Electronic Health Records in Ontario
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The document discusses Ontario's progress toward establishing shared electronic health records (EHR) for its citizens. It notes the initial ambition was to have EHRs by 2015 but Ontario is still lacking in many areas like provider registries and medication profiles being shared. Barriers identified include having too many agencies involved, outdated hospital and physician office systems, past big IT projects failing, and a lack of patient access/demand driving change. It suggests taking incremental approaches, prioritizing patient access, and using quality metrics/incentives to promote improved EHR infrastructure.
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Electronic Health Records in Ontario
- 1. 2016 Engineering Technology Symposium PEO York Chapter Electronic Health Records Panel Mar 22, 2016
- 2. The Question What’s it going to take for Ontario to have shared Electronic Health Records for its citizens?
- 3. Initial Ambition “By 2015, the electronic health record will facilitate the sharing of key clinical data across the continuum of care while protecting the privacy and confidentiality of the information. It will include patient and provider registries that allow for unique identification of and information on diagnostic images, laboratory test results, medication profiles, hospital clinical reports, immunization history, and infectious disease reports. The electronic health record will be accessible from various points within a jurisdiction – acute care hospitals, ambulatory clinics, community health centres, and physician offices – so that an individual care giver, at a minimum, will be able to view a patient’s record.” – Canada Health Infoway Mandate, 2000.
- 4. How’s Ontario Doing? Domain Clinician Access Patient Access Notes Client Registry ~ X We have 4. “Official” Client Registry only used by DI. Provider Registry ~ X Exists but not used. Diagnostic Imaging √ X We have a solid federated XDS implementation. Lab Test Results ~ X Exists but barely used. Private players getting involved. Medication Profiles ~ X Only ODB only in ED, but ambitious plans afoot Hospital Clinical Reports ~ X Hospital Report Manager available in limited regions. Immunization History X X Some municipal registries. Nothing provincial yet. Infectious Disease Reports ? ? (more of a public health thing) eReferral X X
- 5. Why didn’t we make it? And what’s it going to take to get there? 5 angles…
- 6. 1. An Embarrassment of Riches Canada Health Infoway Health Canada CIHI MOHLTC eHealth Ontario OTN OntarioMD OACCAC CCIM CCO
- 7. 2. The last mile leads to a crumbling shack Acute •Obsolete hospital systems ($20B to modernize) •Frozen hospital budgets Ambulatory •At least 12 different EMRs, many small •Interoperability wasn’t part of certification
- 8. Is the Hospital EMR ripe for disruption?
- 9. About that $20B number… • Perhaps should rethink the traditional monolithic Hospital System. • Vancouver: $850M • Toronto: $600M • What if we separated repositories from workflow? • Lower cost • Open up to innovative workflow apps • What about the cloud? • Capital DIY -> Consumption model
- 10. 3. Big Projects Fail • Over 40% of North American IT projects budgeted at over $15M fail. (Ontario’s Health IT ratio is worse.) • Is it possible to develop EHR infrastructure in smaller, incremental steps?
- 11. 4. Give them an Inch… • “If we had started with consumer access, consumer demand would have forced faster progress on a shared EMR” – Eric Hoskins, Ontario Minister of Health • Requires patient “identity proofing” infrastructure • Initial forays failed: Google Health, MS Health Vault. What makes us think it will work this time?
- 12. 5. Quality Metrics • U.S. Meaningful Use offered carrots & sticks to promote data sharing • Regional ACO model established business model for improved EHR infrastructure to support improved outcomes at lower cost. • Could a similar approach work here in Ontario?
- 13. What’s it going to take for Ontario to have shared Electronic Health Records for its citizens? 1. Embarrassment of Riches: Many Agencies 2. Last Mile: Obsolete Hospital & Physician Office software 3. Big Projects Fail: Incremental options? 4. Give them an Inch: Patient Driven Demand 5. Quality Metrics: Incentives