ONTARIO S EHR CONNECTIVITY STRATEGY IMPROVING PRIMARY TO SPECIALIST REFERRAL THROUGH INTEGRATION. Peter Bascom Chief Architect, ehealth Ontario

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1 ONTARIO S EHR CONNECTIVITY STRATEGY IMPROVING PRIMARY TO SPECIALIST REFERRAL THROUGH INTEGRATION Peter Bascom Chief Architect, ehealth Ontario Cindy Hollister Director, Professional Practice, Canada Health Infoway

2 Today s session: What is the Electronic Health Record (EHR)? What is Ontario s EHR Connectivity Strategy? From primary care to specialist a clinical journey Clinician and Patient benefits of EHR integration for referral Learn more 2

3 What is the Electronic Health Record (EHR)? The provincial EHR will bring together all of the health information that follows a person through their life and care journeys EHR 3

4 The Path to the Interoperable EHR Ontario s ehealth Blueprint The What Business View Information View Systems View Standards Provides a future state, high-level view of the EHR Connectivity Strategy The How Current to future state Strategic or tactical assets POS Connectivity Requirements EHR Roadmap The When and Who 4

5 A Comprehensive View of EHR Connectivity Care Settings Primary Acute Community Connectivity States Current Transition Future Clinical Domains Lab Drug Diagnostic Imaging EHR Integration Assets PCR PPR HIAL SSO Consent Audit Portal EHR Integration Provincial ehealth Services Information Flow 5

6 Provincial Connectivity Overview Current State 6

7 Provincial Connectivity Overview Current State Without a connectivity strategy, health information flow from multiple systems is not integrated to flow seamlessly between and across systems 7

8 Provincial Connectivity Overview Future State 8

9 Provincial Connectivity Overview Future State The connectivity strategy defines a standard, interoperable framework and pathways to ensure health information from multiple systems can be shared in any care setting. 9

10 Benefits of Integrating with EHR Assets Provincial Client Registry Provincial Provider Registry Consent and Audit ONE ID Clinical Repositories Health Information Access Layer One client, one record Consistent consent, enables ereferral Consistent control, review of access Provincial single sign-on, context management Consistent EHR availability/quality Consistent privacy/security controls 10

11 More than a Strategy The connectivity strategy describes how health care information will be connected to create a safe, cost-effective, provincially-integrated electronic health record (EHR). Overview Portal and Web Application Connectivity Connectivity Strategy Clinical Benefits of Connectivity EHR Asset Inventory POS Requirements 11

12 Current State of Referrals Today Primary to Specialist Referrals The referral process is often cumbersome and confusing with potential for lost/ missing information, unnecessary delays and privacy/security concerns Current referral process contributes to wait times, which can have serious consequences: Delayed access to care Increased pain, suffering and mental anguish Less than optimal patient outcomes Economic cost to individuals and the health care system Patients often have few choices on their own health care journey Patient and physician frustration 12

13 Maria s Journey Care providers interacting with Maria & each other Primary Care Physician Clinic Admin MARIA Lab Technician Cardiology Technologist 13

14 Maria s Journey Primary Care to Specialist Future state of ereferral Provincial EHR Assets DI CDR Lab X-ray ECG X-ray report Blood tests 14

15 Maria s Journey Primary Care to Specialist Future state of ereferral Provincial EHR Assets DI CDR Lab X-ray ECG X-ray report Blood tests ereferral Solutions ereferral request 15

16 Maria s Journey Primary Care to Specialist Future state of ereferral Provincial EHR Assets DI CDR Lab X-ray ECG X-ray report Blood tests ereferral Solutions 16

17 Maria s Journey Primary Care to Specialist Future state of ereferral Provincial EHR Assets DI CDR Lab X-ray Echocardiogram ECG X-ray report Echo Report Blood tests ereferral Solutions Book specialist appointment 17

18 Maria s Journey Primary Care to Specialist Future state of ereferral Provincial EHR Assets DI CDR Lab X-ray Echocardiogram ECG X-ray report Echo report Consultation report Blood tests 18

19 Maria s Journey Primary Care to Specialist Future state of ereferral Provincial EHR Assets DI CDR Lab X-ray Echocardiogram ECG X-ray report Echo report Consultation report ereferral Solutions Blood tests enotification 19

20 Maria s Journey Primary Care to Specialist Future state of ereferral Provincial EHR Assets DI CDR Lab X-ray Echocardiogram ECG X-ray report Echo report Consultation report Blood tests 20

21 Maria s Journey Primary Care to Specialist Future state of ereferral Provincial EHR Assets DI CDR Lab X-ray Echocardiogram ECG X-ray report Echo report Consultation report Blood tests Information is flowing more efficiently, benefiting patients and providers 21

22 Provincial Connectivity Initiatives in Ontario 2015/16 Led by OntarioMD, the province has a two-pronged approach to facilitate primary to specialty care ereferrals and to support EHR Connectivity Strategy 99% of physicians surveyed believe econsult improves patient care. 12,000+ econsults enables referring physicians to consult with specialists via portal or from s, in a request and response fashion Leverages Health Information Access Layer (HIAL) and integrates with s, provincial identity management and Provider Registry; future integration includes Provincial Client Registry and Clinical Document Repository Phase 1 pilot complete, including benefits evaluation - over 5,000 family physician enrolled and 12,300+ econsults sent Currently in Phase 2 econsult ereferral Will enable referring physicians to electronically refer patients to another clinician or organization Currently in planning stage with goal of initiating Phase 1 in early 2016 Provincial ereferral Solution will implement the Connectivity Strategy and uphold provincial principles such as audit, authentication, physician billing and secure connectivity 3 Days average econsult response time 40% of in-person referrals avoided for patients 22

23 Benefits for Clinicians and Patients Reduced time wasted for patient and provider Improved continuity and quality of care Reduction in duplication of tests Benefits of ereferral with Integration Reduction in costs to patient and health care system Reduction in missing/lost health information Increased security and consistency of data 23

24 In a Clinician s Words Benefits of Ontario s Integrated EHR The benefits of the connectinggta viewer for our patients is that we can get their information in real time. If they are very sick and critically ill we don t have to wait for faxes and phone calls. ~Resource nurse, coronary care unit 24

25 In a Clinician s Words Benefits of Ontario s Integrated EHR Through the connectinggta module you can access information such as blood tests, X-ray results, CT scans, diagnostic imaging tests and specialist consultation notes, and all these reports that help us make care better within our organization ~Physician, Hospitalist 25

26 Learn more Ontario s EHR Connectivity Strategy Ontario s ereferral Provincial Reference Model - Ontario s Ehealth Blueprint online - Canada Health Infoway - Pan-Canadian Clinical Peer Network - A Framework and Toolkit for Managing ehealth Change: People and Processes For more information on econsult in Ontario, please visit OntarioMD