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Driving EMR adoption: from zero to seventy

Driving EMR adoption: from zero to seventy. Gillian Brennan, Project Director EMR Adoption Program, Manitoba eHealth Oct 31, 2012. Presentation Objective. Describe how Manitoba met its target of 1,000 enrolled physicians and NPs by Oct 31, 2012

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Driving EMR adoption: from zero to seventy

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  1. Driving EMR adoption: from zero to seventy Gillian Brennan, Project DirectorEMR Adoption Program, Manitoba eHealth Oct 31, 2012

  2. Presentation Objective • Describe how Manitoba met its target of 1,000 enrolled physicians and NPs by Oct 31, 2012 • Explain how Manitoba intends to continue to increase adoption and drive optimization *70% of eligible population based on 2009 eligible population used for baseline planning

  3. Presentation Outline • Why an EMR? • Program overview • Progress to date • Achieving rapid adoption • Encouraging effective EMR use and maturity • Adoption challenges • Driving adoption and optimization in the future • Conclusions

  4. Why an EMR? • “Within six months, you’ll think you could never go back to paper.” • Dr. Kish. M.D. • “An EMR enables you to access information from anywhere in the world.” • Dr. Rodriguez, M.D. • “The EMR truly helps with preventative medicine.” • Dr. Botha, M.D.

  5. Why an EMR? • “The EMR is instrumental in helping to define your practice population.” • Dr. Duerksen, M.D. • “The EMR helps make me a better doctor.” • Dr. Manness, M.D. • “Practicing with an EMR is better medicine.” • Dr. Iqbal, M.D.

  6. Why an EMR? Manitoba’s Perspective EMRs will: Help operate the primary care practice more efficiently Connect the practice to other components of the health care system to help coordinate care Manage information and provide tools to enable evidence- and analysis-based decision making Coordination of Care / Electronic Health Record Acute Care Community/LT Care Primary Care Public Health Self Care Admin/Corporate EMR Healthcare System Management Infrastructure

  7. EMR Adoption Program • Partnership between Manitoba Health, Manitoba eHealth and Canada Health Infoway • Funding available for 1,000 community-based physicians and nurse practitioners to implement a Manitoba Approved EMR by July 2013 • Reimburses clinics for a portion of EMR implementation costs as well as two years of eligible operating costs, up to a fixed maximum

  8. Clinic Obligations • Obtain signatures of participating clinicians and ensure they understand their obligations • Implement an approved EMR solution within 9 months of enrollment and no later than July 31, 2013 • Ensure that participating clinicians achieve Clinical Value Level 1 by Oct 31, 2013 • Agree in principle to share information with Manitoba’s electronic health record in the future • Submit data extracts to Manitoba Health for population health analysis and planning • Upgrade the EMR within six months of a new version becoming available • Complete a Privacy Impact Assessment

  9. Clinic Obligations (cont’d) Clinical Value Level 1 • Each participating clinician is required to meet 6 of the following 12 criteria: • Enter encounter notes* • Enter problem lists* • Enter allergies* • Enter immunizations* • Enter vital signs* • Enter and print new or renewal prescriptions* • Generate automated alerts • Generate automated reminders • Receive laboratory results • Receive diagnostic imaging (DI) results • Access hospital clinical reports and encounter summaries • Create referral letters or consultation reports *Datamust be entered into discrete EMR data fields where applicable

  10. Eligible clinicians in Manitoba today* *spring 2012

  11. Program progress to date • 773 participating physicians and NPs have implemented an EMR from an approved vendor

  12. Participation by RHA

  13. Achieving rapid adoption • The landscape in 2009 was favourable: • Four Manitoba-approved EMR vendors had been selected • Over 20% of eligible clinicians were already using an EMR from a Manitoba-approved vendor • Strong relationships had been built with early adopters through the Physician Integrated Network (PIN) program • Nearly two-thirds of eligible clinicians practiced in clinics of 5 or more clinicians (large practices are more likely to adopt EMR) • Considerable demand for a program existed

  14. Achieving Rapid Adoption • Program allows clinics a significant degree of autonomy and choice while providing support as needed • Participants can choose one of 4 vendors • Support and advice is provided through a Clinic Service Representative • Services include program orientation, assistance with claiming reimbursement, and general advice and assistance • Few mandatory services • Clinic must complete a Privacy Impact assessment and agree to implement recommendations

  15. Achieving Rapid Adoption • Heavy emphasis on outreach: presence at local physician and health-care events, webinars, one-on-one visits, “The EMR Connection” and other mass communications, publishing articles • Continuously evolving change management and communication plans

  16. Achieving Rapid Adoption • Support and advice is provided through the Manitoba EMR Toolkit • best practice and planning information; • practical tools and templates; and • case studies documenting the experiences of Manitoba’s EMR adopters.

  17. Manitoba Peer-to-Peer Network • Peer Consults • One-on-one talks with peers • EMR Clinic Site Visits • Opportunity for physicians, nurses and clinic staff to visit a peer leader’s clinic and see the EMR in action • Peer Coaching • Small group education sessions, hosted at peer leader clinics, focused on improving effective use of EMRs

  18. Manitoba Peer-to-Peer Network • Peer Collaboration and Education sessions • Provide support in the implementation and optimization of EMRs, build networks within the EMR community • Range of topics such as Moving from Paper to EMR and Chronic Disease Management with EMRs • Presented by peer leaders or industry experts • Offered both in-person and by webinar

  19. Manitoba Peer-to-Peer Network • Peer Collaboration and Education sessions (cont’d) • Continuing professional development credits available to family physicians and specialists • 12 evening sessions have been held to date,with a total of 507 participants: 216 family physicians, 49 specialists, 29 nurses or nurse practitioners, 96 clinic managers

  20. Adoption challenges • Uptake from clinics with an unapproved vendor is lower than expected • the business case for change may not be compelling until approved EMRs become more connected • Uptake from small (1-2 physician) clinics is low; some may require more support than the program currently provides • Private clinics are sometimes suspicious of program intentions and reluctant to share clinical information

  21. Eligible clinicians not participating Physicians & NPs Clinic Size

  22. Encouraging effective use and maturity • Working with clinics to conduct privacy impact assessments and implement recommendations • As a condition of funding, requiring • commitment by physicians to achieving Clinical Value Level 1 • provision of a data extract to support population health analysis, health system planning, and provision of comparative reports to clinicians • Providing opportunities for collaboration and education related to EMR use • Peer Collaboration and Education sessions, Peer Coaching, educational webinars, Manitoba EMR Toolkit

  23. Increasing adoption and driving optimization in the future • Introduce opportunities for interoperability, such as centralized distribution of lab and DI results, eReferral, and Primary Care Network information sharing to improve the EMR value proposition • Continue to leverage clinical champions to develop and promote our vision • Introduce CIHI data standards to facilitate more effective information exchange • Use EMRs to provide evidence of care to support chronic disease management tariff billing • Strengthen services related to consistency of use and optimization

  24. Conclusions • Physicians respond well to a program that provides choice and autonomy • Programming and messaging is most influential coming from experienced, local peers • Clinicians and clinic staff are open to opportunities to liaise and network with their peers, creating a sense of community • Involving clinic managers and other clinic roles is essential to clinic buy-in and effective implementations

  25. Conclusions • Achieving significantly higher levels of adoption in Manitoba may require • Improving the EMR value proposition through increased interoperability and capacity for data sharing • Increased support for small (1-2 physician clinics)

  26. For more information www.manitoba-ehealth.ca/EMRadoption

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