Rapid Response Evaluation for Physician Office Electronic...
Transcript of Rapid Response Evaluation for Physician Office Electronic...
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Rapid Response Evaluation for Physician Office
Electronic Medical Records
Morgan Price, MD, PhD, CCFP
1Tuesday, July 13, 2010
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May 21, 8:30am-10:15am Rapid Evaluation Approaches Morgan Price notes – to be provided prior to class Ref #14 – UVic eHealth Observatory Rapid Response Evaluation Methodology- Resource Tools section
What are the eHealth evaluation tools on this website? Refer to http://ehealth.uvic.ca/resources/tools/tools.php (opens new window)
Can you apply these tools in your organization? If yes, how? If no, why not? What are the implications? (i.e., what needs to be in place within the organization to apply these
tools) Ref #15 –Uvic eHealth Observatory Rapid Response Evaluation Methodology- Resources Study Planning section
What are the eHealth evaluation tools on this website? Refer to http://ehealth.uvic.ca/resources/studyPlanning/StudyPlanning.php (opens new window)
Can you apply these tools in your organization? If yes, how? If no, why not? What are the implications? (i.e., what needs to be in place within the organization to apply these
tools)
May 21, 10:30am-12:30pm Rapid Evaluation Case Study Morgan Price notes – to be provided prior to class Ref #16 – A Proposed Formative Evaluation Study to Examine the Effects of Deploying a Physician Office EMR on Patient Care
What are the questions? What are the approaches used? Are the approaches used in this study valid/important/relevant to your organization? If yes,
how? If no, why not? Can you apply these study approaches in your organization? If yes, how? If no, why not? What are the implications? (i.e., what needs to be in place within the organization to apply these
approaches)
Please email any comments or suggestions to: HINF Webmaster © School of Health Information Science, 2008 Updated by Francis Lau PhD; Last updated on: DATE \@ "MMMM d, yyyy" January 4, 2010
HINF 552: Evaluation in eHealth Class Notes – May 21/2010
Page 1 of 1HINF552 Class Notes May 21/2010
11/05/2010http://web.uvic.ca/~h552boss/notes%20may21.htm
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Who am I?
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Who am I?Researcher at eHealth Observatory
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Who am I?Researcher at eHealth Observatory
Family Doctor: Cool Aid CHC
3Tuesday, July 13, 2010
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Who am I?Researcher at eHealth Observatory
Family Doctor: Cool Aid CHC
UBC Family Medicine Lead Faculty, Informatics
3Tuesday, July 13, 2010
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Who am I?Researcher at eHealth Observatory
Family Doctor: Cool Aid CHC
UBC Family Medicine Lead Faculty, Informatics
Adjunct Faculty, Comp Sci
3Tuesday, July 13, 2010
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Who am I?Researcher at eHealth Observatory
Family Doctor: Cool Aid CHC
UBC Family Medicine Lead Faculty, Informatics
Adjunct Faculty, Comp Sci
Informatics Consultant
3Tuesday, July 13, 2010
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Ground Rules
Please Interrupt
Me with Questions!
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Who are you?
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My Assumptions(about you)
• You have some knowledge in terms of EMR functionality.
• Wanting hands-on / practical advice on evaluation of adoption.
• Want discussion, not lecture
• You are a mix of providers and IT / informatics professionals.
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Anything specific you want to discuss today?
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Objectives
• Appreciate Current State on EMR adoption evaluation
• Appreciate EMR adoption is a process
• Review formative evaluation methods that can help practices adopt EMR successfully.
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Activities
• Review Background from the Literature
• Overview of our evaluation framework
• Overview of the methods and tools
• Trial one of the tools
• Review Two Case Studies
• Discuss Discuss Discuss
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Some Background Literature
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We are completing a systematic review of
EMR benefits in office practice.
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Question:What are the impacts of
EMR systems on physician office practices?
