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The Status of Digital Health Informatics in Canada and Obstacles to Adoption

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Title: The Status of Digital Health Informatics in Canada and Obstacles to Adoption


1
(No Transcript)
2
The Status of Digital Health Informatics in
Canada and Obstacles to Adoption
3
Questions to Ponder
  • What is an EHR? What are we building?
  • What path is the most important?
  • Where is the value? To who?
  • What is the key success factor - or our Achilles
    Heel

4
Public Policy Drivers for Investing in ICTs
  • Better health outcomes
  • Better accessibility
  • More integration
  • Cost efficiencies
  • Client satisfaction


5
The Original Agenda
6
Strategic Directions for Pan Canadian IT Agenda
  • Empower Canadians through better and more
    accessible health information
  • Strengthen and integrate health services to
    improve access and service delivery
  • Create strategic information resources to support
    health care providers
  • Improve protection of personal health information
    to ensure privacy, confidentiality and security

1
7
Strategic Directions for Pan Canadian IT Agenda
  • Health Information for the Public
  • Strengthen and integrate health services to
    improve access and service delivery
  • Create strategic information resources to support
    health care providers
  • Improve protection of personal health information
    to ensure privacy, confidentiality and security

1
8
Strategic Directions for Pan Canadian IT Agenda
  • Health Information for the Public
  • Electronic Health Record, Health Surveillance,
    Selfcare/telecare, Telehealth, Standards
  • Create strategic information resources to support
    health care providers
  • Improve protection of personal health information
    to ensure privacy, confidentiality and security

1
9
Strategic Directions for Pan Canadian IT Agenda
  • Health Information for the Public
  • Electronic Health Record, Health Surveillance,
    Selfcare/telecare, Telehealth, Standards
  • Information for Health Providers, Clinical
    Decision Support, Health Data Holdings, Health
    Information Analysis and Reporting
  • Improve protection of personal health information
    to ensure privacy, confidentiality and security

1
10
Strategic Directions for Pan Canadian IT Agenda
  • Health Information for the Public
  • Electronic Health Record, Health Surveillance,
    Selfcare/telecare, Telehealth, Standards
  • Information for Health Providers, Clinical
    Decision Support, Health Data Holdings, Health
    Information Analysis and Reporting
  • Privacy Protection

1
11
Strategic Directions for Pan Canadian IT Agenda
  • Health Information for the Public
  • Electronic Health Record, Health Surveillance,
    Selfcare/telecare, Telehealth, Standards
  • Information for Health Providers, Clinical
    Decision Support, Health Data Holdings, Health
    Information Analysis and Reporting
  • Privacy Protection

1
12
1
13
How Do We Proceed
14
Where We Are Operationally
National NHSI FNIHIS CANARIE CAnet 4
Nfld/Labrador Centre for Health Information
Canada Health Infoway
PEI Island HIS
Alberta We//net
Manitoba HIN
PQ Infosante
HealthNet BC
Ontario Smart Systems for Health
NS HIA
NB Wellness Network
SHIS
15
Infoways Mandate
  • Mission
  • To foster and accelerate the development and
    adoption of electronic health information systems
    with compatible standards and communications
    technologies on a pan-Canadian basis, with
    tangible benefits to Canadians. To build on
    existing initiatives and pursue collaborative
    relationships in pursuit of its mission.
  • Goal
  • Infoways plan is to have an interoperable EHR in
    place across 50 percent of Canada by the end of
    2009.
  • Core Business
  • We invest with public sector partners to develop,
    replicate and re-use compatible electronic health
    systems, thereby leveraging public funds,
    knowledge and results across Canada, to build a
    safer, more efficient healthcare system.

