Provincial Forum on Adverse Health Event Management

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1 Provincial Forum on Adverse Health Event Management Using Information Systems for the Management of Adverse Events WORKSHOP 1 Salon B May 26, 2008

2 WORKSHOP 1 Salon B Using Information Systems for the Management of Adverse Events Facilitator: Recorder: Presentation: Dr. Doreen Neville Associate Vice President, Academic, Memorial University of Newfoundland Pam Elliott Director of Quality and Risk Management Eastern Health Mike Barron, Chief Executive Officer, Newfoundland and Labrador Centre for Health Information

3 Presentation Objectives 1. Provide high level justification for the use of information systems to manage adverse health events (AHEs) and improve patient safety 2. Describe current NL information technology initiatives that will support improved AHE management (patient safety) Electronic Health Record (EHR) The Rose Project (Eastern Health) Public Health Surveillance Regional Health Authority Consolidation 3. Provide impetus for group discussion (observations, suggestions, priorities)

4 The Need for Electronic Health Records For Every Healthcare in Canada the Challenges 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 )

5 Cont d The Need for Electronic Health Records For Every in Canada 1000 Emergency Department visits 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 are not screened 1000 Canadians recommended for influenza protection are not vaccinated

6 Assumption The availability of comprehensive, accurate, relevant and timely information at the point of care can reduce adverse health events and improve patient safety.

7 Key Success Factor - Adoption The availability of comprehensive, accurate, relevant and timely information at the point of care will not reduce adverse health events and improve patient safety if health care professionals do not adopt (change management).

8 Need for an EHR Bottom Line: Improved health information leads to improved health care and overall population health

9 Provincial Health Information Systems History Implementation of electronic patient systems in NL began in early to mid 1980 s (acute care hospital systems) 1984: First hospital information system (Meditech) 1996: NLCHI established 1998: First integrated community health system (CRMS) 1998: First Diagnostic Imaging/PACS system 1999: First region-wide electronic patient record 2001: Provincial client registry live 2002: NL chosen as national CR/UPI lead by Infoway 2003: Pharmacy requirements completed 2004: Pharmacy, DI/PACS, Telehealth and iehr planning 2005: Infoway supports Pharmacy, DI/PACS, Telehealth, and iehr Projects

10 EHR vs. EMR vs. EPR

11 Current Projects Examples: Electronic Health Record (EHR) The Rose Project (Eastern Health) Public Health Surveillance Regional Health Authority Consolidation

12 Newfoundland and Labrador Electronic Health Record

13 Provincial EHR

14 An Electronic Health Record (EHR) is a secure and private lifetime record of an individual s health and care history, available electronically to authorized health providers. It facilitates the sharing of data across the continuum of care, across healthcare delivery organizations and across geographies. Canada Health Infoway

15 Current EHR Projects Client Registry Provider Registry Pharmacy Network Diagnostic Imaging PACS iehr/labs

16 Client Registry Connects the registration points of all regional health authorities Enables cross-referencing of medical record numbers Facilitates consolidation of health information from multiple sources (future state) Leading Canadian Initiative

17 Client Registry Failure to correctly identify patients is one of the most serious risks to patient safety and applies to all areas of the healthcare practice» Institute for Safe Medication Practices-Canada Technology not the only solution Business Processes i.e. appropriate training and continuing quality assurance

18 Pharmacy Vision Create drug information network that supports population health Person specific and comprehensive All Drugs All People Secure and Confidential Phase I integrates community pharmacies (Lawtons, Shoppers, etc.) and provides webenabled provider look-up and some additional functionality Phase II and III provides integration with institutional pharmacies and computerized order entry functionality (physician offices) and/or integration with EMR systems

19 Pharmacy and AHEs Pharmacy network will help reduce adverse health events before they occur Reduce/avoid adverse drug interaction At point of prescribing and filling Reduce double doctoring (eg. reduce inappropriate use of prescription drugs at the street level) Provide comprehensive drug profile at Emergency Rooms Allergy information Provide more complete drug information across continuum of care

20 What is PACS? PACS = Picture Archiving Communications System Key part of the EHR Involves the use of computers and communications networks to collect, store, manage and access diagnostic images Essentially contains DI images and reports.

21 10,000 ft. View Labrador- Grenfell RIHA Local PACS Image Volume Western RIHA Local PACS Image Volume Central RIHA Local PACS Image Volume Eastern RIHA Local PACS Image Volume PPD Central Archive Repository

22 NL DI/PACS Project Scope NL PACS Vision: A 5 (Prov. DI/PACS Steering Committee, Dec. 2003) Any patient, Any image, Any report, Anywhere and Anytime Objectives: Achieve 95% filmlessness High exam availability to provincial Radiologists / Physicians Leverage NL Client Registry for patient identification Minimize TCO (capital, operating, risk)

23 NL DI/PACS and AHEs Availability province-wide of patient image history reduces unnecessary testing (avoid unnecessary radiation and rationalize capacity) Avoid unnecessary invasive procedures Provide remote access to specialty services to smaller communities (more timely and expert treatment) Avoid unnecessary travel (patient and family stress)

