Transcript Slide 1

Primary Health Care Initiatives
Presentation to MNIA
Monday September 15th 2008
Dr. Diamond Kassum – Chief Medical Information
Officer, Manitoba eHealth
Topics
Manitoba eHealth
iEHR and Active Clinical Projects
Primary Health Care
 PCISS
 PIN
 EMR selection and adoption
 Infoway initiatives
 Access Centres, CAR, Carelinks, BGSC
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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
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The Circle of Care
Homecare
Clinic
Emergency Services
Community
Care Center
Pharmacy
Specialist Clinic
Laboratory
Hospital
Emergency
From the EHRS Blueprint © Canada Health Infoway 2003-2005
Diagnostic
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The Patient Centric & Integrated View of
Consolidated Information
Homecare
Clinic
Emergency Services
Community
Care Center
Pharmacy
QUALITY
SAFETY
INTEGRATED VIEW
Clients/Patients
ACCESSIBILITY
Specialist Clinic
Laboratory
Hospital
Emergency
From the EHRS Blueprint © Canada Health Infoway 2003-2005
Diagnostic
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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.
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66
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An example of an Electronic Healthcare Record
Phone:
204-277-2987
14 Health Road
Manitoba, MB
R2T 3E4
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From the EHRS Blueprint © Canada Health Infoway 2003-2005
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.
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Provincial
Foundation Elements
Client Registry
Provider Registry
Enterprise Architecture
Information Standards
Privacy and Security
Project Methods and Stds
CRM & Portfolio Mgmt
Operations
Service Desk
Point of
Service
Systems
Hospital Information
System
Clinical Supply Chain
Emergency Room
Sterile Instruments
Manitoba eHealth Strategy to
Improve Healthcare Delivery
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
Community
System
Homecare
Mental
Health
Long Term
Care
Tele
Health
Decision
Support
Drug
System
Diagnostic
Imaging
System
Electronic
Medical
Records
Public Health
Surveillance
Immunization
Laboratory
System 9
Electronic Health Record Architecture
Ancillary Data
& Services
Registries Data
& Services
Client
Registry
Outbreak
Management
Data
Warehouse
EHR Data & Services
PHS
Reporting
Shared
Health Record
Drug
Information
Diagnostic
Imaging
Laboratory
Health
Information
Provider
Registry
Business
Rules
EHR
Index
Message
Structures
Normalization
Rules
Longitudinal Record Services
Security
Mgmt
Data
Privacy Data
Configuration
Common Services
HIAL
Communication Bus
Cancer Care
Pharmacy
Systems
Public Health
Services
POINT OF SERVICE
Public
Health
Provider
Pharmacist
RIS/PACS
Radiologist
Lab System
(LIS)
Lab
Clinician
Hospital, LTC,
Community
Physician/
Provider
Physician
Office
EMRs
Physician/
Provider
EHR
Viewer
Physician/
Provider
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Current State of iEHR components in
Manitoba
PROVINCIAL INFRASTRUCTURE
Registries
Manitoba
Insured
Client
Registry
Client
Registry
MIMS
DPIN
(Immunization)
Provider
Registry
REGIONAL
INFOSTRUCTURE
Hospital, LTC,
CCC, EPR
Physician/
Provider
POINT OF SERVICE
Cloverleaf
ADT
Systems
Hospital and
Regional
Radiology
Center
PACS/RIS
Radiologist
Technologist
Lab System
(LIS)
Lab Clinician
Pharmacy
system
Pharmacist
DPINHIST
Physician/
Provider
Medical
Claims
(no view)
Physician
Office
CDM
Public
Health
Physician/
Provider
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Manitoba’s
iEHR
Roadmap
Dec 2007
Jan 2009
Jan 2010
Jan 2011
June 2007
Phase 1
Planning
Jan 2012
MB EHR Version 1
Phase 2.0
Procurement
Phase 2.1
Drug/Portal
“Clinical Information View”
Phase 2.2
Lab
MB Electronic Medical Record Adoption
Phase 2.3
DI & SHR
“Enhanced Clinical
Workflow”
MB EHR
Version 2
EMR Approval Process
EMR Rollout
The EHR Version 1 will be implemented in parallel with the Electronic Medical
Records system adoption within primary care.
