spring 2006 pr

Slide1: 

The BC Health Information Management Professionals Society 2006 Spring Education Session “Collaborative Initiatives – Commendable Results” Macro-Scale Shared Services Model in action “Why are we doing it? How are we doing it?    Implications beyond RSHIP?” Pat Ryan, RSHIP Executive Director March 29, 2006

Conclusions and Common Themes: 

Conclusions and Common Themes Hurdles need to be understood and faced head on Resources to support the change need to be put in place Support for the shared services strategy must take place on several fronts

Conclusions (Continued): 

Conclusions (Continued) It is vital to help people adjust to this new environment. It is critical to foster a culture of service excellence that builds on existing capabilities and rewards improvements It is important to measure progress and learn from experience – your own and that of others

Conclusions (Continued): 

Conclusions (Continued) Significant culture change is required. This drives and stimulates the willingness to address entrenched organizational policies and practices

Conclusions (Continued): 

Conclusions (Continued) Building trusting relationships…provides a foundation for additional innovation in the design and delivery of services.

Final Conclusion: 

Final Conclusion With the increased demand for their services and mounting pressure on their cost structures, shared services can offer a viable approach for bringing together common processes and capabilities…in this way, shared services can generate saving, so scarce resources can be shifted to front-line service delivery.

Slide8: 

CIO Executive Institute Building Blocks to Regional Health Information Organization (RHIO)     Blazing the Trail to a Different Tomorrow in Information Technology International Conference May, 2006

Slide9: 

Business Case Advice to Minister Non-Metro Regional Health Authority Shared Information Management and Information Technology Initiative Non-Metro Regional Health Authority Shared Information Management and Information Technology Project

The Origin of RSHIP: 

The Origin of RSHIP Adopting a collaboration vision to migrate to a common health information system. Selecting Strategic Vendor Partners Original Project: Adopting Common Standards and sharing information, resources and expertise Maximize regional benefits while aligning to Provincial and Pan Canadian Initiatives

Outcomes from RSHIP: 

Outcomes from RSHIP Reduce rate of growth in IM&IT expenditures given the increasing reliance by all regions on IM&IT Enable service delivery and program areas to work as one organization – for improved effectiveness, patient care, and alignment to Alberta Netcare common infrastructure vision RHAs standards policies accountability governance Improve patient care Safer / Higher Quality Care Align to Provincial and Pan Canadian Initiatives Advance emerging business visions

Key Components: 

Key Components Shared EMR Single Data Centre Standards Implementation Project Management and Governance Alignment with Provincial Initiatives

Slide15: 

R1-Chinook Health Region R2-Palliser Health Region R4-David Thompson Health Region R5-East Central Health R7-Aspen Regional Health Authority R8-Peace Country Health Region R9-Northern Lights Health Region Collaborative initiative involving the 7 Non-Metro RHAs Area of Alberta: 661,790 sq. kms. 255,519 sq. miles

Slide16: 

The RSHIP Order of Magnitude Population: 1,036,866 (1/3 of province) Total Combined Budget: $1.7 billion Unique Points of service: 500 Acute Facilities: 106 Long Term Care Facilities: 230 Home Care Offices: 79 Public Health Offices: 96 Acute Beds: 2,686 (includes psychiatric beds) CC Beds: 4,096 Staff: 25,000 = 19,700 Direct Care Providers Number of Physicians: 1,185

Vision: 

Vision A “program of excellence” that delivers and supports a full suite of integrated, standardized clinical and financial applications to support a shared Enterprise-wide Electronic Medical Record among the seven participating Regional Health Authorities. RSHIP - A leading Contributor to Alberta Netcare

Slide18: 

Integration

Slide23: 

21 Applications – Phase 1 13 Clinical Systems ADM-Admitting ALPM ABS-Abstracting A MRI-Medical Records ALPM CWS-Community Wide Scheduling APM ITS-Imaging & Therapeutic Services ALPM PHA-Pharmacy ALP LAB-Laboratory ALP MIC-Microbiology ALP BBK-Blood Bank A PTH-Pathology AP OE-Order Entry ALPM EMR-Enterprise Medical Record ALPM 9 Financial & Administrative GL-General Ledger FA-Fixed Assets AP-Accounts Payable MM-Materiel Management BAR-Billing/Accounts Receivable ESS-Executive Support System B&F-Budgeting & Forecasting PP-Payroll (Chinook & Peace) HRM-Human Resource Mgmt Beta (Chinook & Peace)

Slide24: 

