Saskatchewan ehealth Conference Evolution of Patient Care through EMRs

Saskatchewan ehealth Conference Evolution of Patient Care through EMRs October 4, 014 Queensbury Convention Centre, Regina, Saskatchewan Conference Website and Registration: www.ehealthconfsk.ca The Saskatchewan EMR Program and ehealth Saskatchewan invite you to join us for our inaugural Saskatchewan ehealth Conference, focusing on the evolution of patient care through EMR (electronic medical record) utilization. This is an interactive event for EMR users, offering opportunities to learn and participate in EMR enhancement discussions, EMR training and networking with your peers. The Saskatchewan ehealth Conference features two different content streams for physicians and medical office support staff. Each stream will be provided with up to eight hours of training in either QHR Technologies/Accuro or Telus/Med Access EMR software. In addition to improving your current EMR use, conference participants will hear about strategies to enhance utilization as well as developments in Saskatchewan s electronic health record in 014/01. CONFERENCE REGISTRATION FEE Early Bird before September 1, 014 $10 per person Regular after September 1, 014 $60 per person Registration fee includes: Welcome reception on Thursday evening (October ) Conference meals and breaks Keynote speaker sessions Who should attend? Saskatchewan EMR users and healthcare professionals considering implementing an EMR Why should YOU attend? Understand the full potential of your EMR Learn how to optimize your EMR use Attend training sessions delivered by physician or medical office assistant peers Participate in a panel discussion on EMR utilization Understand the initiatives and resources available through Saskatchewan ehealth and the Saskatchewan EMR Program NOTE FOR PHYSICIANS: This program is accredited by the College of Family Physicians of Canada and the Saskatchewan Chapter for up to 8 Mainpro-M1 credits. Royal College CPD accreditation is not available for specialists. Reimbursement for Saskatchewan physicians is available through the Continuing Medical Education Fund. What should YOU bring? Your laptop or tablet for the training sessions o Accuro users will log into your clinic EMR remotely so bring your access credentials, e.g., username and password

Your interest and your questions CLICK HERE TO VIEW THE CONFERENCE AGENDA AND TO REGISTER. If you have any questions about registration, please contact Nicole Filteau at nicolef@sma.sk.ca or 06..8. CONFERENCE ACCOMMODATIONS Delta Hotel 1919 Saskatchewan Drive, Regina 06.. or 1.800.09. Conference rate: $1 plus applicable taxes*, parking is $9 per day *To secure the conference rate, guests must reference ehealth Conference Block #SMS10014. This special rate expires on September 1.

EMR Co Committee ITEM FOR: INFORMATION ONLY TITLE: EMR Maturity documents SUBMITTED BY: Douglas Dombrosky DATED: August 8, 014 ISSUE: Foundational documents are needed to develop the SK EMR Maturity Model, these are the first three documents to start that development BACKGROUND: The basic SK EMR maturity model concept was developed in RPIW #17 however to operationalize the maturity model, supporting artifacts and more development are needed. CONSIDERATION:. QUESTION:. References: All three documents are in this pdf separated by cover sheets. Info Item Cover Sheet 014.0.4

Maturity Documents 01 EMR_Maturity_Background

01.EMR Program Maturity Model Background Introduction Progress on the mature use or meaningful use of Electronic Medical Records (EMRs) is well underway across Canada. The provinces of British Columbia, Alberta, Manitoba and Ontario have started their EMR maturity model deployments and evaluations. More than 7% of Saskatchewan physicians have adopted an EMR, but like other provinces, effective use of EMRs is significantly lower than adoption numbers. A structured, resourced Saskatchewan EMR maturity model will support physicians and the province towards improved patient health and added clinical value. The Saskatchewan Medical Association (SMA) EMR Program and ehealth Saskatchewan have jointly agreed to adopt and adapt the OntarioMD maturity framework for provincial rollout. This agreement was an outcome from a Lean Rapid Process Improvement Workshop (RPIW) #17 in October 01. COACH, Canada s Health Informatics Association, has also developed a national Canadian EMR Adoption and Maturity Model (CEMRAMM) standard. Alignment to COACH s national tool will allow for broader comparisons of system performance and national comparison on physicians progress. Standards from CEMRAMM have also been obtained and adapted for use. Maturing EMR Use and Data Standards EMR adoption alone does not lead to better patient care. Implementing an EMR is just the beginning of the electronic health record and improved patient care. Mature or advanced use of an EMR, coupled with a provincial electronic health record (EHR), leads to better patient care. The full clinical benefit of EMR will be achieved when providers are not only using basic functionality, but also advanced functionality with an interoperable EHR. That is, the provider will see full clinical benefit when he or she is not only using EMR fundamentals such as scheduling, billing, charting, and prescribing, but also when he or she is using advanced features such as practice patterns, management of online appointments, reports for preventative care, and reconciliation of historical and current lab results to lab orders. In an optimized physician office, all workflows in the clinic become electronic and there is little or no generation of paper. Every business process is examined for efficiency and effectiveness. Clinics run as well oiled machines. Every member of the team is comfortable with navigating and using the EMR software. Patients become empowered by being able to share and view information with their provider at each visit. Providers share information and resources seamlessly across their care teams and stored data is optimized to strengthen integrated care and support disease management. Reporting in the EMR is embraced and visual dashboards for key indicators are used for patient management. Page 1 of

01.EMR Program Maturity Model Background Many EMR users in Canada do not truly understand or appreciate what they need from their EMRs to improve practice efficiency and create connectivity 1. Saskatchewan physicians need to recognize the importance of using EMRs as more than just electronic filing cabinets. An increased awareness and understanding of data standards needs to be generated. This can be achieved through training and educating Saskatchewan physicians on the value proposition of progressing through the EMR maturity model. As the province moves closer to the use of e referrals and greater development of the HAIL (Health Informatics Access Layer) backbone of the electronic record, entry standards will be a requirement for participation. Benefits of Maturing EMR Use Saskatchewan physicians can create greater practice efficiencies and advance the clinical value of their EMRs if they progress along the continuum of maturity. According to Canada Health Infoway s 01 Benefits Report, currently only % to 18% of primary care physicians are effectively using their EMRs for preventative care and improved chronic disease management. Preventative care and supported chronic disease management is a Level of EMR maturity. Canada Health Infoway determined the below benefits of EMR use for primary care and communitybased specialist care. The current benefits are those being achieved to date. The emerging benefits are those that have evidence of occurring through advanced, mature EMR use. It is anticipated that as EMR adoption and maturity of use increase over the long term, additional benefits will accrue. Current benefits of EMR use: EMR use reduces staff time spent on specific paper based administrative tasks EMR users can expect a positive return on investment EMR use reduces the number of duplicate diagnostic tests ordered EMR use improves patient safety through reduced adverse drug events 1 Lyver, Marion (November 01). Canadian Medical Association: Future Practice. Standards: a call to action. http://www.cma.ca/publications/futurepractice. Canada Health Infoway (April 01). The Emerging Benefits of Electronic Medical Record Use in Community Based Care. https://www.infoway inforoute.ca/index.php/resources/video gallery/doc_download/19 theemerging benefits of electronic medical record use in community based care full report. Page of

