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Maureen Charlebois, Chief Nursing Director and Group Director, Canada Health Infoway
This document summarizes Canada Health Infoway's efforts to digitally transform healthcare across Canada in 3 waves: 1) Building foundational systems, 2) Providing digital tools for clinicians, and 3) Empowering patients. It highlights achievements in areas like EMR adoption and e-prescribing, and outlines ambitions to expand telehomecare and online patient services. Clinical leadership, change management, and ensuring clinicians have necessary digital skills are emphasized as key to adoption and realizing benefits of digital health innovations.
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Maureen Charlebois, Chief Nursing Director and Group Director, Canada Health Infoway
- 1. Canada Health Infoway TransformingPractice & Improving Care Across Canada Presentation to the Directors of Nursing and Midwifery Summit Ireland’s Future Health Summit, May 26, 2016 Maureen M. Charlebois Chief Nursing Executive & Group Director Clinical Adoption – Canada Health Infoway
- 2. 2 CANADIAN CONTEXT • Federal government setsand administers national health care principles • 13 provincial/terri torial governments plan, finance, manage, evaluate their health services • 700 + hospitals
- 3. Vision Healthier Canadians through innovativedigital health solutions 3
- 4. Approach – strategicinvestment model $2.098 billion in approved projects to date; 387 active or completed projects Solution deployment projects in each jurisdiction Common Blueprint & Standards Twelve investment programs Program criteria Program eligible costs Project sizing and estimation Approved projects for investment 1. Registries 2. Diagnostic Imaging Systems 3. Drug Information Systems 4. Laboratory Information Systems 5. Interoperable EHR 6. Telehealth 7. Public Health Surveillance 8. Patient Access to Quality Care 9. Innovation and Adoption 10. Infostructure 11. EMR and Integration 12. Consumer Health Solutions
- 5. 5 THREE WAVES OFDIGITAL HEALTH INNOVATION • Building blocks • Digital tools for clinicians • Empowering patients
- 6. 6 Knowing the Planfor Canada CE_Plan_Small.wmv
- 7. 7 THE FIRST WAVE LABORATORY INFORMATION SYSTEMS 85% DIAGNOSTIC IMAGINGIN HOSPITSLS 100% DISPENSED DRUGS 62% CLINICAL DOCUMENTATION 100% PATIENT & PROVIDER REGISTRIES 100% • Foundational infrastructure for digital health: investments in six core components of an electronic health record • Leadership in architecture, standards, privacy • Pan-Canadian strategy
- 8. 8 THE SECOND WAVE:DIGITAL TOOLS FOR CLINICIANS • Electronic medical records • Expansion of telehealth • Public health surveillance Source: 2015 Commonwealth Fund International Survey of Primary Care Physicians
- 9. 9 THE THIRD WAVE: EMPOWERINGPATIENTS • Improving the patient experience • Enhancing patient safetyWhat Patients say they want access to: Online Appointment Booking E-consultations/visits Online lab results/views Online prescription renewal
- 10. Access to resultsdrives value for patients 10 Source: Impacts of direct patient access to laboratory results – Final Report 2015
- 11. Change Management Framework Benefits Evaluation Framework ClinicalEngagement Strategy Clinical Adoption: Accelerate Adoption & Benefits Realization
- 12.
- 13. Overall impact onQuality of Care – Clinicians Perspective Sources: 2014 Infoway-CNA National Nurses Survey, 2014 Infoway National Survey of Community Pharmacists and National Physician Survey (2014) * % Not sure or No Reponses not reported
- 14. Transformative Leadership • Changeleadership is the strategic, systematic approach that supports people and their organizations in the successful transition and adoption of electronic health solutions. • The outcomes of ‘change leadership’ results in adoption and the full realization of benefits and clinical transformation. A Focused Approach to change management that incorporates these six elements noted in the CM Framework helps to ensure alignment of activities, solution adoption and realization of benefits. Change Management Framework Clinical Adoption Framework
- 15. Q1. What hashelped the most to lead change in your organization? Q2. What are the barriers to successful change in your organization? Top 3 Change BarriersTop 3 Change Enablers Leadership is the top Change Enabler • Visible/engaged senior leadership • Stakeholder engagement • Clinical/change champions • Competing priorities • Lack of visible/engaged senior leadership • Lack of effective communications
- 16. Transforming Clinical Practice ‘‘CurrentCurrent State’State’ Whereare we now?Where are we now? ‘‘DesiredDesired State’State’ Where do we want to be?Where do we want to be? Visible Clinical & IT Leadership Budget for Change Management Selected Change Approach/Methodology Engaged Clinicians & Informatics Specialists Communication Plan & Key Messages Workflow Analysis & Practice Process Redesign Role Specific Training & Education Ongoing Technical, Operational & Clinical Support Pre & Post Change Indicators & Evaluation GAP Analysis: What type of support is required to get there?
