electronic prescribing and virtual care in canada: update

©2021 Canada Health InfowayConfidential: For discussion purposes only

Page 1©2021 Canada Health InfowayConfidential: For discussion purposes only

Electronic Prescribing and Virtual Care in Canada: Update on Trends and

Developments

Presented to: Pharmacists’ Association of Newfoundland and Labrador Conference

Presented by: Sandra Aylward, Senior Advisor, Regulatory Affairs, Canada East, PrescribeIT®Colleen Rogers, Engagement Director, Atlantic, PrescribeIT®Jason Ryan, Pharmacist, Bonavista PharmaChoice

Date: October 28, 2021


This program session is sponsored by a contribution from Canada Health Infoway

The following speakers are employees of Canada Health Infoway:• Sandra Aylward, Senior Advisor, Regulatory Affairs, Canada East, PrescribeIT®

• Colleen Rogers, Engagement Director, Atlantic, PrescribeIT®

Disclosure


Canada Health Infoway

• Established in 2001

• Independent, not-for-profit corporation

• Equally accountable to 14 federal, provincial and territorial governments, through the Members (f/p/t Deputy Ministers of Health)

• Independent Board of Directors appointed by the Members


After completing this learning activity, participants will be able to:

• Identify recent and ongoing changes to the delivery of health care in Canada

• Describe recent developments and provincial and national trends in the use of virtual care

• Describe the functional elements of the PrescribeIT®️ electronic prescribing service, and how it integrates with virtual care

• Understand how electronic prescribing is being used in the NL community pharmacy setting

Learning Objective


Infoway is focused on virtual care

5

Canada Health Infoway’s vision is to improve Canadians’ access to health information, digital services and tools, and provider communications


2021 National Survey of Canadian Physicians

Specific objectives of the study were to assess:

VIRTUAL CARE

• Current use, perceptions, and experiences with virtual care (specifically telephone, secure email/messaging video remote monitoring

• Challenges and barriers to use

• Anticipated use of virtual care post pandemic

ELECTRONIC TOOLS / FUNCTIONALITIES

• Use of EMR and identifying vendor

• Use of electronic tools in the care of patients

• Use of electronic communication between providers

• Methods of generating new prescriptions

The 2021 National Survey of Canadian Physicians, conducted

by Canada Health Infoway (Infoway) and the Canadian Medical Association (CMA),

aims to better understand the use of digital health information technology among physicians in

Canada.

https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/benefits-evaluation/3935-2021-national-survey-of-canadian-physicians


Infoway Insights: Custom queries and data visualizations

7LL

https://insights.Infoway-inforoute.ca

Sources Highlighted in this Presentation: Canadian Digital Health Survey, Canada Health Infoway & Léger, 2020 & 2021

https://insights.infoway-inforoute.ca/


Video and secure messaging visits in primary care increased by an estimated 270% during 2020

8

Source: Calculated from the 2020 Canadian Digital Health Survey, Canada Health Infoway & Léger

~ 6 million

~ 22 million


Do you use electronic medical records (EMR) to enter and retrieve clinical patient notes in the care of your patients? Base: Total physicians (n=2,071)

% USE EMR

87%

SPECIALTY REGION

GP(1,040)

Spec.(1,057)

ATL(184)

QC(160)

ON(667)

MB(114)

SK(74)

AB(370)

BC(493)

93% 80% 74% 75% 90% 84% 95% 89% 89%(2017: 82%)

EMR Use Continues to Increase

Source: National Survey of Canadian Physicians, CMA and Canada Health Infoway, 2021


Virtual Care Use Among Physicians


• High use of virtual care: 93% telephone, 51% video, 36% email/messaging

• In-person visits remain prevalent as the most common consult with physicians (49%)

• Satisfaction higher for telephone/video (7 out of 10) compared to email/messaging (50%)

• 96% will continue to use virtual care after the pandemic (64% will maintain or increase their use)

