#1Let's Talk Informatics One Person One Record-Clinical Information System & Physician Engagement: How OPOR leverages technology promoting high-value physician collaboration Dr. Ashley Miller, Dr. Mike Wadden, Dr. Cathy Connell, Lindsay Bertrand, Sree Roy April 29, 2021 WebEx, Halifax, Nova Scotia NOVA SCOTIA OPOR One Person, One Record nova scotia health Wik IWK Health#2The One Person One Record program is currently operating within a controlled vendor environment. Please refrain from comments related to the One Person One Record-Clinical Information System (OPOR-CIS) vendor procurement process.#3What is Informatics? Informatics is the science of how to use data, technology and information to improve human health and the delivery of healthcare to enabling patients to receive the best possible care. Informatics is used to provide the best patient care and best possible outcomes.#4Clinical Informatics... is the application of informatics and information technology to deliver health care. AMIA. (2017, January 13). Retrieved from https://www.amia.org/applications- informatics/clinical-informatics#5Objectives: At the conclusion of this webinar, participants will be able to: . • Identify what knowledge and skills healthcare providers. · . need in order to use information now, and in future. Prepare healthcare providers by introducing them to concepts and local experiences in Informatics. Acquire knowledge to remain current with new trends, terminology, studies, data and breaking news. Collaborate with a network of colleagues, establish connections with leaders who can provide assistance and advice for business issues, best- practice and knowledge sharing.#6Session Specific Objectives: 01 Provide overview of the One Person One Record program and role of the Chief Medical Information Officer. 02 | Provide overview of how One Person One Record engages with physicians across Nova Scotia. 03 | 04 | Present data collected from physicians across Nova Scotia Demonstrate tools and technology OPOR uses to facilitate asynchronous collaboration#7Conflict of Interest Declaration: OPOR does not have any affiliation with any pharmaceutical, medical device, health care informatics organization, or other for-profit funder of this program. OPOR is not involved with the industry and cannot identify any conflict of interest.#8What is One Person One Record?#9OPOR is a Vision and Strategy One Person One Record is a vision and strategy for health system transformation. The OPOR team is facilitating clinical standardization to minimize variation in care across Nova Scotia. The OPOR team is leveraging technology to enable care delivery redesign the prioritizes human factors considerations. The Clinical Information System (OPOR-CIS) is only one element of the broader vision and strategy.#10Guiding Principles 01 Focus on Patient and Family- Centred Care: Partner with Patients 02 Clinician Driven: Integration of Interprofessional Collaboration Based on clinical best practice, 03 Developed by Clinicians 04 evidence and outcomes Documentation is an outcome of care 05 07 06 Variation in care should be minimized, intentional and measurable Leverage work already done across the organization and in other jurisdictions Learn by doing-a continual improvement process DOPOR One Person, One Record NOVA SCOTIA nova scotia health IWK Health#11Core healthcare IM/IT systems are at the end of their life cycles (☑ (x) (☑ (☑ 3 Incomplete patient information poses safety risks and provider frustration Siloed, highly customized health IM/IT systems means information cannot seamlessly flow from one provider to another End-of-Life health IM/IT systems routinely break down and are very expensive to maintain DOPOR One Person, One Record nova scotia NOVA SCOTIA health IWK Health#12One Person One Record-Clinical Information System 01 Modules Ambulatory Emergency Department 02 Internal Applications • • PACS Radiation Oncology Cardiology Cardiac Cath . • . Behaviour Health Long Term Care Infection Control Fetal Monitoring Acute Care Critical Care Oncology Peri-op and Anaesthesia Transplant Registration -CIS Scheduling . OPOR • Endoscopy • Breast Milk Bank • LMS . SAP Nutrition and Food • Services HLA Lab Renal Transcription Coding and Abstracting Archiving Data Warehouse DIS . • Health Records Lab Diagnostic Imaging Pharmacy Population Health Physician Billing Case Costing . Patient Flow Patient portal Clinician Portal Physician Mobility 04 Device Integration 03 External Applications EHS Panorama EMR 1 & 2 Community Pharmacies Vital Statistics Blue Cross#13Chief Medical Information Officer (CMIO)#14What is the role of the CMIO? 