Post on 29-Jul-2020
Rapid Response Evaluation for Physician Office
Electronic Medical Records
Morgan Price, MD, PhD, CCFPFrancis Lau, PhD, eHealth Chair
1Tuesday, July 13, 2010
Introductions
2Tuesday, July 13, 2010
eHealth Observatory Mandate
• Monitor effects of Health information system (HIS) deployment
• Build health informatics research capacity
• Engage healthcare community in knowledge translation
3Tuesday, July 13, 2010
Who am I?
4Tuesday, July 13, 2010
Who am I?Lead Researcher at eHealth Observatory
4Tuesday, July 13, 2010
Who am I?Lead Researcher at eHealth Observatory
Family Doctor: Cool Aid CHC
4Tuesday, July 13, 2010
Who am I?Lead Researcher at eHealth Observatory
Family Doctor: Cool Aid CHC
UBC Family Medicine Lead Faculty, Informatics
4Tuesday, July 13, 2010
Who am I?Lead Researcher at eHealth Observatory
Family Doctor: Cool Aid CHC
UBC Family Medicine Lead Faculty, Informatics
Adjunct Faculty, Comp Sci
4Tuesday, July 13, 2010
Who am I?Lead Researcher at eHealth Observatory
Family Doctor: Cool Aid CHC
UBC Family Medicine Lead Faculty, Informatics
Adjunct Faculty, Comp Sci
Informatics Consultant
4Tuesday, July 13, 2010
Thank you to the team• Dr. Francis Lau the eHealth Chair
• eHealth Observatory Team:
• Tyrone Austen
• Jesdeep Bassi
• Heidi Bell
• UBC Enhanced Skills Trainees:
• Dr. Jeanette Boyd
• Dr. James Lai
• Dr. Colin Partridge
5Tuesday, July 13, 2010
Ground Rules
Please Interrupt
Me with Questions!
6Tuesday, July 13, 2010
Activities
• Review Background from the Literature
• Overview of our evaluation framework
• Overview of the methods and tools
• Review Two Case Studies (time permitting)
7Tuesday, July 13, 2010
EMR Background Literature
8Tuesday, July 13, 2010
We are completing a systematic review of
EMR benefits in office practice.
9Tuesday, July 13, 2010
Question:What are the impacts of
EMR systems on physician office practices?
10Tuesday, July 13, 2010
Methods
Main sources MEDLINECINAHL
Supplemental searchesPublication years: 2000-2009CriteriaReviewers
11Tuesday, July 13, 2010
12Tuesday, July 13, 2010
15,847 Papers
12Tuesday, July 13, 2010
15,847 Papers
Analytic Studies22
Descriptive Studies24
Surveys26
12Tuesday, July 13, 2010
72% of survey indicators were for User Satisfaction
System Quality
Information Quality
Service Quality
Use
User Satisfaction
Net Benefits
Quality
Access
Productivity
13Tuesday, July 13, 2010
Analytic Studies
14Tuesday, July 13, 2010
Country # of Studies
% of Total
Netherlands 5 23%
United Kingdom 5 23%
United States 5 23%
Canada 2 9%
Australia 2 9%
New Zealand 2 9%
Italy 1 5%
Total 22 100%
Location of Studies:
50% Europe
32% North America
18% Australia & NZ
15Tuesday, July 13, 2010
90% of measures were focused on Net Benefits
System Quality
Information Quality
Service Quality
Use
User Satisfaction
Net Benefits
Quality
Access
Productivity
16Tuesday, July 13, 2010
Function # of Studies Positive OutcomesPrescribing 7 3
Prevention 4 3CDM 4 2
Test ordering 2 2Recordkeeping 2 0
Other 2 0Referrals 1 1
Total 22 11
17Tuesday, July 13, 2010
Function # of Studies Positive OutcomesPrescribing 7 3
Prevention 4 3CDM 4 2
Test ordering 2 2Recordkeeping 2 0
Other 2 0Referrals 1 1
Total 22 11
Only 2 studies looked at clinical outcomes (no positive findings)
17Tuesday, July 13, 2010
Description of the Descriptive studies
In ProgressIn Progress
18Tuesday, July 13, 2010
There is some evidence of
mixed benefits...lots of room for
improvement
19Tuesday, July 13, 2010
Overview of our Framework
20Tuesday, July 13, 2010
Scanning
LaboratoryResults
DI ReportsImages
Medications
OtherDocuments
ElectronicFeeds In
ElectronicFeeds Out?
Paper Charts
Paper / FaxOut to others
EMR
Other ElectronicRepositories
(Public and Private)
How to Evaluate?
