Presentation on theme: "Primary Health Care Initiatives"— Presentation transcript:
1Primary Health Care Initiatives Presentation to MNIAMonday September 15th 2008Dr. Diamond Kassum – Chief Medical Information Officer, Manitoba eHealth
2Topics Manitoba eHealth iEHR and Active Clinical Projects Primary Health CarePCISSPINEMR selection and adoptionInfoway initiativesAccess Centres, CAR, Carelinks, BGSC
3Manitoba eHealth – A Provincial Program Was announced by the Minister of Health on April 11, 2007Develops information management processes, tools, and technologyA single organization to ensure alignment with provincial and national objectivesWill ensure a long-term province-wide approachBuilds and acquires solutions that meet Manitoba’s health care needs
6Electronic 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.6666
8Manitoba 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 basedA 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 basedIs a set of components that comprise the mechanism by which patient records are created, used, stored and retrieved. In this context, within a hospital.
9Manitoba eHealth Strategy to Improve Healthcare Delivery Client RegistryProvider RegistryEnterprise ArchitectureInformation StandardsPrivacy and SecurityProvincialFoundation ElementsCRM & Portfolio MgmtOperationsService DeskProject Methods and StdsHealth PrioritiesPatient access to quality care shorter wait timesManage critical human resource shortages - more doctors and nursesFocus on primary and community healthcareCloser to homeSustainability of the health systemManage health system performanceManitoba 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 systemsHome – telehealth, bringing services to the community if doctors are not thereSustainability – allowing the healthcare system to process clients more efficiently through better information managementManagement – 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 timePoint of Service SystemsHospital Information SystemClinical Supply ChainEmergency RoomSterile InstrumentsDrug SystemLaboratorySystemDiagnostic ImagingTele HealthCommunity SystemHomecareMental HealthElectronic Medical RecordsLong Term CarePublic HealthSurveillanceImmunizationDecision Support9
10Registries Data & Services Ancillary Data & Services Electronic Health Record ArchitectureRegistries Data & ServicesClient RegistryProvider RegistryAncillary Data & ServicesOutbreak ManagementPHS ReportingShared Health RecordDiagnostic ImagingLaboratoryDrug InformationEHR Data & ServicesData WarehouseHealth InformationBusiness RulesEHR IndexMessage StructuresNormalization RulesSecurity Mgmt DataPrivacy DataConfigurationLongitudinal Record ServicesHIALCommunication BusCommon ServicesPOINT OF SERVICEHospital, LTC, CommunityPhysician Office EMRsEHR ViewerPhysician/ ProviderLab System (LIS)Lab ClinicianRIS/PACSRadiologistPharmacySystemsPharmacistPublic Health ServicesPublic Health ProviderCancer Care
11Current State of iEHR components in Manitoba PROVINCIAL INFRASTRUCTURERegistriesManitoba Insured Client RegistryClient RegistryDPINMIMS(Immunization)Provider RegistryCloverleafREGIONALINFOSTRUCTUREHospital, LTC, CCC, EPRADTSystemsLab System (LIS)Lab ClinicianRadiology Center PACS/RISRadiologistTechnologistPharmacy systemDPIN-HISTMedical Claims (no view)CDMPhysician/ ProviderHospital andRegionalPhysician/ ProviderPhysician/ ProviderPhysicianOfficePublicHealthPharmacistPOINT OF SERVICE
13Active 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)PHISMIMSDPINCadhamPharmacy – Acute Care (Cerner and GE Centricity)PCH (Momentum MDS)
14In Flight Major Clinical Projects (Provincial) Client Registry (CR)Uniquely identifies individualsImplemented in 2008Provider Registry (PRS)Uniquely identifies Health Care professionalsIn production – to be used in the Electronic Health RecordHome Care Scheduling SystemsPreparing for provincial rollout of home care scheduling systemsManitoba TelehealthImplemented in 61 sites in ManitobaUsed for visitation, consultation, and educationPotential for mobile unitsPotential for FP office
15In Flight Major Clinical Projects (Provincial) Radiology Information System / Picture Archiving Communications Systems (RIS/PACS)Implementing provincial system in 50 facilitiesProvincial Laboratory Information System (LIS)Implemented in WRHA facilitiesInfrastructure renewal and software upgrades 2008Phase 1 provincial rollout started summer 200815
16In 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 2009Hospital Information System – Long Term Care (HISP LTC)Momentum MDS39 WRHA PCH sites activatedEmergency Department Information Systems (HISP EDIS)Implemented at HSC and SBGH in 2007Implementation at Seven Oaks, Grace, Victoria and Concordia Hospitals 200816
17Clinical Practice Expectations with the EHR Enhanced patient safety and quality of careAccess to key demographicsRecent encounters (who and why)Pertinent medical/surgical historyMedication reconciliationChronic disease identification and statusRecent lab and DI infoReduced wait times (consults, integrated scheduling, information exchange)
18Clinical Practice Expectations with the EMR Enhanced patient safety and quality of careLegible ChartsChronic Disease ManagementQuality IndicatorsAlerts and RemindersTrend Plots (BP, Lab)Access to GuidelinesePrescribingConnectivity
