Connectivity in Primary Care Practices

Transcription

1 Connectivity in Primary Care Practices Colin King Clinical Systems Architect Vancouver Coastal Health 4 October 2003

2 Agenda Access to lab results, radiology reports Access to PharmaNet Access to EMR from emergency rooms and other sites Access to information from local hospitals Electronic Medical Summary (e-ms) MoH Secure Web Site for Physicians Overall recommendations 2

3 Agenda Access to lab results, radiology reports Access to PharmaNet Access to EMR from emergency rooms and other sites Access to information from local hospitals Electronic Medical Summary (e-ms) MoH Secure Web Site for Physicians Overall recommendations 3

4 Access to lab results, radiology reports, etc. - today Lab results services are provided today by: PathNET (mostly private labs) MediNet (mostly public labs) PHSA is working on clinical broker interfaces to deliver lab results pilot in Nanaimo (Meditech -> Clinicare) Several EMR vendors provide lab interfaces to PathNET, MediNet, etc. some vendors are further ahead than others BC Lab Test Standard developed in late 90s slow uptake Very little electronic delivery of radiology results 4

5 Access to lab results, radiology reports, etc. - future The lab reform project will implement a provincial lab ordering and results delivery system one system, or a system of systems covering out-patient and in-patient tests standards-based (leverage LTS) access via EMR interfaces and web portal Substantial implementation targetted for Apr 2005 (i.e., 18 mths from now) provincial results service? Fate of PathNET, MediNet, etc. is unclear Standards will make it easier for EMR vendors to implement lab interfaces 5

6 Access to lab results, radiology reports, etc. - future We are anticipating that the lab reform service will lay the groundwork for electronic ordering and resulting for all types of diagnostic services (incl. diagnostic imaging) Within Vancouver Coastal, we will: focus on shaping the lab reform solution to ensure it meets the needs of acute, community and primary care stakeholders lab services (orders and results i/p and o/p) diagnostic imaging services (orders and results) tactically leverage existing services in the short term where appropriate PathNET, MediNet, PHSA clinical broker 6

7 Agenda Access to lab results, radiology reports Access to PharmaNet Access to EMR from emergency rooms and other sites Access to information from local hospitals Electronic Medical Summary (e-ms) MoH Secure Web Site for Physicians Overall recommendations 7

8 Access to PharmaNet The Medical Practice Access to PharmaNet (MPAP) pilot is being opened up to more users Vendors slow to develop PharmaNet interfaces have been waiting for MPAP pilot to open up Web access: available from MediNet expensive being developed by PathNET integrated with lab results delivery pricing tbd Lab reform project may integrate PharmaNet access into lab results viewer? may also impact PathNET and MediNet in general Vancouver Coastal working with MoH and PathNET to improve PharmaNet interface control number of records reported, reduce screen/printout clutter, allow sorting, etc. 8

9 Agenda Access to lab results, radiology reports Access to PharmaNet Access to EMR from emergency rooms and other sites Access to information from local hospitals Electronic Medical Summary (e-ms) MoH Secure Web Site for Physicians Overall recommendations 9

10 Access to EMR in emergency and other sites Several vendors provide access to their EMRs over the Internet non-web systems need to use Citrix or WTS All BC health authorities have agreed that, when health authority employees access clinical data over the Internet, strong encryption and two-factor authentication is required Strong encryption can be provided by a VPN or SSL What is two-factor authentication? 10

11 Two-factor authentication (cont d) Computer systems traditionally depend on single-factor authentication: something you know (a user ID and a password) but user ID and password is vulnerable to attack for Internet applications, because the system is exposed to the entire Internet, and user IDs/passwords are not hard to crack Two-factor authentication is based on two of the following factors: something you know (e.g., user ID plus password) something you have (e.g., a USB key) something you are (e.g., a fingerprint) 11