01.EMR Program Maturity Model Background Emerging benefits of EMR use: EMR use increases the appropriateness of diagnostic tests EMR use has the potential to improve chronic disease management EMR use supports preventative care EMR use improves immunization rates EMR use may lead to faster responses to changes in care and treatment guidelines EMR use supports the improvement of team based care and continuity of care EMR use facilitates improvements in the overall patient experience EMR use improves the quality of the patient/provider encounter Anticipated benefits of EMR use: EMR use will contribute to a one patient record goal for each individual in Saskatchewan EMR use will further facilitate portability of patient records EMR use will allow for seamless mobile and monitoring of patient care Page of

Maturity Documents 0 EMR_Maturity_Model_Details

0.EMR Program Maturity Model Details Saskatchewan EMR Adoption and Maturity Model SASKATCHEWAN EMR ADOPTION & MATURITY MODEL Level Interoperable Population Impact Level 4 Optimized Integrated Care Level Established Integrated Care Level Standardization Clinical Processes Level 1 Basic Functionality Level 0 Non Use Maturity Levels PRACTICE MANAGEMENT INFORMATION MANAGEMENT PATIENT RESULTS MANAGEMENT DIAGNOSIS SUPPORT TREATMENT PLANNING SUPPORT PATIENT ENGAGEMENT & SUPPORT EVALUATION & MONITORING Time Communication & Coordination Practice Billing Appointment Scheduling Business Continuity Planning Registration Information Encounter Documentation Data Quality Nomenclature Consistency Document Privacy & Security Laboratory Requisitions Lab Results DI Requisitions Diagnostic Image Reports Discharge Information Referrals and Consults (Sender) Refrrals and Consults (Receiver) Patient Assessment Tools Preventative / Followup Care Evidence Based Resources Care Planning and Coordination Medication Compex Care / CDM Patient Education Self Care/ Co- Health Quality Indicator Public Health Reporting Health Outcome (Jurisdictional) The above diagram 1 provides a six level model for EMR adoption with seven associated functional measures of maturity. The model portrays the advancement in maturity as users progress through the levels and is supported by an EMR functional categorization. Levels 1 to are serial, consecutive and Levels 4 and are seen as iterative with continuous cycles. The top level () may further evolve and an additional level could be added at some point as physician s use of EMRs grow and evolve over time. To acknowledge a physician being at a specific level of maturity, full capability and applied functionality of that level must be demonstrated either by survey information gathered and reported or objective backend reporting. It is understood that some physicians may not achieve or demonstrate capabilities in certain areas, but progress and use of specific higher level functionality should be acknowledged by this model. 1 Obtained and adapted from Ontario s Jurisdiction EMR Program, OntarioMD. OntarioMD EMR Maturity Model. https://www.ontariomd.ca/portal/server.pt/community/emr_maturity_model reporting/ Page 1 of 18

0.EMR Program Maturity Model Details EMR Maturity Levels EMR Level Progression EMR Adoption Level Description 0 Paper Based Paper is the dominant means of storing, accessing, and exchanging information SERIAL 0 through 1 Basic Electronic Record Keeping Clinical Processes EMR available with basic use for practice management streamlining of foundational clinical efficiency such as encounter documentation, prescription creation and renewal, lab ordering and scanning Established clinical processes with decision making support at the individual patient level, standardization of data coding and fully structured workflow practices. Advanced Disease Enhanced delivery and support of care from automated clinical workflow and process including a focus on outcomes to manage complications and on advanced tracking for treatment adherence. INTERATIVE Through 4 and 4 Integrated Care Population Impact Supports adherence to optimal standard(s) of care1 across/between care teams (internal/external) through integration and exchange of information at the community and regional levels. Profiles (based on risks or conditions) sub populations; measures process and outcomes; provides performance feedback; supports regional health policy planning and reporting at the jurisdictional level. Obtained and adapted from COACH, Canada s Health Informatics Association. Canada s EMR Adoption and Maturity Model (CEMRAMM). http://www.coachorg.com/en/resourcecentre/green_white Papers.asp. Page of 18

0.EMR Program Maturity Model Details Functional Categories and Sub Categories The Saskatchewan EMR maturity model is built upon seven functional categories and 6 associated sub categories. These functions and sub functions provide a means to commonly measure functional capacity of any specific physician s EMR use. The below wording provides a common naming to identify groups of EMR functions for comparison and measurement. The exact description and nature of each function will vary depending on the EMR software as QHR Technologies Accuro EMR or a TELUS Health Med Access EMR use different terms and description in their applications. Practice Referrals and Consults Tracking (Specialist) Appointment Scheduling Diagnosis Support Practice Billing Communication & Coordination Business Continuity Planning Patient Assessment Tools Preventative/Follow up Care Evidence Based Resources Information Treatment Planning Support Registration Information Encounter Documentation Care Planning and Coordination Medication Data Quality (DQM) Nomenclature Consistency Document (Scanning) Complex Care/Chronic Disease Patient Engagement & Communication Patient Education Privacy & Security Self Care/Co Patients Results Evaluation & Monitoring Laboratory Results Diagnostic Image (DI) reports Hospital Summary Information Referrals and Consults Tracking (General Practitioner) Health Quality Indicator Public Health Reporting Health Outcome (Jurisdictional) Page of 18

0.EMR Program Maturity Model Details EMR Functionalities Level 0 Definitions EMR Functionalities in Level 0 Level 0 Practice Information Patient Results Diagnosis Support Treatment Planning Support Patient Engagement & Communication Evaluation & Monitoring Paper based Fully paper based scheduling and billing. Communicate verbally with paper notes and no related business continuity planning. Paper based registration, chart, and encounter documentation. No rules or procedures for data quality management (DQM) and nomenclature consistency. Paper environment based P&S policies. Lab, DI, referrals, consults, and hospital information are paper based. Paper based patient assessment tools and follow up. Access to journals and paper based reference for resources. Paper based care planning, medication management, and CDM. Pre printed promotion/education materials and paper based questionnaire for self care. Paper based reporting for health quality indicators (HQI), health outcomes (HO), and Public Health. EMR Functionalities in Level 1 Level 1 Practice Information Patients Results Diagnosis Support Basic Electronic Record Keeping Hybrid scheduling in place. Billing is printed daily. EMR used to communicate within practice. Plan in place for scheduled downtime and maintenance. EMR used to input patient demographics, patient visit, and encounter notes. Aware of DQM issues. Use varying local codes and non standard nomenclature. Full privacy compliance with applicable legislation. Scan paper based documents with written instructions and notes into EMR. Lab, DI, hospital information is scanned into the EMR. EMR pre populate the generic referral/consult templates. Paper based referral reviewed for specialist. Follow up care and resources are combination of EMR and paper. 0.emr_maturity_model_details.doc August, 014 Page 4 of 18