원#15OPOR and Physician Engagement#16Physician Engagement TIME COMMITMENT Champions Interested Advisory committees Standards lead RFSQ process Building branches Standards working groups RFP process Curious Workflow validation Workshop participation All comers Surveys Public events#17Physician Engagement Strategy Multi-Modal OPOR wants to engage with physicians based on their preference Physician time is valuable Minimize time commitment, remuneration framework Proactive Action high-priority, low-complexity items right away Leverage technology Promote asynchronous opportunities by utilizing modern technology#18Engagement Activities#19Physician Engagement Activities Activity Request for Supplier Qualifications (RFSQ) stage Number of Physicians Involved Vendor selection process: Request for Proposal (RFP) stage 111 Current State Rounding In-Person Engagements (Building Branches, Presentations, Meeting Attendance) Family Medicine CME needs assessment survey (asynchronous) Royal College specialties CME needs assessment survey (asynchronous) Workshops (asynchronous) Clinical Standards Working Group Leads Collaboration Platform Members Physician Advisory Committee Members Clinical Practice Advisory Committee Members +39 +61 111111+100s + Ongoing +110 +200 + Ongoing AAAAAA+ Ongoing 1111 1 +11#20Initial Engagement#21Physician Engagement in Project Planning MLT 2% Biomed Other* 32% RN 28% 2% Dietitian 2% Rad Tech. 3% Physio 3% NP 3% Pharmacist 4% Clerk 6% Vendor Selection Process Request for Supplier Qualifications (RFSQ) stage (in-person) Request for Proposal (RFP) stage (in-person) Physician 15% # Physicians Involved 5 49#22Governance#23Physician Engagement - Governance Neurosurgery Family Medicine Anaesthesia Psychiatry Family Medicine Haematology Clinical Radiology Physician Advisory Committee Approval (PAC) Standards Practice Advisory Committee (CPAC) Cardiac Surgery Respirology Emergency Otolaryngology Obstetrics/ Gynecology Internal Medicine Paediatrics#24Current State Rounding#25Current State Rounding . WZ NZ IWK EZ CZ OPOR visited 12 hospitals across Nova Scotia OPOR connected with 71 physicians H ་ • OPOR visited: Yarmouth • South Shore • Valley • IWK • HI ■Total • VGH • · • Dartmouth General • Colchester Cumberland Aberdeen 0 5 10 15 • St. Martha's • 20 25 Cape Breton Regional#26Current State Rounding OPOR asked: How many systems do you use per shift for your role? How many IT systems do... ■ 2 56% of physicians are using 5+ systems to perform role. ■ 5+ "There is no access to the patient past history. It is difficult and time consuming to acquire this information. You don't have access to information when you are not directly associated with the patient. No single source to access patient information." Physican-Aberdeen "Too many systems, too many passwords - clinical portal too slow" Physician - QEII#27Current State Rounding Do you find it easy to find information required for your role? Province 29% 51% 49% No Yes IWK No Yes 71% "Flipping back and forth between applications, time it takes to login, 10-12 steps to get to the patient information, lots of spots to stall. Spinning circle/blank screen. Accessing multiple computers/closing out system." Emergency Physician - Valley#28Current State Rounding How often do physicians have issues? Every time I log in 10% Multiple times a shift 30% Every few shifts 30% Once a shift 11% Rarely 19% 80% physicians surveyed report experiencing regu lar issues "Multiple systems, scanning of charts behind, not getting typed reports anymore, handwritten reports