Community Information Exchange

Improving the health and wellness of individuals and communities

through a holistic health equity focus

 

Hands holding puzzle pieces in a circle - appear to be coming together.

 

 

A focus of the work of the South Georgian Bay Ontario Health Team (SGB OHT) is to work together to reduce health inequities in the health system.

Health equity is created when individuals have a fair opportunity to reach their fullest health and wellbeing potential, which includes the social determinants of health.

The goal of the Community Information Exchange (CIE) collaborative with 211 Community Connection is to improve access to 24/7 coordination and system navigation services and improve the health and wellness of individuals and populations through a holistic health equity focus.

Many causes of health inequities relate to social and environmental factors including income, social status, race, gender, education and physical environment, which we are working to address through this CIE collaborative.

 

Community Information Exchange

Through this project, a platform is being designed that enables access to 24/7 coordination and system navigation services across South Georgian Bay.

This project will be integrated and complemented by the provincial Health Care Navigation Service to help both patients and providers to navigate our healthcare system more effectively.

This project will offer patients and caregivers 24/7:

  • access to coordination of care
  • system navigation services
  • and a seamless transitions throughout their care journey

The patient’s primary care provider will receive an outcome report following the connection with services, regardless of whether they sent the initial referral or not.

In the first year of the project, we are working on developing a shared technology platform to allow physicians, health care providers and also community service organizations to make electronic referrals to 2-1-1 for people who are impacted by the social determinants of health. Like a physician prescribing medicine, this is social prescribing, a structured way of referring people to the broad range of local, non-clinical services such as food resources, transportation services, income supports or even social activities for those who are alone. With their basic needs supported, people can be more focused on their health and wellbeing. We are so thankful to donors in our communities who support the United Way Simcoe Muskoka, for making this work possible.

Pamela Hillier, Executive Director of Community Connection

Community Information Exchange (Phase 1)

Through this project, a platform is being designed that enables access to 24/7 coordination and system navigation services across South Georgian Bay.

This project will be integrated and complemented by the provincial Health Care Navigation Service to help both patients and providers to navigate our healthcare system more effectively.

This project will offer patients and caregivers 24/7:

  • access to coordination of care
  • system navigation services
  • and a seamless transitions throughout their care journey

The patient’s primary care provider will receive an outcome report following the connection with services, regardless of whether they sent the initial referral or not.

Community Information Exchange (Phase 2)

Through the next project phase, CIE partners will use a common assessment for social determinants of health, 211’s resource database to match appropriate services, and a common risk rating scale to assess and track patients’ progress.

CIE partners will access digital technology and data sharing tools to generate referrals and share patient outcomes. Digital technology will integrate patient data from cross-sector service providers as a longitudinal record, allowing effective coordinated care planning.

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