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Alberta's EHR System - PIN
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1March 1, 2004 Alberta Health and Wellness
Pharmaceutical (PIN) Alberta�s Journey towards the Electronic Health Record (incl. PIN)
2March 1, 2004 Alberta Health and Wellness
Alberta�s Major Milestones on the Journey
1999 200220012000 2004
Seniors Drug Profile Pharmaceutical Information Network Electronic Health Record
2003 2005SDP PILOT
SDP Rollout PIN PILOTPIN Development
EHR 18-mo Strategy
SDP Retired
EHR RolloutPIN
3March 1, 2004 Alberta Health and Wellness
Seniors Drug Profile (SDP) � What Is It? HomecareHospital
Seniors Drug Profile Medication Information
Alberta Blue Cross
Patient
SDP provided Hospitals, Physician Offices, Pharmacies & Homecare Offices with secure access to a profile of recently dispensed prescription drugs for senior citizens who are part of the Alberta Blue Cross Group 66 Plan
Benefits!Saves time (less writing, fewer calls to pharmacies)
!User Friendly application
!Sets stage for migration to PIN
!Particularly beneficial for patients who were poor historians, or had literacy or language barriers
!Users stated that information about patient compliance and behavior was obtained
� Physicians discovered through the Seniors Drug Profile that, after many years of treating regular patients, their patients had been receiving medical treatment from other physicians that they were unaware of �
1999 200220012000 2004
Seniors Drug Profile Pharmaceutical Information Network Electronic Health Record
2003 2005SDP PILOT
SDP Rollout
4March 1, 2004 Alberta Health and Wellness
What is PIN?An information sharing tool that:
8 links community physicians, pharmacists, hospitals and other authorized health care providers
8 provides online decision-support tools for prescribing, dispensing, compliance monitoring, research and policy development.
8 communicates with existing physician office and pharmacy systems, avoiding duplication of data entry.
8 will ultimately enable electronic prescriptions, providing further benefits to health care providers and patients alike.
What is PIN?
5March 1, 2004 Alberta Health and Wellness
How is PIN delivered?8Central clinical data
repository
8No duplicate data entry
8Links existing heterogeneous systems Central Clinical
DataRepository
PIN is conceptually simple
8Via a web browser
8System-to-system
6March 1, 2004 Alberta Health and Wellness
PIN Pilot Profile8 Implemented in 18 sites in two communities (Westlock &
Leduc) in 2002� 12,119 prescriptions were recorded by 34 physicians� 5,399 drug profiles were accessed by 154 users
8Results of pilot evaluation were positive� 90% of pilot users believe that PIN is valuable to their delivery of
care (7% undecided, 3% disagree)� 80% of pilot physicians would recommend PIN to their peers
(20% not yet decided)� Extended pilot
1999 200220012000 2004
Seniors Drug Profile Pharmaceutical Information Network EHR
2003 2005
SDP PILOTSDP Rollout
PIN PILOT
7March 1, 2004 Alberta Health and Wellness
8 Collection of explicit consent for purposes of care and treatment is challenging to explain and administratively burdensome (i.e. less than 1 % of the population decided to opt out)
8 Implementation elapsed time is most influenced by site readiness
8 Sell to clinicians first then to administrators
8 Need to do individual site assessments as sites have unique work flows
8 Voluntary participation impacts take-up however improves clinician �buy-in� over time
Things we learned:
8March 1, 2004 Alberta Health and Wellness
EHR
September 2002
The Minister announces that there will be a provincial Electronic Health Record
by March 31, 2004
1999 200220012000 2004
Seniors Drug Profile Pharmaceutical Information Network EHR
2003 2005
SDP PILOTSDP Rollout
PIN PILOT
EHR 18-mo Strategy
9March 1, 2004 Alberta Health and Wellness
Implementation Initiatives
�.. In 18 Months!!
10March 1, 2004 Alberta Health and Wellness
EHR: What is It ? What an EHR ISIS8 Individual focused8 Individual specific core data set
where elements reside In multiple sources
8 Mechanism for sharing health data about an individual
8 Longitudinal health information about an individual from multiple sources
8 Support for clinical decision making8 Accessible at all points of care in a
timely manner
What an EHR IS NOTNOT8 Provider focused8 An operational system
Operational systems feed data to populate the EHR
8 A data collection system8 A single physical repository8 A Clinical Information System /
Electronic Patient Record nor Physician Office System / Electronic Medical Record, but they are interrelated
EPR and EMR describe the record of the periodic care provided mainly by one institution. It is a complete patient record accessible from a single, automated health care provider system.