19Result in Measurable Care Outcome Improvement QualitySafetyAccessMedication ErrorsDiagnosis and Treatment ErrorsInfection PreventionBlood Transfusion ErrorsChronic Disease ManagementEvidence-based CarePreventive CareScheduling & Waitlist MgmtContinuity of CareUnnecessary Duplication
20Physician EMR Adoption in Canada EMR Penetration in CanadaPaper only 58%EMR Exclusive – 10%EMR + paper – 26%63K licensed physicians – 20% working with EMRs50K physicians are in communityAtlantic – 1-25%Quebec – 0-1%Ontario – 10%MB – 12-16%Sask – 10-20%Alberta – 60%BC – 5-17%Skill level with ComputersAdvanced – 17%Good – 52%Beginner – 23%No use 4%UsageClinical Colleges – 63%Patients – 13%Non – clinical – 50%Overall – 87%Connectivity in OfficeHigh Speed – 71%Dialup – 3%No Access – 14%ToolsAccess to Medical Info – 55%Billing – 53%Schedules / Appointments – 42%Lab / DI – 30%‘Insite Conference March 2008’
21Primary Care Information System Strategy (PCISS) Steering CommitteeReports to DMFPsMike OmichinskiDavid RossChris BurnettScott KishChairCIO Roger Girard
22PIN: Physician Integrated Network 4 PHC ClinicsMorden: Agassiz Medical CentreWinkler: CM Wiebe ClinicWinnipeg: Assiniboine ClinicSteinbach Medical Centre (control)ObjectivesTo improve access to primary careTo improve Primary Care Providers’ access to, and use of informationTo improve the work life for all primary care providersTo demonstrate high quality primary care with a specific focus on Chronic Disease.
23PIN Enablers Add ancillary staff (nurses, dietitians) Improve clinical reporting practices re screening and CDMAssess change management requirementsImplement Quality Based Incentive Funding
24PIN Screening and interventions CDM PAP smears FOBT Flu shots Type 2 diabetesHypertensionCCF
25PIN evaluations Physician - qualitative IncentivesReceptivenessChallengesImpactsQuantitative (Sept 2007 – March 2008 in 2 clinics)All screening tests increasedFlu shots: 39% to 77% in one clinic
26PIN issues EMR vendor compliance Data integrity Data validity Reasons for variationsQBIF
27PIN plan Steinbach conversion to active site 3 year funding to 2011 65 more physicians (4 – 6 more clinics)ActivitiesData collection and analysisIndicator developmentFunding and remuneration
28PCISS – EMR selectionEMR RFQ - select a set of approved EMRs to be adopted and implemented by physiciansASP and on site versionPIN characteristics incorporatedWritten evaluations completedDemos start this weekBC and AB models used for RFQDown to 5 in AB (EMIS, EPIC, MedAccess, Practice Solutions and Wolf)
29EMR adoption support PCISS Office – Physician Office Support System Supports the APLChecks complianceSupports change managementManages vendor contractsEMR fundingStartup, data collection, benchmarksNot yet approved
31Physician 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.
32EMR Cost calculationsAn 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.
33Demonstration 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.
34Demonstration Site Simulated environment Faculty of Medicine simulation lab (Brodie)FP clinic environmentPotential to compare systemsWorkflow analysis possible
35Community Health WRHA Access Centres PARISMH in BCNot an EMRUsed for ancillary healthMay be replaced
36Canadian Association of Radiologists (CAR) DSS (Decision Support System) to help physicians determine which test to orderProvides guidelines and best practice informationPilot in Children’s HospitalFP pilot in Steinbach Family Medical Centre
37CareLink – Patient Access to Quality Care (PAQC) MHHL initiative, Infoway fundedIntegration of services with PHCHealthLinks involvementPart 1: Supports self-managed care in between office visitsPart 2: Provides access to PHC outside normal clinic hours and connects with FP
38WTTF - BGSC (Bridging Generalist and Specialist Care) Fed. funded 2 year pilot project involving <150 FPsDevelop, implement and test streamlined pathways for referrals to specialistsProvides a catalogue of specialistsIntegrated with a Patient Access Registry Tool (PART)DSS – specialist investigationsWeb based communication pathwaysSelected referrals e.g. colorectal, back pain, mental health, orthopedicsPlanned for activation in March 2009
39Other Resources Health Canada’s EMR Toolkit [emrtoolkit.ca] Provides both a structured approach to acquiring an EMR and a compendium of information and links to other resources.Canadian EMR [canadianemr.ca]Site managed by Dr. Alan Brookstone, provides product comparisons, vendor profiles and personal commentary.
40Quotable 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
42Your Physician Peer Leaders Dr.DiamondKassumThe Manitoba Lead for the Peer to Peer Network is Dr. Diamond Kassum, Chief Medical Information Officer, Manitoba eHealthDr. Johann BlignautFamily Physician,WinklerDr. Chris BurnettFamily Physician,NivervilleDr. Johan Du PlooyFamily Physician,BrandonDr. Mark DuerksenFamily Physician,SteinbachDr. José FrançoisFamily Physician,WinnipegDr. Carol HolmesFamily Physician,MordenDr. Pol MortonFamily Physician,BaldurDr. Mary SeshiaPaediatrician,WinnipegDr. Felix SikoraFamily Physician,WinnipegDr. Roy SmithFamily Physician,Winnipeg