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Towards an Electronic Health Record: Investments in Drug Information Systems in Canada

Towards an Electronic Health Record: Investments in Drug Information Systems in Canada CSHP Annual General Meeting August 13 - 16, 2005. Kurtis Bishop Group Director, Drugs and Diagnostic Imaging Investment Programs Management Canada Health Infoway. Today’s Presentation.

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Towards an Electronic Health Record: Investments in Drug Information Systems in Canada

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  1. Towards an Electronic Health Record: Investments in Drug Information Systems in Canada CSHP Annual General Meeting August 13 - 16, 2005 Kurtis Bishop Group Director, Drugs and Diagnostic Imaging Investment Programs Management Canada Health Infoway

  2. Today’s Presentation • Electronic Health Records • Introduction to Canada Health Infoway • Investment Strategy and Approach • Infoway Drug Systems Strategy • Investments in Drug Systems in Canada • Summary

  3. Benefits of Electronic Health Records • Improves patient safety • Helps avoid errors inherent in incomplete records • Enables more timely access to care • Reduces waiting time for services • Supports the provision of care over large distances • Maximizes scarce resources, improves efficiency • Less duplication of lab & diagnostic tests • Less time wasted handling/finding paper records • Improves information sharing and team coordination • Better faster access to information to diagnose and treat patients Bottom-Line: EHRs will support a more patient-centred, responsive and proactive healthcare delivery system

  4. Computerized, Interoperable EHR– Enabling Value • Four things an interoperable EHR does well: • Accumulate vast amounts of structured patient centric data • Process vast amounts of data on queries to find patient information • Transport information between points of care insuring levels of speed, accuracy, completeness, reliability and clarity never before achievable • Enable decision support (not decision making) by applying validated scientific and business oriented rules to patient information

  5. Applications Appl Appl Healthcare Provider’s View of EHR

  6. Generation 4 The Mentor Generation 3 The Helper Generation 2 Functionality and Value Chain Optimization The Documenter Generation 1 The Foundation e.g. Physical infrastructure to support the EHR such as data centers and networking Enablers End of 2009 Evolution of EHR • Order entry and results viewing for laboratory tests, medications and images. • Alert notification (eg. duplicate tests, drug interaction) • Provisioning of CPG’s Generation 3 plus complex Decision Support • Patient demographics • Provider demographics • Location demographics • Results Viewing • Laboratory test results • Dispensed medications • Diagnostic image results

  7. Getting there over time…. Conceptual EHRS Blueprint 2002 2009 2020 Implementing EHR Building Blocks Pan-Canadian interoperable EHR 2009 Target/Focus 2020 Target/Focus • All Application Areas incorporating full “mentoring “ technology • Interoperable EHR based on the fully standardized EHRS Blueprint Architecture • Target 100% of Canada’s population • Five Application Areas • Interoperable EHR using common Presentation Layer & key Blueprint Elements • Target 50% of Canada’s population • Getting there requires stepped improvement in applications developed, technology evolution, geographic coverage, standards coverage

  8. Canada Health Infoway Background • Late 1990s • Growing F/P/T consensus on the need for interoperable electronic health record systems via Canada Health Infoway Report and pan-Canadian Health Infostructure Tactical Plan • September 2000 • Canada’s First Ministers unanimously agree “to work together to strengthen a Canada-wide health infostructure.” • Canada Health Infoway launched in late 2000 • Independent, not-for-profit corporation equally accountable to 14 F/P/T government • $1.2B Capitalization since inception • $500M - Electronic Health Records focus (initial funding) • $600M - Accelerated EHR and Telehealth (March 2003) • $100M - Health Surveillance Systems (March 2004)

  9. Infoway’s Mandate • Mission To foster and accelerate the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan-Canadian basis, with tangible benefits to Canadians. To build on existing initiatives and pursue collaborative relationships in pursuit of its mission. • Goal Infoway’s plan is to have an interoperable EHR in place across 50 percent of Canada by the end of 2009. • Core Business We invest with public sector partners to develop, replicate and re-use compatible electronic health systems, thereby leveraging public funds, knowledge and results across Canada, to build a safer, more efficient healthcare system.

  10. Funder Strategic Investor Intervener Developer “Fund & ignore” “Work alongside & take over if needed” “Write code &build modules” • Invests with partner • Involved with partner in planning, and execution • Ensures success through ongoing, active participation or intervention when something goes wrong • Invests with Partners • Involved in project planning • Monitors progress of projects and quality of deliverables • Gated funding approach allows management of risk • Grants funding • Is uninvolved in project execution • Checks on status of phase-based deliverables • Invests independently • Engages potential partners in needs analysis and testing • Aims for speed and success by working without a partner or on behalf of a future partner “Invest, advise & monitor” Infoway also provides leadership in setting the strategic direction & standards for EHR deployment across Canada Infoway’s Role -- A Strategic Investor

