Introduction What s in it for me? Frequently Asked Questions Integration and Security IT Optimization Alberta Netcare Information The ereferral aims to innovate patient and provider access, make it easier for people to work together, and to focus on providing a quality health system that is accessible and sustainable for all Albertans. This package provides information about ereferral LPR - its scope, proposed time lines and answers to commonly asked questions.
Automating the referral and wait time process Alberta Health Services provides a diverse range of health care services to over 3.6 million Albertans through scheduled services totalling over 4.3 million visits per year (2011/2012). The referral process is used any time a patient transitions between services in the health care system. Few of these transitions are standardized or automated and there is great variability in the business processes and information technology capability. This variability makes care transitions between services prone to error, miscommunication and waste. Since 2009, primary and specialty care providers and administrative staff across the province have been engaged to define Alberta s wait time and referral management vision and to gather requirements for ereferral. The Path to Care: Referral and Wait Time Measurement and Management Program aims to support the development of new people, processes and technological capabilities across AHS to improve access to health services and support a patient centric experience. This work has the ability to improve efficiency, improve care coordination across providers, enable transparency and manage the supply and demand for health services. Under the umbrella of the Path to Care program, the ereferral project is implementing an electronic referral system and undertaking clinical design, business standardization and integration planning to support the Path to Care objectives, including: Improve patient and provider access: appropriate, transparent, consistent, responsive Reduce patient wait times from primary to specialty care Implement service redesign across common process that impact access (i.e. wait time measurement) across zones and strategic clinical networks (SCNs) Develop and maintain a complete provincial health service inventory Standardize the elements of referral and triage criteria across program areas Establish consistent operational policy regarding service response times, patient and provider communication Increase transparency of service availability, wait time, improve request tracking, and status reporting The common platform that Alberta Netcare provides will make it easier for people to work together, to focus on providing a quality health system that is accessible and sustainable for all Albertans. A Brief Introduction Timeline November 2011 Released ereferral Request for Services request for proposals. March 2012 Orion Health selected as the vendor for the ereferral LPR platform. June to December 2012 LPR implementation and scope planning. November 2012 LPR participants confirmed breast cancer, lung cancer and hip & knee joint replacement. February to April 2013 Clinical working group, Orion Health and ereferral team design ereferral platform. April to June 2013 Orion Health completes application design. ereferral implementation planning and team establishment for receiving site participants of LPR. June 2013 Clinical planning with receiving sites begins alongside engagement planning for referring sites. July to September 2013 ereferral system testing. Clinical planning with referring sites. September to October 2013 Clinical stakeholders will participate in user acceptance testing. November 2013 Train-the-Trainer for LPR participant groups. What is the LPR? The limited production rollout (LPR) is the first implementation of ereferral with three specialty areas breast cancer, lung cancer and hip & knee joint replacement. The evaluation of the LPR will provide information on the requirements for broader implementation of ereferral. November 28, 2013 ereferral Go-Live.
What s In It for Me? The patient I have a better idea about my options for care and can discuss them with my doctor. I appreciate that my appointment won t be delayed by an incomplete referral. I feel better knowing how long I should expect to wait for an appointment. The referring provider It s just easier. I know what I need to send, and where. I like that information about wait times is updated monthly for each specialist. No more worrying about lost referrals! The search function is easy to use, and I can search for a specific location, provider or service. I already use Alberta Netcare, so I don t have to learn a new system to use ereferral. I can track my patient s referrals throughout the process, and keep informed on their ongoing care - whenever I want! The receiving provider ereferral reduces incomplete and duplicate referrals, which saves me a lot of time. The list management is flexible and easy to use. It just makes sense. There s no time lost to incorrect referrals. Having an automated system means the information I need is only a click away.