SHR Extension
EMR/EPR Integration
e-Prescribing
e-Referral
PHS
Data Warehousing
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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)
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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
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Implemented in 61 sites in Manitoba
Used for visitation, consultation, and education
Potential for mobile units
Potential for FP office
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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
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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
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Hospitals 2008
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)
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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
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Result in Measurable Care Outcome
Improvement
Quality
•Chronic Disease
Management
•Evidence-based
Care
•Preventive Care
Safety
•Medication Errors
•Diagnosis and
Treatment Errors
•Infection Prevention
•Blood Transfusion
Access
•Scheduling &
Waitlist Mgmt
•Continuity of Care
•Unnecessary
Duplication
Errors
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Physician EMR Adoption in Canada
Skill level with Computers
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Advanced – 17%
Good – 52%
Beginner – 23%
No use 4%
Email Usage
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Clinical Colleges – 63%
Patients – 13%
Non – clinical – 50%
Overall – 87%
Connectivity in Office
 High Speed – 71%
 Dialup – 3%
 No Access – 14%
Tools
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Access to Medical Info – 55%
Billing – 53%
Schedules / Appointments – 42%
Lab / DI – 30%
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
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Atlantic – 1-25%
Quebec – 0-1%
Ontario – 10%
MB – 12-16%
Sask – 10-20%
Alberta – 60%
BC – 5-17%
‘Insite Conference March 2008’
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Primary Care Information System
Strategy (PCISS)
Steering Committee
Reports to DM
FPs
 Mike Omichinski
 David Ross
 Chris Burnett
 Scott Kish
Chair
 CIO Roger Girard
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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.
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PIN
Enablers
 Add ancillary staff (nurses, dietitians)
 Improve clinical reporting practices re
screening and CDM
 Assess change management requirements
 Implement Quality Based Incentive Funding
PIN
Screening and interventions
 PAP smears
 FOBT
 Flu shots
CDM
 Type 2 diabetes
 Hypertension
 CCF
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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
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PIN issues
EMR vendor compliance
Data integrity
Data validity
Reasons for variations
QBIF
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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
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PCISS – EMR selection
EMR RFQ - select a set of approved EMRs to be
adopted and implemented by physicians
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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)
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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
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Infoway initiatives
Peer to Peer (P2P)
 Physicians
 Nurses
 Pharmacists
Demonstration Sites
 Active EMR required
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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.
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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.
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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.
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Demonstration Site
Simulated environment
 Faculty of Medicine simulation lab (Brodie)
 FP clinic environment
 Potential to compare systems
 Workflow analysis possible
Community Health
WRHA Access Centres
PARIS
 MH in BC
 Not an EMR
 Used for ancillary health
 May be replaced
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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 2006-2007
FP pilot in Steinbach Family Medical
Centre 2008-2009
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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
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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
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Other 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.
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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
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Questions?
Your Physician Peer Leaders
Dr.
Diamond
Kassum
Dr. Johann Blignaut
Family Physician,
Winkler
The Manitoba Lead for the Peer to Peer Network is Dr.
Diamond Kassum, Chief Medical Information Officer,
Manitoba eHealth
Dr. Chris BurnettDr. Mark DuerksenDr. Johan Du Plooy
Family Physician, Family Physician, Family Physician,
Niverville
Brandon
Steinbach
Dr. José
François
Family
Physician,
Winnipeg
Dr. Carol Holmes Dr. Pol Morton Dr. Mary Seshia Dr. Felix Sikora Dr. Roy Smith
Family Physician, Family Physician, Paediatrician, Family Physician, Family Physician,
Morden
Baldur
Winnipeg
Winnipeg
Winnipeg
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