24 Interoperable EHR/Labs Project Builds/leverages Client Registry, PACS, and Pharmacy Projects Includes laboratory as part of scope due to NL size (separate investment domain) Will define the glue for provincial EHR technology Will serve as backbone for sharing person-specific health information province-wide

25 Interoperable EHR/Labs and AHEs One stop shopping for comprehensive information Inclusion of province-wide lab information reduces duplicate testing and promotes more efficient use of resources Offers platform for including pertinent information shared health record (discharge summary from hospitals, regional occurrence reporting, or relevant information from EMRs)

26 Provider View of EHR EHR Solution (EHRS) Client Registry Provider Registry EHR Domain Repository (Lab) Domain Repository (Pharmacy) Domain Repository (Diagnostic Imaging) HIAL Common Services Communication Bus EMR Patient Info Patient Info Patient Patient History History Laboratory Drug Profile Diagnostic Imaging Imaging Applications Appl Appl

27 Electronic Health Record Issues Privacy/Confidentiality/Security Timeliness of Information Completeness Availability (province-wide 7x24) Accurate (data quality and standards across source systems) Complexity Cost

28 JURISDICTIONAL INFOSTRUCTURE Client Registry HIAL PHS Data & Services EHR Data & Services EHR Data & Services Provider Registry Location Registry HIAL HIAL Outbreak Services PHS Reporting Services EHR Services HIAL Drug Information Diagnostic Imaging Laboratory HIAL HIAL HIAL Terminology Registry HIAL Security Consent Configuration POINT OF SERVICE HIAL Common Services Communication Bus HL7 EHR IP Public Health Services HL7 EHR IP Pharmacy System HL7 HL7 HL7 EHR IP EHR IP EHR IP Radiology Center PACS/RIS Lab System (LIS) Hospital, Community, etc., EPR HL7 EHR IP Physician Office EMR HL7 EHR IP Clinical Portal Public Health Agent Pharmacist Radiologist Lab Technician Physician/ Provider Physician/ Provider Physician/ Provider

29 Current Projects Examples: Electronic Health Record (EHR) The Rose Project (Eastern Health) Public Health Surveillance Regional Health Authority Consolidation

30 Regional Occurrence System Enhanced (ROSE) Eastern Health initiative (partially funded by Infoway) The occurrence reporting (OCR) process facilitates the identification, monitoring and analysis of adverse events and incidents that place during health care treatment and/or within health care/long term care facilities. Tracks patient complaints about the service provided. OCR is the key health care tool in pursuit of greater clinical safety and satisfaction.

31 Regional Occurrence System Enhanced (ROSE) The ROSE Project will entail the development, implementation and evaluation of an electronic occurrence reporting system across the EH continuum of patient/client/resident care. Every employee and physician will have easy access in the workplace to report occurrences electronically using the EH information network The OCR will be safe, simple, and will provide end-users with timely feedback of useful information, essential to reducing adverse events, and improving clinical safety and the quality of care provided. Supportive of the EH EHR initiative, the OCR will be integrated as part of the clinicians computer desktop.

32 Other Projects and Initiatives The Rose Project Public Health Surveillance Regional Health Authority Consolidation

33 Public Health Surveillance (Panorama) Department of Health and Community Services led initiative. National Software License (Canada Health Infoway) Key stakeholders include RHAs and relevant health professionals Assist in managing pandemics (SARS) and other issues related to public health (egs.inoculation tracking, provincial disease screening, etc.)

34 Regional Health Authority EPR Consolidations Creates a comprehensive client record on a regional health authority basis Provides information that allows for more efficient use of resources (reduce unnecessary retesting) Provides opportunity for standards setting

35 NL EHR Roadmap

36 EHR Roadmap Diagnostic Imaging Province-wide DI/PACS The Pharmacy Network Detailed Design and Development Pharmacies Online & Pharmacy Network Viewer eprescribing Hospital Integration GP/FP Online CR Upgrade/Integration Detailed Design and Development Integration Testing Telehealth Telehealth Connection Chronic Disease Management Lab Information System Planning Province-wide Lab results Electronic Health Records Planning Shared Health Info & EHR Viewer Electronic Medical Records EMR Demo.Project EMR POS Project (not approved) Linked to NL iehr Public Health Surveillance CRMS Planning Client Pay Module and Review Tentative Prov. & Loc. Registries Detailed Design and Development Integration Testing

37 Benefits Evaluation Ensuring implemented systems are meeting envisioned functionality and value Ensure systems are being adopted (if not, why not) Robust benefits evaluation projects are defined for all electronic health record initiatives Lessons learned used to improve current and future system design and delivery

38 NL Approach End users need to be fully engaged with the identification, design and implementation of systems (don t build it and hope they will come) Align initiatives (to the extent possible) to take advantage of opportunities for standardization and other leveraging Collaborate and Communicate

39 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

40 Current Environmental Opportunity All systems design should take into consideration the potential to meet AHE management and communication requirements Create a culture of patient safety and information quality (standards) and imbed it in information systems projects. Ensure robust change management occurs that encourages health providers to adopt available technologies (health transformation)

41 Strong relationships within province Continuous dialogue Our Greatest Strength: People

42 What do you think? Questions?

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