0.EMR Program Maturity Model Details Level 1 Treatment Planning Support Patient Engagement & Communication Evaluation & Monitoring Basic Electronic Record Keeping Subjective, Objective, Assessment and Plan (SOAP) notes for care planning and coordination. EMR is used to create basic prescription and renewals. EMR manages at least one chronic condition using templates for CDM. Patient education material is scanned and indexed in EMR. Patients record self care at each visit. Paper based reporting continued for health quality indicators (HQI), health outcomes (HO), and Public Health. EMR Functionalities in Level Level Practice Information Patient Results Diagnosis Support Treatment Planning Support Patient Engagement & Communication Evaluation & Monitoring Clinical Processes View appointment booking via EMR. Use EMR for A/R, Reconciliation. Task based communication via EMR. Plan in place for short term system downtime (<1 day). Use EMR for advanced registration and clinical data for patients with multiple problems. Reactive approach to DQM. Billing service codes and local coding standards used for nomenclature. Paper based documents scanned into patient record in EMR. Keep abreast of regulations for P&S. Use EMR to generate pre filled lab, DI requisition. Import hospital information directly into the EMR. EMR to send messages for referrals and consults. SOAP notes for patient assessment. EMR triggers reminders for managing routine preventative screening. EMR templates and assessment tools are embedded with up to date evidence and guidance. Individualized objective templates in the EMR for care planning and coordination. EMR to identify diseases by the target modifiers and manage care plans for CDM. EMR to manage and monitor patient s medication. Educate patients via EMR screen and input patient results into EMR with scanned copies. EMR to set up system wide alerts and reminders for health outcomes. EMR to generate reports on infectious diseases. Page of 18

0.EMR Program Maturity Model Details EMR Functionalities in Level Level Practice Information Patient Results Diagnosis Support Treatment Planning Support Patient Engagement & Communication Evaluation & Monitoring Advanced Disease Support Advance appointment tracking with EMR. EMR generates billing related reports. Use EMR to track tasks directly related to patient record. Detailed plan in place for long term system downtime. EMR identifies sub population for recurrent visits or proactive care; enter clinical data for focused patients. Proactive approach to DQM. Agreed upon nomenclature for coding standards and charting. Written protocol. EMR to do advanced tracking and management of lab and DI results. Review and analyze information from hospital. Advanced tracking and management of referrals and consults. EMR documents visual fields, annotate images for support assessment. EMR generates a list of eligible rostered patients due for preventative care. EMR suggests resources and recommends topics and educational resources. Customized templates for care planning and coordination. Customized prescription creation. Manage multiple chronic conditions using customized templates/forms. EMR develops customized educational modules. Set up customized templates for self care/co management. EMR to monitor HQI, HO, and Public Health and generate reports. EMR Functionalities in Level 4 Level 4 Practice Information Patient Results Integrated Care EMR produces analytical report for practice management, post charges directly in EMR, and communicate with patients. End of system plan in place. EMR linked and up to date with patient e rostering system. Use EMR to enter clinic data for complex care using multiple structured templates, custom forms, etc. Managed approach to DQM. Basic coding standards mapped to comprehensive terminology such as SNOMED CT. Fully compliant with provincial privacy legislation for data sharing. Key or input from OCR/PDF all quantifiable and pertinent clinical data from incoming paper based documents. EMR linked to regional repository for lab and DI. Seamlessly share and manage information from hospital and regional e referral system. Page 6 of 18

0.EMR Program Maturity Model Details Level 4 Diagnosis Support Treatment Planning Support Patient Engagement & Communication Evaluation & Monitoring Integrated Care EMR generates recommendations for patient assessment tools. Autopopulate regional registries and do advanced tracking of preventative care such as proactive profiling. EMR updated with emerging, changing, and appropriate evidence and guidance. EMR to access regional registries for care planning and coordination. EMR to share information with regional disease registries regarding CDM. EMR linked to regional system for medication management. Online tools used by patients for education and self care. EMR identifies patient population for HQI. EMR identifies patient population for HO. EMR to report outbreaks in Public Health. EMR Functionalities in Level Level Practice Information Patient Results Diagnosis Support Treatment Planning Support Patient Engagement & Communication Evaluation & Monitoring Population impact Appointments are managed online and linked to EMR scheduler. EMR autopopulates billing codes based on encounter notes. Communicate with other providers through EMR. Use EMR to co manage and reconcile patient enrollment. Send and or/receive data of individual patient records from one EMR to another. Optimized approach to DQM. Advanced nomenclature coding standards. EMR to generate longitudinal lab, DI, and information analysis from different care settings. Patients manage online appointment booking. EMR linked to regional health record for most effective diagnostic procedures. EMR linked to regional repository to access provider specific preventative/follow up care. EMR aggregated database to conduct real time analysis of de identifiable data. EMR related registries for care planning and coordination. Integrating reporting to track care for CDM. Manage medications from multiple medication management systems or provincial pharmacy network. Patients have access to regional web portals for education and selfmanagement. EMR receives information from regional reporting system regarding health outcomes. Generate up to date information based on symptoms for public health. Receive information to define sub population for health quality indicators. Page 7 of 18

0.EMR Program Maturity Model Details EMR Functionalities Level 0 Survey Questions The following 8 statements can be used by a physician to self assess the highest number most reflective his or her current practice. A selection of N/A would also be available if the response did not apply to a physician s role. Practice 1. Appointment Scheduling 0 We use a fully paper based scheduling system. We electronically books appointment and the day sheet is printed from the EMR 1 scheduler. We use the EMR to book basic appointments and the day sheet is viewed through the EMR. We use the EMR for advanced tracking that is tailored to the needs of the practice which includes using templates, blocked times, and recurring schedules. We use the EMR to generate reports to manage our practice efficiency such as reviewing 4 cancellation, no shows frequency, visitation types (ie. CDM s and Completes). We manage online appointment bookings linked to our EMR scheduler integrated with automated patient reminders ie. allowing patients or other health care providers to request or schedule appointments.. Practice Billing 0 We write billable items on paper and enter them into a third party billing system. We write billable items on a printed day sheet and the office staff uses the EMR to 1 manage and submit bills. We create basic billing and billing reconciliation through the EMR (ie. reminders for outstanding bills, claim errors, submissions, tracking of aged accounts and write offs). We use the EMR to generate billing reports (ie. Identify patients that have been seen for a certain billing code over a specified period of time). We use the EMR to send electronic submissions to MSB with electronic reception of 4 return file with complete EMR reconciliation. We use the EMR to auto populate and manage the billing codes directly from the encounter notes entered during the patient visit (ie. EMR triggers code for pap tests).. Communication and Coordination 0 We communicate mainly by phone or verbally with paper notes. 1 We use the EMR to send messages to communicate with staff. We use the EMR to send electronic notification of basic tasks that needs to be performed with priorities set (ie. book follow up appointments, internal requests for requisitions). Page 8 of 18

