ibm healthcare roadshow eithne reichert, rn, mn, pmp president, rwi informatics informatics...
TRANSCRIPT
IBM Healthcare RoadshowEithne Reichert , RN, MN, PMP
President, RWI Informatics
Informatics Consultant,
Saskatchewan, Canada
Email: [email protected]
Lorraine Fernandes, RHIA
Global Healthcare Ambassador
IBM Software Group
San Francisco,, USA
Email: [email protected]
© 2009 IBM Corporation
Building a smarter planet
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Agenda
Australian Health Reform – Challenges and Opportunities Comparison to Canadian approach for national EHR services Starting on the Path – Building Blocks
–Technical & Business Architecture & Standards– Identification requirements to support Integration of Records –The Canadian experiences and lessons learned
Continuing on the Path –Access to More Information, Chronic Disease Management,
Integration to Point of Service–Opportunities for future
Questions / Discussion
© 2009 IBM Corporation
Building a smarter planet
3
Global Health Care State: Inefficiencies from Fragmented Data
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A unified view of patients & providers A unified view of patients & providers improves processes & increases efficienciesimproves processes & increases efficienciesA unified view of patients & providers A unified view of patients & providers improves processes & increases efficienciesimproves processes & increases efficiencies
Patient
Healthcare
Data
Patient
Symptoms
Treatment
Records
Family
History
Admission
History
Exam
Records
Prescription
History
Ambulatory
Data
Clinicians
…re-entering patient demographic
information is time consuming
& error prone
Health information
systems unable
to recognise
clinicians…multiple sources &
contact information is
outdated
…communication is not
timely
or consistent
as a result
Costs continue
to increase…simply implementing new
systems does not solve
the problem
System adoption
is slow…clinicians continue to ‘hunt
& peck’ for information,
waste 20-40% of their time
… lack of complete information
affects decision making,
treatment & outcomes
Registration systems
are not connectedClinicians don't
have access
to all information
© 2009 IBM Corporation
Building a smarter planet
Australia
The future health system is to be powered by the smart use of data and
enabled by the electronic flow of essential information between individuals and the health professionals from whom they seek care and advice. There should be a passionate commitment to measure and improve health and performance outcomes. PCEHR is the core infrastructure element to enable the quick and seamless exchange of patient-controlled, high priority healthcare information.
Canada
A high quality, sustainable and effective Canadian health care system supported by an infrastructure that provides residents of Canada and their health care providers timely, appropriate and secure access to the right information when and where they enter into the health care system. Respect for privacy is fundamental to this vision.
Strategies are similar
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© 2009 IBM Corporation
Building a smarter planet
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How Does Canada & Australia Compare?
CanadaCanada AustraliaAustraliaYear Started 2001 2005 when NEHTA formed
Priorities Common architecture and core services
Foundation infrastructure. Health Identifier, Standards and Snomed
Privacy Provincial and Federal Privacy commissioners with well established policy
Currently no privacy bill for PCEHR. Health Identifier has clauses to prevent privacy commissions prior to PCEHR
Architecture Defined with HIAL, standards To be defined by NEHTA and finalised with PCEHR at a national level. High level architecture released. State level – working on architecture
Certification Started in 2010 Certification for accessing Health Identifier
Funding $CAN 1.6B to date flow through to Provinces and Projects
$467 Million over 2 years for PCEHRNational infrastructure and Community based infrastructure has been funded. No funding at state levels to date.
Outcomes Clinical adoption and outcomes impact now being addressed
Citizens and Providers have a Health Identifier. National Authentication Service and Snomed available. Adoption levels currently low
Weaknesses Later emphasis on adoption and impact on clinical outcomes.
Slow movement towards eHealth – 6 years building. Lack of roadmap to achieve integration.