- 17. Why is changeso hard? 17 Amygdala – ‘Flight or Fight’ Stuck_on_an_escalator.wmv
- 18.
- 19. Beliefs, Attitudes, Behaviors, Benefits? …allow you to use more of your time providing patient/client/resident care while enabling you to act more informed to improve patient/client/resident experiences and outcomes, even save lives.
- 20. Transforming Practice, ImprovingCare Collaboration & Communication Improves Efficiencies & Avoids Duplication Decision Support & Workflow Information Management & Education Timely Access to Information
- 21. 21 Nursing Electronic HealthRecord Reference Document https://www.infoway-inforoute.ca/index.php/resources/guides-workbooks
- 22. Pan-Canadian Clinical PeerLeader Networks Clinical Peer Leaders working with their colleagues providing clinical leadership, support, mentoring and coaching to facilitate learning and use of technology in practice.
- 23. Transforming health care–clinical leadership • 96% of Peer Leaders ‘agree/strongly agree’ they are positively influencing their colleagues understanding and adoption of EMR/other technology systems in their practice settings • 89% of Peer Leaders ‘agree/strongly agree’ that the Peer Network is beneficial to clinicians
- 24. • To ensurethat clinicians in training are ready to practice in, and gain value from, an technology enabled environment when they graduate • To develop and integrate competencies related to the use of technology into the curricula design/ educational processes of the Faculties of Medicine, Nursing and Pharmacy • To establish Faculty Peer Leader Networks to provide mentorship, engagement and influence culture change related to the effective use of technology in clinical practice and Consumer Health solutions through innovative teaching strategies Infoway’s Next Generation Strategy
- 25. These successes positionedInfoway as a strategic investor in eHealth within Canada The Next Generation - Impact
- 26. Entry-to-Practice Competencies forRNs Uses information and communication technologies (ICT) to support information synthesis in accordance with professional and regulatory standards in the delivery of patient/client care: •Uses relevant information and knowledge to support the delivery of evidence informed patient care. •Uses ICTs in accordance with professional and regulatory standards and workplace policies. •Uses information and communication technologies in the delivery of patient/client care. Indicators (a few examples): 1.Analyses, interprets, and documents pertinent nursing data and patient data using standardized nursing and other clinical terminologies to support clinical decision making and nursing practice improvements. 2.Identifies and reports system process and functional issues according to organizational policies and procedures. 3.Uses decision support tools to assist clinical judgment and safe patient care.
- 27. 27 TWO AMBITIOUS GOALSFOR 2016-2017 • Establish a multi- jurisdiction e- prescribing solution • Expand telehomecare and patient online services
- 28. 28 OUR SOLUTION • Willenable prescribers to electronically transmit a prescription to a patient’s pharmacy of choice • This will: • Reduce use of paper prescriptions • Optimize existing drug system investments • Enhance patient
- 29. 29 TELEHOMECARE AND PATIENTONLINE SERVICES • Telehomecare is ready to be immediately scaled • Improves quality of life for patients with chronic conditions • Fewer emergency room visits and hospital stays • Continue to
- 30. ePractice Connecting the Team Communication& Collaboration Connecting to Evidence Based Information Knowledge BasedPractice Connecting to Quality Measures Data Analytics Connecting the Patient Self – Management
- 31. Clinical Leadership –Transforming Practice We need to build capacity and integrate the required digital health competencies into Professional Practice Frameworks and Models of Care
- 32. 32 Technologies are not simplyinventions which people employ but are the means by which people are reinvented. Technologies are not simply inventions which people employ but are the means by which people are reinvented. We shape our tools and thereafterWe shape our tools and thereafter our tools shape us.our tools shape us.
- 33.
