lane eprescribe

Georgian BayFamily Health Team

TORC:Rural Health Forum

TORC:Rural Health Forum

e-Healthe-Prescribing Demonstration Project

James Lane, GBFHT IT Lead

e-Healthe-Prescribing Demonstration Project

James Lane, GBFHT IT Lead

Nov 5, 2009


e-Prescribing Demonstration Project

• Background

• Project Design and Deliverables

• Results

• Next Steps

• Demonstration



Background

Ontario’s Health StrategyBetter health care for Ontarians.

Ontario’s eHealth StrategyEnsure by 2015, Ontario’s health

system is the safest, highest quality, and most sustainable in Canada…

Ontario’s Drug eHealth Strategy

Improve the health and well-being of Ontarians through

optimal medication management.

ePrescribingDemonstrationP

roject

Electronic Prescribing is a component of Ontario’s Health Strategy


Background

4

Electronic Prescribing

Generation

Authorization

Transmission

This definition is a work in progress and the validity of the definition will be tested as part of the Demonstration Project

Electronic prescribing encompasses the electronic generation, authorization and transmission of dispensing directions


Background

5

Electronic Prescribing

Generation

Authorization

Transmission

• The electronic creation of a prescription by entering all information required to safely dispense a drug into a provincial or regional information system, Electronic Medical Record (EMR) or Clinical Management System (CMS), stand-alone prescription writer or other solutions

• The use of an electronic signature, or another symbol or process, by authorized prescribers to provide pharmacists with unique, non disputable directions to dispense a drug or mixture of drugs

• The use of one system to send prescription information directly to:

a. Another system owned and operated by an authorized dispenser

b. A repository that can only be accessed by authorized dispensers

“Generation” implies that data is “machine-readable” which is aligned with the definition of “true e-prescribing” that appears in existing CPSO and OCP standards

“Authorization” removes lingering confusion about signing in an electronic environment

This definition is a work in progress and the validity of the definition will be tested as part of the Demonstration Project

Electronic prescribing encompasses the electronic generation, authorization and transmission of dispensing directions


Goals of e-Prescribing Demonstration Project

• Quickly provide and demonstrate the patient safety and quality of care benefits of electronic prescribing to Ontarians

• Create physician and pharmacist champions of electronic prescribing

• Demonstrate the full cycle of electronic prescribing through to dispensing in a local setting

• Create tools and frameworks for process / workflow change, adoption strategies and benefits evaluation that can be used for the overall provincial roll-out

• Identify and understand the issues, challenges and opportunities of implementing electronic prescribing and apply this understanding to the overall provincial roll-out

• Develop excitement and momentum for the province-wide implementation of electronic prescribing


Goals of e-Prescribing Demonstration Project

• What it is not

• The final solution for e - prescribing



Agenda

• Background



Project Design and Deliverables

• Forward looking report taking ‘lessons learned’ and translating into how they wouldimpact/influence the provincial implementation of e-prescribing

Deliverable3

• Broader environment impact caused by the study

• May contain historical and anecdotal information

• Narrative in nature

Deliverable2

• Focus of study caused by project change

• Quantitative measurement (e.g., time, benefit, value, etc.)

• Focus of analysis

Deliverable1

Identify and

Assess

Consultand

Prescribe

Transmitand

Receive

Identifyat

Pharmacy

FillMedication

Dispense and

Consult

Deliverable 1

E-Prescribing Process

• Study focus• Quantitative and

qualitative

• Environmentalscan

• Observation andmeasurement

• Lessons learnedimpactingprovince

• Speculative

Deliverable 2

Deliverable 3



The focus of the evaluation was on the impacts of ePrescribing on the prescribing and dispensing processes



Project Design:

2 Sites

GBFHT-Collingwood and arearoster size-50,000

GHC-Sault Ste.Marieroster size-60,000



2 Sites-Collingwood, Sault Ste. Marie

chosen because of:

advanced electronic medical records implementations

non-scalable technologygeographically constrained = Rural



Project Design: GBFHT

7-10 pharmacies12-15 physicians /NP’s will participate (mix

of experienced and new EMR users)

19 Pharmacies-all participating bounded by Meaford–>Elmvale–>Creemore

31 Prescribers



Agenda

• Background


• Results



Results

• April 13-June 09, 2009

• EMR E-prescriptions: 20,750

• E-prescriptions downloaded: 20,059

• EMR prescriptions printed: 7,083



Results

• # E-prescribers: 32

• # E-prescribers that prescribed > 20/week: 25

• # medical profile accesses: 1615



Results

• ePrescribing increases prescribing efficiency compared to EMR-generation of paper prescriptions

• Improved Clinical Outcomes - Paper prescriptions can lead to clinically significant adverse events that are often flagged by alerts in electronic systems

• Half of participating pharmacists believe the ePrescribing Project improved dispensing efficiency

• Electronic authorizations improve dispensing efficiency the most, according to pharmacists

• Integration to a DIS is imperative to realize the full benefits of ePrescribing to pharmacists



Results

• Prescribers and pharmacists interact more directly and about more important issues after Go-Live

• 75% of patients expect ePrescriptions to be ready for pickup upon arrival

• 92% of patients comfortable with paperless prescriptions

• Nearly 100% of prescribers believe overall ePrescribing system quality acceptable; 71% pharmacists believe

• no security breaches



Agenda

• Background


• Results

• Next Steps



Next Steps

• Regulatory Colleges - CPSO, OCP, CNO

• 6 month extension

• new letter of support

• auditor to visit GBFHT sites

• eHealth Ontario involvement



Next Steps

• Drug Information System (D.I.S.)

• RFP and procurement 2010

• rollout pharmacies, then EMR prescribers-2011

Future State



Live Demonstration

•HOPE IT WORKS!

lane eprescribe

Health & Medicine

prescribing efficiency

deliverables project

electronic generation

goals of e

thefinalsolutionfor

electronic creation

electronic signature

electronic environment