1. Transforming Northern Health: Innovations Making a Difference Group Health Centre: EMR XTRA and Preparing for ePrescribing (PeP) Lucy Fronzi, Project Manager March 31, 2010
2. Group Health Centre provides primary care to 75% of Sault Ste. Marie residents Ontario’s largest and longest established ambulatory health care organization providing excellence in health care to over half the population of Sault Ste. Marie for 47 years.
11. Health Promotion Initiatives supported by an enterprise EMR Before EMR XTRA , pharmacists not part of the “Circle of Care ” All GHC staff share a single Electronic Medical Record (EMR) system resulting in better communication, coordination of care and patient management
13. Source: Ontario’s eHealth Strategy 2009-2012 Preventable adverse drug events are the fourth-leading cause of death in Ontario 1 Over 10 Ontarians die every day unnecessarily because of adverse drug events
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18. Pharmacist activities with PCPs and patients increased in quantity… Pharmacist-PCP activities, by type Counts per patient ↑ 97% Pharmacist-patient activities, by type Counts per patient ↑ 57%
19. … and quality PCPs’ perceptions of quality of interactions with pharmacists Percent of “Always” or “Often” responses; Baseline Post-implementation
20. Pharmacists and patients perceived improvement in quality of interactions Pharmacists’ perceptions of quality of interactions with patients Percent of “Always” or “Often” responses Pharmacists felt their ability to manage and empower patient self-management of chronic conditions improved Patients perceived an improvement in the coordination and consistency of their care Source: Post-implementation survey results Baseline Post-implementation Patients’ perceptions of quality of interactions with pharmacists Percent of “Always” or “Often” responses
21. In the first year, pharmacists provided 844 services in 353 patient encounters… Top 5 pharmacist services provided Counts Provide initial or F/U review Provide health education Provide drug information Identify DRP Resolve DRP with patient Other
22. … and were better able to manage patients’ medications Drug-related problems (DRP) identified Counts per patient ↑ 94% Medication management recommendations made by pharmacists to PCPs Counts per patient ↑ 246%
25. Demonstration Project sites enabled a “closed loop” prescribing and dispensing process Authorization GBFHT: Secondary PIN GHC: Keystroke Notification EMR sends message to alert pharmacist of pending prescription Pharmacy Management System (PMS) Transcription Pharmacy staff manually enter prescription information into the PMS Pharmacy staff receives / downloads prescription Patient presents to prescriber Prescriber decides to prescribe Prescriber completes prescription Pharmacy staff fills prescription Patient picks up prescription D A B C F G H I Patient requests prescription refill Pharmacy staff requests prescription refill renewal Prescriber receives renewal request E Patient visits community prescriber Community prescriber views patient’s medication profile in the EMR and consults system-integrated decision support tools as needed. Prescriber concludes that patient requires prescription drug therapy and creates a new prescription, authorizes it and posts it to the EMR. Pharmacist accesses EMR, selects the patient’s prescription and flags the prescription as “downloaded” Pharmacist or delegate fills the prescription as per usual procedures Patient presents at pharmacy to pickup medication A B C D E F ePrescribing Demonstration Project Workflow
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30. A ‘how to’ guide has been developed outlining lessons learned and experiences gathered along GHC’s 12 year journey for a fully electronic medical record.
Let’s go to an example to see how this works. Diabetes, one of the first diseases looked at by the HPI group. Evidence based practice focuses on these ten process interventions to obtain better clinical outcomes. So how do you continuously evaluate and provide appropriate evidence-based health promotion interventions to diabetics in a busy provider office.
Having these guidelines in front of the provider for each visit, we saw improvements in clinical outcomes. In fact, there has been a 55% increase in better health outcomes for our diabetics which we refer to as the GHOD score (Good Health Outcomes for Diabetics). The GHOD score is a composite view of the 10 interventions for diabetes.
Anticoagulation clinic is a nurse run clinic set up to provide for management of patients on oral anticoagulation. These nurses work in the EMR to pull together the information required in the care of these patients. This clinic also uses the appointment centre to book lab appointments. The booking of these appointments made it easier for the patients and the lab staff, but it also now provided information to the nurses as to who hasn’t come in for their lab work and they could follow up with a phone call. The anticoagulation clinic outcomes are such that INR results are in the therapeutic range 84% of the time. This is compared to usual care benchmarks of 40-60%.
Marisa Preventable adverse drug events will be the 4 th leading cause of death Many reasons – physician may not monitor drug allergies, prescribe wrong drug or dose MAIN reason 1 – pharmacists have insufficient or unclear information to support effective outcomes MAIN reason 2 – illegible Rx On-line management of Rx medications via EMRxtra which is accessible to pharmacists will prevent these errors and improve pt. safety
Lucy
Lucy
Marisa Quality: Improve clinical interactions between clinicians and with patients Note: Pharmacists documented almost two activities with PCPs per patient 50% (72/145) of patients required pharmacists to address drug-related problems (DRPs) with PCPs Implications Many activities involve information sharing and clarification 20% (72/274) of activities are related to addressing DRPs – integral for managing patient safety Note: The number of pharmacist-patient activities increased by 57% compared to baseline Pharmacists provided significantly more educational services (health education and drug information) compared to baseline Implications Medication reviews improved in quantity and quality – in baseline, reviews based on incomplete profiles By having access to patients’ medical profiles, pharmacists are better informed to provide educational services and address drug-related problems
Marisa Pharmacists and patients perceived an improvement in the quality of their interactions Pharmacists felt their ability to manage and empower patient self-management of chronic conditions improved Patients perceived an improvement in the coordination and consistency of their care
