DRAFT. Electronic Health Records Task Group Snapshot. Enhancing Interdisciplinary Collaboration in Primary Health Care Initiative.

Transcription

1 Enhancing Interdisciplinary Collaboration in Primary Health Care Initiative DRAFT Electronic Health Records Task Group Snapshot Professionals: Working Together to Strengthen Primary Health Care The Enhancing Interdisciplinary Collaboration in Primary Health Care (EICP) Initiative is focused on how to create the conditions for health care providers everywhere in Canada to work together in the most effective and effecient way so they produce the best health outcomes for their patients and clients. Canadians know that health care providers on the front line are there to respond with care and January 2005 skill to their health care needs. Primary health care providers are not only committed to caring for their patients directly, they also facilitate access for patients to other specialized services. But, more and more Canadians are expecting better co-ordination between those providers and they want to optimize their access to the skills and competencies of a range of health care professionals. As much as they want to be treated for illness, they want health promotion advice and information about preventing disease and illness, too. The EICP Initiative, funded through Health Canada s Primary Health Care Transition Fund, is designed to follow on the research evidence that interdisciplinary collaboration in primary health care has significant benefits for both patients and health care professionals. Over the next year-and-a-half, the Initiative will put a spotlight on the best practices and examples that show that collaboration is valueadded for our health care system. The Initiative s legacy will be a body of research, a consultation process that will engage health care providers and get them thinking more about working together, and a framework for collaboration that encourages change and more co-operation. For more information: Tel: (613) ext info@eicp-acis.ca Web site:

2 The EICP Initiative will deliver: A set of principles and a framework that will enhance the prospects and options for more collaborative care in settings across the country; Research about best practices and the state of collaborative care in Canada; Tools to help primary health care providers work together more effectively; and Recommendations that will help the public, provincial/territorial governments, regional health authorities, regulators, private insurers and educators embrace and implement the principles and framework.with the leadership of some of the key players in primary health care in Canada, the EICP Initiative will capture the very best of what is being achieved in interdisciplinary collaboration in this country and will help us learn from it. EICP Partners include: Canadian Association of Occupational Therapists Canadian Association of Social Workers Canadian Association of Speech-Language Pathologists and Audiologists Canadian Medical Association Canadian Nurses Association Canadian Pharmacists Association Canadian Physiotherapy Association Canadian Psychological Association College of Family Physicians of Canada Dietitians of Canada Canadian Coalition on Enhancing Preventative Practices of Health Professionals For more information: Tel: (613) ext info@eicp-acis.ca The material contained in this document does not necessarily reflect the individual views of the sponsoring organizations.

3 Acknowledgements The Primary Health Care Providers Forums are part of the Enhancing Interdisciplinary Collaboration in Primary Health Care Initiative. This Initiative is funded through a $6.5 million contribution agreement from Health Canada s Primary Health Care Transition Fund. It is led by health professionals through a partnership of 10 national associations and a coalition who form the Steering Committee and include: Canadian Association of Occupational Therapists Canadian Association of Social Workers Canadian Association of Speech-Language Pathologists and Audiologists Canadian Medical Association Canadian Nurses Association Canadian Pharmacists Association Canadian Physiotherapy Association Canadian Psychological Association College of Family Physicians of Canada Dietitians of Canada Canadian Coalition on Enhancing Preventative Practices of Health Professionals i

4 Barrier/Enabling Factors Task Groups As part of its comprehensive consultation and research program, the Enhancing Interdisciplinary Collaboration in Primary Health Care (EICP) Initiative has determined that it needs to give focused attention to five key themes that dominate thinking about collaboration in primary health care. As a result, in early 2005, the Initiative will convene five Barrier/Enabling Factors task groups to look more closely at the following issues: Liability/risk management Funding Electronic health records Regulatory factors Health human resources All of these issues offer both challenges and opportunities for health care providers and/or health systems that hope to practice or encourage more teamwork in primary health care. Task group sessions will focus on what encourages, and what stands in the way of, collaboration and teamwork in primary health care. Participants with specific expertise will be invited to participate in the task groups, and many will have contributed to earlier EICP consultations. The work of the Barrier/Enabling Factors task groups will have a significant impact on recommendations that the EICP Initiative will eventually make to the health care community. Combined with other research and consultation inputs, these task groups will further our understanding of the barriers and the enablers to collaboration in primary health care. What We Know Right Now The EICP Initiative has commissioned research and literature reviews, and conducted consultations that are already giving shape to a set of principles and a framework for interdisciplinary collaboration in Canada. We ve heard and learned a lot from the public, health care providers, policy-makers, academics, regulators, educators and governments. Research and consultations to date have allowed the Initiative to develop an early snapshot of the implications of electronic health records for collaboration and teamwork at the front line of primary health care in Canada. This snapshot defines the issue, tells us why it is important and suggests possible solutions and options. Electronic Health Records and Collaboration A Snapshot Electronic health records (EHR) hold promise as one way of assisting new models of collaborative health care delivery to become viable. EHRs have the potential to be a medium for faster, more effective care. One definition describes EHRs as, A shared record of an individual s past and present health status, care received and plan of care, delivered through secure electronic systems that combine this information with decision support and work flow tools, tailored to the context of care delivery. i Some efforts have already been made to institute the use of electronic health records. And, while EHR activities at the primary health care level stem mainly from provincial and regional initiatives, Canada Health Infoway has a mission to accelerate the development of electronic health information systems. Currently, Infoway has a role in infostructure, registries, drug information systems, 1

