Alberta's EHR System - PIN

Pharmaceutical (PIN) Alberta’s Journey towards the Electronic Health Record (incl. PIN) March 1, 2004 1 Alberta Health and Wellness

Alberta’s Major Milestones on the Journey Seniors Drug Profile Pharmaceutical Information Network Electronic Health Record SDP Rollout PIN PILOT EHR 18-mo Strategy EHR Rollout SDP PILOT PIN Development PIN SDP Retired 1999 2000 2001 2002 2003 2004 2005 March 1, 2004 2 Alberta Health and Wellness

Seniors Drug Profile (SDP) – What Is It? SDP provided Hospitals, Physician Offices, Hospital Homecare Pharmacies & Homecare Offices with secure access to a profile of recently dispensed prescription drugs for senior citizens who are part Patient of the Alberta Blue Cross Group 66 Plan Seniors Drug Profile Medication Information Alberta Blue Cross 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 ” Seniors Drug Profile Pharmaceutical Information Network Electronic Health Record SDP Rollout SDP PILOT 1999 2000 2001 2002 2003 2004 2005 March 1, 2004 3 Alberta Health and Wellness

What is PIN? What is PIN? tool that: An information sharing 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. March 1, 2004 4 Alberta Health and Wellness

PIN is conceptually simple How is PIN delivered? 8 Central clinical data repository 8 No duplicate data entry 8 Links existing heterogeneous systems Central Clinical Data Repository 8Via a web browser 8System-to-system March 1, 2004 5 Alberta Health and Wellness

PIN Pilot Profile 8 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 8 Results 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 Seniors Drug Profile Pharmaceutical Information Network EHR SDP Rollout SDP PILOT PIN PILOT 1999 2000 2001 2002 2003 2004 2005 March 1, 2004 6 Alberta Health and Wellness

Things we learned: 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 March 1, 2004 7 Alberta Health and Wellness

EHR September 2002 The Minister announces that there will be a provincial Electronic Health Record by March 31, 2004 Seniors Drug Profile Pharmaceutical Information Network EHR EHR 18-mo Strategy SDP Rollout SDP PILOT PIN PILOT 1999 2000 2001 2002 2003 2004 2005 March 1, 2004 8 Alberta Health and Wellness

….. In 18 Months!! Implementation Initiatives March 1, 2004 9 Alberta Health and Wellness

EHR: What is It ? What an EHR IS What an EHR IS NOT 8 Individual focused 8 Provider focused 8 Individual specific core data set 8 An operational system where elements reside In multiple Operational systems feed data to populate the sources EHR 8 Mechanism for sharing health data 8 A data collection system about an individual 8 A single physical repository 8 Longitudinal health information 8 A Clinical Information System / about an individual from multiple Electronic Patient Record nor Physician sources Office System / Electronic Medical Record, but they are interrelated 8 Support for clinical decision making 8 Accessible at all points of care in a EPR and EMR describe the record of the timely manner periodic care provided mainly by one institution. It is a complete patient record accessible from a single, automated health care provider system. March 1, 2004 10 Alberta Health and Wellness

EHR:What Did We Need to Think About What an EHR IS Individual rights 8 Individual focused Respect for privacy and ethical usage 8 Individual specific core data set where elements reside in multiple Identification of a user sources Access controls Record of users interaction 8 Mechanism for sharing health data about an individual Governance Stewardship of data 8 Longitudinal health information Standards about an individual from multiple Clinical acceptance sources Workflow impact 8 Support for clinical decision making Culture 8 Accessible at all points of care in a Readiness timely manner Remote connectivity Security Education March 1, 2004 11 Alberta Health and Wellness

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 March 1, 2004 12 Alberta Health and Wellness

Relationships Between the 18- month EHR and Other Systems Portal •Single Sign On •Authentication & Authorization •Audit Trail •Person Search Patient EHR Summary System eMPI Demographics EMR to Drugs LAB System Person Lab Identification PIN Results (PPHI) Pharmacy Systems March 1, 2004 13 Alberta Health and Wellness

Privacy and Security Technical Administrative 8 Authentication (Two-factor – Common: SecurID Fobs) 8 Privacy Impact Assessment (PIA) 8 Authorization (Need to know 8 Training principle, Record of use) 8 User ID Registration Process 8 Encryption 8 Confidentiality Agreements 8 Audit Logs 8 Self-Assessment Tool 8 Firewall Secure Network: 8 Intrusion Detection 8 Policies 8 Anti-virus – Minimum Connectivity Requirements (Level 1) – Level 2 2004/2005 – Level 3 2005/2006 Internet: 8 2 Factor ID (FOB) 8 COACH guidelines March 1, 2004 14 Alberta Health and Wellness

Rollout - EHR Campaign Based Campaign = 1 or more health care facilities and surrounding area servicing home care, community physicians and pharmacists 8 Urban 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). 8 Rural Could be grouped to include more than one health care facility to make effective use of implementation resources. Physicians Pharmacy Patient Hospital Homecare March 1, 2004 15 Alberta Health and Wellness