0.EMR Program Maturity Model Details 4 We use the EMR for advanced tracking of tasks directly to the patient s record (ie. preventative care reminders such as pap tests, CDM lab work, colorectal exams). We use the EMR to send messages to some patients for clinical and administrative purposes such as emailing appointment dates, report on generic information or answer general inquiries. We use the EMR seamlessly linked to a provincial system to do advanced co management of patient care services within our circle of care (across different EMR systems) ie. patients status, clinical reminders and pending activities. 4. Business Continuity Planning (maybe want to add n/a as an option this is probably clinic specific) 0 We do not have a plan for our EMR downtime. We have a basic plan in place for downtime of expected system maintenance and 1 upgrades and have a basic BCC in place. We have a policy and procedure in place to support continued operation in the event of downtime such as system maintenance and upgrades of less than 1 business day (i.e. communication plan). We have a policy and procedure in place to support continued operation in the event of scheduled or unscheduled downtime for long term shutdown (i.e. preprinted day sheets, notification procedures, and pre printed forms). We have an end of system plan in place for switching to a new vendor or a product 4 collapse, clearly outlining the vendor's responsibilities to provide access to data in usable form. Information. Registration 0 We use a paper based system for patient registration. 1 We enter basic patient demographics and registration information in the EMR. We use the EMR to maintain all patient demographics and registration with advanced features (e.g. addition of next of kin, emergency contacts, and insurance details). We use the EMR to enter alerts and reminders that identify relevant subpopulations for recurrent visits or proactive care at registration ( ie. Prenatal, CDM, annual checkups). 4 We use the EMR to update patient data through a linked central e rostering system. We can use our EMR, in conjunction with a provincial system, to co manage patient enrollment and electronically exchange relevant patient demographic data. 6. Encounter Documentation 0 We use a paper based system to document all clinical encounters. 1 We enter SOAP notes in the EMR to document simple patient visits and encounters mainly Page 9 of 18

0.EMR Program Maturity Model Details 4 as text. We use the EMR to enter clinical data for patient visits with multiple problems in generic templates or equivalent formats that use discrete searchable fields. We use the EMR to enter clinical data for focused patient visits and encounter notes using customized templates/forms (ie. CDM QIP flowsheets). We use the EMR to enter clinical data for complex care using multiple structured templates/custom forms such as consult letters and accessible parking permits. We electronically transfer and/or import a patient's entire patient records seamlessly from my EMR to any other physician's EMR system external to our practice. 7. Data Quality 0 1 4 We do not have any rules or procedures to control the quality and consistency of data entered. We have basic policies and procedures in place for quality control such as scanning safeguards and what is to be entered into specific fields. We have policies and procedures in place for data quality issues when they are caught for individual patient records and plans on how to correct data inputted in the wrong chart (ie. visit note for Patient A is recorded in Patient B s chart). We have a proactive approach to data quality management such as building queries to discover and generate lists to identify data issues (ie. incomplete checkboxes for CDM flowsheets, incomplete fields in certain flowsheets, etc). We have a managed approach to data quality management such as a committee that addresses accuracy, completeness and integrity of data for research or provincial reporting. We have an optimized approach to data quality management with rigorous processes in place to keep data quality as high as possible such as ongoing staff training, continuous data cleansing and monitoring of quality levels based on our strategic plans. 8. Nomenclature Consistency 0 1 4 We have not considered any standards for coding disease types and inputting our clinical data. We use a variety of local codes or nonstandard approaches for inputting clinical information into our EMR at the practice level. We use billing service codes and basic local coding standards for medications, diagnosis, and problem lists in the EMR such as standard terms, abbreviations, and acronyms through agreed upon standards and use of dropdown lists. We use an agreed upon structured nomenclature coding standard for charting in the active problem lists and/or notes using commonly acceptable standards such as ICD codes. We have basic coding nomenclature standards seamlessly mapped to a comprehensive clinical healthcare terminology for most clinical data. We have advanced nomenclature coding standards seamlessly mapped to a comprehensive clinical healthcare terminology for all free text, structured coding and/or Page 10 of 18

0.EMR Program Maturity Model Details embedded in our templates. 9. Document 0 We store all paper based documentations in patient s paper charts only. We use paper based documentation that is reviewed by a provider with written 1 instruction then scanned into the patient chart. We scan paper based documents into the patient chart that is then sent to the provider s inbox to be reviewed. We have written protocols on incoming paper based documentations to be partially scanned or manually entered for some clinical data in the EMR. We key or input from OCR (Optical Character Recognition)/PDF all quantifiable and 4 pertinent clinical data from incoming paper based documents directly into EMR with minimal or no scanned documents attached to patient s records. 10. Privacy and Security 0 1 4 We have policies in place based on our paper based environment for access to and protection of health records and business information. We are in full compliance with HIPA privacy and security laws for health information management amongst all providers/staff within our practice/group. We keep abreast of the regulations and schedule routine security and risk assessments such as audits and privacy impact assessments of our EMR solution. We are in full compliance with HIPA laws or legislation for data sharing outside our circle of care such as across community/regional/provincial systems. Patient Results 11. Laboratory Requisitions 0 We use the standard preprinted paper based lab requisition form to order labs. We use the EMR to generate lab requisition forms with patient demographics and 1 office/physician data automatically populated. The requisition is printed and requesting tests are manually selected/checked. We use the EMR to generate lab requisition forms with patient demographics and office/physician data automatically populated. The requesting tests are checked off using the EMR or a prefilled favorite requisition form is used. We use the EMR for advanced tracking for special population groups by customizing orders with a list of "favourite" labs based on clinical guidelines ie. allergy, cytology, diabetes standing orders etc. 4 We access the regional lab information system to reconcile patient historical and current Page 11 of 18

0.EMR Program Maturity Model Details lab orders as part of the lab results management and patient care planning in the EMR. We setup the EMR, in conjunction with the provincial laboratory information system, to trigger alerts and reminders for labs when they become due and auto generate the appropriate labs for approval such as those associated with CDM. 1. Lab Results 0 1 4 We receive paper based lab results from the lab facilities or hospitals via fax, courier or mail. We receive lab results and review them in paper form with written instructions then scanned into the patient chart. We receive paper lab results that are then scanned into the patient chart and sent to the provider for electronic review. The EMR is integrated with a regional LIS and lab results come into the EMR electronically into the patient chart and pushed to the provider s inbox for electronic review. The EMR is integrated with a provincial LIS and lab results come into the EMR electronically into the patient chart and pushed to the provider s inbox for electronic review. We use the EMR, in conjunction with a provincial lab system, to generate longitudinal lab reports that can be used for trending analysis of subpopulations to inform patient care plans and contribute to population health planning. 1. Diagnostic Image Requisitions 0 1 4 We use the standard preprinted paper based diagnostic requisition form to order diagnostic imaging reports. We use the EMR to generate DI requisition forms with patient demographics and office/physician data automatically populated. The requisition is printed and requesting tests are manually selected/checked. We use the EMR to generate DI requisition forms with patient demographics and office/physician data automatically populated. The requesting tests are checked off using the EMR or a prefilled favourites requisition form is used. We use the EMR for advanced tracking for special population groups by customizing orders with a list of "favourite" diagnostic tests based on clinical guidelines ie. bone density, ultrasounds, mammography etc. We use the EMR to access the regional diagnostic imaging system to reconcile historical and current orders to support results management and patient care planning in the EMR. We setup the EMR, in conjunction with the provincial diagnostic imaging system, to trigger alerts for duplicate orders or best practice guidelines for optimal orders before submission of request. 14. Diagnostic Image Reports 0 We use a paper based system for reviewing diagnostic imaging reports and patient instructions. Page 1 of 18

