Growth of the iEHR in Canada: User Adoption …...©Canada Health Infoway 2016 Growth of the iEHR in...
Transcript of Growth of the iEHR in Canada: User Adoption …...©Canada Health Infoway 2016 Growth of the iEHR in...
©Canada Health Infoway 2016
Growth of the iEHR in Canada:
User Adoption Landscape and Benefits
Bobby Gheorghiu/Sukirtha Tharmalingam October 13, 2016
Thursday, October 13,2016
1:00PM ET
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Disclaimer
• This webinar represents solely the views of Infoway
• It is intended to be informative only, and cannot be interpreted as providing any indication of Infoway’s present or future strategies or investment criteria
• Infoway does not implicitly or explicitly endorse any particular technology or solution of any vendor or any other person, it does not guarantee the reliability or any proposed results related to the use of such technology or solution, and this notwithstanding that reference may be made directly or indirectly to any such technology or solution in this webinar
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Growth of the iEHR in Canada:
User Adoption Landscape
Bobby Gheorghiu October 13, 2016
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Presentation Objectives
1. To explain the methodology behind Infoway’s adoption measures and to provide context for the reported data
2. To highlight users’ experience with iEHRs across the country and discuss the concept of a maturity model to demonstrate benefits over time
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Who and what is Infoway?
With our partners, Infoway helps accelerate the development, adoption and effective use of digital health solutions across Canada
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Since inception, $2.15 billion in capitalization from federal government
• $500 million: electronic health records (2001)
• $600 million: electronic health records and telehealth (2003)
• $100 million: health surveillance systems (2004)
• $400 million: electronic health records and wait time systems (2007)
• $500 million: EHRs, EMRs, consumer health (2010)
• $50 million: e-prescribing and telehomecare (2016)
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iEHR definition
• The interoperable Electronic Health Record is a secure, integrated view of a person’s medical records from all systems in the network; it provides a comprehensive view of a patient’s medical history
• Similar to a Health Information Exchange (HIE)
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iEHRs accessible in multiple settings with a rich set of data Jurisdiction Go-Live Setting Clinical Domain accessible
British Columbia 2010 Hospitals Labs, DI reports
Alberta 2006 Hospitals, pharmacies, primary care, ambulatory
Lab, DI reports, drug profile, immunization, allergies, clinical reports
Saskatchewan 2013 Hospitals, primary care labs, drug profile, DI reports, clinical reports, immunizations
Manitoba 2011 Hospitals, primary care Labs, DI reports, drug profile, immunization, clinical reports
Ontario 2011 Hospitals , primary care, community/home care
Labs, DI reports, drug profile*, allergies, clinical reports
Quebec 2013 Hospitals, primary care, pharmacies Labs, DI reports, drug profile, immunization
New Brunswick 2010 Hospitals Encounter History, labs, DI reports, cardiology
Prince Edward Island
2008 Hospitals, primary care Labs, DI reports, drug profile
Nova Scotia 2010 Hospitals, primary care Labs, DI reports, clinical reports
Newfoundland 2014 Hospitals Med Profile, allergies/ADEs, Clinical Reports, Discharge Summaries, labs, DI Reports
Northwest Territories
2010 Hospital, primary care Labs, DI reports, clinical reports, consults
Nunavut 2011 Selected hospitals Labs, DI reports, drug profile, clinical reports
*Limited to drug products dispensed under the Ontario Drug Benefit program and the Trillium Drug Program
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Digitization of information for authorized users (June 30, 2016)
Client Demographics 100%
Provider Demographics 100%
Diagnostic Images in Hospitals
100%
Dispensed Drugs 69%
Lab Test Results 95%
Clinical Reports or Immunizations 100%
Digitization does not measure the extent of use by providers, but rather the information and systems that are in place.
2016
Telehealth Videoconferencing in 98% of Hospitals
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Data Collection and Use Reporting
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• System data provided by jurisdictions
• Survey data: Infoway-funded as well as through external partnerships (e.g., NPS, Commonwealth Fund)
• Adoption Trends • Cumulative Benefits
External • Annual Report • Pan-Canadian Studies • International
comparisons Internal • Project tracking against
deliverables • Informs program
strategies
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Principles of Adoption/Use Reporting
Comprehensiveness
Simplicity
Reliability
Comparability
Coherence
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Active user concept
• Defined as access to two or more integrated provincial data assets (e.g., lab information system, drug information system, diagnostic imaging repository, etc.)