© 2009 IBM Corporation
Building a smarter planet
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Canada – Health Care Governance
Source: Canada Health Infoway
• Health care is delivered locally by health authorities (multiple hospitals) and community physicians and providers
• Health care is mostly funded by each province (state) to the delivery organisations
• Standards & directions are developed nationally. EHR projects funded nationally if fit within the standards and directions
© 2009 IBM Corporation
Building a smarter planet
7
Linking Information across Jurisdictions implementations
Source: Canada Health Infoway
Architecture allows some variability in implementation
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR ViewerEHR ViewerPoint of ServicePoint of Service
ApplicationApplication
Point of ServicePoint of Service
ApplicationApplication
HealthHealth
InformationInformation
DataData
WarehouseWarehouse
EHREHR
Data &Data &
ServicesServices
AncillaryAncillary
Data &Data &
ServicesServices
RegistriesRegistries
Data &Data &
ServicesServices
Longitudinal Record ServicesLongitudinal Record ServicesEHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR ViewerEHR ViewerPoint of ServicePoint of Service
ApplicationApplication
HealthHealth
InformationInformation
DataData
WarehouseWarehouse
EHREHR
Data &Data &
ServicesServices
AncillaryAncillary
Data &Data &
ServicesServices
RegistriesRegistries
Data &Data &
ServicesServices
Longitudinal Record ServicesLongitudinal Record Services
Health Information Access LayerHealth Information Access Layer
Diagnostic
Hospital
Emergency
Specialist
Clinic
Homecare
Clients / PatientsClients / Patients
Community Care
Center
Emergency
Services
Pharmacy
Laboratory
Health Information Access LayerHealth Information Access Layer
Diagnostic
Hospital
Emergency
Specialist
Clinic
Homecare
Clients / PatientsClients / Patients
Community Care
Center
Emergency
Services
Pharmacy
Laboratory
© 2009 IBM Corporation
Building a smarter planet
Starting on the Path
The Building Blocks:
Identification of Clients, Providers
Drugs
Labs
DI Images
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© 2009 IBM Corporation
Building a smarter planet
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Connecting Information - Unified Patient Record for the PCEHR
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Local Care Centre
Social Services General Practitioner
Urgent Care
Hospital
PharmacyDiagnostics
Record Locator Service / EMPI / Patient Registry
Local Care Centre
First:
Last:
City/Cntry:
Treatment:
Visit:
Colm
Heaney
London, Eng
Arthroscopy
CCR
08/2008
Social Services
First:
Last:
City/Cntry:
Treatment:
Visit:
Colum
Heaney
Manchester, Eng
Immunization
Records
05/1980
General Practitioner
First:
Last:
City/Cntry:
Treatment:
Visit:
Colm
Heaney
Manchester, Eng
History &
Physical
09/1987
Urgent Care
First:
Last:
City/Cntry:
Treatment:
Visit:
Coln
Heany
London, Eng
Penicillin
Allergy
11/1997
Hospital
First:
Last:
City/Cntry:
Treatment:
Visit:
Colm
Heaney
London, Eng
Myocardial
Infarction
04/2008
Diagnostics
First:
Last:
City/State:
Treatment:
Visit:
Colm
Heanie
London, Eng
CT Scan
04/2008
Mental Health
First:
Last:
City/Cntry:
Outcome:
Visit:
Colum
Heaney
Manchester, Eng
Disability
Approval
06/2008
Pharmacy
First:
Last:
City/Cntry:
Prescription:
Visit:
Coln
Heany
Manchester, Eng
Coumadin 2mg
04/2008
Mental Health
Health Record
08/2008
06/2008
04/2008
04/2008
04/2008
11/1997
09/1997
05/1980
Colm Heaney
Colum Heaney
Colm Heanie
Colm Heany
Colm Heaney
Colm Heany
Colm Heaney
Colum Heaney
Arthroscopy CCR
Disability Approval
CT Scan
Coumadin 2mg
Myocardial Infarction
Penicillin Allergy
History & Physical
DTaP, IPV, PCV, Rota
Name: Colm Heaney City/Country: London, Eng
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Visit Date: Name: Treatment / Prescription: Consent:
© 2009 IBM Corporation
Building a smarter planet
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Sole reliance on National or State Identifiers needs to be considered….