hard to read, dictated reports not active chart and need to use paper and system for full patient story." Physician - Aberdeen#29Current State Rounding What kinds of issues do physicians have? Printing Email Double documentation Downtime Access to systems Slow response/Freezing Not enough computers Time Out Inability to find information 0% 5% 10% 15% 20% 25% 30% 35% Physician- St. Martha's "Multiple systems have caused massive problems; Inability to find information you need" Physician- Cumberland "inaccuracy of data entry, unstandardized documentation for prescriptions"#30Current State Rounding What do physicians do if you don't have/can't find the information you need to perform your role? Call another facility/clinic Ask someone to find Get help from co-workers Inefficient/Time Consuming Ignore-Wing It SHARE review Ask Health Records Ask patient/family 31% 19% 14% 13% 7% 696 696 39 We have ~600k emergency visits a year. If 31% of the time we call another facility and on average it takes 30 minutes to get information from another facility, we have ~93,000 hours of wasted time per year in the emergency department Wait Repeat Investigations/Consults 196 1% "Progress notes and medication orders are still not online. the time I spend trying to find the nurse with the paper chart is crazy. Can't find the meds, notes, etc." Physician - CZ "One content is the worst system I've used in 20 years, it's terrible for trying to find information, the filing is not sensible or intuitive" Physician - CZ#31Needs Assessments#32• Needs Assessment- Family Physicians College of Family Physicians of Canada Certification required a needs assessment • Distributed provincially Standards were ranked Anaphylaxis Transfer of as shown and we are Accountability using this information to prioritize our workshops + Sepsis 8 7 6 91 Standards 5 Consult/Referral 2 Heart Failure 3 4 € COPD Progress Note 711 Frailty Stroke#33• Needs Assessment- Royal College Analogous to Family Physician Needs Assessment Distributed provincially Standards were ranked as shown and OPOR is using this information to prioritize workshops History and Physical Ambulatory Documentatio > 00 iii Procedure Note 8 7 Consult/Referral 91 Standards n 6 5 Progress Note ДД 4 2 3 то !!!!!! Discharge Summary Goals of Care Family History Transfer of Accountability OPOR One Person, One Record nova scotia NOVA SCOTIA health IWK Health#34Needs Assessment- Royal College Dalhousie University Faculty of Medicine Clinical Department Affiliation Mental Health and Addictions Palliative Care & Oncology Surgery Denistry Psychiatry Management and Perioperative Medicine Radiaton Oncology Pediatrics Emergency Medicine Medicine Family Medicine No Faulty of Medicine Affliation Obstetrics & Gynecology DOPOR One Person, One Record nova scotia NOVA SCOTIA health IWK Health#35Needs Assessments What Impact would a standardized approach to care have on you and your patients? Positive Impact (Moderate) What is the educational impact of participating in Provincial Clinical Standards Working Groups? Positive Impact (Moderate) Neutral 28% 13% 7% 8% 49% Positive Impact (High) Neutral 38% 28% 30% 37% Positive Impact (High)#36Needs Assessments One Person One Record is one system, accessible to all who need it- all clinical information in one place/ one patient pathway with ordering capabilities- a complete electronic system for hospital records/from primary care on. "We need a platform to connect physicians, removing attitudes of bias against family medicine between family med MDs and between family med MDs and consultants - the attitude that "your family doctor should have done/ should not have done....". Specialties/Departments cannot send referrals back or reject because their capacity is full as the patient has nowhere to go and we have nowhere to refer." How important is additional education about disease specific, evidence-based Clinical Standards? Positive Impact (Moderate) 37% 43% Positive Impact (High) Physicians indicate that "the One Person, One Record project can optimize health care delivery by providing more effective way to ensure availability of critical health information to the caring physicians." Neutral 14% 4%2%#37Needs Assessments Current Clinical Systems 120 111 100 94 80 60 40 20 0 69 76 79 L.III.