program
Sustainability & capacity building for IT support & costs associated with Mustimuhw program.
Sustainability costsAMC – continued advocacy
IT CapacityClear Concepts – support & capacity building
eHealth developmentCowichan Tribes – product enhancements
Maintenance & MaximizationCommunity champions networkCowichan Tribes - Software support
Wopida – Ekosani – Miigwech – Mahsi – Huy ch q’u – Thank You
Lisa Clarke– eHealth-Technology Coordinator
Assembly of Manitoba Chiefs
2nd Floor - 275 Portage Avenue
Winnipeg, MB R3B 2B3
Phone: 204-956-0610
Fax: 204-956-2109
www.manitobachiefs.com
Steve Sagodi – Mustimuhw Solutions Architect
Ts’ewulhtun Health, Cowichan Tribes
5760 Allenby Rd.
Duncan, BC V9L 5J1
Phone: 250-514-0932
Fax: 250-748-8815
www.mustimuhw.com Terry Wilson – Medical Transportation Coordinator
Peguis First Nation
Box 88
Peguis, MB R0C 3J0
Phone: 204-645-2169
Fax: 204-645-2874
Wanda Sandy – Health Director
Canupawakpa Dakota Nation
PO Box 11
Pipestone, MB R0M 1T0
Tel: (204) 854-2990
Fax: (204) 854-2221