11March 1, 2004 Alberta Health and Wellness
EHR:What Did We Need to Think About What an EHR ISIS8 Individual focused8 Individual specific core data set
where elements reside in multiple sources
8 Mechanism for sharing health data about an individual
8 Longitudinal health information about an individual from multiple sources
8 Support for clinical decision making8 Accessible at all points of care in a
timely manner
Identification of a userAccess controls
Record of users interaction
Readiness Remote connectivity
Security Education
GovernanceStewardship of data
Standards
Individual rights
Respect for privacy and ethical usage
Clinical acceptance
Workflow impact
Culture
12March 1, 2004 Alberta Health and Wellness
EHR 18-month Strategy
� Identify a person� Add a person � newborn, new resident, visitors� Update demographic information� Record history� Post Office address standards� Determine the insurance eligibility� Publish and subscribe for changes
� View and sort lab test results history� Multiple lab sources� Deliver lab test results physician�s EMR� Available for ordering and copied physicians
� View active medication profiles� View and record allergy and intolerance information� Prescribe medication� Look up medications and drug interactions� Dosage checking� Medication dispensing information� Multiple renewals� Integration with physician and pharmacy systems
13March 1, 2004 Alberta Health and Wellness
Relationships Between the 18- month EHR and Other Systems
EMR EMR
Patient EHR Summary
PINPerson
Identification
(PPHI)
LAB
Demographics
Drugs
System
to
System
Lab Results
eMPIeMPI
Pharmacy SystemsPharmacy Systems
Portal�Single Sign On
�Authentication & Authorization�Audit Trail
�Person Search
14March 1, 2004 Alberta Health and Wellness
Privacy and SecurityTechnical8 Authentication (Two-factor �
SecurID Fobs)8 Authorization (Need to know
principle, Record of use)8 Encryption8 Audit Logs8 Firewall8 Intrusion Detection8 Anti-virus
AdministrativeCommon:
8 Privacy Impact Assessment (PIA)8 Training8 User ID Registration Process8 Confidentiality Agreements8 Self-Assessment Tool
Secure Network:8 Policies
� Minimum Connectivity Requirements (Level 1)
� Level 2 2004/2005� Level 3 2005/2006
Internet:8 2 Factor ID (FOB)8 COACH guidelines
15March 1, 2004 Alberta Health and Wellness
Rollout - EHR Campaign Based Campaign = 1 or more health care facilities and surrounding areaservicing home care, community physicians and pharmacists
8 Urban
8 Rural
PharmacyPhysicians
HomecareHospital
Patient
Divided into several communities. Each community has a health care facility, however there may be exceptions (i.e. No hospital in the community, but is considered a community due to its large population and geographic area).
Could be grouped to include more than one health care facility to make effective use of implementation resources.
16March 1, 2004 Alberta Health and Wellness
Physician Office System Program (POSP)
! Joint initiative of Alberta Health & Wellness, the Alberta Medical Association and Alberta�s health authorities (2003)
! Learning in action . . .� first of its kind in Canada� formal evaluation function
! Undertaking at the physician, not the organization level! Targets improvement in products, IMIT services and business
processes
POSP
1999 200220012000 2004
Seniors Drug Profile Pharmaceutical Information Network EHR
2003 2005
SDP PILOTSDP Rollout
PIN PILOT POSP IIEHR 18-mo Strategy
17March 1, 2004 Alberta Health and Wellness
Health IM/ITGovernance
Council
Health IM/ITGovernance
Council
InformationTechnologyCommittee
InformationTechnologyCommittee
Information ManagementCommittee
Information ManagementCommittee
EHR DataStewardshipCommittee
EHR DataStewardshipCommittee
ProvincialTelehealthCommittee
ProvincialTelehealthCommittee
Governance: Decision Making Structure
PhysicianOffice
SystemsProgram
PhysicianOffice
SystemsProgram
Alberta Health & Wellness
Health Regions/Boards� Council of CEOs
Physicians� CPSA� AMA
Pharmacists� ACP� RxA
Public Representation
Project Coordination - Alberta WellnetProject Coordination - Alberta Wellnet
Governance � Relationship Model
18March 1, 2004 Alberta Health and Wellness
Critical Success Factors:8 Senior Chair 8 Incumbents are Decision Makers8 Balanced Representation8 Membership � Critical Few8 Quarterly meetings � at least
Multi-stakeholder Governance
Advantages:
4 Increases stakeholder engagement4 Helps to increase perspective & manage multiple agendas4 Opens communication channels � government isn�t always the translator
19March 1, 2004 Alberta Health and Wellness
EHR Data Stewardship � Building a Trust Relationship
8Key understandings:
� Its duties and responsibilities must reflect current legislative provisions that define the rules related to the appropriate access, use and disclosure of health information
� The role of the EHR Data Stewardship Committee must work within a framework that complements and enhances existing organizational mandates and responsibilities (e.g. professional regulators, custodian responsibilities, etc.)
