Leveraging the EMR to Improve Patient Quality, Safety, and Outcomes: Lessons from Canada’s First HIMSS Davies Enterprise Award Winner

Sanaz Riahi, Director, Practice, Clinical Information & Adolescent Services Wendy Odell, Manager, Clinical Information Dr. Ilan Fischler, Psychiatrist, GNP Program & Medical Director, Clinical Informatics

Presentation Overview

• Discuss system overview and pervasiveness of use • Review clinical decision support strategies and governance structure

sustaining and optimizing health information system

• Review examples of clinical case studies and related benefit realization

• Discuss strategies to further advance service user engagement

• Review lessons learned and future steps

Ontario Shores at a Glance

• Teaching hospital specializing in comprehensive mental health care and addiction services

• 1,300 employees; 326 inpatient beds; over 60,000 outpatient visits • Provide Recovery-oriented care to a wide range of services: Adolescents to Geriatrics • Meditech 6.0 and EMRAM HIMSS Stage 7 – first in Canada and first mental health

facility in the world • 2015 recipient of HIMSS Nicholas E. Davies Enterprise Award of Excellence

Health IT Investment

Business Case for Health IT Investments

• Current systems were not sustainable • Patient safety & quality of care • Supports internal process re-design (Excellence,

Innovation) • Increases capability of supporting our clients across the

continuum (Community, Respect, Safety, Excellence, Innovation)

• Reducing variability in many domains

CONFIDENTIAL – DO NOT DISTRIBUTE

TECHOLOGY TO ENABLE CARE DELIVERY AND

IMPROVED POPULATION HEALTH

Transforming Care Through

Predictive Analytics

Links to Strategies 2 & 4

Integrating Across the Care Continuum Links to Strategies 1 & 2

Harmonizing Clinical Practice & Research

Links to Strategies 2 & 4

Adopting Emerging Models of Care

Links to Strategies 2, 3 & 5

IS/T Strategic Plan Anticipated Transformational Benefits and Outcomes

6

The new IS/T Strategic Plan will enable Ontario Shores to continue its transformation agenda by being an industry leader and achieving the following meaningful benefits and outcomes by breaking new ground

Evolving business intelligence to leverage real-time data for clinical decision making and provide personalized medicine to improve patient outcomes and accelerate recovery

Integrating with care providers all across the care continuum to help provide better patient navigation and a seamless care experience

Bridging the gap between clinical practice and research to truly deliver evidence-based care, specific to the mental health patient population

Continuing to engage staff and patients and supporting the adoption of emerging technologies to connect patients to new models of care, thereby providing the best experience possible

ACCESS TO EVIDENCE-BASED CARE

AND ACCELERATED RECOVERY

External Partners

Researchers

Healthcare Team Clinicians Patients & Families

2007/2008 Planning

2009/10 Phase 1

2010/11 Phase 2

2011/12 Phase 3

2012/13 2013/14 2014/15

• RFI and Vendor Shortlist

• RFP and Vendor Selection

• Business Case Approved

• Contract Signed

• Project resource Plan Developed

• Core Team Assembled

Live Oct.: • ADT • Pharmacy • Finance • Material

Mgmt. Live Dec.: • HR/Payroll • Staff

Scheduling • ACS

Readiness Assessment

Live Oct./Nov.: • Clinical Doc • Physician Doc • Order Entry • Enterprise

Medical Record

• Transcription Live Dec.: • Data

Repository

• RAI Implementation

• Outpatient Implementation

• Meditech 6.06 full system upgrade

• Achievement of HIMSS Stage 6

• Plan of Care Optimization

• CPGs • IAR • Outpatient,

CWS, Lab Optimization

• Smoking Cessation

• Business Intelligence

• Meditech 6.07 full system upgrade

• Patient Portal • CPGs • LOCUS • Front End

Speech Recognition

• QRM Optimization

System Overview: Overall Timeline for EMR Implementation

Pervasiveness of Use

Type Handwritten Dictation/ Transcription Structure Forms Structure forms w

Discrete Data

H&P 0% 6% 0% 94%

Progress Notes 0% 0% 60% 40%

Consult Notes 0% 85% 0% 15%

Discharge Notes 0% 20% 0% 80%

Problem List 0% 0% 0% 100%

Diagnosis List 0% 0% 0% 100%

Pervasiveness of Use: Documentation Percentages

Pervasiveness of Use: Computerized Physician Order Entry (CPOE)

2011 2012 13-Jul

13-Aug

13-Sep

13-Oct

13-Nov

13-Dec

14-Jan

14-Feb

14-Mar

14-Apr

14-May

14-Jun

14-Jul

14-Aug

14-Sep

14-Oct

14-Nov

14-Dec

15-Jan

15-Feb

15-Mar

15-Apr

15-May

15-Jun

15-Jul

15-Aug

15-Sep

15-Oct

15-Nov

15-Dec

16-Jan

16-Feb

16-Mar

16-Apr

CPOE % 90% 93% 91% 89% 88% 90% 91% 91% 91% 92% 92% 93% 93% 93% 94% 93% 94% 93% 94% 93% 90% 93% 94% 95% 94% 95% 96% 96% 95% 95% 95% 94% 95% 95% 95% 97%

Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

82%

84%

86%

88%

90%

92%

94%

96%

98%

Consistently meeting 90% target since October 2013

Incorrect patient scanned:

