eHealth - Jim Maclean

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



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).



EMRs in Ontario



5

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



6

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



7

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



8

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



9

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



The Next Wave of Physicians



What do the next wave of physicians need to adopt EMRs?

• What is the “Value Proposition” that will entice them?

• Clinical case • Business case



EMR/EHR convergence



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



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



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



Things to Consider When Leveraging EHR Data

• Workflow• Screen flow• Nomenclatures

• Use of when entering clinical data• Use when displaying clinical data



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



Website: www.infoway-inforoute.ca

E-mail: [email protected]

Thank you!

Date post:	16-May-2015
Category:	Health & Medicine
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eHealth - Jim Maclean

Health & Medicine