• 84% say virtual care improves patients’ access to care

• 7 in 10 say virtual care enables quality and efficient care for patients

• Challenges ahead: virtual examinations, specific patients/communities, patient preferences, balancing in-person visits, workflow, technology, interoperability, remuneration, licensure


In your practice, are you currently providing patient care through any of the following virtual means? Base: Total physicians (n=2,071)

93

51

36

75

32

18

0

10

20

30

40

50

60

70

80

90

100

Telephone Video Secure email/message

% P

hys

icia

ns

2021

2020

Over 9 in 10 Physicians use virtual care



Half of patient visits are currently in-person

39

10

2

49

0

10

20

30

40

50

60

70

80

90

100

Telephone Video Secure email/message In-person

Ave

rage

% p

atie

nt

visi

ts

Please estimate what proportion of your patient visits are currently delivered through the following means. Base: Total physicians (n=2,071)



Virtual Care with e-Prescribing

Integrated Virtual Care Solutions:

• A better patient experience with patients seeing their own doctor;

• An end-to-end solution from virtual patient consultation to electronic prescription;

• Confidence that the solution ensures patient privacy and security of information; and

• A better clinician experience with a choice of one-stop solutions to provide patient care

Over the past 18 months there has been a shift towards virtual care, along with a heightened appreciation for digital prescribing


Virtual care most useful

when needing a

prescription renewal

Preferred Modality for Various Health Care Encounters

Base: Total respondents (n=12,052)32. Please indicate your preferred visit modality for the following circumstances.Data Source: Canadian Digital Health Survey 2021: What Canadians Think

15%

29%

43%

50%

63%

74%

87%

55%

43%

38%

28%

17%

15%

6%

6%

19%

14%

12%

14%

8%

5%

24%

9%

5%

11%

6%

3%

2%

In-person Phone call Video Other type*

Annual examinations

Routine examination and screening

Mental health

Sexual health / contraception counselling

Follow-up of a health problem

A minor health problem like coughs and colds

Prescription renewal

*Examples for other type of visit includes text, secure message, and email


Demand and use of digital health services

Making

prescribing

more virtual

is a priority

for

Canadians

82%

79%

76%

75%

74%

74%

69%

68%

67%

60%

58%

57%

56%

51%

47%

40%

48%

32%

62%

19%

31%

19%

45%

12%

10%

24%

17%

12%

17%

10%

6%

5%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Have a prescription sent directly to your pharmacy by your physician without receiving a paper prescription

Access your own personal health information electronically

Make a COVID-19 vaccine appointment online or on the telephone

Send a request electronically for a prescription renewal

Receive electronic reminders, notifications or alerts from any of your health care providers or places of care

Make an appointment with your regular doctor or place of care electronically

Have a telephone consultation with a healthcare provider

Access to clinical notes associated with a medical encounter either with a primary health provider or specialist provider

View an electronic version of your referral to a specialist sent by your regular doctor to a specialist

Access websites to perform online self-assessments

Access websites or use mobile apps on a smartphone or digital tablet to help you monitor certain aspects of your health or well-being

Consult with an HCP about a specific health issue or concern either by e-mail or electronic text-SMS message or online chat

Visit with your health care provider virtually online by video

Access websites, mobile applications (apps) or interactive online tools and services to help or support you with mental health issues

Take part in a remote patient monitoring / telehomecare program using a device to manage a chronic health condition from your home and electronically transmit the results to a healthcare provider so that they can

monitor your progressTake part in a remote patient monitoring / telehomecare program using a device to manage symptoms

related to COVID-19

Base: Total respondents (n=12,052)14. Are you interested in having access to this electronically-enabled health service, whether you currently have access or not?15. Have you ever accessed this electronically-enabled health service at anytime in the past?Data Source: Canadian Digital Health Survey 2021: What Canadians Think

Interested

Ever Used


Newfoundland and Labrador Insights

16LLL


Choosing a pharmacy

Most Newfoundlanders

have a home pharmacy

0%

2%

6%

8%

10%

87%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Other reasons

My doctor or other care provider tells me whichpharmacy to pick up the prescription

Whichever pharmacy offers the most affordabledispensing fee

There is only one pharmacy in my community so I go tothat one

Whichever pharmacy is most convenient to my location

I fill most of prescriptions at my regular pharmacy

Q: When you obtain a prescription, how do you decide which pharmacy to go to?

