ehealth - jim maclean
TRANSCRIPT
Diverse solutions,Singular objective,Completing the EHR puzzle
Dr Jim MacleanCanada Health Infoway Inc.
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.2
• Benefits of electronic records• EMRs in Ontario• What about the next wave of physicians?• EMR/EHR convergence
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.3
Benefits of Electronic Health Records• Increased interpretations by remote specialists• Improved wait-times for diagnostic imaging services• Improved availability of community based health
services• Reduced patient travel time and cost to access services• Increased patient participation in home care• Increased patient access and use of their health record
• Increased interpretations by remote specialists• Improved wait-times for diagnostic imaging services• Improved availability of community based health
services• Reduced patient travel time and cost to access services• Increased patient participation in home care• Increased patient access and use of their health record
Access• Availability of Services
• Ability to Access Services
• Consumer Participation
Access• Availability of Services
• Ability to Access Services
• Consumer Participation
Quality• Safety
• Effectiveness
• Appropriateness
Quality• Safety
• Effectiveness
• Appropriateness
Productivity• Efficiency
• Care Coordination
Productivity• Efficiency
• Care Coordination
• Increased access to integrated patient information • Reduced duplicate tests and prescriptions• Reduced physician prescription call-backs• Reduced patient and provider travel costs• Improved vaccine management• Improved information management resulting in reduced
costs
• Increased access to integrated patient information • Reduced duplicate tests and prescriptions• Reduced physician prescription call-backs• Reduced patient and provider travel costs• Improved vaccine management• Improved information management resulting in reduced
costs
InfowayElectronic Health
Record
Demographics Diagnostic Images Laboratory Results
Drug Profile Clinical Reports Immunizations
Telehealth
• Decreased medical errors• Improved interpretation of diagnostic and laboratory
results• Decreased adverse drug events• Decreased prescription errors• Improved prescribing practice • Increased speed and accuracy in detecting infectious
disease outbreaks
• Decreased medical errors• Improved interpretation of diagnostic and laboratory
results• Decreased adverse drug events• Decreased prescription errors• Improved prescribing practice • Increased speed and accuracy in detecting infectious
disease outbreaks
Booz Allen Hamilton have identified benefits exceeding $6 billion annually that could be realized from the Infoway EHR investment
The Canadian healthcare system will not fully realize all of these benefits if clinical point of
service systems (PoS) are not interoperable with the iEHR. In particular hospital clinical systems
(HIS) and physician office systems (EMR).
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.4
EMRs in Ontario
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.5
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OntarioMD• Starting in 2004, OntarioMD began managing the Physician IT Program for
the MOHLTC and the OMA
• The program is made up of four key components: − PC IT Funding
• eligible primary care physicians only (excludes most FFS GPs and all Specialists)
− Clinical Management Systems (EMR) Specification & Certification• certified 18 local EMR solutions and three ASP solutions
− Transition Support • assist eligible physicians and their staff to select and implement an
approved EMR in their practice − Physician Portal
• offers all Ontario doctors and their health care team free access to medical resources, secure email, tools and information
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.6
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EMR Adoption - Ontario and Alberta
500Dec 05
980Mar 07
1,764Mar 08
2,700Aug 08
2,250Dec 07
1,500Mar 03
1,800Mar 06
Oct 01-
500
1,000
1,500
2,000
2,500
3,000
OntarioMD EMR Adoption Alberta POSP EMR Adoption
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.7
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OntarioMD – EMR Adoption Study Findings
• The key focus of the 2008 EMR adoption study for funded Physicians was to explore− how funded Physicians in Ontario are using their EMR solution
• Additional issues explored include:− satisfaction with the EMR solution in place;− the extent to which Physicians have adopted administrative and clinical
features of the EMR; and− the impact of EMR adoption on workflow, patient management and care
• 268 funded physicians completed the online survey
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.8
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OntarioMD – Key Findings• Approximately three-quarters are satisfied with their current EMR and
majority (80%) would recommend an EMR to a physician not currently using one
• 6-in-10 describe their current practice as “primarily paperless”. Among those not currently ‘paperless’, most anticipate relying primarily on electronic patient charts within a year
• Over 80% of physicians use their EMR to create patient referrals.• Over half are using their EMR at least some of the time to:
• complete patient forms • achieve preventative care targets • identify and follow-up with patients for care • produce and manage flow sheets
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.9
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OntarioMD – Key Findings
• The majority of physicians surveyed report that they:− use their EMR as their primary source for accessing and
maintaining cumulative patient profile (CPP) information− write ALL of their patient prescriptions with their EMR − Receive at least half of their new lab results electronically
− scan and store all lab documents NOT received electronically
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.10
The Next Wave of Physicians
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.11
What do the next wave of physicians need to adopt EMRs?
• What is the “Value Proposition” that will entice them?
• Clinical case • Business case
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.12
EMR/EHR convergence
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.13
Registries Data& Services
EHR Data& Services
Ancillary Data& Services
DataWarehouse
ImmunizationManagement
PHSReporting
HealthInformation
Physician Office EMR
Physician/Provider
BusinessRules
EHRIndex
MessageStructures
TerminologyRepository
NormalizationRules
Longitudinal Record Services
HIALCommunication Bus
Security MgmtData
Privacy Data Configuration
ProviderRegistry
LocationRegistry
Common Services
EMR APPLICATIONEMR
Database
ClientRegistry Shared
Health RecordDrug
InformationDiagnostic
ImagingLaboratory
POINT OF SERVICE
JURISDICTIONAL INFOSTRUCTURE
End-User Perspective: EMR Application
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.14
Key Concepts
• There will be a broad range of patient health information in the iEHR that can be consumed by software applications at the point of care
• At some point the EMR software providers need to iEHR enable their applications by leveraging the pan-Canadian messaging standards
• The functioning principle is that you do not copy information from the iEHR, but rather integrate it with local data for presentation to your system users
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.15
Key Concepts
• Data presented that is NOT from the local application needs to be clearly identified in the application, along with information on its source e.g. the provider or organization who sourced the information
• Need for a user interface that allows the clinician to elect to push clinically relevant data to the iEHR
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.16
Things to Consider When Leveraging EHR Data
• Workflow• Screen flow• Nomenclatures
• Use of when entering clinical data• Use when displaying clinical data
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.17
Conclusions
• Our vision is that EHR Viewers will be transitional and their need obviated by capabilities in EMR systems
• There are significant new opportunities for software solution providers as they participate in the EHR
• Solution vendors need to understand that in the world of the EHR, they do not differentiate themselves any longer by the data they hold… but rather by the data they can access and present intelligently
Pan-Canadian Privacy Forum onEHR Information Governance
© 2008 Canada Health Infoway Inc.18
Website: www.infoway-inforoute.ca
E-mail: [email protected]
Thank you!