Measuring health system integration readiness through electronic patient information exchange

Transcription

1 Measuring health system integration readiness through electronic patient information exchange Investigators: Josephine McMurray (1), Dr. Ian McKillop (2), Dr. Ross Baker(3) 1.Health Studies & Gerontology, University of Waterloo 2.David R. Cheriton School of Computer Science, University of Waterloo 3.Department of Health Policy & Management, University of Toronto

2 Our 15 minutes. Patient information flow (electronic) measurement Health system Integration (readiness) 2

3 In the news He decided to forego the system where it actually performs, and put himself in [US] hands where it is far more likely to fall short. I'd have cheered if he had gone south in a snit because he couldn't get team-based, evidence-informed, same-day, patient-centred primary healthcare supported by firstclass information technology.that's the symbolic stick in the eye that Medicare deserves, and the real Achilles heel of the system. from Danny Williams Ironic Adventure Source: Stephen Lewis (2010). Essays. Longwoods Publishing. Accessed March

4 Benefits of integration Improved quality and safety (Gillies et al., 2006) Increased patient satisfaction, improved access to care, care coordination and emphasis on preventive health practices (Alberta Health and Wellness, 2000) Savings from fewer duplicated services (D Amour et al., 2003) Sustainability of health systems (Suter et al., 2009) 4

5 Benefits of electronic information exchange Pivotal to integration (Dobrow et al., 2009;Douglas & Shortell, 1996) A key driver of high performing health systems (Shih et al., 2008) Facilitates integration and coordination along the continuum of care (Pink et al., 2000) Improves quality and reduces the duration of care (Stiell et al., 2003) Increases accessibility (Durbin et al., 2001) Reduces patient transfers (Hodge, 2008) Fewer medical errors (Schabetsberger et al., 2006) Reduces cost (Smith et al., 2008; Labkoff & Yasnoff, 2006)) 5

6 There are compelling reasons for change Source: Ontario Ministry of Finance. (2010) Ontario s Long-Term Report on the Economy. Ministry of Finance website Retrieved March 5,

7 There are compelling reasons for change Source: Statistics Canada. (2009) 2006 Census Analysis Series on the Statistics Canada Website at Retrieved June 19,

8 On the front lines I had a cancer patient come to see me. He was getting treatment at the [local hospital out patient] clinic and was taking a nose dive. I had NO idea what treatment was being given. Family Physician 8

9 On the front lines One of my patients was discharged from [psychiatric institution] and needed their meds renewed as they were only given a week. They came to see me the next day I didn t know what they needed, what the psychiatrist thought, what the recommendations were. Family Health Team Physician 9

10 On the front lines another patient was being treated at [local community hospital] and then was transferred to a nursing home. They followed up with me two days later as the treatment was not working. I had no results, no diagnosis Family Health Team Physician 10

11 The impact of not having the right information available at the right time for clinical decision-making Delayed care phone tag, voice mail Multiple visits Wasted staff & physician time accessing information Guesstimate treatments 11

12 Canada Health Infoway seamless [information flow] across the continuum of care and into community-based settings.[to] coordinate communication and workflows across care settings... Source: Canada Health Infoway. (2007) 2015: Advancing the next generation of healthcare in Canada. Ottawa, Ontario. 12

13 Canada Health Infoway Without an integrated IT infostructure, Canada will struggle to meet the increasing demands of all its stakeholders to delivery superior care at a sustainable cost. Source: Canada Health Infoway. (2007). 2015: Advancing the nextgeneration of healthcare in Canada. Ottawa, Ontario. 13

14 International comparison of physician practices with advanced information processing capability Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. 14

15 Ontario hospitals are developing the capability Source: OHA ehealth Adoption Survey Clinical Capabilities. Accessed 15

16 Interoperability for a shared EHR Source: OHA ehealth Adoption Survey Clinical Capabilities. Accessed 16

17 Spending on health IT varies Source: Anderson, G.F. et al., "Health Care Spending and Use of information Technology in OECD Countries", Health Affairs 25 (May/June, 2006):

18 Our investment in health information technologies continues to grow $1.6 billion for Infoway since 2001.the goal is $350 per capita* Source: Office of the Auditor General of Canada Fall report of the Auditor General of Canada: Chapter 4 Electronic Health Records. * Canada Health Infoway. (2007) 2015: Advancing the next generation of healthcare in Canada. Ottawa, Ontario. 18

19 .and more To achieve the goal of integration through electronic information exchange Total investment over 10 years = $10-12 Billion (acute care) $ billion incremental operating costs (acute care) $3.5 4 billion to include allied health and community Provincial government and individual provider investments are not included 19