• Active users have accessed the system a minimum of one time per month (or three times per quarter)
• Users of point of care systems with data feeds from provincial assets are deemed to be active users of the EHR
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Active iEHR Use Across Canada (Jan. 2015)
Notes: 1. Figures represent active users with access to two or more integrated provincial data assets (e.g., lab information system,
drug information system, diagnostic imaging repository, etc.) 2. Active users have accessed the system a minimum of one time per month 3. This graph does not depict the number of users of individual data assets that are not integrated with other systems. 4. Users of point of care systems with data feeds from provincial assets are deemed to be active users of the EHR 20
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Clinician access to iEHR
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53% of pharmacists can access an electronic list of all medications taken by an individual patient (accessible through a provincial/territorial drug information system)
44% of nurses have access to provincial/territorial patient information systems (e.g. drug, laboratory, diagnostic images)
37% of physicians have access to provincial/territorial patient information systems
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Our approach to evaluating the value of iEHRs
Evidence informed value proposition
Indicators and tools
Adoption monitoring, Project evaluations
Surveys and further research
Pan-Canadian study
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Conclusion: Value of measuring use/adoption
• Data collected allows for multi-year trending and monitoring of progress
• Enables target-driven approach for project reimbursement (gated funding)
– Clear correlation between projects and programs applying evidence-based targets and benchmarking and long-term success
– Effective lever for driving broad deployment and adoption
• Ensures critical mass of users as a foundation for continued development and innovation
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Growth of the iEHR in Canada: Benefits
Sukirtha Tharmalingam October 13, 2016
http://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-016-0330-3
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Evaluating the value of iEHRs in Canada
• Available evidence to date largely focused on individual iEHR components
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Evaluating the value of iEHRs – US examples
• Examples emerging from the US on evaluating the value of Health Information Exchanges (HIEs)
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Approach to understanding iEHR Value
Consolidate evidence from iEHR evaluations across the country:
1. iEHR deployed for province/territory wide use
2. iEHR shared at least 2 or more core clinical data
3. Results available by December 2015
4. System and use survey administered to users based on National Benefit Evaluation Framework
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6 P/T evaluations available for
study
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Synthesizing user survey data
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Survey questions from all 6
P/T evaluations
Extract common questions (used in 2 or more P/T evaluations)
21 questions
Survey Question Response Classification
Positive outcomes
>50% or more respondents reported a positive response/rating/experience
Negative outcomes >50% or more respondents reported a negative response/rating/experience
Mixed outcomes a mix of <50% or more respondents reported a positive or negative response/rating/experience
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Profile of iEHR users studied
• 6 P/T evaluations conducted between 2006- 2014
• N=2,318 • Nurses/NP (33-51%)
• Physicians (12-49%)
• Administrative staff, allied health
• Variety of clinical settings: Hospital, primary, community
• At minimum users had access to lab results and diagnostic imaging
• Duration of iEHR use <1 year
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iEHR user perceptions
• System, Information, Service Quality
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7
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Service Quality
Information Quality
System Quality
0 5 10 15 20 25
Number of outcomes measured from evaluations
Positive Mixed/Neutral Negative
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iEHR user perceptions
• User Satisfaction
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13 1 1
0 5 10 15 20
UserSatisfaction
Number of outcomes measured from evaluations
Positive Mixed/Neutral Negative
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iEHR user perceptions
• Net Benefits
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14
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3
2
1
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0 5 10 15 20
Productivity
Quality
Number of outcomes measured from evaluations
Positive Mixed/Neutral Negative
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Summary of iEHR user perceptions
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2
3
1
1
1
1
1
1
1
1
0 5 10 15 20 25
Quality
Productivity
User Satisfaction
Information Quality
Service Quality
System Quality
Number of outcomes measured from evaluations
Positive Mixed/Netural Negative
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Limitations
• Customization of surveys
• Sample sizes
• Response rates
• Equal weighting of all individual surveys
• 8 year study period
• Variation in care settings, jurisdictional context
• Solution attributes
• Deployment methods
• Additional user details
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• Maturity of benefits occur over time with concerted efforts in other areas:
• System and service quality are foundational to realizing benefits
iEHR Benefit Maturity
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Solution Capabilities
System Integration Challenges
Effective Change Management
• Leadership • Technical support and
training • Workflow integration
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Next steps in iEHR Evaluation
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• Evidence on maturity of iEHR benefits
• Benefits realized in different clinical settings, specific patient populations
• Pan-Canadian benefits estimates from iEHRs
Deployment
• Limited benefits
Early
• Information availability
Medium-term
•Efficiencies
Long-term
• Impact on care
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TO ASK QUESTIONS
All attendees have been muted. Please use the “Q&A” function to ask questions.