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Maureen Charlebois, Chief Nursing Executive and Group Director, Canada Health Infoway
1. Canada Health Infoway
Transforming Practice &
Improving Care Across
Canada
Presentation to the Clinical Leaders Summit
Ireland’s Future Health Summit, May 26, 2016
Maureen M. Charlebois Chief Nursing Executive & Group Director
Clinical Adoption – Canada Health Infoway
2. 2
CANADIAN CONTEXT
• Federal
government
sets and
administers
national health
care principles
• 13
provincial/terri
torial
governments
plan, finance,
manage,
evaluate their
health services
• 700 + hospitals
4. Approach – strategic investment model
$2.098 billion in approved projects to date; 387
active or completed projects
Solution
deployment
projects in each
jurisdiction
Common
Blueprint &
Standards
Twelve
investment
programs
Program
criteria
Program
eligible
costs
Project
sizing and
estimation
Approved
projects for
investment
1. Registries
2. Diagnostic Imaging Systems
3. Drug Information Systems
4. Laboratory Information Systems
5. Interoperable EHR
6. Telehealth
7. Public Health Surveillance
8. Patient Access to Quality Care
9. Innovation and Adoption
10. Infostructure
11. EMR and Integration
12. Consumer Health Solutions
5. 5
THREE WAVES OF DIGITAL HEALTH
INNOVATION
• Building blocks
• Digital tools
for clinicians
• Empowering
patients
7. 7
THE FIRST WAVE
LABORATORY
INFORMATION
SYSTEMS
85%
DIAGNOSTIC
IMAGING IN
HOSPITSLS
100%
DISPENSED
DRUGS
62%
CLINICAL
DOCUMENTATION
100%
PATIENT &
PROVIDER
REGISTRIES
100%
• Foundational infrastructure
for digital health:
investments in six core
components of an electronic
health record
• Leadership in architecture,
standards, privacy
• Pan-Canadian strategy
8. 8
THE SECOND WAVE: DIGITAL
TOOLS FOR CLINICIANS
• Electronic
medical records
• Expansion of
telehealth
• Public health
surveillance
Source: 2015 Commonwealth Fund International Survey of Primary Care Physicians
9. 9
THE THIRD WAVE:
EMPOWERING PATIENTS
• Improving
the
patient
experience
• Enhancing
patient
safetyWhat Patients say they want access to:
Online Appointment Booking
E-consultations/visits
Online lab results/views
Online prescription renewal
10. Access to results drives value for patients
10
Source: Impacts of direct patient access to laboratory results – Final Report 2015
13. Overall impact on Quality of Care – Clinicians
Perspective
Sources:
2014 Infoway-CNA National Nurses Survey, 2014 Infoway National Survey of Community Pharmacists and National Physician
Survey (2014) * % Not sure or No Reponses not reported
14. Transformative Leadership
• Change leadership is the strategic, systematic approach that supports
people and their organizations in the successful transition and adoption of
electronic health solutions.
• The outcomes of ‘change leadership’ results in adoption and the full
realization of benefits and clinical transformation.
A Focused Approach to change management that
incorporates these six elements noted in the CM
Framework helps to ensure alignment of activities,
solution adoption and realization of benefits.
Change Management Framework
Clinical Adoption Framework
15. Q1. What has helped the most to lead change in your
organization?
Q2. What are the barriers to successful change in your
organization?
Top 3 Change BarriersTop 3 Change Enablers
Leadership is the top Change Enabler
• Visible/engaged senior
leadership
• Stakeholder engagement
• Clinical/change champions
• Competing priorities
• Lack of visible/engaged
senior leadership
• Lack of effective
communications
16. Transforming Clinical Practice
‘‘CurrentCurrent
State’State’
Where are we now?Where are we now?
‘‘DesiredDesired
State’State’
Where do we want to be?Where do we want to be?
