Canada Health Infoway Benefits Evaluation and the BE Technical Report July 2012 Presented by What we ll cover Infoway Background Infoway s Approach to Benefits Evaluation A walk through of the BE Technical Report Lessons and experiences 2 1
Canada Health Infoway Created in 2001 $2.1 billion in federal funding Independent, not-for-profit corporation Accountable to 14 federal/provincial/territorial governments Mission: Fostering and accelerating the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan-canadian basis with tangible benefits to Canadians. Infoway will build on existing initiatives and pursue collaborative relationships in pursuit of its mission. Unique strategic investor role 2
Investment approach 12 targeted investment programs totalling more than $2.1 billion Points of care Clinic Homecare Emergency Services Community Care Centre Pharmacy Specialist Clinic Laboratory Hospital Emergency Diagnostic 3
Focus on standards and interoperability Common architecture accepted and in use by jurisdictions Updated architecture includes privacy and security requirements Infoway Standards Collaborative Extensive standards development and implementation underway Architecture and standards are freely available EHR Solution Ancillary Data and Services Point Of Service Applications EHR Infostructure Health Information Data Warehouse HIAL EHR Data & Services Longitudinal Record Services Point Of Service Applications Registries Data & Services EHR Viewer EHR Locator Three Pillars of Benefits Realization Critical S Facto uccess ors 8 4
Discussion Question: What challenges have you faced in gaining consensus and clarity about what projects are intended to achieve? 9 INFOWAY S APPROACH TO BENEFITS EVALUATION 10 5
Infoway s Purpose for Benefits Evaluation Purpose as described in our BE Strategy: Impacts identified will be used to: Advance further investments in EHR solutions Encourage end user adoption Highlight necessary adjustments in the Infoway investment strategy 11 11 Benefits Evaluation Process Environmental scan Draft set of potential indicators National BE Forum Indicator dcato guide gude Evaluations (underway) EMR pan-canadian study 12 6
Indicators https://www.infoway-inforoute.ca/index.php/progress-in-canada/benefits-realization 13 Benefits Evaluation Framework 14 7
Assessment e of user perceptions with standard survey tool: Diagnose and address adoption and benefits realization issues Demonstrate early evidence of benefits 15 Rigorous evaluation of benefits: Set of indicators developed by Subject Matter Experts Measure each of the indicators across a sample of projects 16 8
A WALK THROUGH OF THE BE TECHNICAL REPORT 17 Finding us... https://www.infoway-inforoute.ca/index.php/progress-in-canada/benefits-realization https://www.infoway-inforoute.ca/index.php/resources/reports/benefits-evaluation 18 9
In the beginning System & Use Diagnostic Imaging Drug Information Systems Lab Information Systems Public Health Systems Interoperable Electronic Health Records Telehealth 19 Version 2 Updated indicator sets based upon real life application Added EMR Guidance for planning evaluations 20 10
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23 BE Plan Template 24 12
BE Plan Template 25 BE Plan Template 26 13
BE Plan Template 27 BE Plan Template 28 14
LESSONS AND EXPERIENCES 29 15
ehealth Research in Canada is growing ehealth and Health Informatics Faculties 10 schools offering degree programs (10 years ago there was 1) Over 70 faculty researchers (doubled in the last 10 years) 6 Chairs and 2 more recruiting Graduates bring evaluation skills and mindset to the industry 3 31 Discussion i Question: Who could you work with on an evaluation? 32 16
Prioritize BE Focus Areas EMR Example: Near-term EMR System, Information and Service Quality & Maturity of use (Clinical Value Levels 1 &2) Clinical practice productivity & efficiencies (Net cost savings ROI, improved quality of care and timeliness) Improved care coordination and access to primary and specialized care Long-Term Improved quality and safety of prescribing Improved preventative screening & surveillance Improved population immunization Health system productivity 33 Whenever Possible, Steal 34 17
Look for Quick Wins An example of a study on electronic receipt of lab results into EMRs: 35 The Study in Brief Conducted by U of T Nine community-based primary care settings across Canada (BC, ON, QC, NB, NS) Mix of methods for receiving results: paper, scanned into EMR, electronic EMR-integrated Operations research approach Laboratory information workflow process review Observational site visits Quantitative/Qualitative questionnaire administration 36 18
Lab reporting steps (clinician & admin) Order Sort Review Act Archive Retrieve Sca an Paper In EMR 37 Lab reporting steps (clinician & admin) Order Sort Review Act Archive Retrieve Paper Scan 16 steps ~ 17.9 minutes 10 steps ~ 4.5 minutes In EMR 5 steps ~ 2.3 minutes 38 19
