Serving Patients and Physicians in the Electronic Age; McDonalds has Gone Paperless Why Can’t We?
JOZEF NYCZ, MRT(N)
TIMMINS & DISTRICT HOSPITAL
Financial DisclosureI, Jozef Nycz, have no financial disclosures.
What’s on the Menu
How do we serve our customers?
Government initiatives for digital health
Issues surrounding electronic health format
Introduction to digital solutions
Who are our customers?
The Public Doctors
What are customer expectations?Facility improvements or investment in customer service?
Use of a modern healthcare system
Online appointments
Improved notification
Cell phone, text or email
communication
Access to test results by medical
professionals when needed
Digital Health Partners Canadians
Provincial Jurisdictions
Clinicians and Health Care Community
Health Care Organizations and Associations
IT Professionals
Academia/Researchers
Vendors
Ref. 2
Digital Healthcare Planning
Canada Health Infoway (CHI), 2001
Canadian Patient Safety Inst. (CPSI) ,2003 Healthcare Innovation Agency of Canada, 2014
Canadian Foundation for Healthcare Improvement (CFHI), 1997 (Healthcare Innovation Fund, 2014)
Canadian Institutes of Health Research (CIHR), 2000
Other Pan-Canadian Agencies
Ontario- Smart Systems for Health Agency Ontario, 2008
- eHealth Ontario, 2009
- Regional Programs
- LIHN
- Hospitals
eHealth Ontario concept Connecting Ontario
GTA, Southwest Ontario, Northern and Eastern Region
OLIS
ONE ID, ePortal, ONE Network
OntarioMD (OMA)
Diagnostic Imaging
DIr
ENITS
DI Common Service
DHDR and DPV
ONE mail
EHR Legislation & Standards
How do we serve customers in DI?
Make appointments and perform testing that is requested on paper requisitions
Patients are contacted by telephone
Test information/instructions available on hospital website or by pamphlet
Patient are registered and identified in DI with paper requisition
Patient results are faxed or mailed to the referring physician
Healthcare Innovation Agency of Canada, July 2015
Promotion of health and healthcare literacy
Digital health and precision medicine
Mobile and digital health solutions
Co-ownership of medical records
Health systems integration
Nurture a healthcare industry to interact with multinationals
Patient engagement and empowerment
Ref. 3
Digital Health and Precision Medicine
Promotion of Health and Healthcare Literacy in DI
Populate with hospital information Hospital services Departmental instructions Patient bulletins Common DI testing Etc…
Information Monitors
Digital Health Solutions for DI
HIS/RIS/PACS
DI-R
Order entry
Online Booking
Electronic Requisition template
Cell phone, text and email contact for staff and patients
Technology to improve workflow
PACS Applications for Physicians
Advanced clinical packages for cardiology, orthopaedics , 3D processing
Automated Inelegance ( AI )
Downloads for relevant priors, DI reports, EMR info, Lab results
Automated quantification processing
Built in feed back/image analysis
Hospital Order Entry Offered through HIS/RIS, secure network
Excellent opportunity to paperless
Technologist work list
Touch screen work station in DI
Electronic tracking tools
Online Physician decision making tools
Computerized referral processing
Electronic verification of required test
“ Request for Service”
Online Appointments
Book appointments electronically with their care providersNo current offering for radiology appointmentsSome facilities offer on-line pre-registration once appointment has been madeRegistration kiosks
Canada Health Infoway booking initiative: Granted to limited satellite projectsProvision of baseline and monthly reportsachievement of 30% adoption target
DI requisitions are technical and require validation by radiology staff
Ref. 4
Electronic Requisition Template PDF format
Populate with required fields
Electronic signature
Electronic drop box
Reduce requisition processing time
Easily archived and retrieved
Inexpensive option to installing HIS/RIS at local physicians office
Replace practice of FAX copies
WTIS (Wait Time Information System)
2012 Ontario funding model for MRI and CT
Funding based on number of patients and procedures successfully delivered
DI procedures monitored by Cancer Care Ontario
OBSP, ER and Sleep lab have separate agencies
Understanding workplace process
Benefits of the WTIS Process Accountability
Electronic cataloguing of requisitions
Electronic flags for pending
Requisition processing
Appointments
Reports
Public access for prompt testing
Data bank for assessing and allocating department resources
Allows for spin-off to other departmental processes
Cell Phone, Text or Email
11% of Canadian family doctors communicate with patients via email
35% rate in the USA
Canadian Medical Protection Agency(CMPA) and Ontario Privacy Commissioners Office(CPO)
Secure and encrypted email
Consent from patients for unsecured email
College of Physicians and Surgeons of Ontario(CPSO)
Avoid unsecured methods of electronic communication
Canadian Medical Association(CMA)
Best practice recommends patient consent
Note: Patients must be aware other medical staff and clerical workers may have access
Ref. 5
The Canadian Medical Protective Association
Founded in 1901
The CMPA is a not-for-profit
association, incorporated by an
Act of Parliament.
