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Coordinated Care Plan (CCP) in Health Partner Gateway (HPG)

Resources for Health System Partners


This page has been developed to support health system partners with Coordinated Care Planning, and with their participation in using a digital solution known as Health Partner Gateway.

What is a Coordinated Care Plan (CCP)?

The Coordinated Care Plan (CCP) reflects a provincial standard of care that supports holistic patient care. Developed in collaboration between a cross sector focus group and the Ministry of Health and Long-Term Care (MOHLTC), the CCP identifies and focuses on the patient's goals, with the patient playing a key role in its development. As a collaborative tool for communicating between patients and providers, the CCP is a living document that requires regular review and updates based on the changing status of the patient. 

**The CCP is neither Electronic Medical Record (EMR) software nor a replacement for the patient chart.

CCP Resources

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What is CCP in HPG?

CCP in HPG enables health system partners, who are involved in patient care, to securely initiate, share and/or update a patient’s CCP using a digital solution called Health Partner Gateway (HPG). CCP in HPG is hosted by Health Shared Services Ontario (HSSO).

CCP in HPG fosters collaborative care planning across health system partners by enabling access to one common CCP document. This has benefits to both the patient and health care system and supports the work of Health Links across the province. 

For a list of partners currently using CCP in HPG please click here (PDF).

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Gaining access to CCP in HPG...four easy steps

Step 1 - Reach Out

CCP in HGP is is enabled by the Health Partner Gateway platform. If your practice or organization requires access, please submit the HPG System Authorization Form (Word) to the Home and Community Care Support Services Central West Helpdesk.

For information on the onboarding process, please contact the privacy officer at ext. 7751.

Step 2 - Privacy and Security

After reaching out to your Systems Resource Navigator, please complete and return to the Home and Community Care Support Services Central West Privacy Office all necessary privacy and security documents outlined and linked in the table below. In so doing, please engage and inform the Privacy Officer within your organization.

​Privacy Requirement
​Next Steps
​Consent
​Across the Central West area, an express verbal model of consent has been adopted for obtaining a patient's consent to use CCP in HPG. Health system partners will be granted access to a patient’s CCP in HPG only after the patient has provided express consent.

A Common Consent Guideline (PDF) has been developed for all partners to guide CCP in HPG consent discussions with patients.

Please use this guideline within the structure of your organization's consent process, asking the patient for express verbal consent when:
  1. initiating a new CCP in HPG
  2. requesting your organization's access to an existing CCP in HPG
Start planning internally at your organization to incorporate this consent into your local consent process.

**The Common Consent Form explains that the patient's CCP will be available through provincial and regional systems. This includes the ConnectingOntario clinical viewer system hosted by eHealth Ontario.

​Agreements
​Please contact the Privacy Analyst at Home and Community Care Support Services Central West for the following agreements:
  • Data Sharing Agreement (DSA)
  • Network Services Agreement (NSA)
Signing authorities of partner organizations are asked to review and sign these agreements, as outlined below:
  • DSA p9: fill in fields including Privacy Officer contact information
  • DSA p10: fill in fields - signing authority to sign
  • NSA p18-19: fill in fields - signing authority to sign. 
Please scan and return signed agreements to cw.privacy@lhins.on.ca.

When sending the agreements to Home and Community Care Support Services Central West, please confirm that your organization is a Health Information Custodian. Please cite which part of Section 3 under the Personal Health Information Protection Act (PHIPA) applies to your organization.  

​Privacy and Security Checklist
​Please complete the Privacy and Security Checklist (Excel) and return to cw.privacy@lhins.on.ca
​Policies
​All participating organizations must follow the CCP in HPG Policies listed below:
​Privacy Training
​Each Health Information Custodian is required to ensure their users are appropriately informed of their privacy and security responsibilities. Please let Home and Community Care Support Services Central West know if your organization needs support with this.


Step 3 - Training

Home and Community Care Support Services Central West supports the on-boarding of health system partners to CCP in HPG by providing training related to the Coordinated Care Planning process, as well as how to use the CCP in HPG platform. Work with your Systems Resource Navigator to coordinate the training approach that works for your organization. The following resources are available to supplement training, and to support your ongoing use of CCP in HPG.


​Resources
​When to Use
​Common Consent Guidelines (PDF)
​This document is used to guide the process of seeking express verbal consent from a patient, in order to access HPG for the purpose of initiating a patient's CCP and/or viewing or modifying an existing CCP.  

Health system partners will be granted access to a patient's CCP in HPG only after the patient has provided express consent, as documented on the registration form.

​Registration Form (PDF)
​Use this form to request access to view, modify and/or edit a patient's CCP in HPG. Once submitted to Home and Community Care Support Services Central West, through the HPG platform, authorized health system partners will be granted access. Please refer to the Guidelines for Completion of the Registration/Update Form (PDF) for assistance in completing the registration form. 

​Job Aid: Document Exchange in HPG (PDF)
​This job aid is available to help health system partners understand how to send the CCP in HPG registration form to Home and Community Care Support Services Central West through HPG. 

​Process Maps: Registration, Care Planning, Disengagement (PDF)
​These process maps are available to assist health system partners in reviewing the steps taken by themselves and Home and Community Care Support Services Central West, with respect to registering a patient for CCP in HPG, using CCP in HPG for coordinated care planning, and disengaging when a partner is no longer involved in the patient’s care.

​Job Aid: Coordinated Care Plan in HPG (PDF)
​This job aid is available to assist health system partners in navigating the functionality of CCP in HPG (i.e., viewing, adding, updating, completing, and correcting a patient's CCP).

​Coordinated Care Planning Presentation (PDF)
​Use this slide deck to:
  • Support the identification of patients who are suitable for coordinated care planning
  • Learn about the process for coordinated care planning


Step 4 - Request Access to the CCP in HPG System

After training is completed, please submit an HPG System Authorization Form (Word) to Home and Community Care Support Services Central West, requesting access for all those at your organization who will require access to the CCP in HPG system. Check off the system roles needed for each user. If users have different roles, thereby requiring different levels of access, please use multiple forms.

Please provide an email address within your organization that can receive system-generated notifications. These occur when a CCP, to which your organization has access, is created or updated within HPG.

Forms should be sent to the Home and Community Care Support Services Central West IT Help Desk at cwhelpdesk@lhins.on.ca. The IT Help Desk will then call the user with his/her user name and initial password.

After these steps are completed, a partner is now ready to access the CCP in HPG system.

**Reminder: Access to an individual patient's CCP in HPG is given only after a patient provides express consent according to the process described in Step 3 above.

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Ongoing Use of CCP in HPG

What to do if you need to request CCP in HPG access for a new user, adjust the role permissions for an existing user or need to deactivate a user?
What to do if you encounter a technical issue using CCP in HPG? 
  • Contact your local IT department first
  • If the problem is not resolved within your own organization, contact the Home and Community Care Support Services Central West IT Help Desk at cwhelpdesk@lhins.on.ca. **Do not send identifying patient information via email

What sort of communications about CCP in HPG will be sent to health system partners?

  • Home and Community Care Support Services Central West will: 
  • Notify all CCP in HPG partners if the system will be off-line for any reason i.e., planned upgrades, unplanned outages, etc.
  • Communicate any system functionality changes that impact how CCP in HPG is used
  • Notify all CCP in HPG partners when a new organization is granted access to the system and the list of participants updated
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FAQs and More Information