What practices said: Benefits of lab reports in the EMR Fewer misplaced reports & repeat testing Automated flagging to alert clinician Easier to trend results Review and share results Improved capacity for lab test audits, population health management, patient education Reduce paper/waste Increased job satisfaction Integrating lab results augments the value of EMRs in primary care clinical practice benefits and administrative efficiencies. 39 3 Communication is Central Measuring pan-canadian ad a benefits e Studies completed on Diagnostic Imaging, Gen 2 Drug Information Systems and Telehealth These studies will: Compile findings from Infoway projects and estimate aggregate benefits Compare findings against estimates in Infoway strategies, business cases, etc. Identify gaps and benefits realization requirements to achieve full potential Define key messages and communications approach 40 40 20
Change & Evaluation: Hand in Hand When asked would you rather work for change, or just complain? 81% of respondents replied, Do I have to pick? This is hard. 4 41 National CM framework Information & perspectives garnered through CMWG activities resulted in creation of a National CM Framework, based on six core elements: 1. Governance & Leadership 2. Stakeholder Engagement 3. Workflow Analysis & Integration 4. Communications 5. Training & Education 6. Monitoring & Evaluation 4 42 21
Discussion i Question: Who could you influence with an evaluation? 43 You Are Not Alone! 44 22
Questions What challenges have you faced in gaining consensus and clarity about what projects are intended to achieve? Who could you work with on an evaluation? Who could you influence with an evaluation? Presented by APPENDIX: EXAMPLES 46 23
Improving access to care Diagnostic imaging across Canada Improves radiologist productivity up to 30% Nearly 40% of radiologists use remote reporting to deliver care across vast geographical expanses 47 47 Improving access to information PEI s Electronic Health Record 9 in 10 PEI physicians and nurses are active users 73% agree the EHR improves the sharing of patient information between providers 84% agree the EHR makes accessing laboratory information easier It has made a huge improvement to efficiency. You now have easy access to information from previous patient visits that took place in other facilities. Stakeholder Interview Participant - 48 48 24
49 Benefits of Canada s drug information systems (DIS) Current DIS benefits $436 million in 2010 Estimated potential benefits $2.3 billion annually 49 50 DIS helps avoid ADE at care transitions 28.3% No Drug Profile Viewer With Drug Profile Viewer 5.2% 7.6% 0.9% Patients with at least one unintentional discrepancy Patients with at least one clinically significant discrepancy Source: DPV (ON) Benefits Evaluation Study Impact of a Centralized Provincial Drug Profile Viewer on the Quality and Efficiency of Patient Admission Medication Reconciliation 50 25
Benefits of early eprescribing Illegible prescriptions eliminated with early eprescribing Fewer printed prescriptions (0.7%) than handwritten (1.3%) require clarification calls. On average clarification calls took 9.1 minutes to complete. In addition to achieving patient safety benefits, pharmacists have more time to provide counseling and support to patients. 5 51 Connecting Patients and Providers at a Distance Canada is a Telehealth leader 35% annual growth In 2010: Nearly 260,000 Telehealth events 47 million km of travel saved = $70 million in personal travel costs Telehomecare helped the health system avoid an estimated $21 million in hospital utilization 52 52 26
QC Telehomecare Evaluation 21-month study of 95 chronic disease patients revealed significant benefits: Program could generate equivalent annual savings of $1,368 per patient compared to traditional home care. Drastic reduction (61%) in hospitalization and reduced length of stay High patient satisfaction 53 Manitoba s Physician Integrated Network PIN supports comprehensive, collaborative chronic disease management and preventive practice in primary care Quality Based Incentive Funding EMRs track a range of primary care clinical process quality indicators From 2008 to 2011, half the indicators (9/18) showed improvement across pilot sites, while the other half showed less or no improvement 5 54 27
Evolving the model of care Additional effort and changing roles in the clinic We have some new admin staff because of PIN. They go over the patient s file at the beginning of the day and see which indicators we need to deal with. They do BMIs and book appointments. PIN Physician A shift in focus Because of the EMR and the PIN headings, we feel now that the everyday promotion of health is brought to the forefront in each patient encounter. Illness prevention and health promotion are now the focus. PIN Physician 5 55 Improving cancer care WebSMR WebSMR reports are much more complete than narrative reports: 99% of data, compared to 47%. 51% of reports were entered by surgeons in less than 5 minutes 56 56 28
Promoting a Safety Culture Electronic Occurrence Reporting Systems in BC and NL Enable the capture and reporting of safety and risk-related events by all health care providers with improved tracking and follow-up: Increase in number of occurrences reported (in NL project by 83%); Decrease in the average turn around time between incident occurrence and notification to Quality & Risk management team (in BC project by 24 days) 57 29