Visible Clinical & IT Leadership
Budget for Change Management
Selected Change Approach/Methodology
Engaged Clinicians & Informatics Specialists
Communication Plan & Key Messages
Workflow Analysis & Practice Process Redesign
Role Specific Training & Education
Ongoing Technical, Operational & Clinical Support
Pre & Post Change Indicators & Evaluation
GAP Analysis:
What type of support is required to get there?
17. Why is change so hard?
17
Amygdala – ‘Flight or Fight’
Stuck_on_an_escalator.wmv
20. Transforming Practice, Improving Care
Collaboration &
Communication
Improves
Efficiencies &
Avoids Duplication
Decision Support
& Workflow
Information Management
& Education
Timely Access to
Information
21. Pan-Canadian Clinical Peer Leader Networks
Clinical Peer Leaders
working with their
colleagues providing
clinical leadership,
support, mentoring and
coaching to facilitate
learning and use of
technology in practice.
22. Transforming health care –clinical leadership
• 96% of Peer Leaders
‘agree/strongly agree’ they
are positively influencing
their colleagues
understanding and
adoption of EMR/other
technology systems in
their practice settings
• 89% of Peer Leaders
‘agree/strongly agree’ that
the Peer Network is
beneficial to clinicians
23. • To ensure that clinicians in training are ready to
practice in, and gain value from, an technology
enabled environment when they graduate
• To develop and integrate competencies related to
the use of technology into the curricula design/
educational processes of the Faculties of Medicine,
Nursing and Pharmacy
• To establish Faculty Peer Leader Networks to
provide mentorship, engagement and influence
culture change related to the effective use of
technology in clinical practice and Consumer Health
solutions through innovative teaching strategies
Infoway’s Next Generation Strategy
24. These successes positioned Infoway as a strategic investor in eHealth within Canada
The Next Generation - Impact
25. 25
TWO AMBITIOUS GOALS FOR 2016-2017
• Establish a multi-
jurisdiction e-
prescribing
solution
• Expand
telehomecare and
patient online
services
26. 26
OUR SOLUTION
• Will enable
prescribers to
electronically
transmit a
prescription to
a patient’s
pharmacy of
choice
• This will:
• Reduce use of
paper
prescriptions
• Optimize
existing drug
system
investments
• Enhance patient
27. 27
TELEHOMECARE AND PATIENT ONLINE
SERVICES
• Telehomecare
is ready to be
immediately
scaled
• Improves
quality of
life for
patients with
chronic
conditions
• Fewer
emergency
room visits
and hospital
stays
• Continue to
29. Clinical Leadership – Transforming
Practice
We need to build
capacity and
integrate
the required
digital health
competencies into
Professional
Practice
Frameworks
and Models of Care
30. 30
Technologies are not
simply inventions which
people employ but are
the means by which
people are reinvented.
Technologies are not
simply inventions which
people employ but are
the means by which
people are reinvented.
We shape our tools and thereafterWe shape our tools and thereafter
our tools shape us.our tools shape us.
700+ hospitals and 2,500+ long-term-care homes
Approximately 400,000 general practitioners, specialists, nurses, pharmacists and health care professionals deliver care to Canadian patients
700+ hospitals and 2,500+ long-term-care homes
Approximately 400,000 general practitioners, specialists, nurses, pharmacists and health care professionals deliver care to Canadian patients
Only 4-8% of Canadians have online access to:
Book appointments
View lab results
Consult with clinicians
Renew prescriptions
Satisfaction:
Service users (patients who accessed their most recent result online) were more satisfied with their most recent overall lab test experience:
On the overall process (91% vs. 82%)
For timeliness of the process (91% vs. 78%)
For how results were received (92% vs. 82%)
Are clinicians using the health information systems (HIS)?
Are they using it effectively?
Are they better able to provide quality patient care on the account of it?
Are the systems of benefit?
