Serving Patients and Physicians in the Electronic Age; McDonalds has Gone Paperless Why Can’t We?

JOZEF NYCZ, MRT(N)

TIMMINS & DISTRICT HOSPITAL

Financial DisclosureI, Jozef Nycz, have no financial disclosures.

What’s on the Menu

How do we serve our customers?

Government initiatives for digital health

Issues surrounding electronic health format

Introduction to digital solutions

Who are our customers?

The Public Doctors

What are customer expectations?Facility improvements or investment in customer service?

Use of a modern healthcare system

Online appointments

Improved notification

Cell phone, text or email

communication

Access to test results by medical

professionals when needed

Digital Health Partners Canadians

Provincial Jurisdictions

Clinicians and Health Care Community

Health Care Organizations and Associations

IT Professionals

Academia/Researchers

Vendors

Ref. 2

Digital Healthcare Planning

Canada Health Infoway (CHI), 2001

Canadian Patient Safety Inst. (CPSI) ,2003 Healthcare Innovation Agency of Canada, 2014

Canadian Foundation for Healthcare Improvement (CFHI), 1997 (Healthcare Innovation Fund, 2014)

Canadian Institutes of Health Research (CIHR), 2000

Other Pan-Canadian Agencies

Ontario- Smart Systems for Health Agency Ontario, 2008

- eHealth Ontario, 2009

- Regional Programs

- LIHN

- Hospitals

eHealth Ontario concept Connecting Ontario

GTA, Southwest Ontario, Northern and Eastern Region

OLIS

ONE ID, ePortal, ONE Network

OntarioMD (OMA)

Diagnostic Imaging

DIr

ENITS

DI Common Service

DHDR and DPV

ONE mail

EHR Legislation & Standards

How do we serve customers in DI?

Make appointments and perform testing that is requested on paper requisitions

Patients are contacted by telephone

Test information/instructions available on hospital website or by pamphlet

Patient are registered and identified in DI with paper requisition

Patient results are faxed or mailed to the referring physician

Healthcare Innovation Agency of Canada, July 2015

Promotion of health and healthcare literacy

Digital health and precision medicine

Mobile and digital health solutions

Co-ownership of medical records

Health systems integration

Nurture a healthcare industry to interact with multinationals

Patient engagement and empowerment

Ref. 3

Digital Health and Precision Medicine

Promotion of Health and Healthcare Literacy in DI

Populate with hospital information Hospital services Departmental instructions Patient bulletins Common DI testing Etc…

Information Monitors

Digital Health Solutions for DI

HIS/RIS/PACS

DI-R

Order entry

Online Booking

Electronic Requisition template

Cell phone, text and email contact for staff and patients

Technology to improve workflow

PACS Applications for Physicians

Advanced clinical packages for cardiology, orthopaedics , 3D processing

Automated Inelegance ( AI )

Downloads for relevant priors, DI reports, EMR info, Lab results

Automated quantification processing

Built in feed back/image analysis

Hospital Order Entry Offered through HIS/RIS, secure network

Excellent opportunity to paperless

Technologist work list

Touch screen work station in DI

Electronic tracking tools

Online Physician decision making tools

Computerized referral processing

Electronic verification of required test

“ Request for Service”

Online Appointments

Book appointments electronically with their care providersNo current offering for radiology appointmentsSome facilities offer on-line pre-registration once appointment has been madeRegistration kiosks

Canada Health Infoway booking initiative: Granted to limited satellite projectsProvision of baseline and monthly reportsachievement of 30% adoption target

DI requisitions are technical and require validation by radiology staff

Ref. 4

Electronic Requisition Template PDF format

Populate with required fields

Electronic signature

Electronic drop box

Reduce requisition processing time

Easily archived and retrieved

Inexpensive option to installing HIS/RIS at local physicians office

Replace practice of FAX copies

WTIS (Wait Time Information System)

2012 Ontario funding model for MRI and CT

Funding based on number of patients and procedures successfully delivered

DI procedures monitored by Cancer Care Ontario

OBSP, ER and Sleep lab have separate agencies

Understanding workplace process

Benefits of the WTIS Process Accountability

Electronic cataloguing of requisitions

Electronic flags for pending

Requisition processing

Appointments

Reports

Public access for prompt testing

Data bank for assessing and allocating department resources

Allows for spin-off to other departmental processes

Cell Phone, Text or Email

11% of Canadian family doctors communicate with patients via email

35% rate in the USA

Canadian Medical Protection Agency(CMPA) and Ontario Privacy Commissioners Office(CPO)

Secure and encrypted email

Consent from patients for unsecured email

College of Physicians and Surgeons of Ontario(CPSO)

Avoid unsecured methods of electronic communication

Canadian Medical Association(CMA)

Best practice recommends patient consent

Note: Patients must be aware other medical staff and clerical workers may have access

Ref. 5

The Canadian Medical Protective Association

Founded in 1901

The CMPA is a not-for-profit

association, incorporated by an

Act of Parliament.