What is ereferral? ereferral is the technology solution that will enable end-to-end managing and tracking of referrals throughout the province of Alberta. This will include creation, submission, intake and triage, and direction to the correct specialist service. At all stages in the referral life cycle, any health care professional associated with a referral will be able to track its status and view its details. Who is participating in the LPR? The initial rollout will support referrals provincially for initial consultations to hip and knee joint replacement clinics and for lung cancer and breast cancer referrals to the cancer tertiary and associate centres. When will ereferral be available for all clinical areas across the province? Following LPR in November 2013, a business case has been developed to support additional clinical pathways over a 3-5 year period. What software is being used? The ereferral solution will be an additional functionality within the Alberta Netcare EHR Portal. Orion Health is the vendor that provides both the portal software and ereferral. Initially, referrals will be created and managed within Alberta Netcare Electronic Health Record (EHR) Portal. The long term vision is to have ereferral capabilities seamlessly integrated with clinical applications such as electronic medical records and scheduling systems. How will users access ereferral? Initially, users will create and manage referrals by Frequently Asked Questions launching ereferral from their electronic medical records (EMRs) just as they currently launch into Alberta Netcare Portal. If using an EMR that does not have that capability, ereferral can be accessed by directly logging into the Alberta Netcare Portal. ereferral will use the same rolebased access and security that applies to Alberta Netcare. Concurrent with the rollout of ereferral in the Alberta Netcare EMR Portal, a project is underway to develop standards that will enable EMRs and other point of care systems to integrate seamlessly with ereferral in future releases. Using those standards, the vendors of EMRs and point of care systems can develop functionality to enable their users to create, manage, and track referrals directly in the applications. How will receiving services make the transition to ereferral? During the initial phases of the ereferral rollout, when your centre or office implements ereferral, you will begin to receive and manage referrals on-line through the Alberta Netcare EMR Portal. Clinical design teams are in place to work with each clinic or office to support the transition to ereferral. These teams include a clinical design lead and business analysts with clinical practice knowledge and experience to assist with analyzing and implementing the changes needed during this transition. How are clinics going to find out about using ereferral within Alberta Netcare Portal? Communications will be sent out to clinics and providers through websites, webinars, newsletters and Alberta Netcare. Will ereferral LPR integrate with other clinical information systems? The ereferral will be available only through the Alberta Netcare Portal. A standard messaging specification has been developed to aid with system integration, however the requirements and plan for integration still needs to be developed. Will I have to re-enter data that is already in Alberta Netcare EHR? ereferral has been built so that existing information that is in Alberta Netcare EHR is leveraged to prevent duplicate entry and rework. Our goal is to be able to complete a referral within 3 minutes. Will authorized Alberta Netcare EHR users be able to see the patient s referral history? ereferral will allow Alberta Netcare EHR users to see referrals that have been entered into the ereferral system. This will improve communication, consistency of care and reduce rework and duplicate referrals. How did the specialty groups in the ereferral LPR develop their referral requirements? The requirements were developed by provincial clinical teams and then were reviewed by the ereferral clinical working group to ensure minimal data requirements for what is required to triage a referral.
Planning the Road map for Integration with Point of Care Systems Integration and Security Supporting Partners Mitigating Risk and Security Challenges ereferral utilizes the same protocols, processes and roles currently defined for Alberta Netcare access. These requirements include: Existence of accepted Privacy Impact Assessment Alberta Netcare Information Management Agreement sign-off Provincial Organizational Assessment Appropriate training The ereferral team is currently Working with the security and privacy offices at AHS and Alberta Health to define and get approval to include ereferral in the existing forms. Collaborating with the Alberta Netcare Deployment Team to get access for known LPR participants and plan for the training and support requirements once the system goes live. Streamlining the process to get access to Alberta Netcare while still maintaining the required security and privacy protocols listed in the Information Exchange Protocol and the Alberta Heath Information Act. Key Contacts Director Jodi Glassford jodi.glassford@albertahealthservices.ca Senior Project Managers Nicola Brooks nicola.brooks@albertahealthservices.ca Steven Martinello steven.martinello@albertahealthservices.ca
