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Primary Health Care Initiatives

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Presentation on theme: "Primary Health Care Initiatives"— Presentation transcript:

1 Primary Health Care Initiatives
Presentation to MNIA Monday September 15th 2008 Dr. Diamond Kassum – Chief Medical Information Officer, Manitoba eHealth

2 Topics Manitoba eHealth iEHR and Active Clinical Projects
Primary Health Care PCISS PIN EMR selection and adoption Infoway initiatives Access Centres, CAR, Carelinks, BGSC

3 Manitoba eHealth – A Provincial Program
Was announced by the Minister of Health on April 11, 2007 Develops information management processes, tools, and technology A single organization to ensure alignment with provincial and national objectives Will ensure a long-term province-wide approach Builds and acquires solutions that meet Manitoba’s health care needs

4 The Circle of Care Pharmacy Laboratory Diagnostic Hospital Emergency
Homecare Clinic Emergency Services Specialist Clinic Community Care Center From the EHRS Blueprint © Canada Health Infoway

5 The Patient Centric & Integrated View of Consolidated Information
Pharmacy Laboratory Diagnostic Hospital Emergency Homecare Clinic Emergency Services Specialist Clinic Homecare Clinic Emergency Services INTEGRATED VIEW QUALITY SAFETY ACCESSIBILITY Clients/Patients Community Care Center Pharmacy Specialist Clinic Laboratory Hospital Emergency Diagnostic From the EHRS Blueprint © Canada Health Infoway

6 Electronic Health Record (EHR)
An electronic health record (EHR) is a secure and private lifetime record of an individual’s health and care history, available electronically to authorized health providers. It facilitates the sharing of data – across the continuum of care, across healthcare delivery organizations and across geographies. 6 6 6 6

7 An example of an Electronic Healthcare Record
Phone: 14 Health Road Manitoba, MB R2T 3E4 When you are able to collect and share information from a clients viewpoint, this is what a provider may be able to see in the future., 7 From the EHRS Blueprint © Canada Health Infoway 7

8 Manitoba eHealth’s Terminology
Manitoba’s Electronic Health Record (EHR) A secure and private lifetime record of a patient’s key health history, available to be viewed electronically by authorized health care providers, anywhere, anytime. Interoperable EHR (iEHR) The project to plan and implement Manitoba’s EHR. Electronic Medical Records (EMR) – clinic based A patient medical record in digital format that resides within an integrated system that allows authorized medical staff access to patient information. In this context, within a physician clinic. Electronic Patient Records (EPR) – hospital based Is a set of components that comprise the mechanism by which patient records are created, used, stored and retrieved. In this context, within a hospital.

9 Manitoba eHealth Strategy to Improve Healthcare Delivery
Client Registry Provider Registry Enterprise Architecture Information Standards Privacy and Security Provincial Foundation Elements CRM & Portfolio Mgmt Operations Service Desk Project Methods and Stds Health Priorities Patient access to quality care shorter wait times Manage critical human resource shortages - more doctors and nurses Focus on primary and community healthcare Closer to home Sustainability of the health system Manage health system performance Manitoba eHealth’s strategy is to work on both foundational elements (in green) and point of service systems (in yellow) over the last year in order to meet Health’s priorities. Resource shortage – manage information as more doctors/nurses are added to the system. Information Management is becoming a condition of recruiting. New doctors and nurses assume we have systems in place to manage information and reduce manual processes. Wait times – building both point of care systems to collect the information and systems to share the information between providers, helping to reduce wait times for diagnostic tests and getting results. Primary care – driving EMR adoption and community based systems Home – telehealth, bringing services to the community if doctors are not there Sustainability – allowing the healthcare system to process clients more efficiently through better information management Management – collecting data that can be reported and used to manage the programs in realtime, not 18 months after the fact. eHealth is working on two sides – enablers and client facing systems. We need to put the right foundation in place in order to collect the information and manage it across these points of service systems. The way we are doing that is to create an Electronic Health Record that gives a patient centric view of their health information. What is an electronic health record? Next slide. Spend time on drivers and where we are spending our time Point of Service Systems Hospital Information System Clinical Supply Chain Emergency Room Sterile Instruments Drug System Laboratory System Diagnostic Imaging Tele Health Community System Homecare Mental Health Electronic Medical Records Long Term Care Public Health Surveillance Immunization Decision Support 9

10 Registries Data & Services Ancillary Data & Services
Electronic Health Record Architecture Registries Data & Services Client Registry Provider Registry Ancillary Data & Services Outbreak Management PHS Reporting Shared Health Record Diagnostic Imaging Laboratory Drug Information EHR Data & Services Data Warehouse Health Information Business Rules EHR Index Message Structures Normalization Rules Security Mgmt Data Privacy Data Configuration Longitudinal Record Services HIAL Communication Bus Common Services POINT OF SERVICE Hospital, LTC, Community Physician Office EMRs EHR Viewer Physician/ Provider Lab System (LIS) Lab Clinician RIS/PACS Radiologist Pharmacy Systems Pharmacist Public Health Services Public Health Provider Cancer Care

