AHS: Clinical Information Systems (CIS) Improving Our Clinical Data Assets

1. AHS: Clinical Information Systems (CIS)Improving Our Clinical Data Assets Dr. Sarah Muttitt, MD, FRCPC, MBA Chief Medical Information Officer, AHS HEALTH RESEARCH DATA SYMPOSIUM MAY 29, 2014

2. Anatomy of CIS Health system management, quality improvement, resource allocation, discovery Analytics, evaluation, population health, research Pathways, order sets, guidelines, alerts, reminders, referrals, summaries Clinical decision support, best practice, closed loop communication ALL information about ALL patients captured in real time Encounters, orders, results, demographics, problem lists, medications, procedures,

3. What is it? • Source of truth for patient information • Accurate, complete, trusted information for decision making • Common ordering mechanism • Allows decision support – evidence based guidance • Workflow support • Links and coordinates multiple providers through care pathways • Capacity and service management • Provides real time view of wait times, referrals • Provides real time view of bed capacity, utilization • Research to practice cycle • Best practices and new knowledge can be easily propagated

4. Current State • Calgary – Allscripts SCM – upgrade underway • Rural – Meditech - optimization project underway • Edmonton – no CIS, legacy “at risk” VAX/Tandem systems • Catastrophic failure: the immediate inability to register/track patients, identify patients, order and distribute results, schedule procedures, maintain inventory, bill for services, etc. • Implementation in EZ will support a major transformation in clinical service delivery that will: • Reduce medical errors • Improve outcomes, quality and consistency of care • Enhance productivity • Improve the patient and provider experience • Enable quality and performance measurement • Advance academic and research efforts through richer clinical datasets

5. Breakdown of Opportunity Areas Edmonton Zone CIS – Annual Economic Benefit Values in $M Areas of Opportunity Annual Benefit at Maturity 11% 5% 5% 1st Go-Live 57% 22% Length of Stay Diagnostic Imaging 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20 2020-21 2021-22 2022-23 Drugs Administration Financial Benefits Laboratory

6. Course to Date • In 2008, Epic selected for Edmonton Zone Ambulatory (eClinician) • In the process of developing a new project plan that would see completion of scheduling and EMR deployment to all EZ Ambulatory sites by end of the fiscal year • EZ CIS procurement July 2011-April 2013 to replace vulnerable legacy systems and provide comparable CIS capability as other zones • Steering Committee unanimously selected Epic as preferred vendor • Contract negotiations with Epic nearing conclusion leveraging current Epic Ambulatory install • OA approved year one internal AHS funding

7. But….. • To more fully realize the benefits and the provincial aspiration of One Patient, One Record, additional scope to be considered: • Province wide (Edmonton, Calgary, Rural Zones) • Span the continuum of care (acute, ambulatory, community) • Support consumer health services (e.g. access to personal health records, scheduling, secure communications)

8. Provincial CIS Roadmap Two Alternatives The roadmap is guided by two long-term alternative investment approaches: Implement a single provincial CIS and augment it with other provincial systems Maintain and optimize existing portfolio of Clinical Information Systems

9. Work Underway • Initiated EZ CIS governance with establishment of CIS Executive Steering Committee and the first of three Oversight Councils (Ambulatory) • Advancing provincial standardization of evidence based clinical content and practice (orders, pathways, workflow, decision support) to reduce variation and improve quality, efficiency and outcomes • Broad multi-disciplinary and geographic participation leveraging SCNs • Central content repository – versioning control, maintenance, dissemination • Embedded in CIS with links to evidence • Clinician portal for broader dissemination • Standardization of key operational processes • EZ scope and sequencing

10. Standards, Content and Core Processes • Identity, Access & Encounter Management • Clinical Decision Support • Clinical Assessment, Documentation & Plan (IPOC) Management • Bed /Capacity Management • Order to Results Management • Scheduling/Demand Management • Medication Management • Health Information Records Management • Clinical Content Management • Information Management (Reporting & Analytics) Core processes will drive benefits metrics at each program level

11. Proposed Structure for Provincial Clinical Content Development and Management Core Content development to meet the needs of EZ & maintenance /upgrades for SCM and Meditech Bidirectional flow to Central management of new work & implementing content in the respective CIS Analytics DIMR CMIO Office Governance: Provincial Clinical Informatics Lead + members approved by IM/IT Committee Roles: Centralized Content management (with or without content manager) Dissemination materials and provincially supported and common process Maintenance of content through coordination with content “owners”

12. Content Development “Design Provincially” “Implement Locally” CDS design and build (paper) Clinical documentation build Order set design and build Care path (protocol) build Data structuring for reporting and CDS functions Health system encounters Transactional care Patient derived information (support patient care plans) Historical records System Content CLINICAL INFORMATICS HEALTH INFORMATION MANAGEMENT CMIO Clinical Knowledge Health Information SCN’s, Clinical Programs, Consensus Committees, DIMR Knowledge development (SCNs) Evidence-informed Reporting and analytics Performance measurement Variation analysis New Knowledge from research publications

13. Scope

14. What about Research? • Epic Enterprise • Good innate reporting and analytics capability • Enterprise Data Warehouse • Cohort identification and management • Slicer/Dicer • ****More comprehensive, higher quality clinical and other data • Data Stewardship and Access • ISF (ambulatory) • HIA • Clinical Trials Agreements • Opportunities • Patient compliance and reported outcomes (patient portal) • Translational research – from bench to bedside • Genomics – predictive and personalized medicine

15. AHS CMIO Role • The CMIO role is relatively new to the C-Suite and evolving as quickly as the information and technology in healthcare. • The CMIO forms an essential component of and bridge between the medical and IT functions of AHS. • The CIO and the CMIO form a dyad to achieve the following goals: • designing and integrating IT systems into clinical practice • analyzing the use of technology to determine its effect on patient care, patient outcomes, and patient participation • establishing standards and compliance (clinical and technical) • coaching clinicians on the use of software, studying how the software is used and using that knowledge to optimize future deployment and product enhancement • collaborating on high value, strategic plans for IT. • realizing tangible benefits from IT investments • clinical innovation supported by enabling technology

16. AHS CMIO Role Chief Medical Information Officer Clinical Operations Knowledge and Standards Informatics Competency Development & Professional Standards Edmonton Zone CIS Policy and Process Standardization Informatics Leadership Clinical Analytics E-Quality & Safety Clinical Knowledge & Content Management HIM

17. Thank You! sarah.muttitt @ albertahealthservices.ca