Unique Health Identifiers don’t provide total solution Governance considerations are significant Human and business processes can affect capture and use Implementation and back-porting to legacy records costs are high Identifiers easily associated with personally identifiable health information provides
increased opportunity for privacy breaches
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Accuracy using a UHI alone Accuracy using a UHI alone is insufficientis insufficient to meet to meet identification requirementsidentification requirements
Accuracy using a UHI alone Accuracy using a UHI alone is insufficientis insufficient to meet to meet identification requirementsidentification requirements
© 2009 IBM Corporation
Building a smarter planet
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How It Works…
Source: Canada Health Infoway
POINT OF SERVICE
Ancillary DataAncillary Data
& Services& Services
Registries DataRegistries Data
& Services& Services
EHR DataEHR Data
& Services& Services
DataData
WarehouseWarehouse
OutbreakOutbreak
ManagementManagement
PHSPHS
ReportingReporting
SharedShared
Health RecordHealth Record
DrugDrug
InformationInformation
DiagnosticDiagnostic
ImagingImagingLaboratoryLaboratory
HealthHealth
InformationInformation
Hospital, LTC,Hospital, LTC,
CCC, EPRCCC, EPR
PhysicianPhysician
Office EMR Office EMR EHR ViewerEHR Viewer
Physician/
Provider
BusinessBusiness
RulesRules
EHREHR
IndexIndex
MessageMessage
StructuresStructures
NormalizationNormalization
RulesRules
Security MgmtSecurity Mgmt
DataDataPrivacy DataPrivacy Data ConfigurationConfiguration
Physician/
Provider
Physician/
Provider
Lab SystemLab System
(LIS)(LIS)
Lab Clinician
RadiologyRadiology
CenterCenter
PACS/RISPACS/RIS
Radiologist
PharmacyPharmacy
SystemSystem
Pharmacist
Public HealthPublic Health
ServicesServices
Public Health
Provider
Longitudinal Record ServicesLongitudinal Record Services
HIALHIALCommon ServicesCommon Services
ProviderProvider
RegistryRegistry
LocationLocation
RegistryRegistry
TerminologyTerminology
RegistryRegistry
ClientClient
RegistryRegistry
I need to know what
information is available for
Mr. R. Smith as he is a new
patient referred to me
Drug ProfileVisit History
Laboratory Diagnostic Imaging
Patient Info End-User Info
Clinical View
© 2009 IBM Corporation
Building a smarter planet
14
Use of the EHR Identification Registries Across Canada
Eight out of nine larger provinces using IBM® Initiate® Patient as the provincial EMPI/Client Registry
–Smaller provinces and territories using clinical systems Two provinces also using IBM® Initiate® Provider
as the provider registry–Nova Scotia, Alberta
Six of eight provinces actively integratingEHR with client registry for real timepatient identification
Four of eight provinces integrate clientregistry with Provincial PACS
Five of eight provinces integrate client registry with provincial Lab results
© 2009 IBM Corporation
Building a smarter planet
British Columbia: The First Implementation…
British Columbia is the westernmost of Canada's provinces
Health services primarily delivered through six integrated networkscalled regional health authorities
Ethnically diverse population with significant Asian and Aboriginal citizens
2009 estimatedpopulation 4,420,000
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© 2009 IBM Corporation
Building a smarter planet
Current status of British Columbia: IBM® Initiate® Patient
Links patient identity data from multiple sources–3 regional health authorities and the Ministry’s legacy Client Registry
System using HL7 v3.0 message– Includes 6 contributing sources and 8 million unique person records
Enables data quality remediation–Manage linkages and duplicates across 12 million individual
source records–Manages EHR IDs and changes across receiving systems
Multiple integration points–Source of identity authentication for lab results contributed by two
Health Authorities to the Provincial lab information system
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© 2009 IBM Corporation
Building a smarter planet
Saskatchewan:
Home of publicly funded universal health care:Province funds 90%of health care services
Health services primarily delivered through 11 integrated networks called regional health authorities
Multiple ethnic origins: English, Irish, French, German, Ukrainian, Russian, Middle Eastern, Oriental,and significant Aboriginal population
Many communities borderingAlberta and Manitoba
2009 population 985,000
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© 2009 IBM Corporation
Building a smarter planet
Current status of SCI: IBM® Initiate® Patient