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 Seniors Drug Profile Pharmaceutical Information Network EHR SDP Rollout EHR 18-mo Strategy SDP PILOT POSP PIN PILOT POSP II 1999 2000 2001 2002 2003 2004 2005 March 1, 2004 16 Alberta Health and Wellness

Governance – Relationship Model Governance: Decision Making Structure Alberta Health & Wellness Health Regions/Boards Physician Physician • Council of CEOs Office Office Systems Systems Physicians Program Health IM/IT Health IM/IT • CPSA Program Governance • AMA Governance Council Council Pharmacists • ACP • RxA Public Representation Provincial Provincial EHR Data EHR Data Information Information Information Information Telehealth Telehealth Stewardship Stewardship Management Management Technology Technology Committee Committee Committee Committee Committee Committee Committee Committee Project Coordination --Alberta Wellnet Project Coordination Alberta Wellnet March 1, 2004 17 Alberta Health and Wellness

Multi-stakeholder Governance Advantages: 4 Increases stakeholder engagement 4 Helps to increase perspective & manage multiple agendas 4 Opens communication channels – government isn’t always the translator Critical Success Factors: 8 Senior Chair 8 Incumbents are Decision Makers 8 Balanced Representation 8 Membership – Critical Few 8 Quarterly meetings – at least March 1, 2004 18 Alberta Health and Wellness

EHR Data Stewardship – Building a Trust Relationship 8 Key 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 March 1, 2004 19 Alberta Health and Wellness

Applying the Framework to the EHR Participating Stakeholder Custodians AH&W Organizations College Physicians RxA Pharmacies College AMA Health Council Authorities of CEOs Public Information Information Manager Agreement* Exchange Protocol EHR Ministerial Authorizes use of EHR Guides use of data by Order Binds both parties to custodian and wellnet Data Establishes DSC follow the Information e.g. who can access the Stewardship Exchange Protocol data, how research Committee requests are handled, Manages the etc. protocol Becomes appendix to agreement Alberta Wellnet (AH&W) Information Manager Manages the data in accordance with the Information Exchange Protocol March 1, 2004 20 Alberta Health and Wellness

Major achievements also made in 2003 achievements TOOL INITIATIVE ACHIEVEMENT OUTCOMES ! Tri-partite governance Accessibility POSP Phase II POSP Phase II ! 3 levels of participation Efficiency Accessibility ! Target of > 2,500 new MDs (68% of Alberta’s physicians by March/06) Patient Safety Efficiency CH EHR CH EHR ! Regional EHR (netCARE) implemented CHR Clinical CHR Clinical ! Regional EHR (Eclypsis) selected System and project initiated Accessibility System Patient Safety Efficiency Non Metro Non Metro ! Regional EHR (Meditech) selected Clinical Systems EHR and project initiated Clinical Systems • Wave 1 – pilot complete Alberta Cancer Alberta Cancer • Wave 2 – SDP replacement ! ICCN (Optx) implemented to be completed Mar 04 Board Board • Wave 3 – Pharmacy/MD implementation underway • Drumheller first community to Privacy Privacy ! EHR Data Stewardship Committee Accessibility go live • Infoway Funding partnership established for PIN Security Security Accessibility ! Minimum Connectivity Requirements March 1, 2004 21 Alberta Health and Wellness

Governance Process Used to Define Next Steps IM/IT Governance Council IMC IM/IT(EHR) March 16, 2004 STRATEGIC PLAN I • Overview • Develop & Forward • Domains • Seek Endorsement Recommendations • Goals in Principle • Outcomes • Stakeholder Impact ITC Input and Review IM/IT(EHR) STRATEGIC PLAN II • Costed • Funding Sources & Gaps Pharmacy • Further Plan Development Council of CEOs & Physician Organizations March-June 2004 • Review • Review • Seek Commitment • Seek Commitment in Principle in Principle IMC • Input and IM/IT Governance Council Recommendation • Final Review Stakeholder Signoff • Approve Provincial Plan Annual Refresh March 1, 2004 22 Alberta Health and Wellness

IM/IT Strategic (EHR) Plan 2004-2007 SCOPE Person • Provincial review of Client Registry Strategy Directory • Capture discharge meds Drugs, & • Health region System-to-System 2005-2007 Allergies • Batch dispensing 2004-05 • ACB dispensing • Triplicate Prescription • Implement in Business Intelligence Environment • All provincial lab data made available (CHR, Lab CHA, ACB, Non Metro, Prov Lab, CBS) Results • 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, Diagnostic message specs, report formats, diagnostic codes) Imaging • DI Text Reports Delivery and History available • DI PACS images available from source systems • Provider – Single source of truth of provider Registries information • Facility – Uniform, consistent & accurate identification of facilities across health system Clinical Text • Access to clinical text reports and history Draft Reports (Discharge, Operative, Consultation reports) March 1, 2004 23 Alberta Health and Wellness

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Alberta's EHR System - PIN

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