Alberta Netcare IT Optimization Requirements As of April 1, 2013 there is a new connection methodology in place for the connection between your EMR and Alberta Netcare. Citrix is now in place, which means that Alberta Netcare can allow an unlimited number of licenses and users. The Service Unavailable Issues that users may have faced in the past will no longer be an issue. Each EMR vendor has its own setup and if you have questions about your link to Alberta Netcare you should contact your vendor. The table below lists the information technology requirements to ensure that the Alberta Netcare Portal works as efficiently as possible for you. Component Minimum Recommended Additional Desktop (PC) Configurations For Access to Alberta Netcare Portal within AHS: for basic administrative users (i.e. users of Provincial Person Directory) Pentium 3/1.0 GHz processor 512MB RAM 150MB of free disk space Pentium 4/1.5 GHz processor or higher is recommended 512MB RAM 200MB of free disk space Minimum Requirements for Viewing IMPAX images: Pentium 4 2.8 GHz CPU recommended 1GB RAM recommended 1GB of free hard drive space For clinical users (using full functionality of the Provincial Viewer): For Remote Access to Alberta Netcare Portal via Citrix ICA Client Pentium 3/1.33 GHz processor 512MB RAM 150MB of free disk space Pentium 3/1.0 GHz processor 512MB RAM 200MB of free disk space Pentium 4/1.5 GHz processor or higher is recommended 1024MB RAM 200MB of free disk space Pentium 4/1.5 GHz processor or higher is recommended 1024MB RAM 200MB of free disk space Network Citrix Client Printing Functionality within ereferral A network card (for access over LAN/WAN) and broadband for remote access. TCP/IP protocol support using an Ethernet 10Mbps or 10/100/1000 Mbps The minimum requirement for the Citrix Client for sites connecting to Netcare via the PLB within their EMR is Citrix Receiver 3.3 The minimum requirement for the Citrix Client for sites connecting to Netcare in a standalone setting is Citrix On-Line Plug-In 12.x Adobe version 10.x or newer Operating System Windows XP Pro SP2 Windows XP Pro SP3 Also supported: Windows Vista Business, Windows 7, Windows Server 2003 Applications accessed through Concerto may have specific hardware requirements that are independent of Concerto. The application vendor should be consulted to configure/install the required hardware. Note: As new browsers or desktop Operating Systems are introduced by vendors, they will be unsupported by Alberta Netcare Portal until proper testing is undertaken and the OS and browsers (and associated plug-ins) are formally endorsed through standardized testing. Once testing has been completed and the OS and Browsers have been certified as acceptable, they will be added to this document which defines the supported desktop configurations. Currently some common software versions have not been certified for use with Alberta Netcare Portal. These include but are not limited to: Windows 2000 Windows Server 2008 Adobe Reader 9 iphone, ipod, ipad ANP IT Req - 05-Sep-13
WHAT IS THE ALBERTA NETCARE EHR? Alberta Netcare is the single name for all the projects and activities related to Alberta s Electronic Health Record (EHR). It is a large and multi-faceted program involving many groups of authorized health care providers across the province and the development of many interrelated components, programs and services. The Alberta Netcare Portal viewer provides access to this integrated province-wide electronic health record solution. WHAT INFORMATION IS INCLUDED? Data elements captured from patients clinical records include: laboratory test results, diagnostic imaging text reports and other transcribed clinical reports; medications recorded by prescribers and/or dispensed by community-based pharmacies; known allergies and intolerances; patient hospital admission and discharge history log; immunizations; and personal demographic information to uniquely identify each patient. The Alberta Netcare EHR also offers several decision support tools including: a warning management tool that alerts clinicians to drugto-drug and drug-to-allergy interactions and provides both duplicate therapy and drug dosage alerts; the First DataBank Inc. drug database; drug monographs and patient handouts; and links to related information such as Clinical Practice Guidelines (CPG) from the Alberta Medical Association. WHERE TO GO FOR MORE INFORMATION A number of resources are available to Alberta Netcare EHR users: For more information about the Health Information Act (HIA), contact: HIA Help Desk at 780-427-8089, toll-free at 310-0000-780-427-8089 or e-mail hiahelpdesk@gov.ab.ca. For more information about the Privacy Impact Assessment (PIA), contact: Office of the Information and Privacy Commissioner of Alberta at 780-422-6860, toll-free at 1-888-878-4044, e-mail generalinfo@oipc.ab.ca or visit their website at www.oipc.ab.ca. For more information about enrolling in Alberta Netcare, contact: Alberta Netcare Enrollment Line at: 1-866-756-2647 or 780-642-4082, e-mail health.ehrdeployment@gov.ab.ca or visit our website at www.albertanetcare.ca. www.albertanetcare.ca An Implementation Guide for Physicians How to bring the Alberta Netcare Electronic Health Record into your facility WHO CAN ACCESS THE ALBERTA NETCARE EHR? Only authorized custodians (and their affiliates) can access patient records. Access is based on user role and profession. This means that access permissions and other security credentials are set up so that users have enough information to do their jobs, while ensuring that information is accessed only on a need-to-know basis. Better Patient Information. Better Care Decisions. Better Patient Information. Better Care Decisions.