….. Share Portal 31 Meditech Magic Meditech CS (IWK) (non-IWK) 22 OneContent Clinical Portal Milennium (Central Zone) Private EMR (MedAccess or Accuro) 16 12 10 Xero DIS Other OPOR One Person, One Record nova scotia NOVA SCOTIA health IWK Health#38Needs Assessments Platforms used to communicate with other healthcare providers e consult f nova scotia health + ☑ DOPOR One Person, One Record NOVA SCOTIA nova scotia health IWK Health#39Needs Assessments What is One Person One Record? 1 2 3 4 5 60 7 8 9 "Development of a system in which information about a patient is accessible and available to treating healthcare staff wherever and whenever the patient is seen across the province" "Hopefully a method of reducing error when a patient transitions from one provider to another" "The move to replace the current series of hospital-based ERM systems that are in use with a single system that would be accessible province-wide, no matter the facility or clinic, giving the start to a single flow of clinical information attached to one patient" Physicians want more information on OPOR- CIS "The ability to allow the patient to be at the center of their care and all providers will be able to access the appropriate data to provide the best care possible' "All patient information is in one system for inpatients and outpatients for the whole province that eliminates faxing and printing information for communication and patient care."#40Summary#41Summary • Inefficiencies- multiple logins, inability to find information, lack of interoperability, slow systems • Inconsistent approach to documentation/ processes Clear benefit of standardization Clear benefit of one patient pathway#42Clinical Standardization#43Clinical Standardization Disease-specific Clinical Standards Working Groups are inter-professional, and physician-led. Specialty/Cross-specialty standardization is ongoing with OPOR Team leveraging that work. Physician-specific standardization occurs asynchronously. О OPOR has initiated a Consult/Referral Rapid Workshop. currently underway following physicians targeting this as priority. 20 min time commitment with targeted questions. о Administrative tasks rest with OPOR team.#44Collaboration#45Collaboration- OPOR Engagement Platform Discovery Featured Welcome! Start Here ? Our Big Purpose What documentation needs do all physicians share? Welcome to the One Person One We understand that physician time is Lindsay Bertrand We Built the One Person One Rec We created the One Person One Reco Topics Physician Documentation Consult/Referral Following Lindsay Bertrand TOPIC Physician Workflows Following ollaboration Sonare for Enter Sree Roy TOPIC COPD Clinical Standard Following Asynchronous care delivery amplifies benefits of technology, increases patient access to low- cost, high-value care. Asynchronous visits allow providers to accomplish three to six visits in the time it would take for one synchronous visit OPOR is extending this to our working group methodology. • Asynchronous Collaboration#46Collaboration- Prolaborate Dashboard Physician Validation - Current State [Default] This dashboard is intended for validation of current state workflows for physicians. Central Zone Western Zone Eastern Zone IWK • Buchanan Memorial Hospital ⚫ IWK ° Cape Breton Regional Hospital (CBRH) ■ Intra-Operative CBRH ■ internal medicine • Cobequid Community Health Center • Dartmouth General Hospital ■ Emergency Department Dartmouth General Emergency Department Information System DGH Endoscopy Dartmouth General ■Intra-Operative Dartmouth General • Eastern Shore Memorial Hospital Hants Community Hospital ⚫ Musquodoboit Valley Memorial Hospital Nova Scotia Hospital ⚫ Queen Elizabeth II (QEII) ■ 3A Intensive Care Unit Victoria General 6.1 Cardiology Intermediate Care Unit Halifax Infirmary 6.2 Cardiology In-Patient Unit Halifax Infirmary ■8.2 General Medicine Halifax Infirmary ■ A Day