11 Current State of iEHR components in Manitoba
PROVINCIAL INFRASTRUCTURE Registries Manitoba Insured Client Registry Client Registry DPIN MIMS (Immunization) Provider Registry Cloverleaf REGIONAL INFOSTRUCTURE Hospital, LTC, CCC, EPR ADT Systems Lab System (LIS) Lab Clinician Radiology Center PACS/RIS Radiologist Technologist Pharmacy system DPIN-HIST Medical Claims (no view) CDM Physician/ Provider Hospital and Regional Physician/ Provider Physician/ Provider Physician Office Public Health Pharmacist POINT OF SERVICE

12 Manitoba’s iEHR Roadmap

13 Active clinical systems
HSC – SIMS (GE) and EDIS (Eclipsys) SBGH – (ADT), RR, EDIS (Eclipsys AM and SCM) Brandon – (ADT) and RR (Siemens) DSM – LIS (Sysmex etc.) and RIS/PACS (Agfa) CCM (Varian) PHIS MIMS DPIN Cadham Pharmacy – Acute Care (Cerner and GE Centricity) PCH (Momentum MDS)

14 In Flight Major Clinical Projects (Provincial)
Client Registry (CR) Uniquely identifies individuals Implemented in 2008 Provider Registry (PRS) Uniquely identifies Health Care professionals In production – to be used in the Electronic Health Record Home Care Scheduling Systems Preparing for provincial rollout of home care scheduling systems Manitoba Telehealth Implemented in 61 sites in Manitoba Used for visitation, consultation, and education Potential for mobile units Potential for FP office

15 In Flight Major Clinical Projects (Provincial)
Radiology Information System / Picture Archiving Communications Systems (RIS/PACS) Implementing provincial system in 50 facilities Provincial Laboratory Information System (LIS) Implemented in WRHA facilities Infrastructure renewal and software upgrades 2008 Phase 1 provincial rollout started summer 2008 15

16 In Flight Major Clinical Projects (WRHA)
Hospital Information System – (HISP AC) Phase 1 implementation of Electronic Patient Record (EPR) at SBGH complete (ADT and RR) Phase 2 at SBGH (order entry and clinical documentation) to be implemented in 2008 and 2009 Hospital Information System – Long Term Care (HISP LTC) Momentum MDS 39 WRHA PCH sites activated Emergency Department Information Systems (HISP EDIS) Implemented at HSC and SBGH in 2007 Implementation at Seven Oaks, Grace, Victoria and Concordia Hospitals 2008 16

17 Clinical Practice Expectations with the EHR
Enhanced patient safety and quality of care Access to key demographics Recent encounters (who and why) Pertinent medical/surgical history Medication reconciliation Chronic disease identification and status Recent lab and DI info Reduced wait times (consults, integrated scheduling, information exchange)

18 Clinical Practice Expectations with the EMR
Enhanced patient safety and quality of care Legible Charts Chronic Disease Management Quality Indicators Alerts and Reminders Trend Plots (BP, Lab) Access to Guidelines ePrescribing Connectivity

19 Result in Measurable Care Outcome Improvement
Quality Safety Access Medication Errors Diagnosis and Treatment Errors Infection Prevention Blood Transfusion Errors Chronic Disease Management Evidence-based Care Preventive Care Scheduling & Waitlist Mgmt Continuity of Care Unnecessary Duplication

20 Physician EMR Adoption in Canada
EMR Penetration in Canada Paper only 58% EMR Exclusive – 10% EMR + paper – 26% 63K licensed physicians – 20% working with EMRs 50K physicians are in community Atlantic – 1-25% Quebec – 0-1% Ontario – 10% MB – 12-16% Sask – 10-20% Alberta – 60% BC – 5-17% Skill level with Computers Advanced – 17% Good – 52% Beginner – 23% No use 4% Usage Clinical Colleges – 63% Patients – 13% Non – clinical – 50% Overall – 87% Connectivity in Office High Speed – 71% Dialup – 3% No Access – 14% Tools Access to Medical Info – 55% Billing – 53% Schedules / Appointments – 42% Lab / DI – 30% ‘Insite Conference March 2008’

21 Primary Care Information System Strategy (PCISS)
Steering Committee Reports to DM FPs Mike Omichinski David Ross Chris Burnett Scott Kish Chair CIO Roger Girard

22 PIN: Physician Integrated Network
4 PHC Clinics Morden: Agassiz Medical Centre Winkler: CM Wiebe Clinic Winnipeg: Assiniboine Clinic Steinbach Medical Centre (control) Objectives To improve access to primary care To improve Primary Care Providers’ access to, and use of information To improve the work life for all primary care providers To demonstrate high quality primary care with a specific focus on Chronic Disease.

