alberta's ehr system - pin

1March 1, 2004 Alberta Health and Wellness

Pharmaceutical (PIN) Alberta�s Journey towards the Electronic Health Record (incl. PIN)


Alberta�s Major Milestones on the Journey

1999 200220012000 2004

Seniors Drug Profile Pharmaceutical Information Network Electronic Health Record

2003 2005SDP PILOT

SDP Rollout PIN PILOTPIN Development

EHR 18-mo Strategy

SDP Retired

EHR RolloutPIN


Seniors Drug Profile (SDP) � What Is It? HomecareHospital

Seniors Drug Profile Medication Information

Alberta Blue Cross

Patient

SDP provided Hospitals, Physician Offices, Pharmacies & Homecare Offices with secure access to a profile of recently dispensed prescription drugs for senior citizens who are part of the Alberta Blue Cross Group 66 Plan

Benefits!Saves time (less writing, fewer calls to pharmacies)

!User Friendly application

!Sets stage for migration to PIN

!Particularly beneficial for patients who were poor historians, or had literacy or language barriers

!Users stated that information about patient compliance and behavior was obtained

� Physicians discovered through the Seniors Drug Profile that, after many years of treating regular patients, their patients had been receiving medical treatment from other physicians that they were unaware of �

1999 200220012000 2004

Seniors Drug Profile Pharmaceutical Information Network Electronic Health Record

2003 2005SDP PILOT

SDP Rollout


What is PIN?An information sharing tool that:

8 links community physicians, pharmacists, hospitals and other authorized health care providers

8 provides online decision-support tools for prescribing, dispensing, compliance monitoring, research and policy development.

8 communicates with existing physician office and pharmacy systems, avoiding duplication of data entry.

8 will ultimately enable electronic prescriptions, providing further benefits to health care providers and patients alike.

What is PIN?


How is PIN delivered?8Central clinical data

repository

8No duplicate data entry

8Links existing heterogeneous systems Central Clinical

DataRepository

PIN is conceptually simple

8Via a web browser

8System-to-system


PIN Pilot Profile8 Implemented in 18 sites in two communities (Westlock &

Leduc) in 2002� 12,119 prescriptions were recorded by 34 physicians� 5,399 drug profiles were accessed by 154 users

8Results of pilot evaluation were positive� 90% of pilot users believe that PIN is valuable to their delivery of

care (7% undecided, 3% disagree)� 80% of pilot physicians would recommend PIN to their peers

(20% not yet decided)� Extended pilot

1999 200220012000 2004

Seniors Drug Profile Pharmaceutical Information Network EHR

2003 2005

SDP PILOTSDP Rollout

PIN PILOT


8 Collection of explicit consent for purposes of care and treatment is challenging to explain and administratively burdensome (i.e. less than 1 % of the population decided to opt out)

8 Implementation elapsed time is most influenced by site readiness

8 Sell to clinicians first then to administrators

8 Need to do individual site assessments as sites have unique work flows

8 Voluntary participation impacts take-up however improves clinician �buy-in� over time

Things we learned:


EHR

September 2002

The Minister announces that there will be a provincial Electronic Health Record

by March 31, 2004

1999 200220012000 2004


2003 2005


PIN PILOT

EHR 18-mo Strategy


Implementation Initiatives

�.. In 18 Months!!


EHR: What is It ? What an EHR ISIS8 Individual focused8 Individual specific core data set

where elements reside In multiple sources

8 Mechanism for sharing health data about an individual

8 Longitudinal health information about an individual from multiple sources

8 Support for clinical decision making8 Accessible at all points of care in a

timely manner

What an EHR IS NOTNOT8 Provider focused8 An operational system

Operational systems feed data to populate the EHR

8 A data collection system8 A single physical repository8 A Clinical Information System /

Electronic Patient Record nor Physician Office System / Electronic Medical Record, but they are interrelated

EPR and EMR describe the record of the periodic care provided mainly by one institution. It is a complete patient record accessible from a single, automated health care provider system.