20 Our Research: Measuring integration readiness through electronic patient information exchange Research Assertions: Electronic information exchange between providers is a key enabler of health system integration Providers electronic information flows have dimensions which can be measured and scaled In the aggregate provider metrics of electronic information exchange are a lead indicator of system integration readiness. 20

21 Our Research: Measuring integration readiness through electronic patient information exchange Summary of literature Considerable literature on health system integration and indicators few validated (Raina et al., 2001) Scant literature on the measurement of electronic information exchange Partial frameworks which describe the components of electronic information exchange (Devitt, 2009; Manso, 2009; Walker, 2005; Massetti & Zmud, 1996; Liang, 2004) No measures of provider electronic information exchange related to health system integration 21

22 Electronic information flow framework Dimensions of: Connectivity Interoperability Message Flow Sub-Dimensions Point-to-point; point-to-multi- Point Transportable; transportable & organizable; transportable, organizable & interpretable Structure, standardization, content Direction, volume, breadth 22

23 Our Research: Measuring integration readiness through electronic patient information exchange Scope: Where? What? Who? Regional WWLHIN(local primary care services account for 92% of residents needs (Baigent, 2006)) Electronic patient information exchange between providers Providers included those identified as points of service in Infoway selectronic Health Record Solutions Infostructure Blueprint How? Mixed Methods Three phases: Qualitative Quantitative - Qualitative 23

24 Research: Phase I Qualitative Consensus development 7 invited experts -hospital, CCAC, family practice, university, Ministry of Health, ehealth, public health Nominal group process to advise on potential measures of integration which are enabled by electronic information exchange 24

25 Results Phase 1 22 metrics discussed and ranked anonymously (9 pt Likert) 6 met the criteria of a mean ranking 7-9 and at least 70% agreement ( 3 included in subsequent survey) 25

26 Consensus development process This is a gross measure of the capacity of the providers in a system to electronically share information i.e. it measures the infrastructure in place for providers to electronically share information 26

27 Consensus development process Public health has a mandate to collect and report vaccination information in the province, yet records are incomplete for those vaccinations provided outside the unit [Consistent with the Centre for Medicare and Medicaid s Stage 2 criteria for meaningful use which calls for bi-directional communication with public health agencies ] 27

28 Consensus development process A capacity metric to understand whether the most basic of patient information is being shared across the continuum of care 28

29 Consensus development process Sentinel diseases for which coordination of care across the system is commonly accepted as critical for the provision of quality care i.e. diabetes, cancers. Standard objects i.e. tests and results would be traced across the continuum of care 29

30 Consensus development process Much has been made of central registries for patients suffering from chronic diseases which require informed clinicians and patients. Measure the total number of confirmed cases in the region/province, against the number of patients whose information is available to authorized care providers through the registry. 30

31 Consensus development process A metric to determine the amount of clinical data received electronically which is useful to the clinicians that is, it is available in their EMR and used in the process of providing care. 31

32 Research Phase II (in progress) Quantitative Pilot Study - Webbased survey (Sensus) Survey and scoring matrix in final development both have been iteratively generated, informed by literature and supplemented by questions from key informants Recruitment underway, & survey distribution anticipated early April Data Analysis: May August 32

33 Regional boundaries X X X 33

34 Regional Information Flows - Scope Hospital Diagnostic Imaging CCAC Specialist Out of scope Primary Care Long Term Care 34

35 Participant Panel 10 hospital sites (8 hospital corporations) 1 CCAC 35 long term care homes 4 community health centres 9 family health teams 2 public health units 956 physicians 30 community support services 21 community mental health and addictions services 35

36 Information flows In Canada (pop. 34 million)* 440million laboratory tests performed, 382million prescriptions filled, 322million visits to doctors offices, 35million diagnostic images taken, and 2.8 million hospitalizations In WWLHIN (pop. 750,000)** 10 million laboratory tests performed, 8million prescriptions filled, 7million visits to doctors offices, 1million diagnostic images taken, and 62,000 hospitalizations *Source: Office of the Auditor General of Canada Fall report of the Auditor General of Canada: Chapter 4 Electronic Health Records. ** Estimated based upon 2.2% of the population 36

37 Research Phase III (proposed) Qualitative Data triangulation through case studies Results will be available in the Fall,

38 Acknowledgements: We gratefully acknowledge the Health System Performance Research Network and Ministry of Health & Long Term Care for their generous support of our research. 38

39 Please feel free to contact me with any questions: Josephine McMurray Health Studies & Gerontology, University of Waterloo or x