Newfoundland and Labrador Electronic Health Record

Newfoundland and Labrador Electronic Health Record AHIS September 28, 2007 Getting Started Presentation Objective: – Background on the Centre for Health Information – Overview of Electronic Health Record Initiatives in Newfoundland and Labrador Outline: – The Centre for Health Information – NL EHR – Project updates Newfoundland and Labrador Centre for Health Information “Improved health through improved health information” The Centre Our Mandate: – To provide quality information to health professionals, the public, and health system decision-makers. The Centre’s mandate also includes responsibility for the provincial Electronic Health Record. Our Mission: – By March 31, 2011, the Newfoundland and Labrador Centre for Health Information will have implemented all funded components of the Electronic Health Record, and these will be in use by all authorized users NLCHI Governance • • NLCHI is a freestanding Crown Agency incorporated through its own legislation Board of Management includes representation from the Boards and senior management of the Regional Health Authorities as well as other key representatives from the health care sector, eg. MUN, Government, professional associations (NLMA), public. NLCHI has mandate to develop and govern the electronic health record • NLCHI Growth • The Centre’s base budget: • 2000/01 - $1.1 million • 2006/07 - $ 3.1 • The Centre’s project portfolio – • $3 million in 2000 • $60 million in 2006 • Internal Staffing has increased from • 2000 -18 FTEs • 2006 - 50 FTEs 55FTEs FTEs 18 FTEs 18 FTEs 60 FTEs 60 FTEs •Inception •Inception •Vision •Vision •Strategy •Strategy •BDBC •BDBC •Planning •Planning CR 11$3 M CR $3 M CR 22$6.5 M CR $6.5 M Pharmacy $25M Pharmacy $25M (Implementation) (Implementation) DI/PACS $25 M DI/PACS $25 M (Implementation) (Implementation) PR $1.2 M PR $1.2 M (implementation) (implementation) iEHR/Labs $1.2 M iEHR/Labs $1.2 M (Planning) (Planning) Telehealth $5 M Telehealth $5 M (Implementation) (Implementation) PHS PHS (Fin. Coord.) (Fin. Coord.) EHR EHR Integration Integration 1996 2000 2006 2011 NLCHI/EHR Evolution Provincial EHR Why do we need an EHR? Last Year, in Canada: 35 million Diagnostic Images 440 million Laboratory Tests 2.8 million Inpatient hospitalizations 382 million Prescriptions 3.4 million Vioxx Prescriptions in 2003 for patients that had to be contacted in 2004 322 million office-based physicians visits 94% resulting in handwritten paper records 60,000 physicians faced 1.8 million new medical papers in 20,000 journals and 300,000 clinical trials worldwide Source: Canada Health Infoway 2,000 transactions/minute require documentation & information flow Provincial EHR The Need for Electronic Health Records Healthcare in Canada – the Challenges For Every… …in Canada 1000 hospital admissions 75 people will suffer an Adverse Event 1000 patients with ambulatory encounter 20 people will suffer a serious Adverse Drug Event 1000 patients discharged from hospital 90 people will suffer a serious Adverse Event with the drugs received on discharge 1000 Laboratory tests performed up to 150 will be unnecessary (range 50-150) Provincial EHR The Need for Electronic Health Records For Every… 1000 Emergency Department visits …in Canada 320 patients had an information gap identified, resulting in an average increased stay of 1.2 hours. Study of 168 traditional medical records 81% didn’t have the info required for patient care decisions 1000 women at risk of cervical cancer 300-400 are not screened 1000 Canadians recommended for influenza protection 370-430 are not vaccinated Provincial EHR Current EHR Project Environment - Pharmacy Network - Provider Registry - Client Registry - DIPACS - Telehealth - Operations - Primary Health Care IT Project - EMR Strategy - Governance & Privacy - PHS Pharmacy Network Pharmacy Network Where are we now? The Pharmacy Network will electronically link pharmacists and prescribers to a secure repository of patient medication profiles. – – – – – – Ground work began in 2000 Scoping work completed 2003 RFP in 2005 Awarded to Emergis Consortium Spring 2006 Phase 2 began Summer 2006 Just released communication tools to interact with vendors including an interactive Extranet and the Vendor Resource Guide Pharmacy Network Where are we headed? Key Components of the Pharmacy Network • Centralized patient drug profiles • Medication reconciliation with acute and long-term care facilities • e-Prescribing • Advanced decision support tools Comprehensive Medication Profiles Pharmacy Network Opportunities Quantitative • • • • Impact of decreased adverse drug events on health system use Change in productivity for physicians, pharmacies and hospitals Change in adherence to prescriptions Change in drug cost growth Qualitative • Improved Quality of Care • Better clinical decisions attributable to access to completed medication profile • Improved Safety of Care – 3% of adverse drug events result in death • Decreased Abuse of the System – Reduced fraud and abuse Pharmacy Network Challenges • Direct access and “charting” on the patient’s clinical record – Non prescription medications – Allergies – Indications • Changes to regulatory framework – Privacy legislation – Health Canada Foods and Drug