Manitoba

1
Manitobas Electronic Medical Record Program

• Liz Loewen
• Director, Telehealth and EHR Services
• Manitoba eHealth

2
What is an EMR?

• Electronic Medical Records - the main tool used
  by community physicians to run their practice
• The local, detailed medical record for that
  practice
• The connection point to the Electronic Health
  Record (EHR), through which information will be
  shared with the rest of the health system

• Overview of EMR Functions
• Register Patient
• Schedule Patient Visit
• Triage Patient
• Assess Current Problem
• Manage Current Problem
• Clinical Decision Support
• Care Planning
• Quality Monitoring/Improvement
• Administer Immunization
• Order Investigations
• Order Medications
• Order Consultations
• Manage Referrals
• Manage Billing
• Manage Provider Tasks
• Analyze Patient Population and Practice

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EMRs are key to the provincial eHealth Strategy

• EMRs are a key enabler for primary care
• Manitoba Health and Healthy Living Vision
• Primary Care is the foundation of the health
  system
• Quality Primary Care will be accessible to all
  Manitobans

4
Why are EMRs key to the provincial eHealth
Strategy?

• EMRs provide a core solution to support primary
  care clinics
• Support clinics own internal operations
• To deliver quality care
• To run an efficient operation
• Enhance connections to other parts of the health
  system to enable primary care to play its
  quarterback role e.g.
• Ordering receipt of test results, medication
  orders
• Referral of patients to other services as
  required
• Receipt of information on care provided
  elsewhere, to support continuity of care for
  patients

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Why are EMRs key to the provincial eHealth
Strategy? (contd)

• EMRs are a Pre-Requisite for Primary Care clinics
  to participate in the Physician Integrated
  Network (PIN).
• Primary care initiative which enables
  fee-for-service physician practices to
  demonstrate quality of care and address issues
  such as patient access, physician work-life and
  multi-disciplinary team care
• Supported by Quality Based Incentive Funding
  (QBIF).
• Clinics wishing to participate in PIN must have
  one of Manitobas Approved EMRs to be eligible.
• Measuring quality, as required for QBIF, is only
  practical with the automated tracking built into
  Approved EMRs.

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EMRs are key to the provincial eHealth Strategy
for Specialists

• EMRs are a key enabler for care by specialist
  physicians working in the community
• Running specialists offices efficiently
• Chart management
• Scheduling
• Billing
• Connections to other parts of the health system
• Referral/consultation information to and/from
  primary care
• Booking and supporting information to hospitals

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eHealth Vision for Primary Care
EMRs help reinforce connections with
computer-savvy patients
Community Health Resources
Pharmacies
Specialist Physicians Surgeons
Diagnostic Imaging

• EMRs connect Primary Care to services their
  software

EMRs connect Primary Care to other providers
their software
Primary Care
HealthLinks/ InfoSante
Patient
Labs
Tool EMR
Emergency Rooms
Billing
EMRs provide information for managing quality,
access, capacity and value
In-Patient Hospital Care
EHR
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Other Related Initiatives - the EHR

• Electronic Health Record (EHR)
• Release 1 and 2 of the EHR will be deployed in
  stages (2010 2012).
• Ability to view
• DPIN - Drugs dispensed at retail pharmacies
  throughout the province
• MIMS - Provincial immunization history
• Laboratory Results of most tests done throughout
  the province
• Diagnostic Images and Reports from most public
  facilities
• Pilot implementations to explore how this
  information should be integrated with approved
  EMRs

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Other Related Initiatives - ED

• Emergency Department
• Plan to extend the Emergency Department
  Information System (EDIS) to nine Regional
  Hospitals outside Winnipeg (2011-2012)
• Provision of the emergency visit Care Summary to
  primary care clinics
• The Care Summary will eventually be part of the
  EHR

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Other Related Initiatives - CareLink

• CareLink
• Afterhours support for patients provided through
  the Provincial Health Contact Centre with a
  summary provided to the primary care provider at
  the pilot-site clinic (Access Downtown) in
  Winnipeg
• Implementation in 2010
• Effectiveness to be evaluated.

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What Are Physicians Telling Us?

• I want to improve quality of care
• I want a better quality of life
• I want to reduce risk for my patients and myself
• I want to improve the financial performance of my
  practice

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Improve Quality of Care

• An EMR can support this through
• Better information on patient populations with
  specific conditions (e.g. diabetes)
• Better tracking/prompting of when patients are
  due for visits, tests etc.
• Best practices and clinical guidelines can be
  embedded in standard templates for consistent
  practice
• Quick access to information to respond to
  external issues such as drug recalls
• Increased insight into variability or gaps in
  patient care amongst a multi-disciplinary team
• Quick access to pending orders individually or
  across a clinic group to determine if results
  received
• Access to internet research sites from within the
  record