21Tuesday, July 13, 2010
Scanning
LaboratoryResults
DI ReportsImages
Medications
OtherDocuments
ElectronicFeeds In
ElectronicFeeds Out?
Paper Charts
Paper / FaxOut to others
EMR
Other ElectronicRepositories
(Public and Private) How to Evaluate?
22Tuesday, July 13, 2010
Scanning
LaboratoryResults
DI ReportsImages
Medications
OtherDocuments
ElectronicFeeds In
ElectronicFeeds Out?
Paper Charts
Paper / FaxOut to others
EMR
Other ElectronicRepositories
(Public and Private) How to Evaluate?
How to Provide
Feedback?
22Tuesday, July 13, 2010
We wanted something timely, comprehensible, and useful for clinicians.
23Tuesday, July 13, 2010
We wanted something that could also aid in adoption / impact.
24Tuesday, July 13, 2010
Our framework is built on two sources:
HIMSS & IOM.
25Tuesday, July 13, 2010
HIMSS Analytics
26Tuesday, July 13, 2010
27Tuesday, July 13, 2010
0 Paper Charts for Clinical Information
27Tuesday, July 13, 2010
1
0
Online access to reference materials
Paper Charts for Clinical Information
27Tuesday, July 13, 2010
2
1
0
Hybrid Electronic - Paper Chart
Online access to reference materials
Paper Charts for Clinical Information
27Tuesday, July 13, 2010
3
2
1
0
Electronic Medical Record Used (more passive record)
Hybrid Electronic - Paper Chart
Online access to reference materials
Paper Charts for Clinical Information
27Tuesday, July 13, 2010
4
3
2
1
0
Electronic Chart with Advanced Point of Care Clinical Decision Support
Electronic Medical Record Used (more passive record)
Hybrid Electronic - Paper Chart
Online access to reference materials
Paper Charts for Clinical Information
27Tuesday, July 13, 2010
5
4
3
2
1
0
EMR Integrated within Health SystemPoint of Reflection CDSS
Electronic Chart with Advanced Point of Care Clinical Decision Support
Electronic Medical Record Used (more passive record)
Hybrid Electronic - Paper Chart
Online access to reference materials
Paper Charts for Clinical Information
27Tuesday, July 13, 2010
Institute of Medicine
28Tuesday, July 13, 2010
IOM created a report on the Key Capabilities
of an EHRS(IOM 2003)
29Tuesday, July 13, 2010
IOM focused on care delivery functions and not
infrastructure / data standards.
30Tuesday, July 13, 2010
IOM - 8 Core Functions
31Tuesday, July 13, 2010
IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
31Tuesday, July 13, 2010
IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
31Tuesday, July 13, 2010
IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
31Tuesday, July 13, 2010
IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
31Tuesday, July 13, 2010
IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
31Tuesday, July 13, 2010
IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
31Tuesday, July 13, 2010
IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
31Tuesday, July 13, 2010
IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
31Tuesday, July 13, 2010
Summarize Adoption as a Graph
0
1
2
3
4
5
Health Inform
ation
Order E
ntry
Results M
anagement
Decision S
upport
Electronic C
omm
unication
Patient S
upport
Scheduling B
illing
Practice R
eflection
32Tuesday, July 13, 2010
We can show changes over time
0
1
2
3
4
5
Health Inform
ation
Order E
ntry
Results M
anagement
Decision S
upport
Electronic C
omm
unication
Patient S
upport
Scheduling B
illing
Practice R
eflection
33Tuesday, July 13, 2010
We developed tools to assess adoption
34Tuesday, July 13, 2010
We developed tools to assess adoption
Impact Assessment (I)
EMR Adoption (I)
Workflow Modelling / Rx Functions (I)
Usability Benchmarking (O)
Practice Reflection (G)
EMR System Analysis (I / S)
34Tuesday, July 13, 2010
We developed tools to assess adoption
Impact Assessment (I)
EMR Adoption (I)
Workflow Modelling / Rx Functions (I)
Usability Benchmarking (O)
Practice Reflection (G)
EMR System Analysis (I / S)
34Tuesday, July 13, 2010
We developed tools to assess adoption
Impact Assessment (I)
EMR Adoption (I)
Workflow Modelling / Rx Functions (I)
Usability Benchmarking (O)
Practice Reflection (G)
EMR System Analysis (I / S)
34Tuesday, July 13, 2010
We developed tools to assess adoption
Impact Assessment (I)
EMR Adoption (I)
Workflow Modelling / Rx Functions (I)
Usability Benchmarking (O)
Practice Reflection (G)
EMR System Analysis (I / S)
34Tuesday, July 13, 2010
We developed tools to assess adoption
Impact Assessment (I)
EMR Adoption (I)
Workflow Modelling / Rx Functions (I)
Usability Benchmarking (O)
Practice Reflection (G)
EMR System Analysis (I / S)
34Tuesday, July 13, 2010
We developed tools to assess adoption
Impact Assessment (I)
EMR Adoption (I)
Workflow Modelling / Rx Functions (I)
Usability Benchmarking (O)
Practice Reflection (G)
EMR System Analysis (I / S)
34Tuesday, July 13, 2010
All resources are available at
ehealth.uvic.ca
(version 2.0 coming)
35Tuesday, July 13, 2010
METHOD: we travel
on site, tools in hand.