  11. Investment Program Budget 2003 - 2009 End User Adoption and Setting the Future Direction Innovation & Adoption - $60m The Electronic Health Record Interoperable EHR - $175m Domain Repositories and Healthcare Applications Drug Information Systems Laboratory Information Systems Diagnostic Imaging Systems Public Health Systems TeleHealth $150m $185m $150m $220m $100m Cross Program Components Client, Provider and Location Registries - $110m Architecture and Standards Infostructure - $25m

  12. Objectives of Infoway Drug Systems Strategy • Patient safety – reduced errors in the prescribing process resulting from incomplete, inaccurate and/or illegible information at the point of care, lack of clinical decision support • Cost management – improved formulary compliance; improved efficiencies in workflow in prescribing and dispensing environments; reduced hospitalization • Process efficiency – reduced “callbacks” from pharmacist to physician, ability to integrate e-prescribing tools into workflow • Patient satisfaction – accurate drug profile, reduced wait time in pharmacy, reduced adverse drug events

  13. Recently Documented Need for DIS and e-Prescribing • Prescribed drugs account for 82.5% of drug spending (CIHI, 2005) with approximately 380 million prescriptions dispensed in pharmacies • A recent study regarding seniors and medication (CBC, Tamblyn 2005): • 10% of seniors experience adverse drug events serious enough to require hospitalization • 16,500 seniors have died in last 5 years due to ADEs • 1/3 of seniors are given ineffective/unsafe drugs • CMAJ adverse events study (Baker et al 2004) • AEs occurred in 7.5% of hospital admissions; drug and/or fluid related events were second highest cause (following surgical) • S & W study (Cornish, 2005) suggests that medication errors at time of hospital admission are common • 53% of admissions had at least one discrepancy • Most common discrepancy (46%) was omission of a regularly used medication • Overall, 39% of the discrepancies had the potential to cause harm

  14. Infoway Drug Systems Strategy • Solution Objectives • Patient’s historical drug profile is viewable electronically by the physician and pharmacist • Allows a physician to generate and send a patient’s prescription electronically, allowing any pharmacy to view the order online and to fill the prescription • Automatic notification to the attending physician and pharmacist of adverse drug events

  15. Infoway Drug Systems Strategy • Key Investment Projects • Alberta: Implementing province-wide DIS; Includes e-prescribing, adverse reaction alerts and pharmacy services • Saskatchewan: Developing a province-wide DIS • Ontario: Developing a view-only application with providing on-line ability to view a patient’s dispensed drug profile. Focus is on emergency room access first, in 2005 • Newfoundland: Developing plans for a province-wide DIS. Coordinated national procurement underway • Quebec: Advanced project planning work underway • PEI, YK: Initial project planning work underway • CeRx Project underway to develop national messaging standards for dispensed drug and claims • ePTRS: Health Canada and Infoway have partnered on a project to develop and establish applicable ePrescribing transmission requirements standards

  16. Infoway Drug System Strategy • Investment Program Approach • Support Drug Information System (DIS) solutions: • Generation 3 Drug Information Systems that will: • Capture data on All Drugs for All People • Support viewing of drug profiles, as well as ePrescribing • Generation 2 systems as a stepping stone to a Gen 3 system implementation • Investment in HL7 pan-Canadian drug clinical standards and a vendor adoption strategy • Excludes funding for Drug Claims Processing system components

  17. Provider Access Clinical Management Claims Administration Client Client Registry Registry Network Client Client Domain Repository (Pharmacy) Provider Client Registry Registry Registry Registry Public and Private Claims Adjudication and Administration Clinical Drug Information Systems Pharmacy System Pharmacy Access Dispensing Support Dispensing Message EMR MD Access Claims Message Prescribing Message Prescribing Support Prescribing Support CIS Hospital Access Existing Systems Pharmacy/MD/ Hospital Access Clinical Viewer Existing Messages New Messages

  18. “Gen 2” Drug Information Systems • A Gen 2 Drug Information System allows… • A pharmacist to send a patient’s fill details electronically. . . • to include it in the patient’s longitudinal drug profile. . . • so clinicians – pharmacists, doctors, nurses – can access a complete drug profile. • Some implementations will be All Drugs, All People (ADAP) • Some implementations will be a subset of the population, based on provincial drug programs

  19. “Gen 3” Drug Information Systems • In addition to Gen 2 capabilities, A Gen 3 Drug Information System allows… • a physician to send a patient’s prescription electronically. . . • any pharmacy to view the order online, fill the prescription . . . • a message to be sent electronically to include in the patient’s longitudinal drug profile. • This allows for the provision of prescribing support, and compliance monitoring

  20. Why invest in Gen-2 solutions? • Opportunity for quick wins using available dispensing data • Most Jurisdictions have a drug program that maintains a pharmacy claims database with dispensing information • Some are passing legislation to ensure that they collect fills from “All Drugs All People” • Most are based upon the same message input: CPHA/3 • Alignment with Jurisdictional priorities • Some Jurisdictions have indicated that they will be delivering a view-only solution to acute-care centres first • Recognition of how complex Rx Gen-3 solutions really are • Gen-2 provides high value to clinicians with lower deploy risk • Gen-3 is highly dependent on complex integration of many points-of-service: pharmacies, physician offices and hospitals • It takes time and money to bring it all together