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Better Quality of Life

• An EMR can support this through
• Less clinic time spent searching for paper
  information and charts
• Information to respond to questions on specific
  patients available immediately avoids need to
  call back and play phone tag with patients and
  referring consultants
• Fewer pharmacy callbacks due to legible
  prescriptions
• Templates reduce time for routine tasks such as
  lab requisitions, referral letters, insurance/WCB
  forms
• Easier to provide coverage for another physician,
  since information is documented in the same
  manner and is legible
• Remote access to charts when off-site (if
  physician so chooses)

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Reduce Risk

• An EMR can support this through
• Reduced errors from illegible files, missing
  information
• Prescription support tools re-issue
  prescription based on current information, review
  drug/condition interactions
• Manage patients as a population e.g. identify all
  patients taking a recalled drug in minutes
• Easier chart auditing, clear documentation trail
• Having charts stored in a more secure manner than
  paper charts which could be removed by anybody
  having physical access
• Increased options to reduce lost patient data
  during a catastrophe
• Compliance with privacy requirements -
  information tracking within the file audits of
  who has seen, who has edited

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Improve Financial Performance

• An EMR can support this through
• Reduced space costs for chart storage
• Reduced transcription costs if entering directly
• Fewer chart pulls and less filing/searching for
  files
• Less manual data entry of lab results (when
  interfaced)
• Ability to document and report on funded
  indicators (such as quality based incentives)
• Improved and consistent coding of standard visits
  results in fewer missed billings
• Reconciliation of billing to patients seen

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Key EMR Benefits Depend on Optimization
How do we get more Family Physicians to this
stage?
Benefits
of Manitoba Family Physicians (Speculative)
Up to 75
5-10
15-30
Awareness
Evaluation
Acquisition
Implementation
Optimization
Adoption Stage
PIN
Other Current Future Initiatives
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Supporting EMR Adoption in Manitoba

• Primary Care Information Systems (PCIS) Office
• Established within Manitoba eHealth in Autumn
  2008
• Key drivers included
• Physician Integrated Network (PIN)
• Advent of the Electronic Health Record
• Consistent with similar activities in other
  jurisdictions
• POSP (AB), PITO (BC), OntarioMD

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Funding for EMR Adoption

• Physicians are telling us incentive funding may
  assist them to accelerate a purchase decision
• Canada Health Infoway is presently considering a
  new investment program
• Funded under 2009 Fiscal stimulus package
• Does not yet have federal government approval
• Program details still being worked out
• Manitoba eHealth will be ready for the
  opportunity if Infoway funding does become
  available

18
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PCIS Office Services

• Promote EMR adoption and high standards of use
• Resource for Physicians and RHAs
• Not making the purchase decision, available as a
  resource
• EMR implementation support
• Can be a resource in conjunction with EMR Vendors
• Vendor management on behalf of Manitoba
• Ensure vendors comply with their obligations
  under the Master Standing Agreement
• Track and report on Service Levels
• Requirements management
• Ongoing process to identify and implement new
  requirements in the EMR systems to align with
  other provincial systems (such as the Electronic
  Health Record)
• Support for PIN project
• Information Management/Information Technology
  Support

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Completion Maintenance of the EMR Qualification
Process

• Open tender to EMR Vendors to select Candidate
  Approved Vendors to provide complete EMR
  solution at fixed maximum price
• Selection involved review of written responses
  and vendor demonstrations
• Evaluators reflected a wide range of stakeholders
  including clinicians from a variety of practice
  settings
• Candidate Approved Vendors became Approved
  Vendors after
• Signing a Master Standing Agreement with Manitoba
• Passing the first round of Conformance Testing
  all completed by July 2009
• On an ongoing basis, new requirements will be
  given to vendors once or twice a year
• Vendors must pass Conformance Testing on each new
  set of requirements to remain Approved Vendors

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Status of the Qualification Process

• Four vendors have achieved Approved Vendor
  status
• Approved Vendors and their products, in
  alphabetical order, are
• Clinicare Corporation Product name Clinicare
  EliteCare 6.5
• Code-Med Inc. Product name Freedom Paperless
  Office version 4.5.1 Powered by JonokeMed version
  4.5.1
• Med Access Inc. Product name Med Access version
  3.2.1
• Optimed Software Corporation Product name
  Accuro version 4 (June 1, 2009)

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Physician Peer to Peer Network

• Canada Health Infoway funded project
• Connects Physicians to Peer Leaders to discuss
  questions about acquiring or optimizing an EMR
• Peer Leaders are
• Physicians who have experience using and
  implementing EMRs in a practice setting
• There are 8 physicians who are Peer Leaders in
  Manitoba located in Winnipeg, Steinbach,
  Niverville, Winkler, Morden and Selkirk
• Site visits to some Peer Leader Clinics can be
  arranged to review impacts on all clinic staff

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Contact us

• On the web http//www.manitoba-ehealth.ca/dr.html
  
• Links to resources for physicians, the place to
  go for program updates
• By e-mail PCISOffice_at_manitoba-ehealth.ca

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Thank You

• Liz Loewen
• Director, Telehealth and EHR Services
• Manitoba eHealth
• E-mail lloewen2_at_manitoba-ehealth.ca
• Ph 204.926.9171