EHR:What Did We Need to Think About What an EHR ISIS8 Individual focused8 Individual specific core data set

where elements reside in multiple sources

8 Mechanism for sharing health data about an individual

8 Longitudinal health information about an individual from multiple sources

8 Support for clinical decision making8 Accessible at all points of care in a

timely manner

Identification of a userAccess controls

Record of users interaction

Readiness Remote connectivity

Security Education

GovernanceStewardship of data

Standards

Individual rights

Respect for privacy and ethical usage

Clinical acceptance

Workflow impact

Culture


EHR 18-month Strategy

� Identify a person� Add a person � newborn, new resident, visitors� Update demographic information� Record history� Post Office address standards� Determine the insurance eligibility� Publish and subscribe for changes

� View and sort lab test results history� Multiple lab sources� Deliver lab test results physician�s EMR� Available for ordering and copied physicians

� View active medication profiles� View and record allergy and intolerance information� Prescribe medication� Look up medications and drug interactions� Dosage checking� Medication dispensing information� Multiple renewals� Integration with physician and pharmacy systems


Relationships Between the 18- month EHR and Other Systems

EMR EMR

Patient EHR Summary

PINPerson

Identification

(PPHI)

LAB

Demographics

Drugs

System

to

System

Lab Results

eMPIeMPI

Pharmacy SystemsPharmacy Systems

Portal�Single Sign On

�Authentication & Authorization�Audit Trail

�Person Search


Privacy and SecurityTechnical8 Authentication (Two-factor �

SecurID Fobs)8 Authorization (Need to know

principle, Record of use)8 Encryption8 Audit Logs8 Firewall8 Intrusion Detection8 Anti-virus

AdministrativeCommon:

8 Privacy Impact Assessment (PIA)8 Training8 User ID Registration Process8 Confidentiality Agreements8 Self-Assessment Tool

Secure Network:8 Policies

� Minimum Connectivity Requirements (Level 1)

� Level 2 2004/2005� Level 3 2005/2006

Internet:8 2 Factor ID (FOB)8 COACH guidelines


Rollout - EHR Campaign Based Campaign = 1 or more health care facilities and surrounding areaservicing home care, community physicians and pharmacists

8 Urban

8 Rural

PharmacyPhysicians

HomecareHospital

Patient

Divided into several communities. Each community has a health care facility, however there may be exceptions (i.e. No hospital in the community, but is considered a community due to its large population and geographic area).

Could be grouped to include more than one health care facility to make effective use of implementation resources.


Physician Office System Program (POSP)

! Joint initiative of Alberta Health & Wellness, the Alberta Medical Association and Alberta�s health authorities (2003)

! Learning in action . . .� first of its kind in Canada� formal evaluation function

! Undertaking at the physician, not the organization level! Targets improvement in products, IMIT services and business

processes

POSP

1999 200220012000 2004


2003 2005


PIN PILOT POSP IIEHR 18-mo Strategy


Health IM/ITGovernance

Council

Health IM/ITGovernance

Council

InformationTechnologyCommittee

InformationTechnologyCommittee

Information ManagementCommittee

Information ManagementCommittee

EHR DataStewardshipCommittee

EHR DataStewardshipCommittee

ProvincialTelehealthCommittee

ProvincialTelehealthCommittee

Governance: Decision Making Structure

PhysicianOffice

SystemsProgram

PhysicianOffice

SystemsProgram

Alberta Health & Wellness

Health Regions/Boards� Council of CEOs

Physicians� CPSA� AMA

Pharmacists� ACP� RxA

Public Representation

Project Coordination - Alberta WellnetProject Coordination - Alberta Wellnet

Governance � Relationship Model


Critical Success Factors:8 Senior Chair 8 Incumbents are Decision Makers8 Balanced Representation8 Membership � Critical Few8 Quarterly meetings � at least

Multi-stakeholder Governance

Advantages:

4 Increases stakeholder engagement4 Helps to increase perspective & manage multiple agendas4 Opens communication channels � government isn�t always the translator


EHR Data Stewardship � Building a Trust Relationship

8Key understandings:

� Its duties and responsibilities must reflect current legislative provisions that define the rules related to the appropriate access, use and disclosure of health information

� The role of the EHR Data Stewardship Committee must work within a framework that complements and enhances existing organizational mandates and responsibilities (e.g. professional regulators, custodian responsibilities, etc.)