Base sample (unweighted) = 148Source: Canadian Digital Health Survey, Canada Health Infoway & Léger, 2020


Outcome of the most recent virtual visit

What was the outcome of the

most recent virtual visit?

1%

2%

4%

4%

6%

8%

8%

10%

24%

24%

25%

50%

0% 10% 20% 30% 40% 50% 60%

Advice to call 911 or visit ED immediately

Other

Advice to make an in-person visit with a family doctor/GP

New diagnosis

Advice to make an in-person visit with a pharmacist

A referral for an allied health in-person visit

Advice/information on mental health condition

A referral for an in-person visit with a specialist

A new lab or diagnotic test ordered

A new prescription

Advice/information on the initial medical issue

A prescription renewal



Choosing virtual visits over in-person visits

Under what circumstances would you use

virtual visits instead of an in-

person visit?

8%

0%

1%

2%

11%

16%

17%

26%

26%

32%

43%

77%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Don't know

None

Other

Pregnancy follow-up

Annual examination

A new health problem

Many health issues to discuss

For counseling / therapy session

Routine examination

An urgent but minor health problem

Follow up of a health problem

A prescription renewal



PrescribeIT®: Newfoundland and Labrador

20LLL


What is e-Prescribing?

e-Prescribing is the secure electronic creation and transmission of aprescription between an authorized prescriber and a patient’s pharmacy of choice, using clinical Point of Service (POS) solution, in a manner which integrates clinical workflow and software.

Canadian Medical AssociationCanadian Pharmacists AssociationJoint e-Prescribing Statement2012


• Prescriptions will initially be sent from community prescribers to community pharmacies, with integration into EMRs and Pharmacy Management Systems

• The scope of the service includes all prescriptions, including narcotics and controlled drugs (excludes TRPP in NL)

• Prescribers are authenticated using two-factor authentication before sending a prescription

PrescribeIT® Scope (Current)

Create Rx The prescriber creates a net new prescription

Renew Rx Request

When a prescription runs out of refills, the pharmacist can send a renewal request to the prescriber and if approved, the prescriber sends back a new prescription

Rx StatusThe prescriber will be able to see if their prescription has been dispensed or

the dispense has been cancelled

Public Drug Formulary

Prescribers will have integrated access to public drug formularies to ensure drug coverage in advance of prescribing

Clinical Communication

Secure messaging functionality between prescribers and pharmacies supports improved collaboration


As of 2021-10-06

MOU in place

NL PrescribeIT® Current Status

NEW

NEW

NEW

Newfoundland & Labrador

• 4th jurisdiction to launch PrescribeIT® in December 2019• Phase 1 Complete. 2 communities: 7 live prescribers; 1 live pharmacy• Positive 30-day and 90-day NL PrescribeIT® evaluation results from

Phase 1• Key PMS (Kroll) and EMR (Med Access) vendors conformed to

PrescribeIT®• Current PrescribeIT® pharmacy organizations partners represent

approximately 70% of pharmacies in NL• Funding agreement in place between NLCHI and Infoway to support

PrescribeIT training and deployment to eDOCSNL users. • Phase 2 Deployment dependent upon amendment to the Medical

Act


Patients

• Less risk of losing prescriptions *ʸ

• Increased satisfaction and convenience (e.g. reduced # of trips to pharmacy)*

• Safer prescriptions through reduction in transcription errors *ʸ¹

Prescribers

• Reduced errors*¹

• Better continuity of care due to reduced paperwork and ability to access prescribing functions, manage clinical communications & renewals, and transmit prescriptions remotely through EMR*¹

