jhu global ehr november 2007

Johns Hopkins University School of MedicineDivision of Health Sciences Informatics

Friday 16 November 2007

The Healthcare Information Management Systems Society, Global Enterprise

(EHR) Task Force Findings

Walter W. Wieners, MAHIMSS, Fellow

HIMSS, Co-Chair, Global Enterprise (EHR) Task Force

CME Objectives for this Seminar

• Identify key trends among 15 countries who are leaders in electronic health record deployment

• Compare the EHR programs on Governance, Policy, Technology, Adoption and Outcomes

• Articulate barriers to success in Canada and Australia

Global EHRsToday’s Agenda

• HIMSS Task Force Overview

• EHR Program Comparisons from Matrix

• Emerging Key Trends for White Paper

• Barriers to Success in Two Leading Countries

• Questions from Online Participants and Attendees

Task Force Charter 2007 to 2009

“The goals of the HIMSS Global Enterprise Task Force areto identify and describe significant healthcare information enterprise solution efforts being pursued in one or more industrialized nations; identify those aspects of an enterprisesolution that differ from one nation to another and determine, through ROI in finance and quality, those

aspectsthat represent best practices.”

Current Objectives - Fall 2007

1. To identify and describe significant healthcare information enterprise solution efforts being pursued in one or more industrialized nations;

2. To identify those aspects of an enterprise solution that differ from one nation to another and determine, through ROI in finance and quality, those aspects that represent best practices;

3. To identify the common threads in national EHR adoption that have led to either failure or success, then open communications between all stakeholders;

Current Objectives - Fall 2007

4. To incorporate the best practices into a road map for the development of a successful enterprise solution in the United States and to avoid pitfalls that have had negative impact in other countries;

5. To understand the funding, architecture, and delivery systems of enterprise solutions in other countries such as network models and central versus local data repositories and to determine their applicability in the United States;

6. To join and communicate with other nations of the world to help promote common goals in the global adoption of Electronic Health Records.

20 Members from 9 Countries Plus Expert Advisors

Selected Task Force Members:

Marion J. Ball, Ed.D, IBMGeorge Heidenreich, Siemens, GermanySusan Hyatt, MBA, HYATTDIO, Inc., CanadaYu-Chaun Li, MD, Ph.D, Asia Pacific AssociationDave Nurse, Technical Director, CSW Group, Ltd.Gerry Yantis, Capgemini

Task Force Co-Chairs: Steve Arnold MD, President, Healthcare Consultants InternationalWalter W. Wieners, Fellow, HIMSS

Inclusions in Matrix and White Paper January 2008

•England•Wales•Scotland•Canada•Germany•Netherlands•South Africa•Australia•Singapore•Malaysia•Spain•Portugal

•France•Finland•Greece•New Zealand•Sweden•Italy•Denmark•Hong Kong•France•USA•India•Northern Ireland

Governance - Comparisons and Trends

• All countries and territories are different and we do not observe a pattern in governing structure and financing;

• Canada Health Infoway, an independent not-for-profit corporation, leads the national effort with all fourteen federal, provincial and territorial governments;

• Australia’s national approach combines both centralized and decentralized components;

• England is a worldwide leader in the development of healthcare infrastructure and its funding has been through the government-funded National Health Service (NHS).

Policy - Comparisons and Trends

• Each jurisdiction needs to agree upon a unique patient identifier and Initiate Systems is often employed;

• Laws and regulations regarding privacy and electronic health record access vary widely but must be adopted in each jurisdiction;

• New EU regulations offer the likelihood of standardization among European countries in the future.

Technology - Comparisons and Trends

• All countries suffer from the same issues of lack of healthcare IT standards and barriers to inter-system communication;• HL7 v2 and v3 are commonly being used, standards are different across different applications;

• Germany, the Netherlands and France are attempting to do this by using a variation of the HL7 standard so that interoperability can also occur between countries;

• South Africa is selecting of a mainstream vendor there would be considerable interoperability and utilization of industry standards such as HL7, DICOM, etc.;• England choose Oracle DB as the foundation upon which all applications must be built.

Adoption - Comparisons and Trends

• The actual numbers of different classes of users by country vary widely depending upon which provinces were implemented first and the number of early adapters;• Hong Kong implemented a system which reaches 90% plus of the population for inpatient records;• Israel does not have a national program but 26 different products also reach the majority of citizens;• In contrast, Norway has a small research program and has not implemented significant systems.

Outcomes - Comparisons and Trends

• Research and surveys have attempted to document ROI of implementing EHRs, for example, Denmark, but the studies are not recognized as providing complete answers;

• Most jurisdictions are too early in the implementation process to be able to measure tangible savings or document the impact on healthcare quality;

• Medical error reduction is the most commonly change researchers attempt to confirm.

Key Lessons and BarriersAssessments of Canada and Australia

• Global Perspectives book chapter for “Aspects of the

Electronic Health Record Systems” Second Edition,

Harold P. Lehmann, M.D., Ph.D., Marion J. Ball, Ed.D.,

et.al., Editors, Springer, Inc., April 2006

• Selected leading countries with enabling legislation,

funding and implementations at Provincial levels

• Conducted an observational study benefiting from

senior EHR program executive experience

Key Lessons Learned and Barriers to Success Common Across Australia and Canada

• National EHR programs are industry-wide transformations in an immature IT environment

• Building and maintain genuine physician/clinician involvement

• Developing support from all stakeholders including vendors is critical

• Adopting and adhering to data exchange standards must be achieved early

Key Lessons Learned and Barriers to SuccessCommon Across Australia and Canada

• Developing initial momentum among stakeholders is essential for building a critical mass

• Achievement of national legal and regulatory agreement on privacy and consent issues

• Substantial efforts must be applied to stakeholder communication to ensure successful participation

• Information technology investment and deployment strategies and programs must be customizable

Barriers Recognized - Revised Australian Approach

• HealthConnect re-implementation announced focusing

on change management & point of care information

• Health Ministers create National E-Health Transition

Authority (NEHTA) – national health information

management & information & communication

technology entity (IM&ICT) to address urgent

priorities

• NEHTA – 50% funding Council of Australian

Governments (COAG); 50% State funding

International Knowledge Transfer – New Developments

• Significant sharing among international working groups on standards (Canada, UK, US, Australia)

• May 2006 – first international meeting to share information on EHR systems initiatives – ONC (US), NEHTA (AU), NHS (UK) & Infoway (CAN)

• Many international EHR study tours among Canada, UK and Australia (agencies, governments, regions)

Marion J. Ball, Ed.D.,From “Around the World in Sixty Minutes: Where’s the EHR”

“No country has succeeded in fully deploying an electronic health record on a national basis; however, substantial progress has been achieved in Australia, United Kingdom and Canada.

Several of these healthcare systems have developed innovative solutions to obstacles and challenges that offer constructive guidelines for the United States.”

Questions from Online Participants and Attendees

To participate in the Task Force, please contact:

Walter W. Wieners, FHIMSSCo-Chair, Global Enterprise Task Forcewwieners@w-three.com