16
Investment Program Budget 2003 - 2009
End User Adoption and Setting the Future Direction
Innovation Adoption
- 60m
The Electronic Health Record
- 175m
Interoperable EHR
Drug Information Systems
Laboratory Information Systems
Public Health Systems
Diagnostic Imaging Systems
Domain Repositories and Healthcare Applications
TeleHealth
185m
150m
100m
220m
150m
Cross Program Components
Client, Provider and Location Registries
- 110m
Architecture and Standards
Infostructure
- 25m
17
Jurisdiction Priorities
WEST ON QC
EAST TERRITORIES
NU
NT

NS
PE
NL
YK
MB
NB
SK
AB
BC
Telehealth
Laboratory
Canadian Jurisdiction Priorities
Diagnostic Imaging
INVESTMENT PROGRAMS
Drug Information
Registries
Infostructure
Jurisdictions Priorities
Projects Planned/Underway
18
Key Definition EHR
  • An Electronic Health Record (EHR) provides each
    individual in Canada with a secure and private
    lifetime record of their key health history and
    care within the health system. The record is
    available electronically to authorized health
    care providers and the individual anywhere,
    anytime in support of high quality care.

EHR
19
Maturity of ICTs in Health Sector
Challenges
Skeptics
Technology Enthusiasts
Pragmatists
Visionaries
Conservatives
20
Challenges for Health System
  • Federated nature of Canadian Health system
  • Complexity of health information and ability of
    IT to meet physician needs
  • Lack of a Value Proposition
  • Lack of standards and policies
  • Privacy confidentiality
  • Low rate of adoption/
    Change management

21
Federated Nature of Health System
  • Responsibility for delivery is decentralized
  • Each jurisdiction has taken a slightly different
    approach
  • Sunk investments in IT infostructure
  • Tension between local and provincial/national
    priorities

22
Complexity of Health Information
  • Highly information driven business
  • Information numeric, textual and contextual
  • High touch dimension
  • Teething problems of integrating IT into health
    business practices

23
Lack of Clear Value Proposition
  • Many competing needs
  • Lack of clear ROI or Value Proposition for
    physicians
  • Only 2 spent on ICTs

24
Lack of Standards Policies
  • Timing issue - Investments already made
  • Misalignment of Policies - reimbursement,
    licensure, liability, credentialing

25
Privacy and Confidentiality
  • Protection / Access
  • Patchwork of legislation covering public and
    private sector
  • No consensus on a Pan Canadian policy framework
    but progress being made
  • Physician concerns around data stewardship

26
Low Rate of Adoption
  • The health communitys approach to technology
    issues has been relatively conservative.
  • Little activity with physician community to
    address adoption/change management issues
  • Misalignment of investments and needs
  • Mixing of policy issues and incentives

27
(No Transcript)
28
The Holy Trinity
Processes
Technology
GOAL
Improve Health Care
People
29
IT Adoption
  • Standish Group
  • 8,360 IT Initiatives
  • 250 billion US/year 175,000 projects
  • Three categories
  • deemed successful
  • challenged
  • impaired/cancelled

30
IT Adoption
  • Results
  • 31 cancelled
  • 53 cost overran on average 190
  • 16 on-time and on-budget

31
IT Adoption
  • Successful -
  • user involvement (16), executive management
    support(14) clear statement of
    requirements(13)
  • Challenged -
  • lack of user input(13), incomplete requirements
    and specs(12) changing requirements(12)
  • Cancelled -
  • incomplete requirements(13), lack of user
    involvement(12) lack of resources(11)

32
IT Adoption
  • Successful -
  • user involvement (16), executive management
    support(14) clear statement of
    requirements(13)
  • Challenged -
  • lack of user input(13), incomplete requirements
    and specs(12) changing requirements(12)
  • Cancelled -
  • incomplete requirements(13), lack of user
    involvement(12) lack of resources(11)

33
IT Adoption
  • November 2001study re key factors in
    forecasting EMR/EHR implementation success
  • over 150 factors identified
  • only 2 identified consistently associated with
    successful implementations
  • top management support
  • clinician involvement
  • Sittig, D The Importance of Leadership in the
    Clinical Information System Implementation
    Process