0.EMR Program Maturity Model Details 1 4 We review the diagnostic image results in paper form with written instructions then scanned into the patient chart. We receive paper diagnostic image results that are then scanned into the patient chart and sent to the provider for electronic review. We use the EMR to generate reports and do advanced management of DI results such as automated alerts and reminders, reports on analysis and review etc. We use EMR in conjunction with the regional diagnostic imaging system, to generate longitudinal DI reports that can be used directly from all facilities. We use the EMR, in conjunction with a provincial diagnostic imaging system, to generate longitudinal DI reports that can be used for analysis of subpopulations to inform the patient care plan and population health management. 1. Discharge Information 0 1 4 We use a complete paper based system for receiving and filing hospital report requisitions, receipt of results, notes and patient instructions. We receive discharge reports and they are reviewed and then scanned into the patient chart. We receive discharge reports and they are scanned into the patient chart and sent to the provider for electronic review. We use the EMR to review and analyze information received directly from electronic hospital reports into our patient's medical record such as medical reports (including discharge, consult) and diagnostic imaging reports. We use the EMR to seamlessly share information bilaterally and reconcile multiple hospital reports via regional repositories such as discharge notes, exams, allergy information, problem lists and medication lists. We use the EMR, in conjunction with a provincial hospital system, to conduct longitudinal informational analysis from multiple care points of subpopulations to inform patient care plans such as length of treatment or adverse events vs. hospital admission. 16. Referrals and Consults Tracking Requisition (Sender) 0 We use a paper based system for sending referral and consult letters. We use the EMR to print off referral/consult forms and fill in basic information such as 1 referring physician details and relevant summary details on paper. We use the EMR to pre populate specific referral/consult forms with pertinent patient information such as previous consults, lab results, DI reports, and summary notes. The referral/consult is printed and faxed or mailed to the receiver. We use the EMR to do advanced tracking and management of all referrals/consults such as actions/alerts for follow ups, appointments and return of notes. We use a regional e referral system to seamlessly share, manage and exchange referral 4 information from the EMR such as appointment booking, progress and status, specialty wait times, consultation letters, special needs or alternative treatment options. Patients manage online appointment bookings with preferred specialists via a provincial e referral system integrated with our EMR for specialist details, real time sharing of Page 1 of 18

0.EMR Program Maturity Model Details relevant patient data and notification attached to patient's record. 17. Referrals and Consults Tracking Requisition (Receiver) 0 We use a paper based system for all referral and consult requests received. We review all referral/consult in paper form with written instructions then scanned into 1 the patient chart. The referral/consult is sent directly into the EMR and attached to the patient chart and to the provider to review. Triage and booking instructions are sent with through an electronic task. We use the EMR to do advanced tracking and management of all referrals/consults such as actions/alerts for follow ups, appointments and new/overdue notes or letters. We use a regional e referral system to seamlessly manage all referrals from the EMR such 4 as appointment bookings and sharing of pertinent patient data e.g., allergies, medications, symptoms, clinical notes and patient instructions. Patients manage online appointment bookings from a provincial e referral system linked to our EMR scheduler for receipt of provider details and real time sharing of relevant patient data. Diagnosis Support 18. Patient Assessment Tools 0 I use a paper based system for charting patient s assessments and problems. 1 We use a hybrid system whereas both paper and the EMR SOAP note for monitoring care. We use the EMR SOAP note to track and monitor care recommendations and activities including input by other clinicians and allied health professionals if available. We use the EMR to document visual fields, annotate images with drawing/text, and customize clinical decision support tools and/or templates to support assessment (ie. MMSE, Framingham, spinal images etc) We use the EMR, in conjunction with a regional repository, to create queries and generate 4 report of entire patient records based on the symptoms, signs and historical record of patients to support decision making and targeted population care management. We access a provincial repository of EMR aggregated database to generate real time data of the most effective diagnostic procedures and the appropriate treatment pathways based on symptoms and signs (ie. cancer care, diabetes care). 19. Preventative/Follow Up Care 0 We use paper based screening tools and attach these to the patient s paper chart. We use the EMR SOAP note to enter free text on preventative care services and attach 1 scanned paper based screening tools to patient record (ie. cancer screening, influenza vaccines, and immunizations). We setup EMR trigger reminders and alerts for managing routine preventive screening Page 14 of 18

0.EMR Program Maturity Model Details 4 targets at point of care. We use the EMR to generate a list of eligible patients due for preventive care and monitor overdue clinical services. Follow up with reminder letters and phone calls to patients. We setup the EMR to auto populate regional registries and do advanced tracking of preventive care such as proactive profiling and management of high risk patient population, tracking of responses and follow ups. We use the EMR linked to a provincial repository to access provider specific reports and monitor changes in our practice's performance and results against clinical guidelines for treatment management and care management. 0. Evidence Based Resources 0 We have access to books and paper based references only. 1 We reference online medical libraries and website links directly from the EMR. We use templates and assessment tools in our EMR that are embedded with up to date evidence based guidelines (ie. CDM QIP template). When we enter clinical information such as recommended topics and educational resources which is attached to the patient's record with dates and notes our EMR gives us suggestions. We use a fully integrated EMR seamlessly updated with emerging, changing and 4 appropriate evidence and guidelines from a credible repository. We access a provincial repository of EMR aggregated database to conduct real time analysis of de identifiable data for recommendations to support clinical decision. Treatment Planning Support 1. Care Planning and Coordination 0 We use a paper based system for documenting all treatment and follow up plans. We use of a hybrid system that both paper and EMR SOAP notes are used for treatment 1 and follow up plans. We use a basic EMR SOAP to review follow up care or tests for patient with triggers for reminders at point of care. We use individualized objective templates in the EMR to track treatment plans over time such as recommendations for care by different clinicians, overdue clinical services, intervention methods, expected goals or outcomes and triggers for activities ie. using MMSE, Framingham, HAMD etc. We use the EMR to access regional registries with reconciled patient data across all 4 settings to support treatment plans ie. pre and post treatment review and analysis of subpopulations. We use integrated reports from the EMR and related provincial registries for planned disease management control for high risk and high utilization. Patient population such as more tailored, intensive interventions and care management.. Medication Page 1 of 18