12 Two-factor authentication (cont d) There are two types of authentication second factors (in addition to user ID and password): mobile carried by user, can be used from anywhere static tied to a specific workstation Examples of mobile second factors: SecurID token USB key Fingerprint Static second factor is often supported by an organization certificate (org cert) digital certificate is loaded onto the workstation used by MoH for Client Registry, Physician Secure Web Site, etc. useful where organizations trust each other s security practices 12

13 Two-factor authentication (cont d) The provincial Technical Advisory Group is working on agreed health authority solutions for mobile two-factor authentication (usable anywhere) ideally we would like to provide one standard second factor for all BC care providers that would work with every clinical system e.g., USB key, SecurID token lab reform will probably be a key driver In the meantime, VCH/PHC will begin rolling out tactical solutions using a USB key as the second factor rollout for PACS beginning 4Q

14 Two-factor authentication (cont d) For remote access to an EMR from known, static locations (e.g., in an emergency room), an org cert is probably sufficient as a second factor For mobile access to an EMR from a variety of locations, a mobile second factor such as a USB key is needed Note: using two sets of user IDs and passwords ( something you know and something you know ) is not really twofactor authentication 14

15 Agenda Access to lab results, radiology reports Access to PharmaNet Access to EMR from emergency rooms and other sites Access to information from local hospitals Electronic Medical Summary (e-ms) MoH Secure Web Site for Physicians Overall recommendations 15

16 Access to information from local hospitals VCH is working on infrastructure to provide secure remote access to hospital-based systems hospital information systems PACS Using 2-factor authentication and Citrix/WTS where needed PACS pilot projects underway HIS pilot projects over next 6 months Not currently offering electronic distribution of hospital documents such as discharge summaries can explore further if there s interest future: leverage lab reform infrastructure? 16

17 Agenda Access to lab results, radiology reports Access to PharmaNet Access to EMR from emergency rooms and other sites Access to information from local hospitals Electronic Medical Summary (e-ms) MoH Secure Web Site for Physicians Overall recommendations 17

18 Electronic medical summary e-ms being developed by VIHA and MoH: a standardized core dataset of key health information in support of health care decisions that can be communicated electronically between physician office information systems or transmitted over secure transport protocols to sites with only a personal computer the e-ms is initially expected to include a summary of key health information including patient demographics, allergies, medications current problems, recent procedures and diagnostics 18

19 Electronic medical summary (cont d) Phase 1 completing now: establish stakeholder agreement on the functional and business requirements define the e-ms s data content standard define the preliminary application and technology and architecture standards gain preliminary endorsement of the standards In future, vendor EMR s will be expected to be able to send and receive electronic medical summary messages based on the e-ms standard 19

20 Agenda Access to lab results, radiology reports Access to PharmaNet Access to EMR from emergency rooms and other sites Access to information from local hospitals Electronic Medical Summary (e-ms) MoH Secure Web Site for Physicians Overall recommendations 20

21 MoH Secure Web Site for Physicians Provides a simple, secure method for exchanging information between MoH and primary care practices MoH places files in drop-box on web site e.g., CDM patient register primary care practice logs on to web site, downloads files practice can also upload files to MoH e.g., corrected CDM patient register Planning to expand to allow practices to securely exchange information with other practices (e.g., consult notes, referral letters) 21

22 Agenda Access to lab results, radiology reports Access to PharmaNet Access to EMR from emergency rooms and other sites Access to information from local hospitals Electronic Medical Summary (e-ms) MoH Secure Web Site for Physicians Overall recommendations 22

23 Overall recommendations Select a good EMR with proven capabilities to provide the interface and access capabilities you need lab interfaces remote access etc. Get the EMR up and running in your practice Then plan, prioritize and implement interfaces and remote access Don t under-estimate the complexity of implementing new interfaces particularly first-time implementations for the vendor 23

24 Connectivity in Primary Care Practices Colin King Clinical Systems Architect Vancouver Coastal Health 4 October 2003