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Rapid Response Evaluation for Physician Office
Electronic Medical Records
Morgan Price, MD, PhD, CCFPFrancis Lau, PhD, eHealth Chair
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Introductions
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eHealth Observatory Mandate
• Monitor effects of Health information system (HIS) deployment
• Build health informatics research capacity
• Engage healthcare community in knowledge translation
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Who am I?
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Who am I?Lead Researcher at eHealth Observatory
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Who am I?Lead Researcher at eHealth Observatory
Family Doctor: Cool Aid CHC
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Who am I?Lead Researcher at eHealth Observatory
Family Doctor: Cool Aid CHC
UBC Family Medicine Lead Faculty, Informatics
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Who am I?Lead Researcher at eHealth Observatory
Family Doctor: Cool Aid CHC
UBC Family Medicine Lead Faculty, Informatics
Adjunct Faculty, Comp Sci
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Who am I?Lead Researcher at eHealth Observatory
Family Doctor: Cool Aid CHC
UBC Family Medicine Lead Faculty, Informatics
Adjunct Faculty, Comp Sci
Informatics Consultant
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Thank you to the team• Dr. Francis Lau the eHealth Chair
• eHealth Observatory Team:
• Tyrone Austen
• Jesdeep Bassi
• Heidi Bell
• UBC Enhanced Skills Trainees:
• Dr. Jeanette Boyd
• Dr. James Lai
• Dr. Colin Partridge
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Ground Rules
Please Interrupt
Me with Questions!
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Activities
• Review Background from the Literature
• Overview of our evaluation framework
• Overview of the methods and tools
• Review Two Case Studies (time permitting)
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EMR Background Literature
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We are completing a systematic review of
EMR benefits in office practice.
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Question:What are the impacts of
EMR systems on physician office practices?
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Methods
Main sources MEDLINECINAHL
Supplemental searchesPublication years: 2000-2009CriteriaReviewers
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15,847 Papers
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15,847 Papers
Analytic Studies22
Descriptive Studies24
Surveys26
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72% of survey indicators were for User Satisfaction
System Quality
Information Quality
Service Quality
Use
User Satisfaction
Net Benefits
Quality
Access
Productivity
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Analytic Studies
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Country # of Studies
% of Total
Netherlands 5 23%
United Kingdom 5 23%
United States 5 23%
Canada 2 9%
Australia 2 9%
New Zealand 2 9%
Italy 1 5%
Total 22 100%
Location of Studies:
50% Europe
32% North America
18% Australia & NZ
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90% of measures were focused on Net Benefits
System Quality
Information Quality
Service Quality
Use
User Satisfaction
Net Benefits
Quality
Access
Productivity
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Function # of Studies Positive OutcomesPrescribing 7 3
Prevention 4 3CDM 4 2
Test ordering 2 2Recordkeeping 2 0
Other 2 0Referrals 1 1
Total 22 11
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Function # of Studies Positive OutcomesPrescribing 7 3
Prevention 4 3CDM 4 2
Test ordering 2 2Recordkeeping 2 0
Other 2 0Referrals 1 1
Total 22 11
Only 2 studies looked at clinical outcomes (no positive findings)
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Description of the Descriptive studies
In ProgressIn Progress
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There is some evidence of
mixed benefits...lots of room for
improvement
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Overview of our Framework
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Scanning
LaboratoryResults
DI ReportsImages
Medications
OtherDocuments
ElectronicFeeds In
ElectronicFeeds Out?
Paper Charts
Paper / FaxOut to others
EMR
Other ElectronicRepositories
(Public and Private)
How to Evaluate?
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Scanning
LaboratoryResults
DI ReportsImages
Medications
OtherDocuments
ElectronicFeeds In
ElectronicFeeds Out?
Paper Charts
Paper / FaxOut to others
EMR
Other ElectronicRepositories
(Public and Private) How to Evaluate?
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Scanning
LaboratoryResults
DI ReportsImages
Medications
OtherDocuments
ElectronicFeeds In
ElectronicFeeds Out?
Paper Charts
Paper / FaxOut to others
EMR
Other ElectronicRepositories
(Public and Private) How to Evaluate?
How to Provide
Feedback?
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We wanted something timely, comprehensible, and useful for clinicians.
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We wanted something that could also aid in adoption / impact.
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Our framework is built on two sources:
HIMSS & IOM.
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HIMSS Analytics
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0 Paper Charts for Clinical Information
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1
0
Online access to reference materials
Paper Charts for Clinical Information
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2
1
0
Hybrid Electronic - Paper Chart
Online access to reference materials
Paper Charts for Clinical Information
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3
2
1
0
Electronic Medical Record Used (more passive record)
Hybrid Electronic - Paper Chart
Online access to reference materials
Paper Charts for Clinical Information
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4
3
2
1
0
Electronic Chart with Advanced Point of Care Clinical Decision Support
Electronic Medical Record Used (more passive record)
Hybrid Electronic - Paper Chart
Online access to reference materials
Paper Charts for Clinical Information
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5
4
3
2
1
0
EMR Integrated within Health SystemPoint of Reflection CDSS
Electronic Chart with Advanced Point of Care Clinical Decision Support
Electronic Medical Record Used (more passive record)
Hybrid Electronic - Paper Chart
Online access to reference materials
Paper Charts for Clinical Information
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Institute of Medicine
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IOM created a report on the Key Capabilities
of an EHRS(IOM 2003)
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IOM focused on care delivery functions and not
infrastructure / data standards.
