Tim Graham MD, MSc, CCFPEM, CPHIMS-CA

Transcription

1 Its my pleasure to present our application for the 2016 LEADing Practice Competition. Our initiative involved launching a pilot of a Patient Portal tethered to our Enterprise EMR. I would like to acknowledge that this was a group effort, and there was a tremendous amount of work and dedication that our Working Group led. Tim Graham MD, MSc, CCFPEM, CPHIMS-CA Associate Chief Medical Information Officer, Edmonton Zone, Alberta Health Services Clinical Professor of Emergency Medicine, University of Alberta w: c: e: tim.graham@ahs.ca On behalf of the eclinician MyChart Working Group: Jeff Coloumbe, Dr. Allen Ausford, Karla Vermeeer, Dr. Fraser Armstrong, Dr. Rob Hayward, Dr. Mark Ballermann, Vaishali Singh, Donna Sired, Leahann Mcelveen, Chris Thompson, Shelley Bannister, Deane Stillar, Maureen Armstrong, Randy Fuglsang, Marcus Norman, Sharon McNaughton, David Pincock, Christopher Fulks, Kevin Ulmer, Bev Rhodes, Shelley Bacheldor, Tracy Shaben, and Dr. Karen Kroeker, Dr. Steven Katz, Dr. Penny Smyth, Dr. Jacques Romney

2 Alberta Health Services has a number of EMRs and other information systems being used in various geographies, but in the Edmonton Zone, over the last several years we have been implementing an EMR in our ambulatory clinics that we branded as eclincian, from the vendor Epic.

3 MyChart is the tethered patient portal that comes bundled with the Epicare Ambulatory Module. When AHS originally purchased Epic and branded it as eclinician, we had also purchased their patient portal, but for a number of reasons we were never quite able to get the organizational approvals to make it happen. This presentation describes how we got the MyChart pilot project kicked off, who we engaged with, what we deployed, and some preliminary benefits. One advantage of layering MyChart on top of eclinician was that we could access lab and DI information back to 2006 in our Zone. MyChart Features include: Patient s having electronic remote access to their health information (labs, diagnostic imaging, medications, allergies, problems, etc.) Management and scheduling of appointments Secure health messaging with healthcare team Patient-entered information (glucose, blood pressure, questionnaires)

4 Physicians had been calling for MyChart for years, but organizational factors (focus on ambulatory clinics, funding, alignment with other initiatives, inertia, etc.) prevented its launch. Eventually, there was a strong enough groundswell of clinical interest, and a mature enough EMR installation, that eclinician Clinical Leadership felt we could move the agenda forward. The first step, was getting clinical commitment that clinics would be willing to participate in a pilot. The MyChart team canvassed for interest, then commitment from a physician leader in each pilot clinic before bringing to our Ambulatory Oversight Committee Governance for approval. Each of five pilot clinics and about 30 doctors, had given commitment that they would work with us. This was key to getting our governance and leadership to buy into the concept. This resulted in the launching an eclinician MyChart working group to investigate how we could launch a pilot.

5 The first job of the Working Group was Institutional engagement within AHS (Legal & Privacy, Information Technology, Health Information Management, Lab Services, Zone Medical Advisory Committee) and the Patient and Family Advisory Council. We also engaged with the Alberta Health Ministry Alberta Personal Health Portal (PHP) group, this was key to ensure overall fit with AHS and provincial strategies. We also met with other organizations, and leveraged provincial work that previously investigated various strategies of allowing patients to see their health information. One key to our success was a willingness to make rapid decisions and push boundaries, then course correct, rather than over think things. Our Working Group established some principles early that helped guide us: Principles Keep decision making group small, experienced Focus on the patient Involve affected physicians/clinicians in decisionmaking Seek multi-stakeholder feedback, where possible, balanced by being pragmatic to get things done Drive priority based on clinical needs

6 Ensure compliance with relevant legislation/agreements Don t be afraid to Innovate and challenge the status quo Capture learnings that would inform the larger AHS strategy for patient portals

7 Another major piece of our engagement strategy with both our clinics and executive decision-makers was the idea of driving the implementation via specific use cases in the pilot clinics. This really forced the pilot clinics to think about how they address opportunities for improvement via MyChart, but also helped define which features of MyChart we would be able to test. Each pilot clinic was therefore required to create a simple use case that outline the problem that MyChart would solve. These decisions drove the configuration choices, and evaluation process.

8 Very early on, the MyChart team engaged with our AHS Patient and Family Advisory Committee. Their enthusiasm over patient portals guided the whole pilot.

9 MyChart is accessed through any Web-browser, or with Android and ios mobile apps Appointment scheduling was deployed in two ways, in once clinic we tested completely open scheduling where patients can choose any appointment they wish. In the other specialty clinics, patients get a more limited choice of spots. Once scheduled, patients get an reminder before the appointment. Notification of any new results in MyChart also comes in via , which contains no specific information, but notifies them that there is a new result to be viewed within MyChart. We emphasized that secure messaging was not to be used for emergencies, and that patients can not expect immediate answers. We deployed messaging in several ways as well, some physicians chose to receive direct messaging themselves, others chose to have the messages routed through central pools, and only to receive the most important ones.