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15,847 Papers
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15,847 Papers
Analytic Studies15
Descriptive Studies39
Surveys26
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26 published surveys
9 (35%) clearly positive outcomes
14 (54%) reported mixed outcomes
2 (8%) reported negative outcomes
1 had ambiguous results
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72% of indicators were for User Satisfaction
System Quality
Information Quality
Service Quality
Use
User Satisfaction
Net Benefits
Quality
Access
Productivity
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15 analytic studies - 9 (60%) with positive
outcomes.
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90% of measures were focused on Net Benefits
System Quality
Information Quality
Service Quality
Use
User Satisfaction
Net Benefits
Quality
Access
Productivity
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Only 2 studies looked at clinical outcomes (no positive findings)
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Description of the Descriptive studies
In ProgressIn Progress
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There is some evidence of
mixed benefits...lots of room for
improvement
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We wanted to add to EMR evaluation.
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Overview of our Framework
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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?
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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?
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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?
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We wanted something timely, comprehensible, and useful for clinicians.
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We wanted something timely, comprehensible, and useful for clinicians.
...and rigorous, theoretically sound, evidence-based, comprehensive, replicable, & publishable... 25Tuesday, July 13, 2010
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We wanted something that could also aid in
adoption.
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We considered the premise that stepwise adoption limits change
and maintains productivity.
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From Stead, 2007
Time
Clin
ical
Tea
m P
erfo
rman
ce
ResultsViewer
CommunicationTools
CPOE
ClinicalDocumentation
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We assumed that offices adopt functions more organically over time.
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Time
Clin
ical
Per
form
ance
Increasing Performancewith Practice Improvement
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Adoption increases over time when change
is manageable and improvements are
perceived.
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Adoption may fail where benefit not seen.
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Time
Clin
ical
Per
form
ance
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Support change by showing improvements
and by providing guideposts.
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Our framework is built on two sources:
HIMSS & IOM.
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HIMSS Analytics
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HIMSS is well know for its 7 Levels for Hospitals
(and it has 5 levels for ambulatory care).
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0 Paper Charts for Clinical Information
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1
0
Online access to reference materials
Paper Charts for Clinical Information
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2
1
0
Hybrid Electronic - Paper Chart
Online access to reference materials
Paper Charts for Clinical Information
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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
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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
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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
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Institute of Medicine
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IOM created a report on the Key Capabilities
of an EHRS(IOM 2003)
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IOM focused on care delivery functions and not
infrastructure / data standards.
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IOM - 8 Core Functions
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
42Tuesday, July 13, 2010
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
42Tuesday, July 13, 2010
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
42Tuesday, July 13, 2010
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
42Tuesday, July 13, 2010
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
42Tuesday, July 13, 2010
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
42Tuesday, July 13, 2010
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
42Tuesday, July 13, 2010
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IOM - 8 Core Functions
Health Information & Data
Results Management
Order Entry / Order Management
Decision Support
Electronic Communication
Patient Support
Administrative Processes
Reporting & Population Health
42Tuesday, July 13, 2010
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We created a complex matrix...IOM Features
HIM
SS L
evel
s
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and ended up with a simple 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
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Next, we developed tools to assess adoption
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Next, 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)
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Next, 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)
45Tuesday, July 13, 2010
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Next, 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)
45Tuesday, July 13, 2010
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Next, 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)
45Tuesday, July 13, 2010
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Next, 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)
45Tuesday, July 13, 2010
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Next, 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)
45Tuesday, July 13, 2010
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All resources are available at
ehealth.uvic.ca
(version 2.0 coming)
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METHOD: we travel
on site, tools in hand.
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Two researchers Three days
Focus Group
Feedback Focus Group
Interview
Interview
Interview
Interview
Observation
Observation
Interview
Interview
Usability
Usability
Interview
Interview
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EMR System Assessment
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Should be completed before site visits.
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Evaluation of functionality to provide
“ceiling” on scores.
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Necessary to know what the clinic can and
cannot do.
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Aligned our evaluation with existing functional
requirements.