36Tuesday, July 13, 2010
Two researchers. Three days
Focus Group
Feedback Focus Group
Interview
Interview
Interview
Interview
Observation
Observation
Interview
Interview
Usability
Usability
Interview
Interview
37Tuesday, July 13, 2010
We provide feedback and recommendations
38Tuesday, July 13, 2010
240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
240 6 12 18
Months
Adoption
Finally, we repeat the study.
39Tuesday, July 13, 2010
Two Case Studies
40Tuesday, July 13, 2010
Case Study 1
41Tuesday, July 13, 2010
Here are the scores.
0
1
2
3
4
5
Health Inform
ation
Order E
ntry
Results M
anagement
Decision S
upport
Electronic C
omm
unication
Patient S
upport
Scheduling B
illing
Practice R
eflection
42Tuesday, July 13, 2010
Change Management - variable, based on role.
43Tuesday, July 13, 2010
Prescription Management
• Variable use of EMR
• No alerting
• Not using advanced features
44Tuesday, July 13, 2010
Usability
• Multiple errors from system / GUI
• Users did not use tools efficiently
• Drug selection issues (generic / brand)
• Complexity for newer users
• icons not clear
• Complex prescriptions not handled well.
45Tuesday, July 13, 2010
Other Issues
• Participants quick to highlight challenges.
• Many are relative complaints:
• it is slower now
• scanning takes way more mouse clicks than it used to.
• Technical glitches: freezing
• Training issues.
46Tuesday, July 13, 2010
They didn’t complain about what they didn’t know.
47Tuesday, July 13, 2010
Case Study 2(more briefly)
48Tuesday, July 13, 2010
0
1
2
3
4
5
Health Inform
ation
Order E
ntry
Results M
anagement
Decision S
upport
Electronic C
omm
unication
Patient S
upport
Scheduling B
illing
Practice R
eflection
Here are the scores.
49Tuesday, July 13, 2010
Let’s Compare the Two Cases50Tuesday, July 13, 2010
Case 1
0
1
2
3
4
5
Health Inform
ation
Order E
ntry
Results M
anagement
Decision S
upport
Electronic C
omm
unication
Patient S
upport
Scheduling B
illing
Practice R
eflection
51Tuesday, July 13, 2010
0
1
2
3
4
5
Health Inform
ation
Order E
ntry
Results M
anagement
Decision S
upport
Electronic C
omm
unication
Patient S
upport
Scheduling B
illing
Practice R
eflection
Case 2
52Tuesday, July 13, 2010
Who implemented when?
53Tuesday, July 13, 2010
Case 2 implemented 10 years before Case 1
54Tuesday, July 13, 2010
Why so little difference?
55Tuesday, July 13, 2010
User Challenges
56Tuesday, July 13, 2010
I know how paper works...
57Tuesday, July 13, 2010
I didn’t know what I didn’t know
58Tuesday, July 13, 2010
Short term fixes have long term implications
59Tuesday, July 13, 2010
Terminology, shmerminology - let me write down what I want.
60Tuesday, July 13, 2010
System Challenges
61Tuesday, July 13, 2010
Group1,000s
Classification10,000s
Reference Terminology100,000s
62Tuesday, July 13, 2010
“Flexible Data models”“Add your own terminologies”
63Tuesday, July 13, 2010
From my office...
64Tuesday, July 13, 2010
From my office...
64Tuesday, July 13, 2010
From my office...
64Tuesday, July 13, 2010
From my office...
64Tuesday, July 13, 2010
From my office...
64Tuesday, July 13, 2010
From my office...
64Tuesday, July 13, 2010
From my office...
64Tuesday, July 13, 2010
From my office...
64Tuesday, July 13, 2010
From my office...
64Tuesday, July 13, 2010
From my office...
64Tuesday, July 13, 2010
From my office...
64Tuesday, July 13, 2010
How can I see my practice with data like that?
65Tuesday, July 13, 2010
How can we share data in the future?
66Tuesday, July 13, 2010
67Tuesday, July 13, 2010
Materials available atehealth.uvic.ca
68Tuesday, July 13, 2010