Administering a medication that is not currently due:

Scanning an incorrect barcode type:

Scanning a dose that exceeds the ordered dose:

Pervasiveness of Use: Medication Administration Error Alerts

Pervasiveness of Use: BMV/eMAR Medication and Patient Scanned

2011 2012 2013 14-Jan

14-Feb

14-Mar

14-Apr

14-May

14-Jun 14-Jul 14-

Aug 14-Sep

14-Oct

14-Nov

14-Dec

15-Jan

15-Feb

15-Mar

15-Apr

15-May

15-Jun 15-Jul 15-

Aug 15-Sep

15-Oct

15-Nov

15-Dec

16-Jan

16-Feb

16-Mar

16-Apr

BMV/eMAR - Medication Scanned % 87% 82% 82% 83% 87% 90% 97% 98% 98% 98% 97% 98% 98% 98% 97% 97% 97% 96% 95% 95% 96% 96% 96% 96% 95% 96% 96% 96% 96% 96% 96%

BMV/eMAR - Patient Scanned % 92% 87% 89% 89% 93% 95% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Letters of Expectation issued

Meeting 95% target since April 2014 for Medication scanning

Meeting 95% target since March 2014 for patient ID scanning

Preventing Medication Administration Errors

Clinical Decision Support (CDS)

• Clinical Content – Query Link: triggers based on responses – Reflex orders: actions based on orders – Interaction checking – Protocols – Links to Policies within order and documentation screens – References in Order sets

• Rules

– ‘If-Then’ logic – Required responses

Clinical Decision Support (CDS)

Governance

Data/Information Governance

Benefit Realization

Leveraging Technology to Advance Care: Key Highlights

Safety: • Implementation of clinician-provider order entry (CPOE) and bedside

medication verification (BMV)

• Improvements in infection prevention and control - 85% reduction in number of outbreak days

Leveraging Technology to Advance Care: Key Highlights

Quality: • Systematic implementation of clinical practice guidelines (CPGs) for

Schizophrenia on inpatient units

• Reduction in the use of restraint and seclusion - $776,663 savings in staffing costs

• Transcription – discrete data elements used and cost savings exceeding $425,000

Leveraging Technology to Advance Care: Key Highlights

Utilization: • Level of Care Utilization Scale (LOCUS)

Engagement & Recovery: • Implementation of a patient portal to enhance patient engagement • Statistically significant improvements for patients in mental health recovery

Clinical Practice Guidelines: Dashboard

CPG Provider Summary report. Spider graph measures individual adherence vs. Hospital averages for metabolic monitoring

Adherence to Clinical Practice Guidelines

Infection Prevention & Control

• IP&C reviews patient data documented by nursing staff

• If precautions identified appropriate follow up occurs immediately

Restraint & Seclusion Prevention

Restraint & Seclusion Business Intelligence Tool Dashboard

Restraint & Seclusion Incidents & Staffing Costs

Overall Savings = $776,633

Utilization: LOCUS

Utilization: LOCUS

141

116

95

76 66 69 67

54

0

20

40

60

80

100

120

140

160

Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15

Snapshot - Median Length-of Stay Minus ALC Days (Unit: ASU)

Median days from month-end date minus days on ALC

Patient Engagement Initiatives

HealthCheck Patient Portal – empowering patients

Messaging functionality

allows service users to send

any non urgent messages to

providers

Display clinical data,

including reports,

allergies & conditions,

labs & microbiology

View medications,

education materials and

renew medications

Ability to view all upcoming

booked appointments & appointments

can be requested,

cancelled, & rescheduled

directly from the portal

Ability to view & request updates to

demographic information

*sensitive lab results have been suppressed & reports have a 7-day delay

The Future

The ability for service users to

document within their

chart

Patient Engagement Mobile Solution

• Ontario Shores collaborating with a mobile health patient engagement solution:

• To further advance patient engagement and activation through the implementation of the Mozzaz app and its integration within the EMR in four services as a pilot at Ontario Shores

• Eating Disorder / Geriatric Services /Neuropsychiatry Inpatient & Outpatient/ Transitional Aged Youth Services

Virtual Care & Patient Engagement in Mental Health Enabling patients and families to become active participants in their mental health care

Mozzaz – Mobile Case Management Patient Interactive Care Plan

Patient documentation updates

Individualized Care Plan

Big White Wall

Funding & Oversight: Canada Health Infoway & MOHLTC Collaborating Organizations: OTN, Ontario Shores & Lakeridge Research Partner: Women’s College Hospital Institute for Health System Solutions & Virtual Care

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Lessons Learned

• Leadership (Board of Directors, Senior Team, etc.) engagement is key for success – Formal physician champion role is integral

• Early and ongoing engagement with end-users/clinicians to ensure it

is meaningful – Readiness work

• Advancing technology to ENABLE practice

– Requires significant change management strategies as part of development and implementation

• Evaluation and creating formal opportunities for feedback is critical

for adoption and engagement (i.e. change request process)

Lessons Learned

• 2015-19 IS/T Plan implementation • Collaboration with other Mental Health organization for

shared EMR • Continue to use analytics with BI tool to improve care • Advancing Health Information Exchange strategies • Advance self management – mobile patient engagement

solution • Advance virtual health strategies – e-therapies, e-

consultations • Research to enable predictive analytics

Current & Future Plans

Thank You