Cell Phone, Text or Email cont’d No established network

Protocol

Appropriate subject matter

Urgent and non-urgent

Response expectations

Archiving

Billable component

Financial burden of secure email and texting

Mobile and Digital Health SolutionsMobile Apps:

165,000 apps residing in Apple and Google stores

Definition:

An accessory to a regulated medical device or process used to transform a mobile platform to a regulated device

Image viewing

Image processing

Computer-aided detection

Ref. 6

Mobile Device Considerations Access control

Protected against tampering and destruction

Support remote IT management

Maintain access log

Disable automatic WI-FI connection

Disable downloads and install of unauthorized apps

Support device audits

Users must comply with incident report policies

Encrypted email and text functions

Co-ownership of Medical Records

For an EMR submit a written request to the healthcare provider, facility or eHealth Ontario

Administrative costs from family doctors

Processing time with eHealth Ontario maybe up to 30 days

Hospital sites can share diagnostic images and reports digitally within their region

One View requires additional username and password, time consuming

Pay for an electronic copy of diagnostic testing

DI Common Services, central registry is pending

eHealth EHR form

Digital Pitfalls

Access to services

Cost/ Benefit

Generation Gaps

Adapting to change

Are you having fries with that?

Confidentiality

Identity theft

Incorrect patient ID

Data entry errors

Data transfer errors

Release of records to minors

etc….

Digital Heath and Ethics

Release of EHRs to minors

Security

System implementation and maintenance

Data transfer

Data errors

Cut and paste

Drop down errors

Other uses of patient data

Research

Standard of care

Guides and White Papers

Status of Digital Health A National and Provincial schedule for implementing digital framework

Funding model

Integration

National/Provincial strategy DI-r

Global identification number

Secure Networks

Encryption

Clinical software compatible with HIS/RIS

Understanding various Clinical Processes

Cost benefit

Corporate Plans

ConnectingOntario Northern and Eastern Region is in implementation.

DI-Common Services, targeted completion 2017/18

Adoption awareness activities are underway

Canada Health Infoway 2017/18 Launch limited production release of ePrescibe in two provinces with

targeted clinicians

Expand telemedicine in 5 regions for at least 5000 patients

Bring to near completion existing EHR and EMR projects with “Investment Portfolio Optimization”

Provide continued leadership and promote standardization

Progress with ”Benefits Evaluation Strategy" with focus on consumer health solutions

Continued research with ePrescribe and EMRs

Stimulate the Canadian economy

Estimated budget, $90 to $100 million

Funding Model? What agency? CHI or eHealth Ontario

Communication between healthcare facilities and government agencies

Digital project manager

Limited time and targeted offering for digital projects

Non-standardized application for funding

Who are the investors

Data access strategy for DI-r

ProvinciallyONE ID, eHeath Portal, ONE VIEWDI Commons Services (central registry)

LocallyPACSHIS/RISPhysician office EMRTablet and Smart phone apps

All require:

Authentication of user and device

Connection to a secure server

Global Patient Identifier (GPI)

Integration

Clinical Processes Deploying online patient self-

scheduling, CHI April 5th,2017

E-booking, use and survey, CHI June 11th,2015

Adopting eHealth solutions: Implementation strategies, RNAO 2017

Digital Health Spin-offs Job Creation

2014-2019 hiring of 6,200 to 12,200 IT jobs

10,700 person years of employment

Investment

2010, Federal Gov. invested $500 million in CHI

$1.48 return for every $1 invested

Economic Gain

$400 million gain in GDP by patients

not missing work

Growth in domestic health IT

Ref. 8

eHealth EMR Fast Facts, 2015

eHealth’s value to the health care system is at least $5.7 billion

$200 million in annual value

$13 million from reduced hospitalizations due to adverse drug events

$95 million from reduced clinician time spent on chart management processes

$46 million and $37 million from avoided duplicate laboratory and diagnostic tests, respectively

In 2015, Telehealth helped patients save nearly $240 million in personal travel costs.

Ref. 7

Costs of a CorporateData Breach, 2016 Canada

24 Canadian companies participated

$1.94 million is the average cost spent on detection

$1.67 million is average post data beach cost

$278 is average cost per stolen record (50,000 records or more)

$6.03 million is average total cost of data breach

Ref. 1

In Summary Definite public shift towards electronic format

Federal and Provincial investment since late 1990s in digital health

Status of digital health programs is uncertain

Healthcare providers debate universal access, ethics and cost/benefit issues

Digital implementation is hampered by bureaucracy and other economic mandates

Underestimated funding

Thank You

Contact

•Jozef Nycz

Charge TechnologistTimmins & District Hospital / Ontario / Nuclear Medicine

•700 Ross Avenue EastTimmins, ON, Canada P4N 8P2

•Phone: (705) 267-6376

•Fax: (705) 267-6346

•E-mail:jnycz@tadh.com

References

1- 2016 Cost of Data Breach Study, Ponemon Inst. Research report June 2016

2 and 4- Canada Health Infoway

3- Unleashing Innovation: Excellent Healthcare for Canada, Advisory Panel on Healthcare Innovation July 2015

5- Why can’t you email your doctor, HealthyDebate articles April 30,2015

6- How many Health Apps Actually Matter, Health Care IT NewsSept. 23,2015

7- eHealth Ontario News

8- Digital Heath in Canada an Exploratory Analysis Canada’s Domestic Health ICT Sector, The Information and Communications Technology Council Report 2015