eHealth - Jim Maclean


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  • eHealth - Jim Maclean

    1. 1. Diverse solutions, Singular objective, Completing the EHR puzzle Dr Jim Maclean Canada Health Infoway Inc .
    2. 2. <ul><li>Benefits of electronic records </li></ul><ul><li>EMRs in Ontario </li></ul><ul><li>What about the next wave of physicians? </li></ul><ul><li>EMR/EHR convergence </li></ul>
    3. 3. <ul><li>Benefits of Electronic Health Records </li></ul><ul><li>Increased interpretations by remote specialists </li></ul><ul><li>Improved wait-times for diagnostic imaging services </li></ul><ul><li>Improved availability of community based health services </li></ul><ul><li>Reduced patient travel time and cost to access services </li></ul><ul><li>Increased patient participation in home care </li></ul><ul><li>Increased patient access and use of their health record </li></ul><ul><li>Access </li></ul><ul><li>Availability of Services </li></ul><ul><li>Ability to Access Services </li></ul><ul><li>Consumer Participation </li></ul><ul><li>Quality </li></ul><ul><li>Safety </li></ul><ul><li>Effectiveness </li></ul><ul><li>Appropriateness </li></ul><ul><li>Productivity </li></ul><ul><li>Efficiency </li></ul><ul><li>Care Coordination </li></ul><ul><li>Increased access to integrated patient information </li></ul><ul><li>Reduced duplicate tests and prescriptions </li></ul><ul><li>Reduced physician prescription call-backs </li></ul><ul><li>Reduced patient and provider travel costs </li></ul><ul><li>Improved vaccine management </li></ul><ul><li>Improved information management resulting in reduced costs </li></ul><ul><li>Decreased medical errors </li></ul><ul><li>Improved interpretation of diagnostic and laboratory results </li></ul><ul><li>Decreased adverse drug events </li></ul><ul><li>Decreased prescription errors </li></ul><ul><li>Improved prescribing practice </li></ul><ul><li>Increased speed and accuracy in detecting infectious disease outbreaks </li></ul>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). Infoway Electronic Health Record Demographics Diagnostic Images Laboratory Results Drug Profile Clinical Reports Immunizations Telehealth
    4. 4. EMRs in Ontario
    5. 5. OntarioMD <ul><ul><li>Starting in 2004, OntarioMD began managing the Physician IT Program for the MOHLTC and the OMA </li></ul></ul><ul><ul><li>The program is made up of four key components: </li></ul></ul><ul><ul><ul><li>PC IT Funding </li></ul></ul></ul><ul><ul><ul><ul><li>eligible primary care physicians only (excludes most FFS GPs and all Specialists) </li></ul></ul></ul></ul><ul><ul><ul><li>Clinical Management Systems (EMR) Specification & Certification </li></ul></ul></ul><ul><ul><ul><ul><li>certified 18 local EMR solutions and three ASP solutions </li></ul></ul></ul></ul><ul><ul><ul><li>Transition Support </li></ul></ul></ul><ul><ul><ul><ul><li>assist eligible physicians and their staff to select and implement an approved EMR in their practice </li></ul></ul></ul></ul><ul><ul><ul><li>Physician Portal </li></ul></ul></ul><ul><ul><ul><ul><li>offers all Ontario doctors and their health care team free access to medical resources, secure email, tools and information </li></ul></ul></ul></ul>
    6. 6. EMR Adoption - Ontario and Alberta 500 Dec 05 980 Mar 07 1,764 Mar 08 2,700 Aug 08 2,250 Dec 07 1,500 Mar 03 1,800 Mar 06 Oct 01
    7. 7. OntarioMD – EMR Adoption Study Findings <ul><ul><li>The key focus of the 2008 EMR adoption study for funded Physicians was to explore </li></ul></ul><ul><ul><ul><li>how funded Physicians in Ontario are using their EMR solution </li></ul></ul></ul><ul><ul><li>Additional issues explored include: </li></ul></ul><ul><ul><ul><li>satisfaction with the EMR solution in place; </li></ul></ul></ul><ul><ul><ul><li>the extent to which Physicians have adopted administrative and clinical features of the EMR; and </li></ul></ul></ul><ul><ul><ul><li>the impact of EMR adoption on workflow, patient management and care </li></ul></ul></ul><ul><ul><li>268 funded physicians completed the online survey </li></ul></ul>
    8. 8. OntarioMD – Key Findings <ul><ul><li>Approximately three-quarters are satisfied with their current EMR and majority (80%) would recommend an EMR to a physician not currently using one </li></ul></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>Over 80% of physicians use their EMR to create patient referrals. </li></ul></ul><ul><ul><li>Over half are using their EMR at least some of the time to: </li></ul></ul><ul><ul><ul><li>complete patient forms </li></ul></ul></ul><ul><ul><ul><li>achieve preventative care targets </li></ul></ul></ul><ul><ul><ul><li>identify and follow-up with patients for care </li></ul></ul></ul><ul><ul><ul><li>produce and manage flow sheets </li></ul></ul></ul>
    9. 9. OntarioMD – Key Findings <ul><ul><li>The majority of physicians surveyed report that they: </li></ul></ul><ul><ul><ul><li>use their EMR as their primary source for accessing and maintaining cumulative patient profile (CPP) information </li></ul></ul></ul><ul><ul><ul><li>write ALL of their patient prescriptions with their EMR </li></ul></ul></ul><ul><ul><ul><li>Receive at least half of their new lab results electronically </li></ul></ul></ul><ul><ul><ul><li>scan and store all lab documents NOT received electronically </li></ul></ul></ul>
    10. 10. The Next Wave of Physicians
    11. 11. What do the next wave of physicians need to adopt EMRs? <ul><li>What is the “Value Proposition” that will entice them? </li></ul><ul><li>Clinical case </li></ul><ul><li>Business case </li></ul>
    12. 12. EMR/EHR convergence
    13. 13. End-User Perspective: EMR Application Registries Data & Services EHR Data & Services Ancillary Data & Services Data Warehouse Immunization Management PHS Reporting Health Information Physician Office EMR Physician/ Provider Business Rules EHR Index Message Structures Terminology Repository Normalization Rules Longitudinal Record Services HIAL Communication Bus Security Mgmt Data Privacy Data Configuration Provider Registry Location Registry Common Services EMR APPLICATION EMR Database Client Registry Shared Health Record Drug Information Diagnostic Imaging Laboratory POINT OF SERVICE JURISDICTIONAL INFOSTRUCTURE
    14. 14. Key Concepts <ul><li>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 </li></ul><ul><li>At some point the EMR software providers need to iEHR enable their applications by leveraging the pan-Canadian messaging standards </li></ul><ul><li>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 </li></ul>
    15. 15. Key Concepts <ul><li>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 </li></ul><ul><li>Need for a user interface that allows the clinician to elect to push clinically relevant data to the iEHR </li></ul>
    16. 16. Things to Consider When Leveraging EHR Data <ul><li>Workflow </li></ul><ul><li>Screen flow </li></ul><ul><li>Nomenclatures </li></ul><ul><ul><li>Use of when entering clinical data </li></ul></ul><ul><ul><li>Use when displaying clinical data </li></ul></ul>
    17. 17. Conclusions <ul><li>Our vision is that EHR Viewers will be transitional and their need obviated by capabilities in EMR systems </li></ul><ul><li>There are significant new opportunities for software solution providers as they participate in the EHR </li></ul><ul><ul><li>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 </li></ul></ul>
    18. 18. Website: E-mail: [email_address] Thank you!