0.EMR Program Maturity Model Details 0 1 4 We use a paper based system to create or renew all medications and attach to patient s paper chart. We use the EMR for basic prescriptions and renewals with drug to drug interactions and updated FDB Formulary checked. Prescriptions are printed and provided to the patient. We use the EMR to manage and monitor patient s medication list (ie. allergy check, medication history, renewals and treatment plans, and drug utilization tracking). We customize the EMR with frequently used prescription drug favorites and adjust the severity levels for all drug to drug and drug to allergy interactions (ie. magic mouth wash and Newman s Paste). We use the EMR to electronically send prescriptions via a regional system to pharmacies of a patient s choice, access patient s comprehensive medical histories, ODB formulary/funding model and generate reports on medication use. We use the EMR, in conjunction with a provincial system, to manage and reconcile medications from multiple providers to support decision making and medication treatment plans.. Complex Care/Chronic Disease 0 We use a paper based system for complex care and provincial toolkits and/or forms. We use the ERM to management at least one chronic condition using flow sheet and 1 templates integrated with relevant clinical data such as lab results, medication lists and progress notes with associated alerts and reminders (e.g., diabetes care). We use the EMR to periodically generate targeted reports of high risk patients to support personalized care management (ie. diabetic patients and HbA1C results not tested in last six months or overdue eye and foot exams). We use the EMR to do advanced management of patients with multiple chronic conditions such as care plans embedded with alerts and reminders to the care team for overdue or upcoming examinations, abnormal labs etc. (ie. DM, Asthma, COPD, CHF, INR, depression). We use the EMR to share information with regional disease repositories and conduct 4 trending analysis for high risk population management such as care targets and patients progress throughout all encounters. We use the EMR to access integrated provincial performance reports to track patients with complex care by multiple care teams across all settings and contribute to regional treatment planning and care management. Patient Engagement and Support 4. Patient Education 0 1 We provide preprinted health promotion/education materials with face to face communication. We scan educational material into our EMR. Printed copies are made available during face to face communications. Page 16 of 18

0.EMR Program Maturity Model Details 4 We use the EMR to educate patients directly from the screen or with printouts of their medical progress over time such as showing them patterns in their BMI, blood sugars, levels and lab work over time. We use the EMR to develop tailored educational modules focusing on patient's condition or linked to care plan such as culturally appropriate educational programs. Follow up through website, printed or emailed patient instructions. We give patients access to our practice's online tools linked to the EMR with access to health files, health information and pertinent health education integrated with web based interactive tools/credible links for continuous education by patient or caregiver. We give our patients access to a provincial web portal with access to health files, health information and provincial heath care services.. Self Care/Co 0 1 4 We give patients a paper based questionnaire and/or journal for home monitoring which is reviewed and returned at each visit ie. home blood pressure readings. We scan patient s results from home monitoring diary or devices into the EMR to track progress over time as part of the care plan for follow up at visits (ie. diary record of blood glucose levels, meals, notes as well as dosage information). We use the EMR to input patient s results from home monitoring diary or devices. Alerts are reminders and used to identify patient related topics for discussion of self care and monitoring activities during the patient s visit (ie. medication use, exercise, diet, smoking, communities of support, and other resources). We use the EMR to setup customized templates/forms for our patients to conduct selfassessments in the office. We review results directly from patient charts prior to seeing each patient such as questionnaires on lifestyle behaviors. We give patients access to our practice's online tools linked to the EMR to track their care plans and results as well as other resources ie. post visit instructions, documentation of lifestyle and nutrition targets and interactive health tools. We give our patients use a provincial web portal that facilitates personalized care plans as well as remote monitoring tools to transmit vital signs and other bio data directly from their home. Evaluation & Monitoring 6. Health Quality Indicator We use a paper based system or do not have the capacity to produce standardized 0 reports on health quality outcomes. 1 We use a paper based system. We use the EMR to build simple adhoc queries and searches to routinely generate practice level information ie. how many diabetic patients within the practice do we have and how many have not received routine diabetes screening in the past 1 months. We use the EMR to monitor and generate interim reports that capture and aggregate data based on demographics, provider and/or clinical markers related to provincial quality Page 17 of 18

0.EMR Program Maturity Model Details 4 measures over time at the practice level only. We use the EMR to extract anonymized real time clinical data on demographics, provider and/or clinical markers related to provincial quality measures and send to a regional electronic reporting system ie. CPSSN, ICES etc. We use the provincial reporting system to access information to define subpopulations for comparative analysis, evaluation of patient population and contribute to health planning ie. preset reports for CIHI PHC Voluntary Reports, HQC etc. 7. Public Health Reporting We use a paper based system or electronic forms to identify and share information on 0 infectious diseases or outbreaks, upon request, with Public Health authorities (e.g. Flu Watch). 1 We use a paper based system. We use the EMR to generate reports on infectious diseases or outbreaks such as data points required from the surveillance sheet for input to the public health online website. We use the EMR to generate reports on public health information such as recall events or accountability for number of immunizations delivered based on eligibility status of all children, dosage, date. We use the EMR to report notifiable outbreaks seamlessly and in real time from clinical 4 data as patient encounters occur directly to our local or regional electronic public health system. Our EMR is linked to an electronic provincial public health system and can automatically generate up to date information based on symptoms or signs keyed such as "influenza like illness". 8. Health Outcome (Jurisdictional) We review paper based provincial reports based on a combination of demographics, 0 billing codes and clinical marker ie. diabetes, colon reporting & ischemic heart disease etc. 1 We use a paper based system. We use the EMR to setup system wide alerts and reminders for clinical markers from the paper based reports to manage at risk patients at point of care such as by age group, gender, disease type. We use the EMR to generate reports to monitor clinical markers within the practice and reconcile against provincial reports ie. screening for modifiable risk factors in adults with diabetes. We use the EMR to identify select patient population and report anonymized real time 4 clinical data seamlessly to the regional electronic reporting system. We use the provincial reporting system to access information for comparative analytic reports, evaluation of subpopulations and contribute to health planning. Page 18 of 18

Maturity Documents 0 EMR_Maturity_Model_Strategy

0.EMR Program Maturity Model Strategy Saskatchewan Medical Association (SMA) EMR Program Maturity Model Strategy EMR adoption alone does not lead to better patient care. Mature or advanced use of an EMR, coupled with a provincial electronic health record, provides to better patient care. This maturity progression or meaningful use is necessary to get the maximum benefit of the EMR to the health care system. Deploying the Saskatchewan EMR maturity model will provide physicians with the knowledge and tools to learn the power of the data they have collected, to think about their patients in a new way, and then create change on a larger scale. The Saskatchewan Medical Association (SMA) EMR Program and ehealth Saskatchewan have jointly agreed to adopt and adapt the OntarioMD maturity framework for provincial rollout. This agreement was an outcome from a Lean Rapid Process Improvement Workshop (RPIW) #17 in October 01. COACH, Canada s Health Informatics Association, has also developed a national Canadian EMR Adoption and Maturity Model (CEMRAMM) standard. Standards from CEMRAMM have also been obtained and adapted for use. Alignment to COACH s national tool will allow for broader comparisons of system performance and national comparison on physicians progress. Saskatchewan EMR Maturity Model Overview The Saskatchewan EMR maturity model has six levels of maturity and seven functional areas of assessment with 6 sub functions. This robust model allows for not only the evaluation of functionality and breadth of use, but it also looks to evaluate outcomes for improved patient health and clinical value. The EMR model demonstrates the progressive clinical value each clinic or physician can achieve along his or her adoption journey. And while not all functionalities currently exist in SK, the model is designed to incorporate new and advanced functionality as they become available. This model is also believed to be the most robust and comprehensive of all provincial EMR models. Summary of EMR Maturity Levels (6) The SK EMR maturity model provides six levels of progress, adoption, and use. This model shows the progression that physicians should follow to have increasingly advanced EMR capabilities. The continuum is along levels of 0 through, with being the highest and 0 being the lowest. Each level of maturity builds upon the functionality or maturity of the preceding level. Achievement of levels 1 through will transform practice efficiency. Achievement of levels to will strengthen integrated care. Levels 1 to are serial or consecutive and levels 4 and are seen as iterative with continuous cycles. Currently, in some functional areas, a level is not Page 1 of 10

0.EMR Program Maturity Model Strategy achievable in SK. For example, a Level Diagnosis Support would require a physician s EMR to link to a regional health record. Currently this is not available for fee for service providers with a stand alone EMR. Looking forward, it s possible that the top level will further evolve and an additional level could be added at some point as physician s use of EMRs grow and evolve over time. Level Criteria Capabilities 0 Paper Based Paper is the dominant means of storing, accessing and exchanging information. 1 Basic Electronic Record Keeping Streamlining of foundational office admin and clinical efficiency. Clinical Processes Transforming clinical efficiency as the EMR becomes an asset. Advanced Disease Enhancing patient centered delivery and management of care. 4 Integrated Care Population Impact Sharing information and resources seamlessly across care teams at the regional level. Supporting population reporting, health management. Summary of EMR Functional Areas (7) and Sub Functions (6) The Saskatchewan EMR maturity model is built on seven functional categories and 6 associated sub categories. These functions and sub functions provide a means to commonly measure functional capacity of any specific physician s EMR use. The below wording provides a common naming to identify groups of EMR functions for comparison and measurement. The exact description and nature of each function will vary depending on the EMR software as QHR Technologies Accuro EMR or a TELUS Health Med Access EMR use different terms and description in their applications. 1. Practice includes appointment scheduling, Practice Billing, Communication & Coordination, and Business Continuity Planning.. Information includes registration information, encounter documentation, data quality management (DQM), nomenclature consistency, document management (Scanning), and privacy & security. Page of 10

0.EMR Program Maturity Model Strategy. Patients Results includes laboratory results, diagnostic image (DI) reports, hospital summary information, referrals and consults tracking (Physician), and referrals and consults tracking (Specialist). 4. Diagnosis Support includes patient assessment tools, preventative/follow up care, and evidence based resources.. Treatment Planning Support includes care planning and coordination, medication management, and complex care/chronic disease management. 6. Patient Engagement & Communication includes patient education and self care/comanagement. 7. Evaluation & Monitoring includes health quality indicator, public health reporting, and health outcome (Provincial). EMR Maturity Advisory Group At the outset, practicing clinicians with a balance of health informatics expertise and perspective will be involved. Both internal and external stakeholders will be engaged to make recommendations and validate the EMR maturity model development and deployment. Representatives from other stakeholder groups will be invited to attend committee meetings on an as needed basis. The functions of the committee will include: 1. Determine the scope of work for which the advisory group will assist. This along with role and responsibility will feed into the long term planning needs for the maturity model which will align with overall maturity strategy. Determine the needs of SK physicians in order to transform practice efficiency (Maturity Level 1 through ) and strengthen integrated care (Maturity Level through);. Identify and clearly define the preferred metrics to be measured and reported; 4. Define the requirements for the production of an EMR dashboard that would objectively measure (1) Practice Efficiency and () Clinical Value based on defined indicators,. Assist in determining EMR maturity best practices which will benefit providers and patients in primary care, specialty practice and hospitals; 6. Assist in determining project management with a strong emphasis on change management delivery and reinforcement; 7. Prioritize EMR maturity model policies and actions with a view to providing the most value to patients and physicians; Page of 10

0.EMR Program Maturity Model Strategy 8. Work within the maturity model framework to develop governance and a supporting governance toolkit; 9. Liaise and consult with other EMR maturity model Jurisdictional groups and the national Canada s Health Informatics Association (COACH) on their Canadian EMR Adoption and Maturity Model (CEMRAMM) standard initiatives; 10. Liaise and consult with other technology providers to review and recommend new technology innovations that may be of value to the Saskatchewan EMR maturity model development and deployment; 11. Co ordinate certification and delivery of information technology related CME for physicians. Program Objectives and Goals The EMR Program maturity model objectives are to (1) transform practice efficiency and () strengthen integrated care. Transforming practice efficiency is maturity level 1 and strengthening integrated care is maturity level. Specific goals will be determined through the SK EMR Program, the SK EMR Program Co Committee, and the SK EMR Maturity Advisory Group. Consideration to COACH s Canadian EMR Adoption and Maturity Model will be given in setting the program goals. National performance indicators and measurements for provincial comparison may be required. All goals will follow SMART guidelines and be specific, measurable, action oriented, realistic and timed. Examples of EMR maturity model program goals may include: 100% of EMR physicians at a Level 1 by 01 16 90% of EMR physicians at a Level by 016 17 80% of EMR physicians at a Level by 017 18 0% of EMR Physicians at a Level 4 by 017 18 10% of EMR Physicians at a Level by 017 18 90% of EMR physicians integrated with Saskatchewan Laboratory Results Repository (SLRR) 90% of EMR physicians using the electronic chronic disease management (CDM) flow sheets 90% of EMR physicians integrated with the Pharmaceutical Information Program (PIP) to EMRs Goals may also be based on progression from baseline, such as the following table: Page 4 of 10

0.EMR Program Maturity Model Strategy 014 1 01 16 016 17 017 18 Model, Production and baseline measure % improvement over baseline 1% improvement over last year s measure 10% improvement over last year s measure The timelines on Program Goals will be dependent on how quickly the Saskatchewan EMR Maturity Model moves into production. For comparison, OnatrioMD s Maturity model was years of development one year in concept (011) and one year in model (01). Model production began in 01. Physician EMR Dashboards An EMR dashboard provides a quick visual of specific data a physician want to see related to his or her practice management or patient population. Examples of dashboard indictors are unanswered tasks/messages, outstanding referral letters, labs under review, or a listing of all patients with Type 1 Diabetes who have not has an A1C test in the last six months. Individual physicians will set up these dashboard or goals with guidance and support by the EMR Program Change Advisor (CMA). The physician can choose which goals or dashboard indicators are most applicable to his or her practice, but mandatory provincial measurement may also be required. The CMA will work with the physicians and staff on achieving their goals. Dashboards have successfully been implemented in select practices in B.C. with physicians incorporating it into their daily practice and customizing it to make changes. In Saskatchewan, the dashboard feature currently exists within the TELUS Health Med Access EMRs and is being embraced by Med Access users. The dashboard does not however currently exist for QHR Technologies Accuro EMRs. Benchmarking for comparison will be a valuable compliment to individual physician goals. Benchmarking against the province or his or her specialty could provide relative comparisons and motivation to improve. Provider goals will also follow the SMART guidelines and measure both practice efficiency and integrated care. Examples of these may include: HSN recorded for 100% of patients by December 014 Patient Contact Information on 9% of patients by March 01 Prescription Writer use for 90% of patient June 01 Encounter Notes typed for 80% of patients October 01 Height / Weight recorded for 70% of patients January 01 Page of 10

0.EMR Program Maturity Model Strategy Smoking Status use for 80% of patients December 014 Learning Contracts A learning contract is a collaboratively written agreement between the EMR User (physician or staff) and the Change Advisor (CMA). The learning contracts will be the formal process to advance a user along the EMR maturity continuum and achieve the aforementioned Physician Dashboard Goals. It outlines specific EMR functionality and workflow gaps and provides a plan to close the gap. The nature of the agreement is that it collaborative and creates the ultimate buy in from the physician or staff. The physician or staff will feel a stake in EMR progress and feel a sense of ownership over their learning/training. The learning contract should be flexibility, but will generally contain five key features: 1. What EMR function or workflow will be learned. The methods and strategies that will be used to learn the function/workflow. The resources to be used in order to learn the content, such as online training, change advisor, or peer leader 4. The type of evidence that will be used to demonstrate learning. Specify how the evidence will be validated, and by whom An additional benefit of a learning contract is that it provides a maturity roadmap for each EMR user on the existing and potential EMR capabilities. The physician can easily identify Where I am Now in terms on their EMR capability and use and Where I want to be Next indicating what he or she would like to achieve in the next level of progress to full EMR use. The learning contracts will be iterative and a physician or staff member will typically use seven steps to achieving the next level of EMR use: 1. Become aware of the EMR maturity benefits. Assess his/her current EMR use. Identify gaps and opportunities for change 4. Set personalized goals. Implement improvement projects 6. Evaluate impact Page 6 of 10

0.EMR Program Maturity Model Strategy 7. Review and move to next assessment phase The most impactful learning will occur when the physician or staff can learn by doing in an informal atmosphere using a variety of learning methods. The training should be delivered in a layered approach, starting with basic first then adding exercises and practice applying the information. The following training / learning approaches are recommended: Individual or group sessions presented by the SK EMR Program or the EMR Vendor Online training videos, resources and tools hosted by the SK EMR Program or the EMR Vendor Access to ehealth Saskatchewan Peer Leaders to provide coaching EMR Use Assessment In order to assess a physician being at a specific level of maturity, full capability and applied functionality of a level must be evaluated. This can be evaluated either through a survey, where the data is gathered and reported on, or an objective backend data capture and automated reporting. The three principle ways EMR use can be measured: 1. Objective EMR Software Reporting. Created by the EMR Vendors, the EMR Program or a physician can conduct an automated assessment of current EMR use. Using defined data analysis indicators on the backend of the system, reports can be generated to identify which functionality is currently being used. This tool does not currently exist within Saskatchewan EMRs. Further analysis on requirements, costs, and speed to market would be required with both TELUS Health Med Access EMR and QHR Technologies Accuro EMRs.. Online Self Assessment. Using an EMR Progress Reporting (EPR) application, a physician can conduct a self assessment of their current EMR use. Physicians can use the application periodically to see how they have improved their knowledge over time and make a request to meet with a Change Advisor for one on one support. The tool is currently used by OntarioMD for their EMR maturity reporting. It is hosted as an application on their website that physicians log into to access. Physicians must complete this survey assessment as part of the terms and conditions on their EMR funding but is also available to physicians wishing to enhance their EMR performance.. Survey Self Assessment. Using an in house survey assessment, a physician would be sent a link to complete a self assessed survey. The survey would be distributed annually with results Page 7 of 10

0.EMR Program Maturity Model Strategy gathered and assessed. Aggregate results would be distributed to all and granular results would be distributed to each individual who responded. This tool is currently used by ehealth Saskatchewan with the Primary Health Care providers for their EMR maturity reporting. One survey has been administrated with a response rate of less than %. EMR Maturity Model Constraints Despite the demonstrated and emerging evidence about the benefits of EMRs, there are still considerable barriers to adoption, basic and maturing use. To build and execute a Saskatchewan EMR Program Maturity Model it will require dedicated resources, structure program materials, and considerable marketing. For the physician to embrace maturing EMR use, he or she will need to invest time, improve computer skills, and possibly make hardware investments to find the greatest efficiencies. Program Constraints Resourcing. Adequate budget and knowledgeable, skilled resources will be required to develop and execute the EMR maturity model. Additional people or training maybe required depending on the scope, delivery, and reinforcement methods decided. Rewards and Reinforcement. To affect lasting change in physician behaviour, a reward or reinforcement is required. Remuneration such as funding or bonuses for maturity achievement is recommended. Conversely, the removal of existing EMR Program funding could be implemented. Improved Support from EMR Vendors. Good working relationships currently exist between the EMR Program and both EMR Vendors. Additional collaboration and strong support will be required by both QHR Technologies Accuro EMR and TELUS Health Med Access EMR vendors. This collaboration will be especially important if objective software reporting is required. Additionally, training for EMR Program staff or direct to the physicians may be required. Physicians Constraints Financial. Clinicians will be concerned that any upgrades or further investments in EMR related products will yield a positive return. The benefits of undergoing the EMR maturity journey will need to outweigh the costs. Time. Not having enough time is the primary reasons stated for poor EMR usage. Notable, physicians do not see the benefits in taking time to find the patient's record, navigate to the input area of the electronic chart, type the note or click the prompts, edit, review, save and close. This frustration is especially prevalent among specialists. Page 8 of 10

0.EMR Program Maturity Model Strategy Readiness. If the office or staff do not have open communication or have recently undergone a significant change, the clinic will not be ready to undergo the EMR maturity journey. Readiness by the physicians or staff will need to be assessed prior to implement EMR maturity changes. Training and Engagement. In order for physician to be comfortable with their EMR maturity, training will be essential. The physicians needs to be well supported whether it be direct by the EMR vendor, their peers, or the EMR Program. Project Approach A structured, planned project management approach will be required to develop and execute the EMR Program maturity model successfully. The initiation of the maturity project would include the following primary project documents and planning: Project charter Scope statement Selected planning team Sponsorship plan Stakeholder assessment Defined deliverables and a work breakdown structure Schedule timeline and sequential plan of activities Resources estimates required for activities Time and cost estimates for activities Budget Risk management plan Once the planning components of the project have been established and the work begins, the project would transition into being monitored and controlled. The monitored and controlled phase will also have structure with regular status reports, distribution of information, managing stakeholder expectations, and creating awareness of the maturity model. Change Approach A structured, planned change management approach will also be required to develop and execute the EMR Program maturity model successfully. The below plans will support both individuals and the organization. This change management approach will not only apply to the project management, but also to the delivery of the model to Saskatchewan providers. At a high level, the change management approach should include: Maturity model benefits description Readiness assessment Communication plan Sponsorship roadmap Page 9 of 10

0.EMR Program Maturity Model Strategy Coaching plan Training plan Adoption measures and management Resistance management plan The development of materials will follow the Prosci Change Methodology, ADKAR (Awareness, Desire, Knowledge, Ability, and Reinforcement). ADKAR is an individual model, so it describes the change process from the perspective of one employee or one physician whose daily tasks is being changed as a result of the EMR maturity progression. Prosci tools to drive results by managing the people side of change will be utilized. The emphasis will focus on individual change management because of the reality that change ultimately happens one individual at a time. Page 10 of 10