10 Benefits evaluation is ongoing, and was a foundational part of our thinking. We have a Benefits Evaluation Framework document that we continually revise and update. Survey data are automatically collected in the background (on line surveys are automatically ed to users at 1,6,12 months after go-live), and free text entries used to help guide interface improvements. Key informant interviews are going to be underway soon, as well as the administrative data review, which will join MyChart data to our NACRS and DAD databases re Emergency Department visits and inpatient admissions. We have good data on leading indicators such as patient satisfaction which is really high, and look forward to analyzing our lagging indicators such as clinic no-show rates, visits to the ED and inpatient admissions. This evaluation will feed into the final report on MyChart, at the end of our pilot phase, to determine the ongoing strategy for patient portals for AHS in general, and for MyChart in particular.

11 Two Key policy decisions These two decisions represented the bulk of the work and engagement. The technical decisions about which features to turn on and off were much more straightforward. Multistakeholder Feedback We sought feedback from MyChart WG, AHS Lab Leaders, Alberta Health Provincial Health Portal Group, clinicians feedback and experience at other jurisdictions to guide our approach to lab release. In many cases this was breaking new ground in the province, and had to be willing to make pragmatic decisions that at times made people uncomfortable, with the commitment to modify if needed. By always keeping the patient-centered approach at the forefront, we were able to advocate for releasing more tests than some clinicians were advocating for initially. This also meant that in general a physician would not be the arbiter of whether or not a test results can be released, as all tests eventually get released (although a physician can release a result earlier than 10d if they choose). Lab and DI Release Strategy

12 Auto release of any and all data that might be related to chronic disease management or generally considered non-sensitive. These may be required for day-to-day management of illness. E.g.: Hematology (cbc, wbc), electrolytes, renal function, liver function, lipids, diabetes monitoring (glc, HgbA1c), anticoagulation, heart tests (troponin, BNP),

13 etc. Time Delayed Auto Release (10d) of any and all data that would typically perceived to require face-to-face explanation or management. Note that a provider can autorelease these results manually before the default auto delay. E.g.: Pathology reports HIV, Hepatitis C, blood tests used to screen for or follow cancers (e.g. PSA, CEA) Diagnostic Imaging reports Genetic testing (Newborn screening, Diagnostic testing (e.g for angioedema, protein C deficiency, Carrier testing, Prenatal testing, Preimplementation testing) Microbiology testing Proxy Access - our proxy access criteria are

14 slightly different than in other jurisdictions and we are still gaining experience with them. We have three categories: Adults 18y and older Minors less than 18, were not given access, unless Mature Minors physicians are able to declare that a patient is a mature minor, in which case they are treated as an adult.

15 The main practice changes relate to those features that we were able to deploy. We are seeing increasing acceptance of secure messaging, and that patients will regularly have access to all of their health information. Not all of our physicians have bought into directly secure messaging with their patients, and prefer to have it managed with nursing or administrative pools. We now have enough experience that there is a lot of thought about how we might be able to leverage MyChart features to gradually address issues of clinic efficiency and promote increasing care in the community versus in facility-based clinics, and further developments in asking patients to enter data into the EMR at home that can directly relate to patient care in the clinics (e.g. pre-visit assessments, functional assessments like disease severity scores etc.). Patients find that the self scheduling features in particular are game changing, and value having access to their health data.

16 We carefully designed the launch of MyChart (focused in select AHS clinics) to fit in with both AHS and Provincial strategy relating to portals. Alberta launched the Alberta Provincial Health Portal, MyHealth, several years ago, and it contains a huge amount of patient information about health and wellness, how to manage acute conditions, what lab tests mean, and way finding MyChart pilot is the first EMR-specific Patient Portal to leverage the PHP investment We leveraged some of the technical infrastructure and infostructure to deploy MyChart We were able to configure deep linking out of MyChart via HL7 into information about lab tests, e.g. right click on a test result in MyChart and it launches out into the PHP informational material

17 Provider feedback has been generally positive, however we are aware that we are dealing with an enthusiastic group of early adopters. This means that our feedback is likely skewing more positive than it might otherwise with a more widespread deployment.

18 Patient feedback has been generally very positive. The main negative comments usually pertain to the management of usernames and passwords (and the need to reset them) and also the two-factor authentication process that we have to maintain to satisfy the privacy and security requirements for AHS. We also get comments about some of the reports that are in MyChart being difficult to understand as they are in medical jargon.

19 This has certainly been the most satisfying project that I have ever been involved with, and I think this sentiment is shared by many in our initiative. We feel that in our pilot we have met our objectives, and are excited to get the remainder of our benefits evaluation completed to see if we can get a better feel of some of our lagging indicators such as no-show rates, and visits to the emergency department. Tim Graham MD, MSc, CCFPEM, CPHIMS-CA Associate Chief Medical Information Officer, Edmonton Zone, Alberta Health Services Clinical Professor of Emergency Medicine, University of Alberta w: c: e: tim.graham@ahs.ca On behalf of the eclinician MyChart Working Group: Jeff Coloumbe, Dr. Allen Ausford, Karla Vermeeer, Dr. Fraser Armstrong, Dr. Rob Hayward, Dr. Mark Ballermann,

20 Vaishali Singh, Donna Sired, Leahann Mcelveen, Chris Thompson, Shelley Bannister, Deane Stillar, Maureen Armstrong, Randy Fuglsang, Marcus Norman, Sharon McNaughton, David Pincock, Christopher Fulks, Kevin Ulmer, Bev Rhodes, Shelley Bacheldor, Tracy Shaben, Dr. Karen Kroeker, Dr. Steven Katz, Dr. Penny Smyth, Dr. Jacques Romney