• More secure prescribing through direct transmission to the pharmacy*¹

• Improved communication with the pharmacy*¹

Pharmacists

• Improved accuracy of prescriptions received ʸ

• Improved interactions with prescribers through clinical communications ˣʸ°¹

• Efficiency gains processing prescriptions and renewals ˣʸ°

• Reduced lost and stolen prescriptions ʸ

• Supports remote care and reduced handling of paper prescriptions in pharmacy°N

L R

ep

ort

ed

Be

nef

its

Sources: * Prescribers 30 Day review / Dr. Magrabi CBC interview; ˣ Pharmacy 30 Day review; ʸ Pharmacy Survey (NL);° Pharmacy 90 Day Review; ¹Prescriber 90 Day review


✓ Increased convenience and efficiency:

• Prescription information is pre-populated in the system – just the instructions need to be typed

• Improved and more timely communication with prescribers to resolve questions and issues using the clinical communication feature

• Don’t have to waste time rummaging through a pile of faxes for a specific prescription –it is in the queue in the PMS

• Prescribers are able to work remotely from different locations and maintain communication with the Pharmacy

• Future considerations:

• There is not currently a notification feature for communications from prescribers so you have to look for it

• Education of patients - while prescriptions are sent immediately they are not prepared immediately

• Prescribers - Improved EMR medication module use and data quality

PrescribeIT® Experience in Bonavista

Electronic prescribing has been available Since December 2019 at the Bonavista PharmaChoice

Approximately 80% of all prescriptions received at the pharmacy are now electronic through PrescribeIT®


• Electronic prescribing is a key element of virtual care that can deliver value in the community pharmacy practice setting

• While there is currently a gap between the demand for virtual health care services, and the availability, Canada Health Infoway is anticipating continued growth in the Virtual Care Program and PrescribeIT® to address the gap

Conclusions


Question & Answer


Want to learn more?

Visit PrescribeIT.ca

Twitter @PrescribeIT_CA

Ask a Peerhttps://prescribeit.ca/ask-a-peer

Let’s Connect on LinkedInCanada Health Infoway


2021 National Survey of Canadian Physicians Methodology

©2021 Canada Health Infoway

Data collection took place from April 29th to May 25th, 2021.

Using CMA membership data, weighting was applied according to specialty, region, age, and gender in order to render a representative sample of the CMA member population. Sample base sizes indicated are unweighted. A margin of error cannot be associated with a non-probability sample in a panel survey. For comparison purposes, a probability sample of this size would have a margin of error ±2.12%, 19 times out of 20.

10-minute web survey of 2,071 physicians practicing in Canada who are members of CMA, including 1,000 GP/FMs, 973 specialists, and 98 residents.

The survey was made available in both English and French.


The Digital Health Surveys of Canadians are based on a variety of specific system utilization and attitudinal tracking metrics used in previous years as well as new areas of inquiry. The surveys include core tracking questions as well as new questions that will provide actionable insights to help advance the digital health landscape in Canada.

The 2020 Canadian Digital Health Survey was conducted by Leger with 6,002 Canadians over the age of 16, selected from LEO’s (Leger Opinion) representative panel. Data collection took place between August 13 to 31, 2020, via Computer-Assisted Web Interviewing technology (CAWI). Using 2016 census reference variables, the Canadian data was then analyzed and weighted by Leger statisticians according to region, gender, and age, in order to render a representative sample of the general population.

The LEO (Leger Opinion) panel is the largest Canadian panel with over 400,000 representative panelists from all regions of Canada. LEO was created by Leger based on a representative Canadian sample of Canadian citizens with Internet access. Leo's panelists were randomly selected (RDD), panelists from more hard-to-reach target groups were also added to the panel through targeted recruitment campaigns.

* Note that all sample sizes shown throughout the report are unweighted, some responses may not add up to 100% due to rounding.

Digital Health Survey of Canadians

electronic prescribing and virtual care in canada: update

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