CPOE: Why is Canada losing the race, but poised for a comeback?

1. CPOE:Why is Canada losing the race, but poised for a comeback? Jeremy Theal, CMIO, North York General Hospital eHealth Conference, Ottawa • May 28, 2013

2. Faculty/Presenter Disclosure • Faculty: Jeremy Theal MD FRCPC • Relationships with commercial interests: • Grants/Research Support: Canada Health Infoway • Speaker Honoraria: Cerner CanadaOntario Hospital Association Provincial Health Services AuthorityVancouver Island Health Authority • Consulting: Provincial Health Services Authority

3. Disclosure of NO conflict of interest • The Canadian CPOE Toolkit/NYGH has received financial support from Canada Health Infoway in the form of development funding. • No conflict of interest to declare: • The Canadian CPOE Toolkit is a service available free of charge to any publicly-funded Canadian healthcare institution • North York General Hospital, as the host organization for the Canadian CPOE Toolkit, does not receive any financial support or financial gain from the Toolkit aside from the initial development funding it received from Canada Health Infoway • No products other than the Canadian CPOE Toolkit will be discussed in this presentation

4. Canada: Losing the CPOE race • US has 12x the proportion of sites at HIMSS Stage 4 and above compared with Canada (38.3% vs 3.1%) • Progression to HIMSS EMRAM Stage 4 and above is associated with improved quality and safety outcomes - AmarasinghamR et al. Arch Intern Med 2009 169(2):108-14- 2006 HIMSS EMR Sophistication Correlates to Hospital Quality Data- 2012 HIMSS Analytics Report: Quality and Safety Linked to Advanced IT-Enabled Processes

5. Why is Canada falling behind? • Differences in funding, incentives and penalties • Misunderstanding of definition of CPOE and its benefits Amarasingham R et al. Arch Intern Med 2009 169(2):108-14 • Heterogeneity of implementation approaches • Risk of negative patient and provider outcomes • High quoted failure rate of CPOE projects (>30%) • Lack of “critical mass” of successful projects in Canada • Large amount of evidence-based content required for both go-live and ongoing maintenance • Limited sharing of content and expertise within the public system, without incurring extra cost

6. Why do we need to succeed? • Patientsdeserve better quality and safety of care Baker GR, Norton PG. Canadian Adverse Events Study. CMAJ 2004 170(11): 1678-86Berwick DM et al. The 100,000 Lives Campaign. JAMA 2006 295(3): 324-7 • Governmentexpects evidence-based care, and hospitalsneed to report detailed quality outcome data Excellent Care for All Act, Leg Assemb Ontario 2010Quality-Based Procedures, MOHLTC, Ontario 2012 • Healthcare providersneed systems that provide evidence built into clinical workflows, to improve quality and safety of care Kawamoto K et al. Systematic review of clinical decision support system success factors. BMJ 2005

7. CPOE + cds + Evidence = improved outcomes

8. CPOE + cds + Evidence = improved outcomes Study population of all Medicine patients at NYGH with primary discharge diagnosis of COPD or Pneumonia: • Pre-CPOE (Jan-Sep 2010) n=520 • Post-CPOE (Jan-Sep 2011) n=511

9. A potential solution:Canada makes a comeback • Canada compared withUnited States: • Healthcare based on single-payer (govt/taxpayer) • Not based on competition (challenge is accommodation)! • No competitive barriers to open information resource sharing • Can benefit from economies of scale • Significant proportion of cost and time required for CPOE implementation is due to: • Development of evidence-based standardized clinical content (order sets, clinical decision support) • Workflow review, refinement and integration • Adoption of content, workflows and system by clinicians  These factors are VENDOR-INDEPENDENT and MANDATORY FOR SUCCESS

10. Leverages the non-competitivestructureof Canadian healthcare to create a no-cost sharing platform for Canadian CPOE development resources • CPOE Implementation guide (>500 pages) • Evidence-based CPOE order sets: • Searchable library with >500 order sets(over 50% no license restrictions) • Specialties include:Medicine, Surgery, Critical Care, Paediatrics • Coming soon: Maternal-Newborn, Mental Health • Multi-publisher sharing model: • Each contributing organization shares content at no cost, retains full ownership of all contributions • Contributions pending from multiple organizations

16. Toolkit-affiliated organizations • North York General Hospital • Alberta Health Services • Brant Community Health Services • Centre for Addiction and Mental Health (CAMH) • Fraser Health Authority • Humber River Regional Hospital • London Health Sciences Centre • North Bay Regional Health Centre • Sunnybrook Health Sciences Centre • St. Joseph’s Hospital, Toronto • Provincial Health Services Authority • Mackenzie Health Richmond Hill • Ontario Hospital Association • Canada Health Infoway • St. Michael’s Hospital (pending) • Ontario Shores Centre for Mental Health Sciences (pending) • Vancouver Island Health Authority (pending) 14 organizations and over 220 users in first five months

17. Thank you Join today at: http://www.cpoe-toolkit.ca