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Meeting the Challenge; Creating Collaborative Harmonization for Canadian Drug Information Systems eHealth 2013 May 28, 2013.

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Presentation on theme: "Meeting the Challenge; Creating Collaborative Harmonization for Canadian Drug Information Systems eHealth 2013 May 28, 2013."— Presentation transcript:

1 Meeting the Challenge; Creating Collaborative Harmonization for Canadian Drug Information Systems eHealth 2013 May 28, 2013

2 2 Welcome! Panelists Lynne Zucker, VP Clinical Systems Integration, Canada Health Infoway Paul Caines, CIO & Chief Privacy Officer, NL Centre for Health Information Justin Bates, VP Pharmacy Affairs, Canadian Ass. of Chain Drug Stores Bonnie Cochrane, VP Clinical Information Programs and Quality, NL Centre for Health Information

3 3 Faculty/Presenter Disclosure Faculty: Lynne Zucker Relationships with commercial interests: NIL Faculty: Paul Caines Relationships with commercial interests: NIL Justin Bates Relationships with commercial interests: NIL Faculty: Bonnie S. Cochrane Relationships with commercial interests: NIL

4 Now that you know us

5

6 6 AGENDA 15:30 – 15:35Welcome and introductionsBonnie 15:35 – 15:55Setting the ContextLynne 15:55 – 16:15DIS Harmonization; How did we Get Here?Paul 16:15 – 16:30DIS Harmonization; Pharmacy Industry PerspectiveJustin 16:30 – 16:45Harmonized Message Set with ImpactsPaul 16:45 – 16:50SummaryBonnie 16:50 – 17:00Q&A; Close

7 7 Panel Session Objectives 1.Introduce diverse perspectives related to challenges, complexities and opportunities faced implementing provincial Drug Information Systems (DIS) in Canada 2.Provide an overview of the identified need & opportunity for a broad & inclusive national multi-stakeholder partnership to tackle the challenges and opportunities 3.Describe ongoing work toward the achievement of Harmonization 4.By sharing lessons learned, provide an understanding of the evolutionary nature of this work, necessary for optimal benefits realization for the DIS and beyond, while setting the stage for the future.

8 Setting the Context Lynne Zucker

9 386 active and completed projects with an estimated value of $2.10 billion as at December 31, 2012 Program Activity Summary (December 31, 2012)

10 Drug Information System Programs Shared common objectives among all major stakeholders: Reducing adverse drug events Provide the best possible medication history to support clinical decision making across the health system

11 JURISDICTIONAL INFOSTRUCTURE EHR Data & Services POINT OF SERVICE SYSTEMS Registries Data & Services HIAL Communication Bus Common Services Client Registry Provider Registry Location Registry HIAL Terminology Registry HIAL Inter-Jurisdiction: EHR PCSStandards Pharmacy System Hospital System POS-6 Consumer Systems HIAL Domain and Shared EHR Repositories EMR Fitting the Pieces Together Drug Information System EHR Viewer

12 Early Benefits Long-Term Benefits Benefits Evolve with System Maturity

13 Per cent Access Western Jurisdictions Central Jurisdictions Eastern Jurisdictions SettingNationalBCABSKMBONQCPENL Community Pharmacists 34%100% -11%100%40% Hospital Pharmacists 46%100% 40%<1%100%- Hospital (ED Only) 70%100% 3%100%1 pilot live * Original source: National Impacts of Generation 2 Drug Information Systems Technical Report, September Numbers in table above updated September Estimated Access to Drug Information Systems (DIS)*

14 Standards Drug Information Systems use many standards -Architecture -Messaging Standards -Terminology

15 In Spite of the Standards…. The Drug Information Systems in place across Canada make use of these standards, however, each jurisdiction had to adapt to balance many requirements: legacy systems already in production needs of clinical stakeholders level of EMR use legislation and policy requirements capabilities of vendors optionality included in the standards procurement of commercial components The resulting variety of models and approaches has resulted in a variation in requirements between provinces. This creates a challenge for companies that need to manage streamlined, national solutions that can interact with multiple DIS environments.

16 E-Prescribing Harmonization In addition to harmonization for pharmacy systems, there is also work underway to align e-Prescribing approaches for Electronic Medical Records (EMR) and other prescriber systems 1.First pass identification of jurisdiction variances and targeted reduction of 50% 2.Creation of jurisdiction message sets – libraries to support more plug and play capabilities This work is to be completed in collaboration with the pharmacy harmonization initiatives.