In The Life of MD on General Medicine ■ Adult Congenital Clinic Allergy Clinic ■ Anatomical Pathology Halifax Infirmary Anesthesia QEII ■ Arrhythmia Clinic ■ Audiology Clinic Ambulatory ■ Bone Marrow Transplant Clinic Referral ■ Bone Marrow Transplant In Patient ■Bone Marrow Transplant Medical Day Unit Patient Flow Bone Marrow Transplant Patient Transplant Journey ■Cancer Care Halifax Covid-19 Screening ■Cancer Care Radiation Oncology Cardiac Day Unit ■ Cardiac History & Physical Clinic Cardiac Mumford Road Clinic. • Annapolis Community Health Centre Digby General Hospital • Eastern Kings Memorial Community Health Centre • Fishermen's Memorial Hospital ■ Alternative Level of Care unit (12 beds) ■ cardiac respiratory services diagnostic imaging (X-ray) ■ emergency medicine ■ family medicine ■maternal and child services ■ medical unit (six beds) ■mental health and addiction services day program ■ midwife clinic occupational therapy ■palliative care consultation service ■ physiotherapy ■ restorative care unit (12 beds) • Queens General Hospital Roseway Hospital ■ audiology ■ cardiac care ■ continuing care diagnostic imaging emergency medicine ■ gastroenterology ■ internal medicine ■laboratory services (Lockeport) outpatient mental health and addiction services ■nutrition and diabetes counseling obstetrics & gynecology otolaryngology physiotherapy plastic surgery ■recreation therapy ■speech language pathology. ■ anesthesiology ■ cancer and supportive care ■ cardiac respiratory ■ dermatology ■ diabetes education services diagnostic imaging ■ dialysis emergency medicine ■ general surgery ■ geriatric assessment and rehabilitation ■ intensive care unit • Glace Bay Health Centre My Dashboard My Diagrams Feeds Physician Valida... ■ Perfusion Operating Room - Pediatrics Intra-Operative-Pediatrics ■Intra-Operative- Adults ■ laboratory services ■ maternal/child support services ■ mental health and addiction services ■ neonatal care ■nutrition and diabetic counseling ■ obstetrics and gynecology ■ occupational therapy ■ ophthalmology Northern Zone ■ otolaryngology ■ palliative care ■ physiotherapy • plastic surgery ■ social work ■ spiritual and religious care ■ volunteer services • Eastern Memorial Hospital • Aberdeen Hospital ⚫ All Saints Springhill Hospital ■ anesthesiology ■cancer and supportive care ■cardiac respiratory dermatology ■diabetes education services ■ diagnostic imaging dialysis ■ emergency medicine general surgery ■geriatric assessment and rehabilitation Validation of current state workflow is integral to ensuring the clinical information system meets physician needs. Provincial scope Multi- zone including IWK representation is key.#47Resident/Radiologist Physician Engagement- Current State Workflows IWK Emergency Triage / Vetting/Protocoling Requestor Start Triage Required? No. (OE) request for consultation. Patient arrives in DI department Yes Complete and Submit Order Entry Print HIS OE form to DI Technical Workarea Ambulatory? Name: Author: IWK Emergency metcalfed Version: 1.0 Created: 12/11/2019 8:40:41 AM Updated: 4/7/2021 11:34:12 AM Triage Decision Protocol requested procedure Yes No Yes by Radiologist Calls next patient by name and verifes identity Select patient from MML on acquisition device Perform test, release to PACS Yes PACS PACS CM IMPAX Report Study Power Scribe Others Advise of critical result Critical Result Reporting? «flow>> <flow>> Impax No Sign/Submit report Distribute Result (s) via RIS Patient Leaves DI department End#48Ongoing Engagement#49Methodology • Ensure audiences understand the Why. Clinical Standardization and OPOR-CIS are integral to one another. • Human Factors Design focus • Fail Fast philosophy. • One Person One Record Team are not content experts but are facilitators of change. • Quick wins- there's no need to wait for OPOR-CIS. • Decrease administrative burden. . • Offer engagement opportunities aligned with physician beliefs about healthcare transformation. Multi-modal engagement with asynchronous options.#50Questions? [email protected] [email protected] [email protected] [email protected]