Links patient identity data from multiple sources–11 regional health authorities, the Saskatchewan Cancer Agency,
the provincial insurance registry – Includes 80 facilities and 2.3 million unique person records
Enables data quality remediation–Manage linkages and duplicates across 5 million individual
source records–Manages EHR IDs and changes across receiving systems
Multiple integration points–Source of identity authentication for provincial PACS,
lab results, and drug repositories–Future integration with public health surveillance
and document repository
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© 2009 IBM Corporation
Building a smarter planet
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How IBM® Initiate® Patient Helped AddressClient Identification Challenges Very good algorithm tweaked to your specific demographics Excellent recognition of duplicates – even hard to find ones Consistent data linkage matching across sources Ability to query at point of service against all records System recognises manual review & intervention when required as
higher authority Ability to be flexible in the configuration settings and business
requirements to manage sources uniquely Application is easy to use, easy to train users
Manual ReviewLowestPossibleScore
LowestPossibleScore
HighestPossibleScore
HighestPossibleScore
Don’tLinkDon’tLink
LinkLink
LowestThreshold
UpperThreshold
Should be Linked
Should not be Linked
© 2009 IBM Corporation
Building a smarter planet
Benefits of client & provider identification for EHR services
Building block for EHR communication Better identification through improved search and verification from
different sources and consuming systems Better understanding of health care recipients & referral patterns
between sources Improved health record - both paper & electronic Better duplicate identification & less duplicate creation Information more accurate and comprehensive in real time Assistance with management of paper health records
and outcome measurement
An EHR starts with a An EHR starts with a solid foundationsolid foundation for patient identification for patient identificationAn EHR starts with a An EHR starts with a solid foundationsolid foundation for patient identification for patient identification
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© 2009 IBM Corporation
Building a smarter planet
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Challenges for projects and programs
Technical Technical ChallengesChallenges
Organisational Organisational ChallengesChallenges
• Data quality & integrity is affected by processes
• Differences in collection & use of records within and across sources
• Data quality role(s) within the organisation is lacking
• Privacy is an issue when sharing data - how much, whom to share, for how long
• Best practices & processes need to be confirmed regardless of standards
• Clinical use of data may be different than departments who send data
Business Process Business Process ChallengesChallenges
• Hard to influence changein other organisations and other people
• Stakeholders may have to ‘choose’ to participate
• Politics, opinions andvision issues
• Requires large & diverse. working groups
• Stakeholders are busy and involved in other needs
• Who was going to managethe combined data?
• It seems to be so hard – how can we make it easier/ quicker?
• Older systems, limited money for replacements
• Each hospital & office may be managed independently
• Common practice may not be used across organisations doing the same thing
• ‘Integration’ knowledge &experience is limited
• Limited interoperability platforms established
• Network, firewalls, infrastructure connectivity issues
© 2009 IBM Corporation
Building a smarter planet
23
Building an EHR: Lessons Learned
Need to understand business processes that generate datain messages so integration rules need context
Integration knowledge& experience is evolving
Need to work through and with standards & solutions
Technically integrated environments need comprehensive testing
Interoperability between systems has an overhead, regardless
No single solution is going to fit all needs, technology cannot mandate business process
BusinessBusiness Privacy concerns require
education & discussion Sensitivity with diagnostic &
health data, in particular with mental health and infectious diseases
Real data is often requiredfor testing and trainingto manage decision-making on configuration
Best practice & data standards help stakeholder understanding of accountabilities and risks
Need for people who know – health info professionals, knowledge leaders
TechnicalTechnical
© 2009 IBM Corporation
Building a smarter planetImplementation timeframes can be fairly quick….