Editor's Notes
- #3 700+ hospitals and 2,500+ long-term-care homes Approximately 400,000 general practitioners, specialists, nurses, pharmacists and health care professionals deliver care to Canadian patients
- #6 700+ hospitals and 2,500+ long-term-care homes Approximately 400,000 general practitioners, specialists, nurses, pharmacists and health care professionals deliver care to Canadian patients
- #10 Only 4-8% of Canadians have online access to: Book appointments View lab results Consult with clinicians Renew prescriptions
- #11 Satisfaction: Service users (patients who accessed their most recent result online) were more satisfied with their most recent overall lab test experience: On the overall process (91% vs. 82%) For timeliness of the process (91% vs. 78%) For how results were received (92% vs. 82%)
- #12 Are clinicians using the health information systems (HIS)? Are they using it effectively? Are they better able to provide quality patient care on the account of it? Are the systems of benefit? Analytics & Value Proposition at the individual, organization, provincially and nationally
- #14 1. NPS (2013) – Productivity : How has the quality of the patient care you provide changed since electronic records were implemented: Greatly Increased; Increased; Did not change; Decreased; Greatly Decreased; Not sure 2. Infoway-CNA National Nurses Survey (2014) – Productivity : Base: All respondents in clinical practice providing direct care and using EMRs (n=750) How has the quality of the patient care you provide changed since electronic records were implemented: Greatly Increased; Increased; Did not change; Decreased; Greatly Decreased; Not sure 3. Community Pharmacists 2014 Survey Q12. How has the quality of the patient care you provide changed since the availability of an electronic provincial DIS? e. (Decrease 11-50%, Decrease 1- 10%, No impact, increase 1-10%, increase 11-50%, increase more than 50%)
- #16 Organization has senior leader accountable for change management 39% Project leaders accessible to make decisions, remove barriers for project team 45% Key messages delivered by senior leader all or most of the time 46% Training is segmented by user type and role all or most of the time 61% Change management process includes reviewing and monitoring change tactics 35% Workflow analysis and integration is conducted on change activities all or most of the time 43% Change management process includes structured stakeholder engagement all or some of the time 36%
- #17 Motivation is in effect a means to reduce and manipulate the gap Commitment Build Organization Capacity resources, structures & mechanisms Enable a decentralized ‘power’ base Focus on Safety & Patient Satisfaction People Process System Staff Empowered & Passionate about their work Investment in Staff Focus on Safety & Improvement in Patient & Staff Satisfaction
- #21 Since launching in 2012, CEC has continues to build awareness and engagement amongst clinicians and health care leaders: Estimated reach = over 530,000 91 individual Clinical Champions 38 Committed Partner organizations 14,275 You tube views 3,852 Resource downloads 33,863 CEC Webpage Views Leading Practices…
- #23 FY2015-16: 3 Faculty Peer Leader Networks, almost 30 Faculty Peer Leaders reaching almost 4,000 colleagues (e.g. through e-Resource and coaching) Cumulative: 3 Faculty Peer Leader Networks, almost 30 Faculty Peer Leaders reaching almost 7658 colleagues FY2015-16: 7 active jurisdictional Peer Leader Networks, with over 200 Peer Leaders engaging over 2,000 colleagues Cumulative: almost 750 Peer Leaders engaging over 36,000 colleagues
- #31 to connect the team to improve communication & collaboration; to connect the patient – to improve self management and person centered care, to connect to evidenced based information to support knowledge based practice and to connect to required data analytics needed at the individual/clinician level, at the management/organizational level as well as at the provincial and national level to achieve Better Health, Better Care and Better Value…Getting there will require clinical, technical and strategic partnerships, change leadership and collaborations at all levels across organizational, system and professional boundaries. Issues such as usability, governance and professional accountability will need to be resolved.
- #33 We shape our tools and thereafter our tools shape us. Herbert Marshall McLuhan, CC (July 21, 1911 – December 31, 1980) was a Canadian philosopher of communication theory and a public intellectual. His work is viewed as one of the cornerstones of the study of media theory, as well as having practical applications in the advertising and television industries.[1][2] He was educated at the University of Manitoba and Cambridge University and began his teaching career as a Professor of English at several universities in the U.S. and Canada, before moving to the University of Toronto where he would remain for the rest of his life. McLuhan is known for coining the expressions the medium is the message and the global village, and for predicting the World Wide Web almost thirty years before it was invented.[3] Although he was a fixture in media discourse in the late 1960s, his influence began to wane in the early 1970s.[4] In the years after his death, he continued to be a controversial figure in academic circles.[5] With the arrival of the internet, however, interest in his work and perspective has renewed.[6