Quality, Safety, and eHealth Do electronic records improve Q and PS

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Quality, Safety, and e-HealthDo electronic
records improve Q and PS?

• Annual WHIN Symposium
• Vancouver , BC
• May 21, 2008

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Quality, Safety, and e-Health

• Quality and Safety
• Current e-Health update from MB
• Something entirely different

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Quality and Safety

• Are quality and safety variations on the same
  theme? (Sonias Chip Stand vs. McDonalds)
• Dekker Quality is mainly about the performance
  of specific components of a system safety is
  concerned with the patterns and relationships
  between units and sub-units in a system
• Hollnagel Quality management works by
  constraining processes and performances while
  safety is achieved through the management and
  understanding of performance variability
• Are the methods of measurement different?
  (quali/quanti)

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Update from MBCurrent Active Clinical Projects

• HSC SIMS (GE) and EDIS (Eclipsys)
• SBGH ADT, RR, EDIS (Eclipsys AM and SCM)
• Brandon ADT and RR (Siemens)
• WRHA Access Centres CSIS (Paris)
• DSM LIS (Sysmex etc.) and RIS/PACS (Agfa)
• CCM (Varian)
• PHIS
• MIMS
• DPIN
• Pharmacy Acute Care (Cerner and GE Centricity)
• PCH (Momentum MDS)
• PHC EMRs in 16

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Update In Flight Major Clinical Projects
(Provincial)

• Client Registry (CR)
• Uniquely identifies individuals
• Implemented in approximately 80 of the province
• Rollout expected to be completed May 2008
• Provider Registry (PRS)
• Uniquely identifies Health Care professionals
• In production to be used in the Electronic
  Health Record
• Home Care Scheduling Systems
• Preparing for provincial rollout of home care
  scheduling systems
• Manitoba Telehealth
• Implemented in 26 sites in Manitoba
• Provincial scheduling system to be procured
• Used for visitation, consultation, and education

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Update In Flight Major Clinical Projects
(Provincial)

• Radiology Information System / Picture Archiving
  Communications Systems (RIS/PACS)
• Implementing provincial systems in 50 facilities
• Victoria, HSC, and Seven Oaks have RIS
  implemented
• HSC to implement PACS end of June
• Selkirk as next implementation site
• Provincial Laboratory Information System (LIS)
• Implemented in WRHA facilities
• Infrastructure Renewal and Software upgrade
• Phase 1 provincial rollout to start summer 2008
• Brandon (Siemens) to keep their own system
• Cadham lab to activate new system (LabWare)

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UpdateIn Flight Major Clinical Projects (WRHA)

• Hospital Information System (HISP AC)
• Phase 1 implementation of Electronic Patient
  Record (EPR) at SBGH complete
• Phase 2 at SBGH (order entry and clinical
  documentation) to be implemented in fall 2008 and
  2009
• Hospital Information System Long Term Care
  (HISP LTC)
• Momentum MDS
• 29/39 WRHA PCH sites activated
• Emergency Department Information Systems (HISP
  EDIS)
• Implemented at HSC and SBGH in 2007
• Preparing for implementation at Seven Oaks,
  Grace, Victoria and Concordia Hospitals

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UpdatePrimary Health Care

• Physician Integrated Network (PIN)
• 4 PHC Clinics (Morden, Winkler, Winnipeg,
  Steinbach)
• Improve clinical reporting practices
• Identify change management requirements
• QBIF
• Primary Care IS Strategy (PCISS)
• EMR RFQ - select a set of approved electronic
  medical records (EMR) systems to be adopted and
  implemented by physicians
• PCISS Office Physician Office Support Program
• Peer to Peer (P2P)
• Physicians
• Nurses
• Demonstration sites

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HISP Phase 1 Implementation at St. Boniface
Hospital (April 12th 2007)

• Eclipsys Access Manager and Sunrise Clinical
• Manager
• ADT and Demographics
• Advance Directives and ARO
• Allergies
• Care Providers
• Patient Lists
• Results Reporting lab and DI

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EDIS Phase 1 HSC and SBGH (2007)

• Patient tracking
• Patient location
• Length of stay
• Status - disposition or treatment
• Bed status
• Care providers
• Temporary locations, and length at location
• Results viewing
• ExitCare discharge instructions

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HISP Phase 2 Implementation (Fall 2008)

• Order Entry (CPOE) and eMAR
• Order Sets
• Rules and Alerts
• ClinDoc
• Transcription interface (discharge summary)

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Something completely different (WRHA)

• Critical Incident Notification System
• Old
• Part of paper-based OR system
• Lots of tick boxes
• 45,000 reports yearly (44,750 NM O, 250 CI)
• New
• 24/7 live operator telephone notification (April
  07)
• Simple protocol narrative
• No Paper (Yahoo!!)

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Something completely different (WRHA)

• 24/7 CI Notification process
• Changes
• Increase in notification
• Timeliness of notification
• Range of notifiers
• Richness of narrative as source of information
• Ability to notify widely through system when
  provisional
• Ability to open the privilege umbrella more
  quickly
• Recent transition from CIRL to CIRSL (Dec 2007)

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Quality, Safety, and e-Health

• Questions?
• Contact
• Dr. Rob Robson,
• Chief Patient Safety Officer, WRHA
• Tel [phone]
• rrobson_at_wrha.mb.ca