Analytics & Value Proposition at the individual, organization, provincially and nationally
1. NPS (2013) – Productivity :
How has the quality of the patient care you provide changed since electronic records were implemented:
Greatly Increased; Increased; Did not change; Decreased; Greatly Decreased; Not sure
2. Infoway-CNA National Nurses Survey (2014) – Productivity : Base: All respondents in clinical practice providing direct care and using EMRs (n=750)
How has the quality of the patient care you provide changed since electronic records were implemented:
Greatly Increased; Increased; Did not change; Decreased; Greatly Decreased; Not sure
3. Community Pharmacists 2014 Survey
Q12. How has the quality of the patient care you provide changed since the availability of an electronic provincial DIS? e. (Decrease 11-50%, Decrease 1- 10%, No impact, increase 1-10%, increase 11-50%, increase more than 50%)
Less than 20% of transformational projects achieve their full objectives
The norm is over budget, over schedule, with a lack of benefits realization:
56% of change projects are behind schedule
37% are over budget
84% do not hit their targets
7% do not achieve scope/functionality
Organization has senior leader accountable for change management
39%
Project leaders accessible to make decisions, remove barriers for project team
45%
Key messages delivered by senior leader all or most of the time
46%
Training is segmented by user type and role all or most of the time
61%
Change management process includes reviewing and monitoring change tactics
35%
Workflow analysis and integration is conducted on change activities all or most of the time
43%
Change management process includes structured stakeholder engagement all or some of the time
36%
Motivation is in effect a means to reduce and manipulate the gap
Commitment
Build Organization Capacity
resources, structures & mechanisms
Enable a decentralized ‘power’ base
Focus on Safety & Patient Satisfaction
People Process System
Staff Empowered & Passionate about their work
Investment in Staff
Focus on Safety & Improvement in Patient & Staff Satisfaction
Are clinicians using the health information systems (HIS)?
Are they using it effectively?
Are they better able to provide quality patient care on the account of it?
Are the systems of benefit?
Analytics & Value Proposition at the individual, organization, provincially and nationally
Since launching in 2012, CEC has continues to build awareness and engagement amongst clinicians and health care leaders:
Estimated reach = over 530,000
91 individual Clinical Champions
38 Committed Partner organizations
14,275 You tube views
3,852 Resource downloads
33,863 CEC Webpage Views
Leading Practices…
FY2015-16: 3 Faculty Peer Leader Networks, almost 30 Faculty Peer Leaders reaching almost 4,000 colleagues (e.g. through e-Resource and coaching)
Cumulative: 3 Faculty Peer Leader Networks, almost 30 Faculty Peer Leaders reaching almost 7658 colleagues
FY2015-16: 7 active jurisdictional Peer Leader Networks, with over 200 Peer Leaders engaging over 2,000 colleagues
Cumulative: almost 750 Peer Leaders engaging over 36,000 colleagues
to connect the team to improve communication & collaboration; to connect the patient – to improve self management and person centered care, to connect to evidenced based information to support knowledge based practice and to connect to required data analytics needed at the individual/clinician level, at the management/organizational level as well as at the provincial and national level to achieve Better Health, Better Care and Better Value…Getting there will require clinical, technical and strategic partnerships, change leadership and collaborations at all levels across organizational, system and professional boundaries.
Issues such as usability, governance and professional accountability will need to be resolved.
Getting there will require clinical, technical and strategic partnerships, change leadership and collaborations at all levels across organizational, system and professional boundaries.
Issues such as usability, governance and professional accountability will need to be resolved.
We shape our tools and thereafter our tools shape us. Herbert Marshall McLuhan, CC (July 21, 1911 – December 31, 1980) was a Canadian philosopher of communication theory and a public intellectual. His work is viewed as one of the cornerstones of the study of media theory, as well as having practical applications in the advertising and television industries.[1][2] He was educated at the University of Manitoba and Cambridge University and began his teaching career as a Professor of English at several universities in the U.S. and Canada, before moving to the University of Toronto where he would remain for the rest of his life.
McLuhan is known for coining the expressions the medium is the message and the global village, and for predicting the World Wide Web almost thirty years before it was invented.[3] Although he was a fixture in media discourse in the late 1960s, his influence began to wane in the early 1970s.[4] In the years after his death, he continued to be a controversial figure in academic circles.[5] With the arrival of the internet, however, interest in his work and perspective has renewed.[6