A Single “Patient Centric” EMR (complete July 2006) Est. 2,000,000 unique patient records. Covering 500 Unique Points of service. Covering 106 Acute Facilities (complete July 2006) 13 Integrated Clinical Information Systems. (complete July 2006) Flowing EHR data to Netcare (Lab and DI text - complete Sept- Oct 2006) Netcare flowing EHR data to Physician Office Systems (Lab and DI text - complete Sept-Oct 2006) Collaborative initiative involving the 7 Health Regions Area of Alberta: 661,790 sq. kms. 255.519 sq. miles

30 Months - Start to Finish???: 

30 Months - Start to Finish??? AH&W Agreement signed December 2003 Tender completed Data Centre Built and Operational Software received Single System Designed Standards Built Core Systems fully installed July 2006

External ReviewSummary and ConclusionMarch 2006: 

External Review Summary and Conclusion March 2006

Slide30: 

Strengths Commitment to timeline established by RSHIP Accelerated benefits Strong regional collaborative effort Adaptability of partners

Slide31: 

Strengths Strong commitment to regional standards development Establishment of shared data centre with built in on site redundancy Single instance of Meditech

Slide32: 

Strengths Commitment to pEHR Single technical centralized support desk for Meditech technical issues Commitment to long-term vision for RSHIP

There are five main improvement opportunities for RSHIP: 

There are five main improvement opportunities for RSHIP Ranked in order of importance, they are: Improving financial oversight and reporting Improving communication management Addressing business continuity requirements Tightening RSHIP processes Building on the shared service model

Slide34: 

Weaknesses No back-up data centre to support business continuity in a disaster Grasp of financial situation Communication Between RSHIP and AHW Within AHW Within RSHIP Links with CHA and CHR Potential for standards divergence amongst regions Lack of benefits realization strategy

RSHIP should be commended for the achievements it has made to date: 

RSHIP should be commended for the achievements it has made to date Meditech is installed and configured appropriately for provision of shared services. RSHIP appears to adhere to appropriate provincial and national standards. RSHIP is achieving or exceeding internal timeline expectations.

RSHIP should be commended for the achievements it has made to date: 

RSHIP should be commended for the achievements it has made to date Regions are satisfied with progress to date. Regions were at various stages of IT sophistication, but RSHIP has done much to level the playing field. Expenditures are generally in-line with regional and AHW expectations.

Slide37: 

RSHIP Organization Chart (March 2006) PACS PM PACS Technical Manager PHA Coordinator 1 New Resource

Slide39: 

Alberta to create province-wide PACS network EDMONTON – Alberta has announced plans to invest $189 million over a three-year period to create a province-wide, computerized network for diagnostic imaging. The network will include Picture Archiving and Communication Systems (PACS), and digital modalities such as X-ray, MRI and CT. It will also make use of radiological information systems (RIS), the text reports which describe and analyze patient images. Overall, it’s said to be the largest digital diagnostic imaging project launched in Canada. Canada Health Infoway is involved as a partner, and will inject $46 million, its largest contribution so far. Alberta intends to invest $143 million. The pan-Albertan network is expected to be completed by March 2008. The blueprint calls for three major repositories – one in Calgary for the Calgary Health Region, another in Edmonton for the Capital Health area, and a third in Red Deer, for the remaining regions as part of the Regional Shared health Information Program (RSHIP).

Slide40: 

Advanced Clinical Systems 10 Applications – Phase 2 EDM-Emergency Department Mgmt A ORM-Operating Room Management A PCS-Patient Care System. Incls. InterRAI - MDS 2.0 for LTC ALPMH BMV-Bedside Medication Verification AL PCM-Physician Care Manager AL CC-HC - Continuing Care (Home Care) H PH1 - Public Health Phase 1 - Immunization & Adverse Events P MH - Mental Health M

Reality: “Adverse Events Happen”: 

Reality: “Adverse Events Happen”

Slide44: 

The patient safety phenomena – raised to a national consciousness level by the 1999 Institute of Medicine (IOM)

Iceberg Model of Accidents and Errors: 

Iceberg Model of Accidents and Errors Misadventure Death\severe harm No Harm Event No harm done but potential for harm may be present Near Miss Unwanted consequences were prevented because of recovery Denis Protti School of Health Information Science University of Victoria dprotti@uvic.ca

The 1999 IOM Report Findings: 

The 1999 IOM Report Findings 44,000 – 98,000 unnecessary deaths in the US. Even using the lower estimate, more people die from clinical mistakes each year than from highway accidents, breast cancer, or AIDS 7,000 Americans are die each year from medication errors alone – approximately 16% more than the number attributable to work-related injuries Medical errors cost the U.S. approximately $38 billion per year, with about $17 billion of those costs associated with preventable errors

How extensive are medical errors?: 

How extensive are medical errors? The National Committee on Vital and Health Statistics (NCVHS) reported the following (1999): 3% of adverse effects cause permanent disabling injury; of these 1 in 7 leads to a patient death. Preventable medical errors account for 12-15 % of hospital costs. About 23,000 hospital patients die each year from injuries linked to medication use. 80% of nurses calculate dosages incorrectly 10% of the time, and 40 percent of nurses make mistakes more than 30% of the time. Approximately 180,000 unnecessary deaths and 1.3 M injuries occur from medical treatment in the United States.