34
IT Adoption
  • November 2001study re key factors in
    forecasting EMR/EHR implementation success
  • over 150 factors identified
  • only 2 identified consistently associated with
    successful implementations
  • top management support
  • clinician involvement
  • Sittig, D The Importance of Leadership in the
    Clinical Information System Implementation
    Process

35
IT Adoption
  • Cedars-Sinai 2003
  • Hospital believed it had sufficiently involved
    physicians in design/implementation process by
    working with 40-physician medical executive
    committee
  • turned off CPOE after complaints from hundreds of
    physicians cumbersome, didnt follow physician
    workflow
  • underestimated impact on ancillary departments,
    complexity of implementation and work involved in
    transitioning to CPOE

36
IT Adoption
  • Cedars-Sinai 2003
  • Hospital believed it had sufficiently involved
    physicians in design/implementation process by
    working with 40-physician medical executive
    committee
  • turned off CPOE after complaints from hundreds of
    physicians cumbersome, didnt follow physician
    workflow
  • underestimated impact on ancillary departments,
    complexity of implementation and work involved in
    transitioning to CPOE

37
IT Adoption
  • They poorly designed a system, poorly sold it
    and then jammed it down our throats and had the
    audacity to say everybody loves it and that its
    a great system - physician at Cedars-Sinai
    Medical Center in Los Angeles

38
IT Adoption
  • Upstate New York Veterans Healthcare Network
  • in lt 5 years, went from poor performer to a
    leading performer among VA 22 networks
  • conscious attempt to empower frontline employees
    by
  • increasing patient outcomes focus
  • adopting a learning environment
  • increasing frontline autonomy
  • encouraging grass-roots innovation
  • developing esprit de corps among frontline
    workers
  • Timothy J. Hoff/IBM

39
IT Adoption
  • Upstate New York Veterans Healthcare Network
  • in lt 5 years, went from poor performer to a
    leading performer among VA 22 networks
  • conscious attempt to empower frontline employees
    by
  • increasing patient outcomes focus
  • adopting a learning environment
  • increasing frontline autonomy
  • encouraging grass-roots innovation
  • developing esprit de corps among frontline
    workers
  • Timothy J. Hoff/IBM

40
What the stakeholders said…
  • significant convergence among views of payers,
    vendors, end-users, CIOs
  • end-user engagement seen as absolutely
    critical, a no brainer, essential, crucial
  • agreement on critical success factors
  • commitment to process - trust is earned
  • all parties need to be prepared to change their
    going in position requires active listening
  • acknowledgement of interdependence
  • recognition and acceptance of different drivers
  • creating a climate of mutual respect

41
Stakeholders (cont.)
  • performance spotty across the country
  • generally poor reviews at the national level
  • balancing province-wide system needs with
    one-on-one medical care creates challenge
  • only two provinces have issued a strategic IT
    plan
  • vendors not generally involved/seen as the enemy
  • cultural differences (project managers vs end
    users) get in the way of effective end-user
    engagement
  • need to migrate from create and direct to
    facilitate and empower
  • AB generally perceived to be engaging
    stakeholders
  • process slow and painful but making real progress
  • growing awareness, increased attention/

1
42
Key Messages
  • Physicians not computer phobic
  • Peer to peer world
  • Independently minded - therefore like programs
    where there is a choice
  • There is a governor on the speed of
    implementation
  • Will be an incremental process

43
Rules of Engagement
  • interest-based versus positional-based approach
  • start having the conversations, building the
    relationships now
  • allow adequate time for engagement
  • jointly define clear statements of requirements
  • engage end-user organizations on strategic and
    implementation issues
  • work with informed end-users at the project
    level
  • at ALL stages of the process
  • engage skilled facilitators

44
Rules of Engagement
  • Make the program voluntary and help with the
    transition
  • build in peer to peer interaction
  • do not put in part systems
  • the jobs not done with implementation
  • build in a feedback loop after implementation
  • ensure end-users arent out of pocket for their
    time
  • include those who are going to deliver the
    product….e.g., the vendors (VCUR)
  • use consistent processes

45
QUESTIONS
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