Act – Provincial regulatory authorities • Business Policy, Standards of Practice – Transferring prescriptions Pharmacy Network Challenges • Potential challenges to scope of practice – Who is responsible for Drug Utilization Review? • Workflow – – – – When is a prescription committed to a patient’s profile Status of paper prescriptions during and after transition Managing privacy and consent Number of Drug Utilization Reviews to be managed • Governance – Policy setting – Data access – Classes of users • Costs for Stakeholders Provider Registry Provider Registry Where are we now? • Completing the customization, testing and integration of our Provider Registry into the EHR • Working with 6 providers on memorandum of understanding: Physicians, Nurses, Pharmacists, Dentists, Optometrists, Veterinarians • Entering final phases of the project Provider Registry Where are we headed? • Provide a link between a single provider’s information across all care settings • Use this information for identification purposes and maintaining messaging standards • In addition to basic demographic data, the Provider Registry is designed to store and share specific details (licenses, privileges and restrictions) on a provider as part of the required security and privacy considerations of an EHR Provider Registry Where are we headed? The first clinical information system to use the Provider Registry will be the Pharmacy Network. Requirements include: • Provider Registry data will be used to set up the – Pharmacy Network User Registry – Authorization & Authentication role & permission matrix – Provider permissions and restrictions table • Synchronizes data with the Pharmacy Network by notifying of any new or updated data • Unique identifiers for provider in Provider Registry are reused in Pharmacy Network Client Registry Client Registry Where are we now? • 2001, NL first Canadian province to provide a basic patient identifier cross-reference system built specifically for health care • 2003, Infoway EHRs Blueprint developed. Allowed for a progression from the provincial UPI to the current Client Registry – completed upgrade to initial Client Registry System in collaboration with Regional Health Authorities and the Infoway • 2005, Centre developed plan for the Pharmacy Network – recognition that Pharmacy system had to be linked to Client Registry • 2006, iEHR\Labs project plan completed which exposed limitations to the current Client Registry, a key piece of the overall iEHR solution Client Registry Where are we headed? Today’s Client Registry Requirements in Support of Pharmacy Network Project Work has begun on the project, in two interconnected streams to allow the Client Registry to continue to be an integral part of NL’s Electronic Health Record Phase 2.1 Prerequisite Client Registry upgrade to Initiate v7.5 Phase 2.2 HL7 integration allowing for Pharmacy Network connectivity to the Client Registry DIPACS DIPACS Eastern Health (HCCSJ, Avalon & Peninsulas) Regional Project Sponsors (Shawn Thomas & Terry Mouland) Central Health (Central East & Central West) Regional Project Sponsors (Lester White & Mary Locke) Western Health LabradorGrenfell Health (Labrador & Grenfell) Regional Project Sponsor (Wendy Christensen) Regional Project Sponsors (Sheila Freake & Rob Perry) NLCHI Project Office Tom King GE Canada Sales & Project Management, Implementation Plato Group Project Team Lead Kevin Duggan DIPACS Where were we in 2003? A5 • NL was <50% 2007 2006 PACS enabled 2005 • Multi-vendor 2004 environment 2003 • Decentralized 2002 regional archives 2001 • Storage running 2000 low 1999 • Critical lack of BC/DR to support 1998 filmless state Infoway/NL/PACS Phase 2 Implementation (24-36 months) Infoway/NL/PACS Phase 1 (3-6 months) Shared procurement (HCCSJ, WHCC, HLC) Infoway/NL/PACS Phase 0 (3 months) Image transfers begin (inter-regional/provincial) GRHS adds PACS CHIPP/Tele-i4 adds PACS at 4 more regions CHIPP Funding Central East installs 1st regional PACS Infoway Investment ~40% PACS implemented NL DIPACS What was the goal? 5 • NL PACS Vision: A (NL DIPACs Steering Committee, Dec 2003) Any patient, Any image, Any report, Anywhere and Anytime • Objectives: – Achieve 95% filmlessness by 2006 - 2007 – High exam availability to provincial Radiologists / Physicians by 2006-07 – Leverage NL Client Registry for patient identification DIPACS Where are we? A5 • 100% PACS enabled • Single-vendor environment • Provincial archive • Immediate failover ‘hot site’ BC/DR Infoway/NL/PACS Phase 2 Implementation (24-36 months) Infoway/NL/PACS Phase 1 (3-6 months) Infoway/NL/PACS Phase 0 (3 months) Shared procurement (HCCSJ, WHCC, HLC) Image transfers begin (inter-regional/provincial) GRHS adds PACS 2007 2006 2005 2004 2003 Infoway Investment ~40% PACS implemented NL 2002 2001 2000 1999 1998 CHIPP/Tele-i4 adds PACS at 4 more regions CHIPP Funding Central East installs 1st regional PACS DIPACS How it was done? • Total project cost was greater than $20 million • Infoway investment of $10.4 million • Province contributed $4 million • Regions funded the rest. DIPACS How did we do? Achieved greater than targeted filmlessness Will finish on time and at or under budget GE’s first ever customer worldwide for IHE PIX Designed and implemented an original architecture • Developed a migration model that reduced projected migration time down from 2 years to 6 months • • • • Project Goals DIPACS What’s left? • Last site go-live on provincial network (Monday – October 1st) Project Goals • Completion of the Health Information Network • Governance model • IHE PIX and Client Registry integration DIPACS What were the challenges? • Finding the right architecture for low bandwidth connections • Migration of legacy images – especially non-GE • IHE PIX and Client Registry integration • Governance • Security between autonomous regional networks Project Goals NL DIPACS End State Labrador City IV Goose Bay IV Grand Falls IV St. Anthony Corner Brook IV Clarenville/Burin IV Gander IV NL Provincial PACS 2.1 PACS Back Office 10 Mbps WAN 30/50 Mbps WAN 100 Mbps WAN Carbonear St.John’s Health Information Network LabradorGrenfell Health Local PACS Image Volume Western Health Local PACS Image Volume Central Health Local PACS Image Volume Eastern Health Local PACS Image Volume Central Archive Repository Central and Disaster Recovery Infrastructure Central Site Health Science Centre Disaster Recovery Site Waterford Telehealth Chronic Disease Management (CDM) Program Telehealth Where are we now? • Telehealth Strategy developed in 2005 • 3-year Telehealth CDM Implementation Plan Telehealth Where are we now? Five Strategic Directions • • • • • Selfcare-telecare Chronic Disease Management (CDM) Access to Specialists & Specialty Services Home Care Point of Care Learning Implementation Areas of Focus – Oncology* – Nephrology – Diabetes - Mental Health - Neurology Telehealth Where are we headed? Telehealth Implementation • Initial focus clinical activity – Chronic Disease Management • Video conferencing and peripheral devices are the initial technologies to be used – Mobile medical carts (CSA approved) – Stethoscopes, Probe sets – Potential for desktop • Support the coordination, standardization & integration of telehealth Operations Operations Where are we now? How do the information systems and components work as a single EHR? • EHR Operations provides connectivity to each region of the province. • Its telecommunications infrastructure connects 200 pharmacies and other health service facilitates across the province • Keeping the systems running 24 hours a day, 7 days a week, 365 days a year Operations Where are we headed? Operation resources will provide support in the following areas: • • • • • Service Desk Data Centre Application support Data Communications SLA Management Health Health Information Information Network Network Primary Health Care Enhanced Information Technology Project Primary Health Care Where are we now? • The Centre was engaged by the OPHC to assist with enhancing the information technology available to PHC interdisciplinary teams in two reference sites, one rural (Connaigre Peninsula) and one urban (St. John’s) • All enhancements basically completed • Currently testing Meditech (Lab and DI) interfaces and MCP Primary Health Care Where are we now? Centre engaged by OPHC (September 2003) Needs assessment and requirements gathering (2004) CDM planning and development (Winter/Spring 2005) Reference sites CDM rollout (Spring/Summer 2005) Protection of personal health information procedures development (ongoing) • Basic EMR live in all four clinics (December 2006) • Currently testing Meditech (Lab and DI) and MCP interfaces • Project Completed • • • • • EMR Strategy EMR Strategy Where are we headed? • Assess the current EHR environment with regards to EMR, its level of adoption in NL, and how this compares to other jurisdiction across Canada • Develop a vision of an EMR for NL that defines what services and benefits an EMR will offer and who will be able to take advantage of them • Perform a gap analysis between the current situation and the vision • Develop a high-level architecture that the proposed EMR solutions must fit within • Define the potential solution options that are available to achieve the vision iEHR/Labs iEHR/Labs Where are we now? • Completed Phase 0/1: scoping and planning – completion late October, 2006 • Decision was made to put the iEHR/Labs project “neutral” because of current workload requirements both within the Centre and in the Regional Health Care Authorities. • Now putting together a revised business case to Infoway for purposes of proceeding in the Spring, 2008 EHR Desired State Governance & Privacy Governance and Privacy • Worked with key CEOs and executive directors in the extended health system to develop a governance model that uses the Centre for Health Information’s Board of Directors • More work will be completed over the next six to nine months • Supported government in its consultations on legislation to protect the privacy of personal health information. Hope to see legislation introduced in next 6-8 months. Public Health Surveillance Key Success Factor – Collaborative Processes Key Success Factor – Collaborative Processes • NL’s greatest asset is its highly engaged stakeholders • Many years spent planning and building consensus (Benefits Driven Business Case 1998) • Open and continuous communications • Culture of collaboration permeates all projects • Autonomous organizations working together for the common good…the Virtual Health Enterprise