� It is a requirement of stakeholders to have a say in the further propagation of, or access to, data they are contributing to the provincial EHR


Alberta Wellnet (AH&W)Information Manager

Manages the data in accordance with the Information Exchange Protocol

Information Manager Agreement*Authorizes use of EHRBinds both parties tofollow the InformationExchange Protocol

InformationExchange ProtocolGuides use of data by custodian and wellnete.g. who can access the data, how research requests are handled, etc.Becomes appendixto agreement

EHRData

StewardshipCommitteeManages the

protocol

MinisterialOrderEstablishes DSC

PhysiciansPharmacies

HealthAuthorities

ParticipatingCustodians AH&W

CollegeRxACollege

AMACouncilof CEOs

StakeholderOrganizations

Public

Applying the Framework to the EHR


Major achievements also made in 2003 achievements

EHREHR

TOOL INITIATIVE

POSP Phase IIPOSP Phase II

CH EHRCH EHR

CHR Clinical System

CHR Clinical System

Non MetroClinical Systems

Non MetroClinical Systems

! Tri-partite governance! 3 levels of participation! Target of > 2,500 new MDs (68% of

Alberta�s physicians by March/06)

� Wave 1 � pilot complete� Wave 2 � SDP replacement to be completed Mar 04

� Wave 3 � Pharmacy/MD implementation underway

� Drumheller first community to go live

� Infoway Funding partnership established for PIN

ACHIEVEMENT OUTCOMES

EfficiencyEfficiencyAccessibilityAccessibility

! Regional EHR (netCARE) implemented

! Regional EHR (Eclypsis) selected and project initiated

! Regional EHR (Meditech) selectedand project initiated

SecuritySecurity! Minimum ConnectivityRequirements

AccessibilityAccessibility

AccessibilityAccessibilityPatient SafetyPatient SafetyEfficiencyEfficiency

AccessibilityAccessibilityPatient SafetyPatient SafetyEfficiencyEfficiency

Alberta CancerBoard

Alberta CancerBoard

Alberta CancerBoard

Alberta CancerBoard

! ICCN (Optx) implemented

PrivacyPrivacy ! EHR Data Stewardship Committee AccessibilityAccessibility


Governance Process Used to Define Next Steps

� Overview� Seek Endorsement

in Principle

IM/IT Governance CouncilMarch 16, 2004

� Develop & ForwardRecommendations

IMC IM/IT(EHR)STRATEGIC PLAN I� Domains� Goals� Outcomes� Stakeholder Impact

IM/IT(EHR)STRATEGIC PLAN II� Costed � Funding Sources & Gaps� Further Plan DevelopmentMarch-June 2004 � Review

� Seek Commitmentin Principle

Council of CEOs

� Review� Seek Commitment

in Principle

Pharmacy & Physician Organizations

Stakeholder Signoff � Final Review� Approve Provincial Plan

IM/IT Governance Council

Input and Review

ITC

� Input and Recommendation

IMC

Annual Refresh


IM/IT Strategic (EHR) Plan 2004-2007

PersonDirectory

Drugs, &Allergies

LabResults

Diagnostic Imaging

Registries

Clinical TextReports

� Provincial review of Client Registry Strategy

SCOPE

� Capture discharge meds � Health region System-to-System 2005-2007� Batch dispensing 2004-05� ACB dispensing� Triplicate Prescription� Implement in Business Intelligence Environment

� All provincial lab data made available (CHR, CHA, ACB, Non Metro, Prov Lab, CBS)� Agreed to Standards in place� Lab Test Results Delivery (LRD) and Lab Test Results History (LTRH) available to up to 60% of MD population� Order Entry of lab tests available

� DI Text Report Standards in place (exam codes, message specs, report formats, diagnostic codes)� DI Text Reports Delivery and History available� DI PACS images available from source systems

� Provider � Single source of truth of provider information� Facility � Uniform, consistent & accurate identification of facilities across health system

� Access to clinical text reports and history (Discharge, Operative, Consultation reports)Draft

alberta's ehr system - pin

Health & Medicine

elements reside

regional ehr

wellness ehr

care

physician

wellness

data

individual