23 PIN Enablers Add ancillary staff (nurses, dietitians)
Improve clinical reporting practices re screening and CDM Assess change management requirements Implement Quality Based Incentive Funding

24 PIN Screening and interventions CDM PAP smears FOBT Flu shots
Type 2 diabetes Hypertension CCF

25 PIN evaluations Physician - qualitative
Incentives Receptiveness Challenges Impacts Quantitative (Sept 2007 – March 2008 in 2 clinics) All screening tests increased Flu shots: 39% to 77% in one clinic

26 PIN issues EMR vendor compliance Data integrity Data validity
Reasons for variations QBIF

27 PIN plan Steinbach conversion to active site 3 year funding to 2011
65 more physicians (4 – 6 more clinics) Activities Data collection and analysis Indicator development Funding and remuneration

28 PCISS – EMR selection EMR RFQ - select a set of approved EMRs to be adopted and implemented by physicians ASP and on site version PIN characteristics incorporated Written evaluations completed Demos start this week BC and AB models used for RFQ Down to 5 in AB (EMIS, EPIC, MedAccess, Practice Solutions and Wolf)

29 EMR adoption support PCISS Office – Physician Office Support System
Supports the APL Checks compliance Supports change management Manages vendor contracts EMR funding Startup, data collection, benchmarks Not yet approved

30 Infoway initiatives Peer to Peer (P2P) Demonstration Sites Physicians
Nurses Pharmacists Demonstration Sites Active EMR required

31 Physician Peer to Peer Network
What is the PP2P Network? A program funded by Canada Health Infoway but operated by Manitoba eHealth, that provides a Physician Peer Leader as a mentor and advisor who will answer questions regarding EMRs and direct the physician to specialized resources if required. Why is the program being offered? Acquiring, implementing an optimizing an EMR into family practice is complex, and it makes sense to learn from others rather than go it alone. The premise of this program is that physicians will learn best from other physicians. Who are the Peer Leaders? The Peer Leaders are practicing Manitoba physicians with years of experience in implementing and using EMRs in a practice setting.

32 EMR Cost calculations An interactive EMR Worksheet has been developed by Dr. Chris Burnett. It includes cost assumptions for basic and optional technology components that reflect Dr. Burnett’s own experience and the EMR product he uses. The worksheet allows you to input factors that apply to the clinic (e.g. number of workstations required) to estimate a rough cost.

33 Demonstration Sites Program
Visit a clinic that has had an EMR in place for years and learn how they work. Or … visit several clinics to compare and contrast solutions.

34 Demonstration Site Simulated environment
Faculty of Medicine simulation lab (Brodie) FP clinic environment Potential to compare systems Workflow analysis possible

35 Community Health WRHA Access Centres
PARIS MH in BC Not an EMR Used for ancillary health May be replaced

36 Canadian Association of Radiologists (CAR)
DSS (Decision Support System) to help physicians determine which test to order Provides guidelines and best practice information Pilot in Children’s Hospital FP pilot in Steinbach Family Medical Centre

37 CareLink – Patient Access to Quality Care (PAQC)
MHHL initiative, Infoway funded Integration of services with PHC HealthLinks involvement Part 1: Supports self-managed care in between office visits Part 2: Provides access to PHC outside normal clinic hours and connects with FP

38 WTTF - BGSC (Bridging Generalist and Specialist Care)
Fed. funded 2 year pilot project involving <150 FPs Develop, implement and test streamlined pathways for referrals to specialists Provides a catalogue of specialists Integrated with a Patient Access Registry Tool (PART) DSS – specialist investigations Web based communication pathways Selected referrals e.g. colorectal, back pain, mental health, orthopedics Planned for activation in March 2009

39 Other Resources Health Canada’s EMR Toolkit []
Provides both a structured approach to acquiring an EMR and a compendium of information and links to other resources. Canadian EMR [] Site managed by Dr. Alan Brookstone, provides product comparisons, vendor profiles and personal commentary.

40 Quotable quotes “In all affairs it is a healthy thing to hang a question mark on the things you have long taken for granted.” Bertrand Russell “The person who believes it cannot be done should not interrupt the person doing it.” Ancient Chinese proverb

41 Questions?

42 Your Physician Peer Leaders
Dr. Diamond Kassum The Manitoba Lead for the Peer to Peer Network is Dr. Diamond Kassum, Chief Medical Information Officer, Manitoba eHealth Dr. Johann Blignaut Family Physician, Winkler Dr. Chris Burnett Family Physician, Niverville Dr. Johan Du Plooy Family Physician, Brandon Dr. Mark Duerksen Family Physician, Steinbach Dr. José François Family Physician, Winnipeg Dr. Carol Holmes Family Physician, Morden Dr. Pol Morton Family Physician, Baldur Dr. Mary Seshia Paediatrician, Winnipeg Dr. Felix Sikora Family Physician, Winnipeg Dr. Roy Smith Family Physician, Winnipeg

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