  21. What are the Benefits? Order & View Interfaces to Retail Pharmacy EHR and Access layer Benefits

  22. In Place Provinces starting in different places Not Started Implementing Planned

  23. What can we expect moving forward? • Jurisdictions will be facing increasing political and time pressures to improve patient safety and reduce medical errors due to drug-2-drug interactions – they need quick wins • Jurisdictions are facing increasing pressure to mitigate increasing drug costs – they need quick wins • Health Canada is facing increasing pressure to respond to adverse drug events from new medications – they need quick wins • Even Provinces (e.g. BC, QC, SK, PE and NL) that are moving towards Gen-3 will likely want a Gen-2 solution in place first, and fast • Resolution of S2S integration issues will be crucial to the long term success of any Jurisdictional level solution • Pharmacies, Physician Office and HIS • Significant resources will be needed to ensure that pharmacists and physicians support and adopt solutions

  24. Adoption will be key to success… • Relative to other Infoway investment tracks… • Drug Information System is highly dependent on collaboration with... • Private sector stakeholders - i.e. retail pharmacies (Rx) - to implement the technology solution • Professional colleges - i.e. colleges of pharmacists and physicians - to support changed professional roles and work processes • Ministries of Health - to align with their drug benefit systems • Standards Projects - National electronic Claims Standard (NeCST) and Clinical Message development (Rx-5) • Pan-Canadian deployment is highly dependent on supporting provinces to evolve their pharmacy networks • Deployment of Gen 3 Drug is highly dependent on physician connectivity and adoption.

  25. Scope: Queries Prescribing and Dispensing Prescription updates and prescription status management Contraindications and drug permissions Clinical support Infrastructure Benefits: Improved Quality of Care Increased Adoption Enable Interoperability Facilitate Replication National Standards Project – CeRx

  26. CeRx Timelines • Scope and plan were developed during the first 6 months of 2004 • Execution of the plan is underway • Messages are being developed with international consultation and cooperation • The project will deliver a series of implementable HL7 V3 specification documents in packages this year

  27. National Standards Project – CeRx June - July 2005

  28. Lessons Learned • Need Leadership in terms of High-Level Government Strategic Commitment to Health Records • Need Global Standards for Healthcare Records for • interoperability of disparate systems • enabling economies of scale • reducing risk and cost of “re-inventing the wheel” • supporting backward compatibility of older systems • More stakeholder involvement, collaboration and strategic alignment • End-user training and providers’ buy-in is vital • Strict project management and accountability • Privacy issues critical at every stage • Need mechanisms for sharing best practices and software

  29. Summary • EHR systems are seen as key to a safer, cost-effective healthcare network • Interoperable EHRs in place across 50 percent of Canada by end of 2009 • Tangible value is being delivered as we proceed, focused on • Registries • Diagnostic Imaging Systems • Drug Information Systems • Laboratory Information Systems • Telehealth • Public Health Surveillance • Interoperable Electronic Health Record • EHR securely integrates data from varied clinical information systems • Privacy is addressed in everything we do • Healthcare community support and adoption are key to our success

  30. Thank You! www.infoway-inforoute.ca

  31. Branding Guidelines • What is the significance of the floret, circles, wave and photographs? • The floret symbolizes the five core patient-facing programs in which Infoway invests. The petals represent Diagnostic Imaging, Drug Information Systems, Laboratory Information Systems, Telehealth and Public Health Surveillance • The interconnecting circles are a metaphor for the healthy connections Infoway and its partners create by developing and connecting health information systems. Hence the tag line, Creating Healthy Connections. • The wave represents the acceleration of the development and adoption of interoperable Electronic Health Records • The photographs portray people as heroes with technology in a supporting role. The facing forward with a smile composition serves to articulate that Infoway is having a positive impact on the lives of patients and clinicians across Canada.

  32. Branding Guidelines • What is the significance of the bold colours? • Each of the programs is represented by a bold colour representing its strategic role in supporting the development and adoption of interoperable Electronic Health Records – EHR. • The colour palette is bright, positive, energizing and harmonious.

  33. Presentation Guidelines • Corporate Presentations • Corporate presentations should use the green colour. However, tangerine and blue are acceptable alternatives: • Program Presentations • Program specific presentations should use the colour defined by the branding guidelines (See customized Program templates). • Colours should not be mixed and matched.

  34. Master Title - Times 30pt • Master First Heading - Times 20pt Black • Master Second Level - Arial 15 pt Grey • Master Third Level - Arial 15pt Grey • Master Fourth Level - Arial 15pt Grey

  35. Drug Information Systems • Speaking to those in Drug Information Systems • Use the lavendar colour scheme when speaking to members of the DIS community

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