� It is a requirement of stakeholders to have a say in the further propagation of, or access to, data they are contributing to the provincial EHR
20March 1, 2004 Alberta Health and Wellness
Alberta Wellnet (AH&W)Information Manager
Manages the data in accordance with the Information Exchange Protocol
Information Manager Agreement*Authorizes use of EHRBinds both parties tofollow the InformationExchange Protocol
InformationExchange ProtocolGuides use of data by custodian and wellnete.g. who can access the data, how research requests are handled, etc.Becomes appendixto agreement
EHRData
StewardshipCommitteeManages the
protocol
MinisterialOrderEstablishes DSC
PhysiciansPharmacies
HealthAuthorities
ParticipatingCustodians AH&W
CollegeRxACollege
AMACouncilof CEOs
StakeholderOrganizations
Public
Applying the Framework to the EHR
21March 1, 2004 Alberta Health and Wellness
Major achievements also made in 2003 achievements
EHREHR
TOOL INITIATIVE
POSP Phase IIPOSP Phase II
CH EHRCH EHR
CHR Clinical System
CHR Clinical System
Non MetroClinical Systems
Non MetroClinical Systems
! Tri-partite governance! 3 levels of participation! Target of > 2,500 new MDs (68% of
Alberta�s physicians by March/06)
� Wave 1 � pilot complete� Wave 2 � SDP replacement to be completed Mar 04
� Wave 3 � Pharmacy/MD implementation underway
� Drumheller first community to go live
� Infoway Funding partnership established for PIN
ACHIEVEMENT OUTCOMES
EfficiencyEfficiencyAccessibilityAccessibility
! Regional EHR (netCARE) implemented
! Regional EHR (Eclypsis) selected and project initiated
! Regional EHR (Meditech) selectedand project initiated
SecuritySecurity! Minimum ConnectivityRequirements
AccessibilityAccessibility
AccessibilityAccessibilityPatient SafetyPatient SafetyEfficiencyEfficiency
AccessibilityAccessibilityPatient SafetyPatient SafetyEfficiencyEfficiency
Alberta CancerBoard
Alberta CancerBoard
Alberta CancerBoard
Alberta CancerBoard
! ICCN (Optx) implemented
PrivacyPrivacy ! EHR Data Stewardship Committee AccessibilityAccessibility
22March 1, 2004 Alberta Health and Wellness
Governance Process Used to Define Next Steps
� Overview� Seek Endorsement
in Principle
IM/IT Governance CouncilMarch 16, 2004
� Develop & ForwardRecommendations
IMC IM/IT(EHR)STRATEGIC PLAN I� Domains� Goals� Outcomes� Stakeholder Impact
IM/IT(EHR)STRATEGIC PLAN II� Costed � Funding Sources & Gaps� Further Plan DevelopmentMarch-June 2004 � Review
� Seek Commitmentin Principle
Council of CEOs
� Review� Seek Commitment
in Principle
Pharmacy & Physician Organizations
Stakeholder Signoff � Final Review� Approve Provincial Plan
IM/IT Governance Council
Input and Review
ITC
� Input and Recommendation
IMC
Annual Refresh
23March 1, 2004 Alberta Health and Wellness
IM/IT Strategic (EHR) Plan 2004-2007
PersonDirectory
Drugs, &Allergies
LabResults
Diagnostic Imaging
Registries
Clinical TextReports
� Provincial review of Client Registry Strategy
SCOPE
� Capture discharge meds � Health region System-to-System 2005-2007� Batch dispensing 2004-05� ACB dispensing� Triplicate Prescription� Implement in Business Intelligence Environment
� All provincial lab data made available (CHR, CHA, ACB, Non Metro, Prov Lab, CBS)� Agreed to Standards in place� Lab Test Results Delivery (LRD) and Lab Test Results History (LTRH) available to up to 60% of MD population� Order Entry of lab tests available
� DI Text Report Standards in place (exam codes, message specs, report formats, diagnostic codes)� DI Text Reports Delivery and History available� DI PACS images available from source systems
� Provider � Single source of truth of provider information� Facility � Uniform, consistent & accurate identification of facilities across health system
� Access to clinical text reports and history (Discharge, Operative, Consultation reports)Draft