5 diagnostic imaging systems, laboratory information systems and tele-health. How Do Electronic Health Records Affect Interdisciplinary Collaboration? While EHRs have the potential to improve continuity of care, the benefits of improved practice, reduced duplication and fewer adverse events have yet to be realized. Some experts consider EHRs to be critical to improving continuity of care. In Deber and Baumann s report for the EICP, they cite Reid et al s definition of three types of continuity: Informational (information on prior care of a patient/client is used for current care); Relational (knowledge of the patient/client as a person the importance of the ongoing provider/patient client relationship); and Management continuity (ensures care provided by different providers is connected and coherent). To date, our research and consultation phase has identified the following key electronic health record issues related to interdisciplinary collaboration: 1. There are concerns related to financial or funding issues. Individual providers were concerned that there could be financial and administrative burdens imposed on them with the use of EHRs. Questions were raised as to how EHRs would be funded system-wide. 2. Privacy and confidentiality issues were raised. Ownership of the health record was questioned, as well as who should have access to it, and to what degree. Other questions concern the use of the information held in the record, for the purposes of population research. 3. Technology issues were discussed in relation to the standardization and security of the information held on clients. Specifically, data interface and the capture of data elements have been problematic. 4. Providers were concerned about the need for education, skill development and training associated with the uptake and use of EHRs. Implementation issues can be significant. Specific concerns related to the time and compensation required for health providers to adapt, when technology is introduced. Providers want user-friendly, standardized systems. 5. Providers indicated that they believe that the benefits of EHRs should first be established through evidence from existing pilot projects. Extensive work has already been done in select regions of the country and providers did not want to duplicate efforts. Why and How are Electronic Health Records Important to Encouraging More Collaboration? As part of the EICP Initiative s consultative process, primary health care providers from across the country were asked to participate in a series of one-day provider forums. As a precursor to these sessions, 191 providers were asked to complete surveys to gather their thoughts and ideas. Specific findings include: One-third of survey respondents currently use an electronic health or medical record in their practice; Many believe that greater uptake of EHR is part of the probable future of the primary health care system in Canada; Providers expressed the wish for a single, confidential health record for each person, accessible by each provider; At the same time they were concerned about the possible administrative and financial burdens which the use of EHRs might impose (the time and compensation involved in getting up-to-speed on the use of technology was one example given); 2

6 Providers also worried about related privacy and confidentiality issues; Participants wanted to know who, ultimately, owns the EHR and whether or not the record can be used, for example, as a basis for population health studies or other research; and Fears were expressed about the possible commercialization of data and the differing legal obligations of various organizations. As the use of EHRs moves beyond the limited access of a single organization, these issues will become more critical, since the public is typically more tolerant of information-sharing within an organization than they are of the pervasive use of them throughout a whole system. At present, barriers and opportunities vary according to whether or not providers are linked and how they are connected. There are differences in data interfaces, with a lack of standardization. Also, the capture of soft data elements, such as professional notes, has been problematic, due, in part, to the time constraints of providers. Many providers surveyed by the EICP Initiative view electronic health records as a critical component of primary health care reform and interdisciplinary collaboration. Participants felt that work needs to be done to establish a clear definition of the electronic health record and who has access to the information it incorporates. Patients/clients also need to be informed about what it means to them. The providers surveyed said that access to shared patient information is necessary for the development of successful interdisciplinary collaboration. Most believe that electronic health records allow for professions to better share information, saving time and reducing duplication. Providers also felt that EHRs will improve the quality of care delivered by interdisciplinary teams in primary health care. At the public consultation sessions held by the EICP Initiative, some participants indicated that the lack of EHRs increases duplication in such areas as documenting medical and health histories. How Can We Use Electronic Health Records to Encourage More Collaboration? At the Leaders Forum on Interdisciplinary Collaboration in Primary Health Care, which was held Dec. 7, 2004, electronic health records were discussed in-depth. The following actions were proposed at this session: A broad cost/benefit analysis of the role of EHR in the broader health care system needs to be funded. The definition of electronic health record should be expanded to include who has access to it and what the client s understanding of it is. The issue of ownership of the health record should be addressed. Health providers and the public need to be educated about the electronic health record and its use. Other EHR systems in primary health care should be surveyed, so that the wheel is not reinvented. A wealth of experience with EHRs in interdisciplinary settings has already been developed in some regions across Canada. Other suggestions that were heard through the consultation process include: Leadership is needed. In order to link multiple distinct organizations to one electronic health record with common standards, there must be leadership at a high level. Undoubtedly, implementation will require new funds and the commitment of many stakeholders. Standardization is required. If providers are to have confidence in the system and be able to use it as a tool for collaboration, attention must be paid to the issues of 3

7 standardization, security, privacy and confidentiality. Technical support is needed. Implementing an EHR will require technical support, improved access to system options and user-friendly processes. Pilot projects benefits should first be demonstrated through pilot projects and information exchange, before the supporting infrastructure for a broader system is put in place. EICP stakeholders and consultation participants have begun to paint a picture of the future of primary health care in Canada. They ve said that they hope the primary health care system of the future can encourage interdisciplinary collaboration, while ensuring equitable sharing of responsibility and liability. Like any snapshot, this is a picture in time, and future EICP consultations will further refine and amend these core elements, leading to recommendations about how to encourage and sustain interdisciplinary collaboration at the primary health care level. The EICP Initiative is focused on how to create the conditions for health care providers everywhere in Canada to work together in the most effective and efficient way, so they can produce the best health outcomes for their patients and clients. The EICP Initiative is funded by Health Canada s Primary Health Care Transition Fund and has a mandate to produce a set of guiding principles and a framework for interdisciplinary collaboration by the spring of It is hoped that these principles and framework will encourage health care professions and governments to remove impediments to collaboration and reform the primary health care system in Canada accordingly. i Calgary Health Region, Electronic Health Record Overview: FAQs [on-line: cited January 11, 2005]. Available at: 4

8 For more information: Tel: (613) ext Web site: