growth of the iehr in canada: user adoption …...©canada health infoway 2016 growth of the iehr in...

©Canada Health Infoway 2016

Growth of the iEHR in Canada:

User Adoption Landscape and Benefits

Bobby Gheorghiu/Sukirtha Tharmalingam October 13, 2016

Thursday, October 13,2016

1:00PM ET


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• This webinar represents solely the views of Infoway

• It is intended to be informative only, and cannot be interpreted as providing any indication of Infoway’s present or future strategies or investment criteria

• Infoway does not implicitly or explicitly endorse any particular technology or solution of any vendor or any other person, it does not guarantee the reliability or any proposed results related to the use of such technology or solution, and this notwithstanding that reference may be made directly or indirectly to any such technology or solution in this webinar


Growth of the iEHR in Canada:

User Adoption Landscape

Bobby Gheorghiu October 13, 2016


Presentation Objectives

1. To explain the methodology behind Infoway’s adoption measures and to provide context for the reported data

2. To highlight users’ experience with iEHRs across the country and discuss the concept of a maturity model to demonstrate benefits over time

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Who and what is Infoway?

With our partners, Infoway helps accelerate the development, adoption and effective use of digital health solutions across Canada

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Since inception, $2.15 billion in capitalization from federal government

• $500 million: electronic health records (2001)

• $600 million: electronic health records and telehealth (2003)

• $100 million: health surveillance systems (2004)

• $400 million: electronic health records and wait time systems (2007)

• $500 million: EHRs, EMRs, consumer health (2010)

• $50 million: e-prescribing and telehomecare (2016)

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iEHR definition

• The interoperable Electronic Health Record is a secure, integrated view of a person’s medical records from all systems in the network; it provides a comprehensive view of a patient’s medical history

• Similar to a Health Information Exchange (HIE)

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©Canada Health Infoway 2016 10


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Availability

Use

Benefits

Current Types of Reporting

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iEHRs accessible in multiple settings with a rich set of data Jurisdiction Go-Live Setting Clinical Domain accessible

British Columbia 2010 Hospitals Labs, DI reports

Alberta 2006 Hospitals, pharmacies, primary care, ambulatory

Lab, DI reports, drug profile, immunization, allergies, clinical reports

Saskatchewan 2013 Hospitals, primary care labs, drug profile, DI reports, clinical reports, immunizations

Manitoba 2011 Hospitals, primary care Labs, DI reports, drug profile, immunization, clinical reports

Ontario 2011 Hospitals , primary care, community/home care

Labs, DI reports, drug profile*, allergies, clinical reports

Quebec 2013 Hospitals, primary care, pharmacies Labs, DI reports, drug profile, immunization

New Brunswick 2010 Hospitals Encounter History, labs, DI reports, cardiology

Prince Edward Island

2008 Hospitals, primary care Labs, DI reports, drug profile

Nova Scotia 2010 Hospitals, primary care Labs, DI reports, clinical reports

Newfoundland 2014 Hospitals Med Profile, allergies/ADEs, Clinical Reports, Discharge Summaries, labs, DI Reports

Northwest Territories

2010 Hospital, primary care Labs, DI reports, clinical reports, consults

Nunavut 2011 Selected hospitals Labs, DI reports, drug profile, clinical reports

*Limited to drug products dispensed under the Ontario Drug Benefit program and the Trillium Drug Program


Digitization of information for authorized users (June 30, 2016)

Client Demographics 100%

Provider Demographics 100%

Diagnostic Images in Hospitals

100%

Dispensed Drugs 69%

Lab Test Results 95%

Clinical Reports or Immunizations 100%

Digitization does not measure the extent of use by providers, but rather the information and systems that are in place.

2016

Telehealth Videoconferencing in 98% of Hospitals


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Availability

Use

Benefits


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Data Collection and Use Reporting

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• System data provided by jurisdictions

• Survey data: Infoway-funded as well as through external partnerships (e.g., NPS, Commonwealth Fund)

• Adoption Trends • Cumulative Benefits

External • Annual Report • Pan-Canadian Studies • International

comparisons Internal • Project tracking against

deliverables • Informs program

strategies

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Principles of Adoption/Use Reporting

Comprehensiveness

Simplicity

Reliability

Comparability

Coherence

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Active user concept

• Defined as access to two or more integrated provincial data assets (e.g., lab information system, drug information system, diagnostic imaging repository, etc.)

• Active users have accessed the system a minimum of one time per month (or three times per quarter)

• Users of point of care systems with data feeds from provincial assets are deemed to be active users of the EHR

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Other examples of active use

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Growth in active use of electronic health records


Active iEHR Use Across Canada (Jan. 2015)

Notes: 1. Figures represent active users with access to two or more integrated provincial data assets (e.g., lab information system,

drug information system, diagnostic imaging repository, etc.) 2. Active users have accessed the system a minimum of one time per month 3. This graph does not depict the number of users of individual data assets that are not integrated with other systems. 4. Users of point of care systems with data feeds from provincial assets are deemed to be active users of the EHR 20


Clinician access to iEHR

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53% of pharmacists can access an electronic list of all medications taken by an individual patient (accessible through a provincial/territorial drug information system)

44% of nurses have access to provincial/territorial patient information systems (e.g. drug, laboratory, diagnostic images)

37% of physicians have access to provincial/territorial patient information systems


Electronic health record user adoption landscape


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Availability

Use Benefits


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Our approach to evaluating the value of iEHRs

Evidence informed value proposition

Indicators and tools

Adoption monitoring, Project evaluations

Surveys and further research

Pan-Canadian study


Pan-Canadian Studies

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Estimated aggregate benefits of $16 billion since 2007


Conclusion: Value of measuring use/adoption

• Data collected allows for multi-year trending and monitoring of progress

• Enables target-driven approach for project reimbursement (gated funding)

– Clear correlation between projects and programs applying evidence-based targets and benchmarking and long-term success

– Effective lever for driving broad deployment and adoption

• Ensures critical mass of users as a foundation for continued development and innovation

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For more information

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http://www.biomedcentral.com/1472-6947/16/8


Growth of the iEHR in Canada: Benefits

Sukirtha Tharmalingam October 13, 2016

http://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-016-0330-3


Evaluating the value of iEHRs in Canada

• Available evidence to date largely focused on individual iEHR components

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Evaluating the value of iEHRs – US examples

• Examples emerging from the US on evaluating the value of Health Information Exchanges (HIEs)

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Approach to understanding iEHR Value

Consolidate evidence from iEHR evaluations across the country:

1. iEHR deployed for province/territory wide use

2. iEHR shared at least 2 or more core clinical data

3. Results available by December 2015

4. System and use survey administered to users based on National Benefit Evaluation Framework

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6 P/T evaluations available for

study


Synthesizing user survey data

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Survey questions from all 6

P/T evaluations

Extract common questions (used in 2 or more P/T evaluations)

21 questions

Survey Question Response Classification

Positive outcomes

>50% or more respondents reported a positive response/rating/experience

Negative outcomes >50% or more respondents reported a negative response/rating/experience

Mixed outcomes a mix of <50% or more respondents reported a positive or negative response/rating/experience


Profile of iEHR users studied

• 6 P/T evaluations conducted between 2006- 2014

• N=2,318 • Nurses/NP (33-51%)

• Physicians (12-49%)

• Administrative staff, allied health

• Variety of clinical settings: Hospital, primary, community

• At minimum users had access to lab results and diagnostic imaging

• Duration of iEHR use <1 year

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iEHR user perceptions

• System, Information, Service Quality

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3

19

7

1

1

1

1

Service Quality

Information Quality

System Quality

0 5 10 15 20 25

Number of outcomes measured from evaluations

Positive Mixed/Neutral Negative



• User Satisfaction

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13 1 1

0 5 10 15 20

UserSatisfaction





• Net Benefits

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14

15

3

2

1

1

0 5 10 15 20

Productivity

Quality




Summary of iEHR user perceptions

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14

13

19

3

7

2

3

1

1

1

1

1

1

1

1

0 5 10 15 20 25

Quality

Productivity

User Satisfaction

Information Quality

Service Quality

System Quality


Positive Mixed/Netural Negative

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Limitations

• Customization of surveys

• Sample sizes

• Response rates

• Equal weighting of all individual surveys

• 8 year study period

• Variation in care settings, jurisdictional context

• Solution attributes

• Deployment methods

• Additional user details

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• Maturity of benefits occur over time with concerted efforts in other areas:

• System and service quality are foundational to realizing benefits

iEHR Benefit Maturity

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Solution Capabilities

System Integration Challenges

Effective Change Management

• Leadership • Technical support and

training • Workflow integration


Next steps in iEHR Evaluation

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• Evidence on maturity of iEHR benefits

• Benefits realized in different clinical settings, specific patient populations

• Pan-Canadian benefits estimates from iEHRs

Deployment

• Limited benefits

Early

• Information availability

Medium-term

•Efficiencies

Long-term

• Impact on care


TO ASK QUESTIONS

All attendees have been muted. Please use the “Q&A” function to ask questions.


Thank you

growth of the iehr in canada: user adoption …...©canada health infoway 2016 growth of the iehr in...

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