Georgian BayFamily Health Team
TORC:Rural Health Forum
TORC:Rural Health Forum
e-Healthe-Prescribing Demonstration Project
James Lane, GBFHT IT Lead
e-Healthe-Prescribing Demonstration Project
James Lane, GBFHT IT Lead
Nov 5, 2009
Georgian BayFamily Health Team
e-Prescribing Demonstration Project
• Background
• Project Design and Deliverables
• Results
• Next Steps
• Demonstration
Georgian BayFamily Health Team
e-Prescribing Demonstration Project
Background
Ontario’s Health StrategyBetter health care for Ontarians.
Ontario’s eHealth StrategyEnsure by 2015, Ontario’s health
system is the safest, highest quality, and most sustainable in Canada…
Ontario’s Drug eHealth Strategy
Improve the health and well-being of Ontarians through
optimal medication management.
ePrescribingDemonstrationP
roject
Electronic Prescribing is a component of Ontario’s Health Strategy
e-Prescribing Demonstration Project
Background
4
Electronic Prescribing
Generation
Authorization
Transmission
This definition is a work in progress and the validity of the definition will be tested as part of the Demonstration Project
Electronic prescribing encompasses the electronic generation, authorization and transmission of dispensing directions
e-Prescribing Demonstration Project
Background
5
Electronic Prescribing
Generation
Authorization
Transmission
• The electronic creation of a prescription by entering all information required to safely dispense a drug into a provincial or regional information system, Electronic Medical Record (EMR) or Clinical Management System (CMS), stand-alone prescription writer or other solutions
• The use of an electronic signature, or another symbol or process, by authorized prescribers to provide pharmacists with unique, non disputable directions to dispense a drug or mixture of drugs
• The use of one system to send prescription information directly to:
a. Another system owned and operated by an authorized dispenser
b. A repository that can only be accessed by authorized dispensers
“Generation” implies that data is “machine-readable” which is aligned with the definition of “true e-prescribing” that appears in existing CPSO and OCP standards
“Authorization” removes lingering confusion about signing in an electronic environment
This definition is a work in progress and the validity of the definition will be tested as part of the Demonstration Project
Electronic prescribing encompasses the electronic generation, authorization and transmission of dispensing directions
Georgian BayFamily Health Team
Goals of e-Prescribing Demonstration Project
• Quickly provide and demonstrate the patient safety and quality of care benefits of electronic prescribing to Ontarians
• Create physician and pharmacist champions of electronic prescribing
• Demonstrate the full cycle of electronic prescribing through to dispensing in a local setting
• Create tools and frameworks for process / workflow change, adoption strategies and benefits evaluation that can be used for the overall provincial roll-out
• Identify and understand the issues, challenges and opportunities of implementing electronic prescribing and apply this understanding to the overall provincial roll-out
• Develop excitement and momentum for the province-wide implementation of electronic prescribing
Georgian BayFamily Health Team
Goals of e-Prescribing Demonstration Project
• What it is not
• The final solution for e - prescribing
Georgian BayFamily Health Team
e-Prescribing Demonstration Project
Agenda
• Background
• Project Design and Deliverables
Georgian BayFamily Health Team
Project Design and Deliverables
• Forward looking report taking ‘lessons learned’ and translating into how they wouldimpact/influence the provincial implementation of e-prescribing
Deliverable3
• Broader environment impact caused by the study
• May contain historical and anecdotal information
• Narrative in nature
Deliverable2
• Focus of study caused by project change
• Quantitative measurement (e.g., time, benefit, value, etc.)
• Focus of analysis
Deliverable1
Identify and
Assess
Consultand
Prescribe
Transmitand
Receive
Identifyat
Pharmacy
FillMedication
Dispense and
Consult
Deliverable 1
E-Prescribing Process
• Study focus• Quantitative and
qualitative
• Environmentalscan
• Observation andmeasurement
• Lessons learnedimpactingprovince
• Speculative
Deliverable 2
Deliverable 3
Georgian BayFamily Health Team
Project Design and Deliverables
The focus of the evaluation was on the impacts of ePrescribing on the prescribing and dispensing processes
Georgian BayFamily Health Team
Project Design and Deliverables
Project Design:
2 Sites
GBFHT-Collingwood and arearoster size-50,000
GHC-Sault Ste.Marieroster size-60,000
Georgian BayFamily Health Team
Project Design and Deliverables
2 Sites-Collingwood, Sault Ste. Marie
chosen because of:
advanced electronic medical records implementations
non-scalable technologygeographically constrained = Rural
Georgian BayFamily Health Team
Project Design and Deliverables
Project Design: GBFHT
7-10 pharmacies12-15 physicians /NP’s will participate (mix
of experienced and new EMR users)
19 Pharmacies-all participating bounded by Meaford–>Elmvale–>Creemore
31 Prescribers
Georgian BayFamily Health Team
e-Prescribing Demonstration Project
Agenda
• Background
• Project Design and Deliverables
• Results
Georgian BayFamily Health Team
e-Prescribing Demonstration Project
Results
• April 13-June 09, 2009
• EMR E-prescriptions: 20,750
• E-prescriptions downloaded: 20,059
• EMR prescriptions printed: 7,083
Georgian BayFamily Health Team
e-Prescribing Demonstration Project
Results
• # E-prescribers: 32
• # E-prescribers that prescribed > 20/week: 25
• # medical profile accesses: 1615
Georgian BayFamily Health Team
e-Prescribing Demonstration Project
Results
• ePrescribing increases prescribing efficiency compared to EMR-generation of paper prescriptions
• Improved Clinical Outcomes - Paper prescriptions can lead to clinically significant adverse events that are often flagged by alerts in electronic systems
• Half of participating pharmacists believe the ePrescribing Project improved dispensing efficiency
• Electronic authorizations improve dispensing efficiency the most, according to pharmacists
• Integration to a DIS is imperative to realize the full benefits of ePrescribing to pharmacists
Georgian BayFamily Health Team
e-Prescribing Demonstration Project
Results
• Prescribers and pharmacists interact more directly and about more important issues after Go-Live
• 75% of patients expect ePrescriptions to be ready for pickup upon arrival
• 92% of patients comfortable with paperless prescriptions
• Nearly 100% of prescribers believe overall ePrescribing system quality acceptable; 71% pharmacists believe
• no security breaches
Georgian BayFamily Health Team
e-Prescribing Demonstration Project
Agenda
• Background
• Project Design and Deliverables
• Results
• Next Steps
Georgian BayFamily Health Team
e-Prescribing Demonstration Project
Next Steps
• Regulatory Colleges - CPSO, OCP, CNO
• 6 month extension
• new letter of support
• auditor to visit GBFHT sites
• eHealth Ontario involvement
Georgian BayFamily Health Team
e-Prescribing Demonstration Project
Next Steps
• Drug Information System (D.I.S.)
• RFP and procurement 2010
• rollout pharmacies, then EMR prescribers-2011
Future State
Georgian BayFamily Health Team
e-Prescribing Demonstration Project
Live Demonstration
•HOPE IT WORKS!