WHAT ARE THE BENEFITS AND IMPACTS ON MY PRACTICE? The Alberta Netcare EHR is a secure lifetime record of an Albertan s key health information. It is not a patient s full health or medical record, but provides the ability to: access up-to-date information at the point of care; view patient demographics; view specific lab results, flowsheets and chart lab values to spot trends; prescribe electronically and view a patient s current Medication Profile; search for a patient s Unique Lifetime Identifier (ULI) or Personal Health Number (PHN) and verify Alberta Health Care Insurance Plan eligibility; and organize records into easy-to-locate patient lists. The Alberta Netcare EHR helps improve the quality and safety of patient care by: providing more up-to-date and more accurate core medical information about a patient, which reduces the possibility of medical error; providing this information at the point of care, which reduces delays in treatment; streamlining the secure sharing of health information and building a common understanding of the patient s health condition; and preventing the duplication of tests, unnecessary treatments and adverse events, such as harmful prescription drug interactions. HOW DO I IMPLEMENT THE ALBERTA NETCARE ELECTRONIC HEALTH RECORD? The implementation of the Alberta Netcare EHR occurs over four phases. Your Transition Coordinator is available to guide you through this process. Phase 1 ensures your readiness to implement Alberta Netcare within the security, privacy and technology guidelines set by government and regulatory agencies. This involves: reviewing the EHR Information Exchange Protocol and the custodian completing an Information Manager Agreement (IMA). The Information Exchange Protocol outlines specific rules for the collection, use and disclosure of information through the EHR; completing the Privacy Impact Assessment (PIA) for acceptance by the Office of the Information and Privacy Commissioner (OIPC). As a participant in the Physician Office System Program (POSP), you can receive assistance with your facility s PIA; completing the provincial Organizational Readiness Assessment (p-ora) a minimum set of administrative, technical and physical security requirements that community sites (clinics, pharmacies, doctor s offices, etc) must meet; and completing a technical site assessment to ensure hardware, software and network requirements are met. Phase 2 identifies roles and responsibilities and prepares your practice for the implementation of the EHR. This involves: completing the Terms of Reference that define roles and responsibilities (e.g. Access Administrator), implementation process and timelines; conducting a workflow assessment for implementation of the EHR; completing Access Administrator and User Registration forms for your site; and testing and confirming your system s connection with the Alberta Netcare EHR. Phase 3 consists of training and going-live. This involves: each authorized staff member receiving training tailored to their permission level and job role; a review of how the EHR is incorporated in your facility s workflow; and distribution of user IDs, passwords and RSA SecurID remote access fobs. Phase 4 is a post-implementation period involving follow-up and support. Your feedback will also be solicited six to eight weeks after implementation of the EHR at your facility. Ongoing support is always available for the Alberta Netcare EHR user community through: the Transition Coordinators, the provincial/alberta Health Services Help Desks, the Alberta Netcare Portal Login page and the Learning Centre. How much will it cost? There is no cost for the use of this application; however, there may be a cost if a facility requires additional technical and network configuration. WHAT ARE SOME TYPICAL NEW USER QUESTIONS? What is the timeframe for implementation? Once the Privacy Impact Assessment (PIA) and provincial Organizational Readiness Assessment (p-ora) are accepted, and the facility meets technical and security requirements, implementation occurs within approximately four to six weeks. Do I have to give up my office Electronic Medical Record? No the Alberta Netcare EHR can be used as a supplementary information tool, or in some instances it can be integrated into an existing system configuration. Implementation steps and timeframe may vary. Please contact the Alberta Netcare EHR Transition Coordinators for more information.