E-Notification Add-On to Hospital Report Manager Improves Coordination of Care

Rationale / Objectives

Healthcare delivery, particularly for complex patients, requires communication and coordinated care that can traverse multiple departments and providers. Despite the push for providers to deliver more in terms of continuity of care, they often don't have access to patient information quickly enough to enable this. OntarioMD wanted to streamline workflow and further improve communications between the hospitals and physicians during a patient's hospital journey in order to enable faster follow-up.

Project/Program Description & Major Achievements

In 2013, eHealth Ontario and OntarioMD implemented Orion HealthTM Rhapsody Integration Engine to roll out the Hospital Report Manager (HRM), an electronic application that enables primary care clinicians and specialists to securely receive patient reports from participating healthcare facilities. HRM offers seamless integration with OntarioMD-certified electronic medical records (EMRs). In April 2014, OntarioMD used HRM to pilot the first add-on feature to HRM: eNotifications; a faster, enhanced notification system that notifies family physicians when a patient has been discharged from the Emergency Department or has been admitted or discharged as an inpatient. In less than two years, HRM has been a significant driver for Ontario's 85% EMR adoption rate among community-based family physicians. Over 190,000 clinical reports per month are being sent to clinician EMRs. 2,900 clinicians use the HRM through their EMRs, and the e-Notification review rate by family physicians was 100%, signaling strikingly high engagement levels with potential to positively impact patient care.

Lessons Learned

The proper intuitive system architecture and the scalability of the Rhapsody Integration engine allowed for easier implementation of e-Notifications. Having data pushed directly to the physician's inbox, rather than having them source the information themselves, greatly improved the physician's active engagement in follow-up care. Having the program seamlessly integrated into physician's automated workflow ensured that patient events were seen in a timely fashion.

Further Description

In April 2014, OntarioMD used Hospital Report Manager (HRM), powered by Orion’s Rhapsody. This pilot was done in partnership with Toronto East General Hospital (TEGH), the Ontario Association of Community Care Access Centres (OACCAC) and OntarioMD. An e-Notification feature that seamlessly worked with the HRM was developed. This e-Notification was rolled out through the HRM and CHRIS system in TEGH. The development of e-Notifications presented a new set of challenges as it is a unique style of messaging, different from the traditional medical records and diagnostic imaging reports that the HRM system was originally designed for. In order to be able to use the HRM, clinicians must already be using an OntarioMD-certified EMR at the latest specification. The e-Notification solution can then be connected providing that clinicians have the HRM system already in place and are connected to OACCAC Client Health and Related Information System (CHRIS).

Major Achievements

The HRM is available in Local Health Integration Networks (LHINs) 1 to 13. E-Notifications have been sent from TEGH to primary care providers since going live, and over 400 clinicians using HRM have received e-Notifications. The e-Notification add-on to the HRM has demonstrated significant benefits, such as:

  • Near-real time alerts sent to the physician’s office
  • Increased timeliness in patient information dissemination
  • Seamless integration, with no clinicians requiring additional training for its use


OntarioMD has now partnered directly with the Ministry of Health and Long-Term Care (MOHLTC) and has received approval from MOHLTC for expansion of e-Notifications through CHRIS and HRM. E-Notifications will begin rolling out to other hospitals within the province across several LHINs.

Metric Result Detail
Clinical reports sent to clinician EMRs Over 190,000 Per month [1]
All reports sent Over 1 million [1]
Number of clinicians using the HRM through their EMRs 2,900 [1]
Number of distribution locations live on HRM 74 [1]
HRM rate of adoption 500 physicians per quarter [1]
Percentage of notifications reviewed by family physicians within 7 days 100% 57%  representing complex patients [1]


Supporting Evidence: