Ontario Shores Journey to EMRAM Stage 7 October 21, 2015
ICE BREAKER
Agenda System overview & pervasiveness of use Review Clinical Practice Guideline implementation Discuss Patient Portal implementation Activity Review Lessons Learned Questions/Comments
Ontario Shores at a Glance Teaching hospital specializing in comprehensive mental health care and addiction services 1,300 employees; 328 inpatient beds; over 50,000 outpatient visits Recovery-oriented care provide to a wide range of services: Adolescents to Geriatrics Meditech 6.0 and EMRAM HIMSS Stage 7 first in Canada and first mental health facility in the world
What is Stage 7?
Electronic Medical Record Adoption Model (EMRAM)
Why Stage 7?
EMRAM Stage 7 What is expected at Stage 7? Paperless Use analytics to find care issues to address Use of clinical decision supports CPOE > 90%; emar/bmv > 95%; Case studies demonstrating use of HIS for quality improvement Benefit Realization of Stage 7: EMR is adopted to: Enhance quality of care Advance and ensure patient safety through analytics Create access and efficiencies in care Increase utilization of evidence-based tools and clinical decision supports
System Overview: Overall Timeline for EMR Implementation 2007/2008 Planning 2009/10 Phase 1 2010/11 Phase 2 2011/12 Phase 3 2012/13 2013/14 2014/15 Planned RFI and Vendor Shortlist RFP and Vendor Selection Business Case Approved Contract Signed Project resource Plan Developed Core Team Assembled Live Oct.: ADT Pharmacy Finance Material Mgmt. Live Dec.: HR/Payroll Staff Scheduling ACS Readiness Assessment Live Oct./Nov.: Clinical Doc Physician Doc Order Entry Enterprise Medical Record Transcription Live Dec.: Data Repository RAI Implementation Outpatient Implementation Meditech 6.06 full system upgrade Achievement of HIMSS Stage 6 Plan of Care Optimization CPGs IAR Outpatient, CWS, Lab Optimization Smoking Cessation Business Intelligence Meditech 6.07 full system upgrade Patient Portal CPGs LOCUS Front End Speech Recognition OCAN QRM Optimization Connecting GTA (cgta)
Pervasiveness of Use
Pervasiveness of Use: Computerized Physician Order Entry (CPOE) Consistently meeting 90% target since October 2013
Pervasiveness of Use: BMV/eMAR Medication and Patient Scanned Letters of Expectation
Pervasiveness of Use: Medication Reconciliation on Admission 100% % Medication Reconciliation on Admission 95% 90% 85% 80% 75% 70% % Med Rec on Admission
% Med. Rec. on Discharge Pervasiveness of Use: Medication Reconciliation on Discharge 100% 98% 96% 94% 92% 90% 88% 86% 84% 82% 80% % Med Rec on Discharge Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 100% 95.70% 100% 98.40% 100% 91.50% 93% 100% 91.70% 100% 96.30% 93.70% 100% 100% Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 98% 98% 98% 98% 98%
Pervasiveness of Use: Documentation Percentages Type Handwritten Dictation/ Transcription Structure Forms Structure forms w Discrete Data H&P 0% 6% 0% 94% Progress Notes 0% 0% 60% 40% Consult Notes 0% 85% 0% 15% Discharge Notes 0% 20% 0% 80% Problem List 0% 0% 0% 100% Diagnosis List 0% 0% 0% 100%
Pervasiveness of Use: Scanned Documentation Form Scanning turnaround time Code white, code blue, Mental Health Act forms Downtime reports, Electroconvulsive Therapy Ontario Review Board, Integrated Community Access Program referrals 30 minutes 4 hours 24 hours Discharge charts 24 hours All other non-clinical documents 48 hours
Pervasiveness of Use: Uploading Patient Photos to the MAR
Pervasiveness of Use: Patient Identification on the MAR
Pervasiveness of Use: Medication Administration Error Alerts Incorrect patient scanned: Scanning a dose that exceeds the ordered dose: Administering a medication that is not currently due: Scanning an incorrect barcode type:
Pervasiveness of Use: Medication Administration Warning Alerts Scanning a medication that is not ordered for the patient: Scanning a medication that has been discontinued: Scanning a dose that is less than the ordered dose:
Pervasiveness of Use: Quality Improvement Cycle for Medication Incidents Implement, communicate, educate and monitor Patient notification entered Recommendations to Safe Medication Practice Committee Confirm medication and patient scanned Identify any system changes to prevent further incident
Transfer of Accountability Status Board
Predictive Surveillance: Infection Prevention and Control Status Board
Clinical Decision Support (CDS)
Clinical Decision Support (CDS) Clinical Content Query Link: triggers based on responses Reflex orders: actions based on orders Interaction checking Protocols Links to Policies within order and documentation screens References in Order sets Rules If-Then logic Required responses
Clinical Decision Support: Physician Admission Assessment
Clinical Decision Support: Orders that Trigger Reflex Sets
Clinical Decision Support: Order Set References
Clinical and Business Intelligence
Data/Information Governance Data/Information Governance Committee Communicate Strategic Direction Communicate project prioritization and resource requirements SMT Data/Information Stewardship Committee IT Clinical Information Decision Support Manage Change (Project) Requests & Request for Data/Reports Clinical Professional Practice Finance Physicians Others Submit Change (Project) Requests & Request for Data/Reports
Business Intelligence Tool Scorecard with Drill-through Functionality
Business Intelligence Tool Dashboard with Drill-through Functionality
BREAK
Clinical Practice Guidelines
Clinical Practice Guidelines at Ontario Shores Year 1 Assessment and treatment of Schizophrenia (inpatients only) Metabolic monitoring for individuals on antipsychotics (inpatients and outpatients) Year 2 Assessment and treatment of Schizophrenia (Outpatients) Depression Years 3-5 Dementia Bipolar Personality Disorders Concurrent Disorders ECT
Approach to Improving Metabolic Monitoring at Ontario Shores Automated physician decision support/reflexive order set that is triggered from physician documentation Clinical dashboard sent monthly to physicians/clinical managers that indicates their adherence to monitoring guidelines compared to hospital average Quality improvement projects to improve adherence based on reported results
Clinical Practice Guidelines: Physician Admission Assessment
Clinical Practice Guidelines: Dashboard CPG Dashboard with drill down / rollup functionality at Hospital / Program / Unit / Provider / Patient levels
Clinical Practice Guidelines: Dashboard CPG Provider Summary report. Spider graph measures individual adherence vs. Hospital averages for metabolic monitoring
Clinical Practice Guidelines: Metabolic Monitoring Adherence Rates 60% 50% 40% 30% 20% 10% 0% Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 5/5 25% 29% 27% 41% 52% 44% 42% 46% 43% 40% 46% 43% 4/5 30% 25% 25% 23% 28% 27% 30% 28% 27% 27% 22% 30% 3/5 24% 24% 28% 17% 10% 18% 19% 13% 19% 20% 18% 15% 2/5 14% 17% 9% 11% 6% 6% 6% 8% 9% 11% 9% 9% 1/5 5% 4% 6% 3% 3% 3% 3% 4% 1% 2% 5% 1% 0/5 3% 1% 4% 4% 1% 1% 1% 1% 2% 1% 1% 2% 5/5 4/5 3/5 2/5 1/5 0/5 Adherence Indicators: Blood Pressure, Waist Circumference, HbA1C, BMI, Fasting Lipids
Clinical Practice Guidelines: Percentage of Patients on Multiple Antipsychotics (Excluding Clozapine) 60% 50% 40% 30% % Patients on Multiple Antipsychotics (excluding Clozapine) 20% 10% 0% 15-Jan 15-Feb 15-Mar 15-Apr 15-May 15-Jun 15-Jul 15-Aug 15-Sep 15-Oct 15-Nov
Patient Portal
Patient Portal Implementation Aim to: Enhance access Remedies existing gaps related to: active engagement and partnership between patients, families and health care providers Supports the paradigm shift towards patient-driven care Evolves current practices and culture from having the provider be the keeper of the information to one where the provider and the patient are partners in care
Patient Portal Functionality Messaging functionality allows patients to send any non urgent messages to providers Display clinical data, including reports, allergies & conditions, labs & microbiology View medications, education materials and renew medications *sensitive lab results have been suppressed & reports have a 7-day delay Ability to view all upcoming booked appointments & appointments can be requested, cancelled, & rescheduled directly from the portal Ability to view & request updates to demographic information
Utilization of Patient Portal: Enrollment
DAVIES Since 1994, the HIMSS Nicholas E. Davies Award of Excellence has recognized outstanding achievement in the generating improvement of care outcomes and return on investment through the use of health information technology. The Davies Award program promotes EHR-enabled improvement in patient outcomes through sharing best practices and lessons learned on implementation strategies, workflow design, analytics, and change management.
ACTIVITY Jeopardy
Lessons Learned Early engagement with end-users/clinicians Advancing technology to enable practice requires significant change management strategies as part of development and implementation Evaluation and creating formal opportunities for feedback is critical for adoption and engagement Clinical leadership engagement is key for success
Lessons Learned Formal physician champion role is integral Leverage efficiencies and collaboration among interprofessional team members Spend time developing new work flows that maximize efficiencies and reduce documentation workload
Future Plans 2015-19 IS/T Plan implementation Continue to use analytics with BI tool to improve care HIE cgta, Hospital Report Manager, Justice, Law Enforcement, Housing Provincial registries client and provider Advance use of Patient Portal Research to enable predictive analytics, quality of care, etc. Waypoint Collaboration
Thank You