Ontario s Enhanced 18-Month Well-Baby Visit Electronic Medical Record (EMR) Integration and Repository Project
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1 Ontario s Enhanced 18-Month Well-Baby Visit Electronic Medical Record (EMR) Integration and Repository Project Ministry of Children and Youth Services (MCYS)/Better Outcomes Registry & Network (BORN) Ontario/eHealth Ontario February 7, 2015
2 The Project Building of a repository of 18-month data that would: Track children who are receiving the Enhanced 18-month Well-Baby Visit (18-month EWBV); Identify toddlers who are at risk or who have been identified with developmental delay; and Provide population-level understanding of the health of children at this important age. Specifically the project tested: Integration of paediatric best-practice clinical guidelines into an EMR system, to guide physicians in delivering paediatric care in line with current best evidence; Collection of 18-month data from the EMR; Transmittal of the 18-month data to the BORN registry; and Reporting of 18-month results. Clinical Education Support was provided At the end of the project, a comprehensive evaluation was undertaken to inform whether further investment and expansion of the initiative is warranted and recommendations for appropriate approaches to be taken. 2
3 10 Family Health Teams 2 EMR Vendors (QHR Technologies) (Oscar EMR) participated in the EMR Integration Project 3
4 Data Elements Collected Electronically 1,337 well-baby visits were captured in the Born Information System (BIS) including: NDDS month checklist elements and responses Ontario Rourke Baby Record (RBR) month elements and responses RBR Summary Report markers Vaccine Data up to 2 years Supplemental data elements including: 4 Provider name; Billing code and date; and Pick list for Problems and Plans section to include Ontario wide community resource referrals and action steps.
5 Linking and Matching Success 95.5% of the months old child records collected via the 18 month EWBV project matched BIS Birth records 5
6 Opportunities & Lessons Learned Understanding what health and development concerns are being identified and documented within the RBR, NDDS and summary (visit) report; Ability to connect the data across the child continuum and healthcare providers across the province; Ability to strengthen the tools and EMR workflow to inform child development and improve child development outcomes; and Working with EMR vendors to ensure standardized use of the latest version of the RBR and NDDS forms within the EMR user community. 6
7 Primary Care: Growing into Child with the Kid econnect Strategy Expansion of the 18-month EWBV EMR Integration and Repository Project A1/A2 Pilot 3 FHTs, 2 vendors 18m EWBV Pilot 10 FHTs, 2 vendors All Well Baby/Well Child visits, 0-5 yrs Rourke Baby Record NDDS Visit Report Add EMR vendor Child Reporting For person, practice and province Community Referral pathways Integrating community resources Patient Entered Data Add user groups Fundamentals: continue to develop specifications for HIAL/OLIS/OMD Spec. Integration 7
8 Proposed Kid econnect Well-Baby Visit Collection Plan and Registry BIS BORN Kid econnect Registry 8
9 BORN Impact Well Baby Visits Population Public Reports Facilitate and conduct research Organization Innovative Dashboards Screening follow-up & outcomes to improve screening algorithms Provider Report on general or specific outcomes QI (Antenatal forms, NT measurements) Individual Patient summaries & reminders at discharge Identify patients who did not receive key interventions and provide reminders 9
10 Sample: Kid econnect dashboard Key Performance Indicators rate (%) Status Target (green) Benchmark Rates (%) Comparator Rates (%) Warning (yellow) Alert (red) Other clinics in this LHIN Other Clinics Caring for 1k-3k Kids Rate of kids who received their 18 Month enhanced well baby visit between 17 and 24 Months 97 > < Rate of kids with height and weight meausred at last visit 40.1 > < Ontario Rate of Kids in the top 10th percentile of BMI Rate of kids in the bottom 10th percentile of BMI Rate of kids who were offered their vaccinations within 2 months of recommendation 10.1 < > < > > < Data source- BORN Ontario ( ) Notes- 1. rates and status are based on 3 prior months of data that have been acknowledged for submission, allowing a one month lag. HUGE opportunity to create value for providers! 10
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