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IOM - 8 Core Functions
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
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Summarize Adoption as a Graph
0
1
2
3
4
5
Health Inform
ation
Order E
ntry
Results M
anagement
Decision S
upport
Electronic C
omm
unication
Patient S
upport
Scheduling B
illing
Practice R
eflection
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We can show changes over time
0
1
2
3
4
5
Health Inform
ation
Order E
ntry
Results M
anagement
Decision S
upport
Electronic C
omm
unication
Patient S
upport
Scheduling B
illing
Practice R
eflection
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We developed tools to assess adoption
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We developed tools to assess adoption
Impact Assessment (I)
EMR Adoption (I)
Workflow Modelling / Rx Functions (I)
Usability Benchmarking (O)
Practice Reflection (G)
EMR System Analysis (I / S)
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We developed tools to assess adoption
Impact Assessment (I)
EMR Adoption (I)
Workflow Modelling / Rx Functions (I)
Usability Benchmarking (O)
Practice Reflection (G)
EMR System Analysis (I / S)
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We developed tools to assess adoption
Impact Assessment (I)
EMR Adoption (I)
Workflow Modelling / Rx Functions (I)
Usability Benchmarking (O)
Practice Reflection (G)
EMR System Analysis (I / S)
34Tuesday, July 13, 2010
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We developed tools to assess adoption
Impact Assessment (I)
EMR Adoption (I)
Workflow Modelling / Rx Functions (I)
Usability Benchmarking (O)
Practice Reflection (G)
EMR System Analysis (I / S)
34Tuesday, July 13, 2010
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We developed tools to assess adoption
Impact Assessment (I)
EMR Adoption (I)
Workflow Modelling / Rx Functions (I)
Usability Benchmarking (O)
Practice Reflection (G)
EMR System Analysis (I / S)
34Tuesday, July 13, 2010
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We developed tools to assess adoption
Impact Assessment (I)
EMR Adoption (I)
Workflow Modelling / Rx Functions (I)
Usability Benchmarking (O)
Practice Reflection (G)
EMR System Analysis (I / S)
34Tuesday, July 13, 2010
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All resources are available at
ehealth.uvic.ca
(version 2.0 coming)
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METHOD: we travel
on site, tools in hand.
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Two researchers. Three days
Focus Group
Feedback Focus Group
Interview
Interview
Interview
Interview
Observation
Observation
Interview
Interview
Usability
Usability
Interview
Interview
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We provide feedback and recommendations
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240 6 12 18
Months
Adoption
Finally, we repeat the study.
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240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
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240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
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240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
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240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
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240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
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240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
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240 6 12 18
Months
Adoption
Finally, we repeat the study.
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240 6 12 18
Months
Adoption
Finally, we repeat the study.
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Two Case Studies
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Case Study 1
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Here are the scores.
0
1
2
3
4
5
Health Inform
ation
Order E
ntry
Results M
anagement
Decision S
upport
Electronic C
omm
unication
Patient S
upport
Scheduling B
illing
Practice R
eflection
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Change Management - variable, based on role.
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Prescription Management
• Variable use of EMR
• No alerting
• Not using advanced features
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Usability
• Multiple errors from system / GUI
• Users did not use tools efficiently
• Drug selection issues (generic / brand)
• Complexity for newer users
• icons not clear
• Complex prescriptions not handled well.
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Other Issues
• Participants quick to highlight challenges.
• Many are relative complaints:
• it is slower now
• scanning takes way more mouse clicks than it used to.
• Technical glitches: freezing
• Training issues.
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They didn’t complain about what they didn’t know.
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Case Study 2(more briefly)
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0
1
2
3
4
5
Health Inform
ation
Order E
ntry
Results M
anagement
Decision S
upport
Electronic C
omm
unication
Patient S
upport
Scheduling B
illing
Practice R
eflection
Here are the scores.
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Let’s Compare the Two Cases50Tuesday, July 13, 2010
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Case 1
0
1
2
3
4
5
Health Inform
ation
Order E
ntry
Results M
anagement
Decision S
upport
Electronic C
omm
unication
Patient S
upport
Scheduling B
illing
Practice R
eflection
51Tuesday, July 13, 2010
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0
1
2
3
4
5
Health Inform
ation
Order E
ntry
Results M
anagement
Decision S
upport
Electronic C
omm
unication
Patient S
upport
Scheduling B
illing
Practice R
eflection
Case 2
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Who implemented when?
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Case 2 implemented 10 years before Case 1
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Why so little difference?
55Tuesday, July 13, 2010
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User Challenges
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I know how paper works...
57Tuesday, July 13, 2010
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I didn’t know what I didn’t know
58Tuesday, July 13, 2010
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Short term fixes have long term implications
59Tuesday, July 13, 2010
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Terminology, shmerminology - let me write down what I want.
60Tuesday, July 13, 2010
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System Challenges
61Tuesday, July 13, 2010
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Group1,000s
Classification10,000s
Reference Terminology100,000s
62Tuesday, July 13, 2010
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“Flexible Data models”“Add your own terminologies”
63Tuesday, July 13, 2010
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From my office...
64Tuesday, July 13, 2010
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From my office...
64Tuesday, July 13, 2010
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From my office...
64Tuesday, July 13, 2010
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From my office...
64Tuesday, July 13, 2010
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From my office...
64Tuesday, July 13, 2010
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From my office...
64Tuesday, July 13, 2010
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From my office...
64Tuesday, July 13, 2010
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From my office...
64Tuesday, July 13, 2010
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From my office...
64Tuesday, July 13, 2010
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From my office...
64Tuesday, July 13, 2010
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From my office...
64Tuesday, July 13, 2010
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How can I see my practice with data like that?
65Tuesday, July 13, 2010
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How can we share data in the future?
66Tuesday, July 13, 2010
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67Tuesday, July 13, 2010
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Materials available atehealth.uvic.ca
68Tuesday, July 13, 2010