Professionalism and Leadership: EHR in an era of Challenges

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Professionalism and LeadershipEHR in an era of
Challenges
Presented to BCHIMPS Fall Education Session By
Jim Mickelson, Executive Director Western
Canada Canada Health Infoway November 13, 2009
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In case you havent been paying attention
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Gartner Hype Cycle
Visibility
Technology Trigger
Peak of Inflated Expectation
Trough of Disillusionment
Slope of Enlightenment
Plateau of Productivity
Maturity
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Lets rewind
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CMAJ June 1, 1996
Manitoba to develop information
network ------------------------------------------
--------------------------------- The Manitoba
government has signed a 5-year contract with
Smarthealth for the development of a
health-information network that will link
authorized professionals across the province and
provide fast access to patient information such
as prescriptions, treatment and immunization
history, and laboratory and x-ray results. The
government believes the 100-million cost of the
computer system will be recovered quickly through
increased efficiency, reduced health care fraud
and the creation of new preventive-care
programs.
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May 1999

• Newfoundland creates pay-for-itself health
  network
• By Andy Shaw
• A unique, Benefits Driven Business Case has
  given the Newfoundland and Labrador Centre for
  Health Information (NLCHI) the ammunition to seek
  approximately 10 million in government money to
  implement the first two phases of an integrated
  health information network (HIN) for the
  province. The business case, developed by a
  consortium led by SmartHealth of Winnipeg,
  proposes rather unusually that the initiative be
  funded from within existing health ministry
  funds. As such, it may become a model for HIN
  development everywhere.

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May 2000

• Consultants recommend SmartHealth be disbanded
• By Jerry Zeidenberg
• WINNIPEG A review of information technology
  projects in Manitoba has concluded that
  SmartHealth a plan to electronically connect
  all care-givers in the province has been a
  poorly managed effort that delivered a low return
  on investment.

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• I have not failed. I've just found 10,000 ways
  that won't work.- Thomas Edison

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Maybe the ehealth Hype Cycle looks like
Visibility
Technology Trigger
Peak of Inflated Expectation
Trough of Disillusionment
Slope of Enlightenment
Plateau of Productivity
Maturity
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So why do we still believe?

• What Canadians expect from their health care
  system

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Signposts of success

• Availability of care
• Patient safety
• Quality of Care
• Continuity of clinical care

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Availability of care

• Diagnostic imaging across Canada
• Clinicians in urban centres can review images of
  patients in rural areas instantly. Reduces lag
  time for diagnosis and need for travel, and
  lowers health care costs.
• 76 filmlessness achieved in Canada.

• Will generate 1 billion a year in health-system
  efficiencies once fully implemented.
• Productivity increases equivalent to up to 500
  additional specialists.
• 25-30 increase in radiologists productivity.
• As many as 40 per cent of radiologists report
  providing services to new or remote sites.
• Reduces patient transfers.

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Patient safety

• PharmaNet
• Drug information system captures every
  prescription dispensed in British Columbia
  pharmacies and provides alerts to pharmacists
  some physicians.
• Similar comprehensive drug information systems
  being implemented across Canada.

• In 2007, over 47 million prescriptions via
  PharmaNet.
• 2.5 million significant drug interactions
  identified.
• When translated to Canada, the emerging evidence
  indicates
• A reduction of about 55 million inappropriate
  prescriptions
• Over 20 million significant drug interactions
  will be identified

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Quality of care

• 40 of users are physicians (23) and their
  office support staff (17) 28 of users are
  nurses.
• When a fully implemented throughout Canada, it is
  estimated that comparable EHR systems will
  generate integrated benefits in the 6.0 billion
  to 7.6 billion range (in 2006 dollars) on an
  annual basis.
• Our staff can now focus on better patient care
  instead of the administrative side of the way the
  office runs. Dr. Allen Ausford, Edmonton

• Alberta Netcare
• Electronic health record which includes
  demographic, diagnostic imaging, drug, laboratory
  and hospital data.
• 20,000 authorized health care providers are
  active users of the electronic health record.

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Quality of care

• Web Synoptic Medical Records
• Structured abstract employing key words to record
  clinically relevant elements, made available
  electronically for cancer patients developed by
  Alberta Cancer Board and health region
  clinicians.
• Represents a new standard for clinical care.
• Opportunity exists to apply to all surgeries
  downstream.

• In the past, 85 of reports were submitted over
  one month following the surgery. Now, 91 of
  surgical reports are submitted through WebSMR
  within one hour of surgery.
• WebSMR reports contain 100 of mandatory data,
  compared to narrative report types missing 53 of
  data.
• In use for peer-to-peer reviews, quality
  assurance and teaching best practices.
• Functioning synoptic reporting systems now in
  multiple provinces including Alberta, Manitoba,
  Ontario, Quebec and Nova Scotia.

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Thank you