we have all this data, now what? - telus · 2016-11-01 · we have all this data, now what? western...

We have all this Data,

Now What?

Western EMR User Conference 2016

Dr. Daniel Ngui, Family Physician, Fraser Street Medical, S. Vancouver

Mirella Chiodo, Quality and Informatics Supervisor, University of

Alberta Department of Family Medicine

Dr. Ewan Affleck, Family Physician and CMIO Government Northwest

Territories

Facilitated by

Sheri Ross, RN, Managing Principal, TELUS Health

A Cross Practice and Organizational

Sponsorship View on Data Management

Mirella Chiodo, Department of Family

Medicine, University of Alberta

Department of Family Medicine Teaching Structure

Department of Family Medicine,

University of Alberta

Royal Alex Family

Medicine Centre

Misericordia Family

Medicine Centre

NECHC Family

Medicine Centre

Grey Nuns Family

Medicine Centre

8 additional

community urban

practices who teach

year 1’s and some

teaching year 2’s.

Academic Sites:

Roughly 20,000 active

patients

60,000 visits per year

Rural Training

Program

- Red Deer

- Grand Prairie

- Fort McMurray

Supporting Innovative Best Practices in the

Discipline of Family Medicine

“A primary health care system that supports

Albertans to be as healthy as can be.”

Alberta’s Primary Health Care Strategy vision for the future

• All patients will have a health home

• Focus on wellness and prevention of disease

• Chronic disease management

• Team based, systems based care

• Measurement and evaluation framework

The Burden of Chronic Disease

Western EMR User Conference 2016 5

Report of the Auditor General September 2014 – Health – Chronic Disease Management

EMR Evolution in the Department of Family

Medicine, U of A

Expensive word processors – “paper charts on steroids”.

To a tool to help us deliver efficient effective, timely patient care.


Quality Improvement Basics

Outcome

Process

Structure

Quality Improvement Basics

Outcomes

Management

Identification

Assumptions

• Timely data

• Easily Accessible data – by entire team

• Accurate

• Actionable

• Shows progress over time

Western EMR User Conference 2016

Quality Improvement Dashboard Project

• Introduction of 3 standardized clinic level CDM dashboards

• Diabetes

• COPD

• Heart failure

• Organizational viewer – system level, physician shared metrics for

program management and evaluation

• Cross system platform


Clinic Level Dashboard - Diabetes


Drill Down to see Trend and Peer Average


Clinic Level - COPD

13

Sharing Statistics with the Organization


Organizational Viewer - Diabetes

Organizational Viewer Heart Failure

Organizational Level - COPD

Drill Down

Why?

• Provide well organized, population based care for our CDM patients

• Enables the multi-disciplinary team to focus attention where needed most

• Allows for peer to peer comparison

• Role modeling for our future family physicians

• What gets measured gets managed

• Transparent sharing of data and team discussions around that data • Culture shift around measurement

• Paradigm shift from the old looking after patients “one at a time by yourself” to looking after “one’s patient population with a team”

• System level knowledge and learning from each other

Early Lessons Learned

Identification is Key

• Importance of clean, verified panels

• Importance of Profile use and coding

Standardized Processes

• Standardized documentation processes necessary

Sharing Data

• Was not as big an issue as we thought it would be,

importance of who is collecting the statistics

cannot be understated

Next Steps

• Develop relevant indicators for each condition to

increase value of the tool at the clinic level

• Continue to support and encourage coding,

standardization, evidence based care and team

based care

• Engage other clinics to participate

21

Electronic Medical Record Data Use In the

Northwest Territories

Ewan Affleck, CMIO

Northwest Territories Health & Social Services Authority

Introduction:

Northwest Territories

What is Population of the Northwest Territories?

1) 42,000 2) 82,000 3) 282,000

What is the average number of days in January in Yellowknife below -40 degrees C.?

1) 8 2) 17 3) 23

The Northwest Territories has how many official languages?

1) 2 2) 7 3) 11

Which of the following famous Canadians was not born in the Northwest Territories?

1) Margot Kidder 2) Jordan Tootoo 3) Mark Carney



eHealth NWT:

Introduction Context - NWT Heath

Current State - EMR

Strategy - Networked Health

Current State

Performance Evaluation

Health Analytics Projects

Examples

Obstacles

eHealth NWT:

Context – Health Environment


Sustainable?

Size

Population

Cost per Capita

Chronic Disease Burden

Staffing

Medical Travel

Performance Evaluation

Governance

Knowledge

= Quality Deficit

eHealth NWT:

Current State - EMR

Single EMR database

October 17, 2016

78% of population

Over 500 users

First Fully Digital Remote Nursing Station

Services

Primary care (78%), Specialties (Gen. Sx, ENT,

Ortho, Peds. IM (67%)), Public Health, Home Care,

ER, Population Health, Rehab

Connects to inpatient services:

Hospitalist, Birthing services, Emergency Room.

End of 2017:

100% of out-patient population & services

eHealth NWT:

Strategy – Networked Health Environment

Two Value Propositions:

1. Distributed Care

• Remote community coverage

• Intrinsic eReferral / eConsultation

• Passive: • Shared patient data

• Informal: • Biliary Colic

• Palliative care

• Formal: • Pediatrics & Psychiatry

2. Performance Evaluation

eHealth NWT:

Current State – Performance Evaluation


Professional Accountability

Strategic Approach

Quality Care: Driving appropriate care & management Limiting unwarranted care & management

EMR Analytics Projects (Rule & Queries) Analytics Project Plan template Clinical Standards Output & Outcome indicators Clinic pathways

- site specific Data management Change management Implementation Scale & Spread

eHealth NWT:

Current State – Health Analytics

Projects:

Rules

Diabetes

Cancer Screening

Renal

Queries

Lithium Monitoring

Influenza Monitoring

Choosing Wisely

PPI de-prescribing

CPCSSN

….Much More on Tap


eHealth NWT:

Diabetes Analytics


Observations

Registries

Program Based Care

Team Based Care

eHealth NWT:

Diabetes Analytics


Observations

Compliance with Rules

Provider feedback

Communication

eHealth NWT:

Diabetes Analytics


Observations

Spread & scale

Different workflows

Data delay for rules

eHealth NWT:

Performance Evaluation - Obstacles

Operational Performance Evaluation Framework / All data sources

Staffing & Knowledge Deficit Partnerships (IHPME / CPCSSN / Choosing Wisely / CIHI / etc.)

Technology shortfall Patient-centric Informatics / Fewer applications / clinical decision support / business integration / interoperability

Data management deficit Enterprise Data Warehouse / Standard Nomenclature / Data integrity / Robust policy environment

Privacy Health Information Act / Quality Commissioner / Cultural shift

Policy shortfall Governance / Robust policy environment

Culture impediments Business Process Management / Leadership / Evidence / Time / Education


eHealth NWT:

Performance Evaluation - Culture

What is your profession?

nurse / physician / administrator / vendor / other

Who can define what unwarranted variation is?

In 2013 what was the third leading cause of death in American hospitals?

How many of you know what your annual budget is?

Of 17 Canadian medical schools had curricula on analytics in 2014?


Canadian Health Industry:

Attitude: Data and Performance Evaluation


A research lacuna…

Resistent to evaluation

Poor attitude toward data

Lack of accountability

Young physicians entering the industry

Conservative industry

eHealth NWT:

Performance Evaluation – Looking Ahead

Cultural Shift

Accountability

The 4th Revolution

Mainstream Appropriateness

Lack of sustainability Optimism – where the money is buried

Youth movement

Questions

Thank you

we have all this data, now what? - telus · 2016-11-01 · we have all this data, now what? western...

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