Cell Phone, Text or Email cont’d No established network
Protocol
Appropriate subject matter
Urgent and non-urgent
Response expectations
Archiving
Billable component
Financial burden of secure email and texting
Mobile and Digital Health SolutionsMobile Apps:
165,000 apps residing in Apple and Google stores
Definition:
An accessory to a regulated medical device or process used to transform a mobile platform to a regulated device
Image viewing
Image processing
Computer-aided detection
Ref. 6
Mobile Device Considerations Access control
Protected against tampering and destruction
Support remote IT management
Maintain access log
Disable automatic WI-FI connection
Disable downloads and install of unauthorized apps
Support device audits
Users must comply with incident report policies
Encrypted email and text functions
Co-ownership of Medical Records
For an EMR submit a written request to the healthcare provider, facility or eHealth Ontario
Administrative costs from family doctors
Processing time with eHealth Ontario maybe up to 30 days
Hospital sites can share diagnostic images and reports digitally within their region
One View requires additional username and password, time consuming
Pay for an electronic copy of diagnostic testing
DI Common Services, central registry is pending
eHealth EHR form
Digital Pitfalls
Access to services
Cost/ Benefit
Generation Gaps
Adapting to change
Are you having fries with that?
Confidentiality
Identity theft
Incorrect patient ID
Data entry errors
Data transfer errors
Release of records to minors
etc….
Digital Heath and Ethics
Release of EHRs to minors
Security
System implementation and maintenance
Data transfer
Data errors
Cut and paste
Drop down errors
Other uses of patient data
Research
Standard of care
Guides and White Papers
Status of Digital Health A National and Provincial schedule for implementing digital framework
Funding model
Integration
National/Provincial strategy DI-r
Global identification number
Secure Networks
Encryption
Clinical software compatible with HIS/RIS
Understanding various Clinical Processes
Cost benefit
Corporate Plans
ConnectingOntario Northern and Eastern Region is in implementation.
DI-Common Services, targeted completion 2017/18
Adoption awareness activities are underway
Canada Health Infoway 2017/18 Launch limited production release of ePrescibe in two provinces with
targeted clinicians
Expand telemedicine in 5 regions for at least 5000 patients
Bring to near completion existing EHR and EMR projects with “Investment Portfolio Optimization”
Provide continued leadership and promote standardization
Progress with ”Benefits Evaluation Strategy" with focus on consumer health solutions
Continued research with ePrescribe and EMRs
Stimulate the Canadian economy
Estimated budget, $90 to $100 million
Funding Model? What agency? CHI or eHealth Ontario
Communication between healthcare facilities and government agencies
Digital project manager
Limited time and targeted offering for digital projects
Non-standardized application for funding
Who are the investors
Data access strategy for DI-r
ProvinciallyONE ID, eHeath Portal, ONE VIEWDI Commons Services (central registry)
LocallyPACSHIS/RISPhysician office EMRTablet and Smart phone apps
All require:
Authentication of user and device
Connection to a secure server
Global Patient Identifier (GPI)
Integration
Clinical Processes Deploying online patient self-
scheduling, CHI April 5th,2017
E-booking, use and survey, CHI June 11th,2015
Adopting eHealth solutions: Implementation strategies, RNAO 2017
Digital Health Spin-offs Job Creation
2014-2019 hiring of 6,200 to 12,200 IT jobs
10,700 person years of employment
Investment
2010, Federal Gov. invested $500 million in CHI
$1.48 return for every $1 invested
Economic Gain
$400 million gain in GDP by patients
not missing work
Growth in domestic health IT
Ref. 8
eHealth EMR Fast Facts, 2015
eHealth’s value to the health care system is at least $5.7 billion
$200 million in annual value
$13 million from reduced hospitalizations due to adverse drug events
$95 million from reduced clinician time spent on chart management processes
$46 million and $37 million from avoided duplicate laboratory and diagnostic tests, respectively
In 2015, Telehealth helped patients save nearly $240 million in personal travel costs.
Ref. 7
Costs of a CorporateData Breach, 2016 Canada
24 Canadian companies participated
$1.94 million is the average cost spent on detection
$1.67 million is average post data beach cost
$278 is average cost per stolen record (50,000 records or more)
$6.03 million is average total cost of data breach
Ref. 1
In Summary Definite public shift towards electronic format
Federal and Provincial investment since late 1990s in digital health
Status of digital health programs is uncertain
Healthcare providers debate universal access, ethics and cost/benefit issues
Digital implementation is hampered by bureaucracy and other economic mandates
Underestimated funding
Thank You
Contact
•Jozef Nycz
Charge TechnologistTimmins & District Hospital / Ontario / Nuclear Medicine
•700 Ross Avenue EastTimmins, ON, Canada P4N 8P2
•Phone: (705) 267-6376
•Fax: (705) 267-6346
•E-mail:[email protected]
References
1- 2016 Cost of Data Breach Study, Ponemon Inst. Research report June 2016
2 and 4- Canada Health Infoway
3- Unleashing Innovation: Excellent Healthcare for Canada, Advisory Panel on Healthcare Innovation July 2015
5- Why can’t you email your doctor, HealthyDebate articles April 30,2015
6- How many Health Apps Actually Matter, Health Care IT NewsSept. 23,2015
7- eHealth Ontario News
8- Digital Heath in Canada an Exploratory Analysis Canada’s Domestic Health ICT Sector, The Information and Communications Technology Council Report 2015
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