JUNE
2004 2005
JULY AUG SEPT OCT NOV DEC JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC JAN
Phase IPhase I Phase IPhase I
Phase IIPhase II Phase IIPhase II
Phase IIIPhase III PIIIPIII PIIIPIII
Phase IV
Scoping & PlanningScoping & Planning Funding
Approval
Funding
Approval
Data
Analytics
Data
Analytics
Requirements/
Specifications
Requirements/
Specifications
ImplementationImplementation
Data
Quality
Message
Testing
Production +
GO
LIVE
GO
LIVE
2006
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© 2009 IBM Corporation
Building a smarter planet
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Know the business….
Shared Information / Shared Accountability for Quality in the EHR
• Know what you are wanting to do:
– Clinical quality and patient safety may be different than financial
– Support the business needs of source systems
– Understand the business processes that may affect shared data
– Understand issues and plan for data governance program
– Align the fit with community EMRs and hospital systems needs
– Consider the future:
– EHR identification to the clinical strategies, PACS, Lab, & Drugs, chronic disease, patient information
– Understand the downstream use of data sent
© 2009 IBM Corporation
Building a smarter planet
Understand the Data Use and Reuse – Data Governance Downstream
OriginalID Data
Lab
Client Registry
EMR
Referral
Portal
Drugs
Consent
Error - Patient presents sister’s health card
Information shared broadly and instantly
Need to Audit data back to a specific point of time
Need consistent validation & correction
PACS
© 2009 IBM Corporation
Building a smarter planet
Evolving Standards
Data & Message Standards provide a roadmap for implementation
Data integration quality is more than messaging; Business process is key to quality Continued work for integration and data quality of combined
record Implementation projects can challenge & evolve the standards Accountability is imperative for data quality in the PCEHR
Small steps can go a long way! Start on the path……
© 2009 IBM Corporation
Building a smarter planet
28
Implementation Words of Wisdom…
Never underestimateNever underestimate the importance of the importance of data quality at the data quality at the foundation of your foundation of your EHR initiativesEHR initiatives
Never underestimateNever underestimate the importance of the importance of data quality at the data quality at the foundation of your foundation of your EHR initiativesEHR initiatives
Understand Understand downstream impactsdownstream impactsof data use & re-useof data use & re-use
Understand Understand downstream impactsdownstream impactsof data use & re-useof data use & re-use
Allow adequate timeAllow adequate time & resources to & resources to address governance address governance & accountability& accountability
Allow adequate timeAllow adequate time & resources to & resources to address governance address governance & accountability& accountability
Understand Understand impact of impact of patient & provider patient & provider misidentification for misidentification for shared datashared data
Understand Understand impact of impact of patient & provider patient & provider misidentification for misidentification for shared datashared data
© 2009 IBM Corporation
Building a smarter planet
So where to Next?
Opportunities and Future Directions
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© 2009 IBM Corporation
Building a smarter planetCollaborate: Client Care Team & Communities of Practice -
Source – Primary Health Care Project
NurseNurse
EducatorEducatorPharmacistPharmacist
SpecialistSpecialistPhysicianPhysician
TherapistTherapist
Nurse Nurse PractitionerPractitioner
ProgramProgram
Client & FamilyClient & Family
© 2009 IBM Corporation
Building a smarter planetIntegrate: Tele-HealthTele-Consultation, Tele-Home Care, Tele-Triage
© 2009 IBM Corporation
Building a smarter planet
Create Access: Patient Portals - What Canadians Say: Functions Most Likely to Use
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Source: Canada Health Infoway
© 2009 IBM Corporation
Building a smarter planet
Launch Public Awareness Campaign
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Source: Canada Health Infoway
© 2009 IBM Corporation
Building a smarter planet
35
Start somewhere and get going…..it is a longer path than you may imagine…..
Questions /Comments???