“If the Institute of Medicine's numbers are right, then 1.3 GM employees, retirees or dependents die every day from medical mistakes. If accidents were killing people in GM's plants at that rate, the outcry would have closed them down long ago.”: 

“If the Institute of Medicine's numbers are right, then 1.3 GM employees, retirees or dependents die every day from medical mistakes. If accidents were killing people in GM's plants at that rate, the outcry would have closed them down long ago.” Bruce Bradley, GM Executive Washington Post March 26, 2002

Improving patient care - a case study: 

Improving patient care - a case study A New Zealand study looked at the medical records of 1575 patients admitted to three Auckland hospitals during 1999, and found 10.7% of all the screened records registered an adverse event. Davis P Adverse Events Regional Feasibility Study: Indicative Findings NZ Medical Journal May 11, 2001

Adverse Events Rate in Canada: 

Adverse Events Rate in Canada 7.5 out of every 100 Hospital Admissions experience an AE. 36.9% were preventable. Death resulted in 20.8% of these Adverse Events. Death Rate = 1.56% of Admissions

Typical Medication Process: 

Typical Medication Process Assessment Written Order or Prescription Verify and Transcribe Dispense Nurse Administer (or self-administer) Monitor A process that typically involves 50-60 discrete steps with many human and system handoffs.

Slide54: 

Swiss Cheese Model Modified from Reason, 1991 © 1991, James Reason

More from the Commonwealth Fund study: 

More from the Commonwealth Fund study The report also points to serious problems of communication between patients and doctors, as well as a widespread failure to monitor chronic medical conditions such as heart disease, breast cancer, and diabetes. Computerized reminder systems and drug cross checks could help assure better care; as well as preventing errors. But most hospitals have not invested in the information technology (IT) that could help.

Slide56: 

“Physicians can’t effectively care for patients nowadays without the help of computers. We don’t expect travel agents to memorize hundreds of airline flight schedules, and we certainly can’t expect physicians to memorize all the available drug options”. Bruce Bagley, M.D. Past President American Academy of Family Physicians

Human clinicians cannot be blamed: 

Human clinicians cannot be blamed Medical information doubles almost every five years and, often, new knowledge makes established treatments obsolete. There are ~22,000 new journal articles per year, at least 30 new drugs per year, and more than 6,000 combinations of drug compatibilities to consider. The number of drugs has grown 500% in just the last decade to over 17,000 trade and generic names for pharmaceuticals marketed in North America. The information flood, long working hours and a busy schedule make it increasingly difficult for clinicians to keep up with, and incorporate, current knowledge.

The realities about errors: 

The realities about errors Clinicians do not make mistakes on purpose. The 1999 IOM report concluded that errors result from system failures, not people failures and that achieving acceptable levels of patient safety will require major systems changes. Poor processes, not error-prone people, are the main cause of medical errors. Errors result from faulty systems, not from faulty people, so it is the systems that must be fixed.

RSHIP is Enhancing Quality & Patient Safety: 

RSHIP is Enhancing Quality & Patient Safety Positive Patient Identification Computer bar-coded verification of Labs Electronic Nursing Documentation Bedside Medication Verification Physician Order Management with “decision support”.

Slide60: 

Advanced Clinical Systems 10 Applications – Phase 2 EDM-Emergency Department Mgmt A ORM-Operating Room Management A PCS-Patient Care System. Incls. InteRAI - MDS 2.0 for LTC ALPMH BMV-Bedside Medication Verification AL PCM-Physician Care Manager AL CC-HC - Continuing Care (Home Care) H PH1 - Public Health Phase 1 - Immunization & Adverse Events P MH - Mental Health M

The Quality Circle: 

The Quality Circle Positive Patient Identification Lab Specimen Collection Nursing Documentation Online MAR and Medication Verification Physician Order Management Primary Care Linkages

Physician participation: 

Physician participation Physician participation (as of November/05) 2,855 active participants (approx. 52% of practising physician population Level 2 – 2,354 (83%); Level 1.5 – 284 (10%); and Level 1 – 217 (7%) 880 clinics physician retention high (93%) meeting program outcomes re: use of technology is high (85%) – see evaluation Target to March/06 – approximately 60% of physician population

Results of Phase 2 evaluation: 