17 Canadian Stakeholders Coming Together Challenges facing our provinces are not unique – other jurisdictions have discovered there is no simple answer In June 2012, a group of stakeholders came together – public sector jurisdictions and private sector pharmacies and vendors to try a different approach to achieve harmonization necessary for success Fellow panelists going to share not only the issues and opportunities but also how this approach has built stronger buy in and participation in achieving a common resolution

18 Pharmacy Harmonization “How did we get here?” A provincial perspective May 2013

19 19 Reminder… JURISDICTIONAL INFOSTRUCTURE EHR Data & Services POINT OF SERVICE SYSTEMS Registries Data & Services HIAL Communication Bus Common Services Client Registry Provider Registry Location Registry HIAL Terminology Registry HIAL Inter-Jurisdiction: EHR PCSStandards Pharmacy System Hospital System POS-6 Consumer Systems HIAL Domain and Shared EHR Repositories EMR Drug Information System EHR Viewer

20 20 Many vendors …with legacy products Many jurisdictions …with legacy environments …diverse, complex stakeholder groups …many different starting points Other complex ingredients in our ‘regimes’: -Standards: international considerations, different jurisdictional implementations, etc -Business processes, service desk interactions, on-call protocols… Jurisdictional variances expected A Complex Environment

21 21 Fully involved in development of pan-Cdn standard Made sense to adopt broad implementation of standard -Adopt next generation after PEI -Build in flexibility through variances -Others adopted a narrower standard, but maintained more rigidity Working with vendor community Good work done; we are building on that NL Standards History

22 22 Since NL go-live: Core Drug system has evolved -Version 1.3 to All POS systems have evolved -Kroll: 8.3 to 9.2 -Telus: Assyst to Ubik (new platform) Conformance process has evolved Major Client Registry upgrade Clearer shared understanding among partners BUT - core standard - and protocols - have (essentially) remained the same! A Dynamic Environment

23 23 Critical mass of implementations Different stakeholders now “speak the same language” Vendors: DIS, POS, etc Technical, clinical, standards, management, etc Operational processes (conformance, training, etc) March 2013 harmonization forum Go-forward approach needs further work… …but such a conversation was not possible even 2 years ago! Standards are a success: they have gotten us to this point Can build on Time is Right for Harmonization Discussion

24 DIS Harmonization Pharmacy Industry Perspective Justin Bates May 2013

25 CACDS We are the voice and advocate of our members who: Operate more than 6,500 neighbourhood pharmacies across Canada and provide pharmacy and other core healthcare products and services; Focus on wellness, treatment and prevention; Ensure fulfillment of almost 70% of Canadian prescriptions each year; Employ more than half a million Canadians, including 75% of pharmacists practicing in neighbourhood pharmacies across Canada; We engage stakeholders in dialogue about our industry, our people and our role in providing quality neighbourhood-based healthcare products and services. 25

26 CACDS Members Pharmacy retailers Independent Banners Grocery Mass Merchandisers Corporate Represent pharmacy software vendors 120+ organizations in the supply chain 26

27 Background Pharmacy organizations are partners in making eHealth work in a cost effective framework Provincial eHealth agencies, software vendors, and pharmacy organizations are working collaboratively to learn from experience to date and: Design a truly pan-Canadian system that can be adopted across all jurisdictions Focus on health outcomes and clinical value Pharmacy software vendors and the NL Centre for Health Information began to work together in the Spring of 2012 to address the need for national harmonization CACDS become involved to bring the industry perspective and help drive change 27

28 Overview Goal is to mesh past and current harmonization efforts into a new multi stakeholder group Canada Health Infoway, provinces, pharmacy retailers, CACDS and pharmacy software vendors Develop priority areas Inaugural meeting held in Toronto in June 2012 Established an executive committee to oversee efforts NL Center for Health Information and pharmacy software vendors co-developed harmonized message set Harmonized message set presented to all stakeholders in Feb 2013 Proposal simplifies DIS with a reduced message set with a focus on clinically relevant messages Pharmacy supports a basic DIS with harmonized national message set that includes: e-Prescribing – harmonize regulations for e-signature Adverse Drug Reaction Reporting 28

29 29 Guiding Principles eHealth must drive positive patient outcomes Must provide additional value added information to assist healthcare professionals improve health outcomes Support a minimal set of standard messages – simplify solution to: Decrease implementation time for PMS vendors and DIS, thereby; Decrease time for patients to realize benefits of a well designed and implemented solution Lower bandwidth burden to allow for: Implementable solution across different provincial IT infrastructures Reasonable message response times

30 30 Guiding Principles Continued eHealth should complement existing processes and workflow The workflow of healthcare professionals and retailer operations varies, and cannot be dictated by technology Messages should be designed and implemented with the flexibility to accommodate for different healthcare professional workflow choices, and the evolving role of pharmacists and technicians in community practices Best practice guidelines need to be developed Boards, colleges and associations should be involved in guidelines. National guidelines (NAPRA) preferable Must be informed throughout development by stakeholders with practical experience in developing and implementing eHealth solutions