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Our focus was on Medication
Management
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Impact Assessment Interview
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Two part interview
• Part 1
• Impact Assessment
• Mainly open-ended questions
• Part 2 (Pare)
• Focused on Change Management / Deployment
• 23 questions, 5 point scale
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Impact Assessment Examples
• What do you think about the quality of the system in terms of functionality and performance?
• What opportunities do you see with the use of the EMR as compared to how things were previously done?
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EMR Deployment Examples
• 1-5 Scale of Agreement to statements like:
• There was alignment of the system with local practices and processes.
• There were positive attitudes on the part of project team members.
• It was a small and simple project.
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EMR Adoption Interview
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EMR Adoption Interview
• Covers all eight functional areas
• Currently an interview
• Could be survey, after validation
• Each question scored based on current use
• Developing MOA and MD versions.
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EMR Adoption Interview is a good level of detail for an
office.
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We are going to trial this 25 question interview today.
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Activity: (45 min)
EMR Adoption Interview
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Break(and scoring)
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Debrief the Interview - what did you find?
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SCORES
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Yunyong
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
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Mohamed
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
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AHIP
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
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Anything Unclear
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Anything we missed?
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Any surprises from the scores?
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Workflow Modeling / Medication
Management Interview
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Explores detailed processes of medication
management.
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Takes a broad view of the workflows of
medication management.
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Distilled to a set of questions with answers
that map to the five levels.
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Some questions BC specific.
(Special Authority)
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These questions also
tend to educate.
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Usability Benchmarking
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Observation (in this case) of
prescribing activity.
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We developed six standardized cases.
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Standardized cases allow for comparison at three levels: user, clinic, & EMR.
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Feedback: early to users, later to users and
to vendor.
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Practice ReflectionFocus Group
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First, we open the floor to their reflection, as a
group.
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We provide feedback and recommendations
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Focus Group reviews findings, agrees to
priorities and discusses how to implement.
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240 6 12 18
Months
Adoption
Finally, we repeat the study.
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240 6 12 18
Months
Adoption
and look for change over time.
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240 6 12 18
Months
Adoption
and look for change over time.
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240 6 12 18
Months
Adoption
and look for change over time.
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240 6 12 18
Months
Adoption
and look for change over time.
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240 6 12 18
Months
Adoption
and look for change over time.
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240 6 12 18
Months
Adoption
and look for change over time.
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240 6 12 18
Months
Adoption
and look for change over time.
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240 6 12 18
Months
Adoption
and look for change over time.
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240 6 12 18
Months
Adoption
and look for change over time.
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Two Case Studies
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Case Study 1
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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
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Change Management - variable, based on role.
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Prescription Management
• Variable use of EMR
• No alerting
• Not using advanced features
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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.
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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.
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They didn’t complain about what they didn’t know.
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Case Study 2(more briefly)
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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.
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Let’s Compare the Two Cases101Tuesday, July 13, 2010
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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
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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
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Who implemented when?
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Case 2 implemented 10 years before Case 1
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Why so little difference?
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User Challenges
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I know how paper works...
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I didn’t know what I didn’t know
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Short term fixes have long term implications
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Terminology, shmerminology - let me write down what I want.
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System Challenges
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Group1,000s
Classification10,000s
Reference Terminology100,000s
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“Flexible Data models”“Add your own terminologies”
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From my office...
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From my office...
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From my office...
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From my office...
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From my office...
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From my office...
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From my office...
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From my office...
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From my office...
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From my office...
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From my office...
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How can I see my practice with data like that?
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How can we share data in the future?
117Tuesday, July 13, 2010
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Thank you to the team• Dr. Francis Lau and the eHealth Chair
• Tyrone Austen
• Jesdeep Bassi
• Heidi Bell
• UBC Enhanced Skills
• Dr. Jeanette Boyd
• Dr. James Lai
• Dr. Colin Partridge
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Materials available atehealth.uvic.ca
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