Results of Phase 2 evaluation Physicians are using office automation (in descending order of use): Scheduling (86%) Billing (80%) Communicating (76%) Charting (71%) Staff are using it too (in descending order): Scheduling (100%) Filing (94%) Billing (91%) Communicating (78%)

Results of Phase 2 evaluation: 

Results of Phase 2 evaluation impact on workflow: positive access to information better charting improved workflow scheduling easier messaging negative computer crashes need to scan paper computer use has increased since implementation many say they are now dependent on computer

Results of Phase 2 evaluation: 

Results of Phase 2 evaluation office processes have changed: workflow altered little staff savings productivity savings offset by: learning new processes need to scan paper physician productivity has improved, but not significantly basic computer skills are greatest need expressed in this area

VCUR – where we were…: 

VCUR – where we were…

Originating principles: 

Originating principles Standards-based, physician choice of systems Multiple vendors; let the ‘free market’ play Focus on interoperability

Why multiple vendors?: 

Why multiple vendors? No vendor had it all (nor do they now) One size doesn’t fit all Some physicians had already invested No vendor with sufficient capacity Competition breeds innovation Monopoly doesn’t serve physicians’ needs Business risk Declining performance/increasing price Who picks, the majority (i.e., GPs), the Ministry, health authorities?

Alberta solution - VCUR : 

Alberta solution - VCUR Collaborative process to develop requirements for physician office systems (POS) that will support the POSP vision of an integrated health information system collaboration involves: physicians clinic managers regional health authorities Alberta Health & Wellness physician office system vendors through CHITTA

VCUR history: 

VCUR history VCUR 2004 published April 1, 2003 became effective April 1, 2004 conformance testing conducted 17 conforming products from 11 vendors VCUR 2006 published April 1, 2005 conformance testing to start September 2005 to become effective April 1, 2006 VCUR 2007 planning started in August 2005 to be published June, 2006 to become effective June, 2007

Annual VCUR process: 

Annual VCUR process Current state & emerging trends Environmental scan Consultants Provincial IM/IT directions SIPS team Stakeholder Needs SIPS team Physicians Clinic Managers Regions Provincial EHR leaders Vendors Business Objectives for POS SIPS team POS Desired Functionality Task Force POS requirements Work groups VCUR

VCUR approach - benefits: 

VCUR approach - benefits stakeholder consultation ensures requirements have wide backing addresses business issues increases alignment between key needs and vendor offerings allows time for vendors to meet new requirements establishes an objective functionality and technical “bar” for POS supports but does not replace the individual POS solution selection process

VCUR Vision 2008 – where we’re going…: 

VCUR Vision 2008 – where we’re going…

Committee objectives: 

Committee objectives Develop a mid-term (2008) vision for the physician office to provide a framework/reference for future versions of VCUR Conduct periodic review of requirements to identify ‘incremental’ or maintenance improvements to physician office systems Allow major new requirements to be added to the current VCUR as these are developed, with a 6-month compliance window Shorten timeline between publishing requirements (even incremental requirements) and conformance to 6 months from 12 months Attract vendors with greater stability, stronger features and more functionality Set up processes for version control

Renewed VCUR timeline: 

Renewed VCUR timeline Vision 2008 provides framework for VCUR v3, v4….

Slide77: 

British Columbia Physician Information Technology Office (PITO) The Government shall establish the Physician Information Technology Office (PITO) to facilitate the timely and optimal care of patients by encouraging and supporting the continued implementation of information technology for GP’s and Specialists. PITO shall operate from April 1, 2006 – March 31, 2012.

Slide78: 

One time: $20 million 2006/07: $3 million 2007/08: $5 million 2008/09: $6 million 2009/10: $1.5 million 2010/11: $6.9 million 2011/12: $2.5 million

The Quality Circle: 

The Quality Circle Positive Patient Identification Lab Specimen Collection Nursing Documentation Online MAR and Medication Verification Physician Order Management Primary Care Linkages

Slide80: 

RSHIP Organization Chart (March 2006) PACS PM PACS Technical Manager PHA Coordinator 1 New Resource

Slide81: 

Career Opportunities Picture Archive Communications System (PACS) Project Manager Senior PACS Administrator Server Administrator Integration Coordinator Health Information Management Systems Coordinator Diagnostic Imaging Systems Coordinator Laboratory Information Systems Coordinator Shared Application Systems Coordinator Therapeutic and Care Systems Coordinator For more information about these positions and the RSHIP career experience, please visit our website. www.rship.ca

Slide82: 

The BC Health Information Management Professionals Society 2006 Spring Education Session “Collaborative Initiatives – Commendable Results” “Thank You” - Questions?? Macro-Scale Shared Services Model in action “Why are we doing it? How are we doing it?    Implications beyond RSHIP?” Pat Ryan, RSHIP Executive Director March 29, 2006