31 Process Moving Forward eHealth Ontario developed a national template to collect feedback to the harmonized message set proposal Pharmacy industry meetings with each province to discuss harmonized proposal Develop national chart that identifies by province: Alignment Partial Alignment Requires Further analysis Establish a SME Task Force to work on a group of messages Develop proposal for proposed changes to SCWG Integrate other harmonization efforts with e-prescribing and EMR 31

32 Harmonized Message Set With Impacts May 2013

33 33 NL metrics, examples used …but the principles are the same for all Disclaimer

34 34 NL - Current Context JURISDICTIONAL INFOSTRUCTURE EHR Data & Services POINT OF SERVICE SYSTEMS Registries Data & Services HIAL Communication Bus Common Services Client Registry Provider Registry Location Registry HIAL Terminology Registry HIAL Inter-Jurisdiction: EHR PCSStandards Pharmacy System Hospital System POS-6 Consumer Systems HIAL Domain and Shared EHR Repositorie s EMR Drug Informati on System EHR Viewer

35 35 Pharmacy deployed as an EHR application – Thru a HIAL – Real-time client registry integration – Business processes support this integration EG Real time identity issue follow-up; on-call protocols NL - Current Context

36 36 Large number of messages – 82 in NL Many are similar – Eg abort, cancel Extensive processes to build, sustain – Value, but a cost: significant per-transaction overhead Great example of where we have learned – Time is right to step back more methodically Messaging – NL Current Status

37 37 27 areas for increased harmonization – Messages (19) Reminder: NL currently has 82 – Business practice Conformance, training approaches Ongoing: system availability, service levels – Data, terminology Proposal

38 38 Aligned: – Fully:11 – Partially: 6 Further Analysis required: 9 Gap:1 Impact of proposed message set (NL)

39 39 Current - separate messages for dispense of: – Drugs – Devices – OTCs – professional services Proposed: one dispense message Example - Dispense

40 40 Current: 18 query messages – Includes broad and narrow payloads – Reality – with variances, there are more than 18… Proposed: 3 query messages – Broader messages Example - Query

41 41 Fewer messages (and more harmonized processes) to: – Build, document, test, optimize, conform, maintain, troubleshoot, etc…. – …Across multiple jurisdictions Each with some level of per-message variance (ie reality is that there are currently more than 18…) – …Across each jurisdiction’s very complex technical environments – …For each POS vendor–each with its own operation..but still deliver the value; MUST deliver same content Why?

42 42 Shift interoperability burden to HIAL – From POS software – HIAL designed to enable interoperability Reduces overhead – Currently significant per-transaction overhead Testing (development, UAT, conformance, etc) Simplifies environment – Facilitates communication – Clarifies boundaries Can still maintain flexibility More Benefits

43 43 Notable effort – Requires work on multiple fronts POS/jurisdiction/DIS-backend – Has to be “right” Will still have sustainability challenges – Hopefully fewer/”better” ones! May increase load for some transactions Challenges of harmonization

44 44 Harmonization brings benefits (simplification, etc) Systems are evolving anyway – Why not make the evolution in a harmonized way? Won’t be easy Aligned themes: – Minister Aglukkaq: “ putting (ehealth) into action is hard” – Peake (innovation): effective>efficient>improving>cutting>…. – Topol: “needs to be a changing of the guard” Time to accelerate the change! Jurisdictional Benefits Summary

45 Summary May 2013

46 46 Summary – Key Messages The vision of this partnership is to simplify our very complex systems, to ensure optimal value is realized The value to be realized is value to the health system, care providers and patients We need this broad and inclusive partnership, which is collaborative and focused to achieve success The work we are doing is part of an ongoing evolution; we are making progress. Are we there yet? ……..the evolution continues!

47 47 Panel Session Objectives 1.Introduce diverse perspectives related to challenges, complexities and opportunities faced implementing provincial Drug Information Systems (DIS) in Canada 2.Provide an overview of the identified need & opportunity for a broad & inclusive national multi-stakeholder partnership to tackle the challenges and opportunities 3.Describe ongoing work toward the achievement of Harmonization 4.By sharing lessons learned, provide an understanding of the evolutionary nature of this work, necessary for optimal benefits realization for the DIS and beyond, while setting the stage for the future.

48 48 THANK YOU

49 49 Questions for the Panel You have said the core standard has remained the same, while systems continued to evolve; can you comment further? When do we expect to have this DIS harmonization completed and implemented in Canada Are there lessons for the EHR generally? Are there generalizable lessons learned? What are we losing with the decreased # of messages? What are we gaining? Can you speak to the partnership? Is it a transferable model?


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