Alberta's EHR System - PIN

1. Pharmaceutical (PIN)
Alberta’s Journey towards
the Electronic Health Record
(incl. PIN)
March 1, 2004 1 Alberta Health and Wellness

2. Alberta’s Major Milestones on the Journey
Seniors Drug Profile Pharmaceutical Information Network Electronic Health Record
SDP Rollout PIN PILOT EHR 18-mo Strategy EHR Rollout
SDP PILOT PIN Development PIN SDP Retired
1999 2000 2001 2002 2003 2004 2005
March 1, 2004 2 Alberta Health and Wellness

3. Seniors Drug Profile (SDP) – What Is It?
SDP provided Hospitals, Physician Offices,
Hospital Homecare
Pharmacies & Homecare Offices with secure
access to a profile of recently dispensed
prescription drugs for senior citizens who are part Patient
of the Alberta Blue Cross Group 66 Plan Seniors Drug Profile
Medication Information
Alberta Blue Cross
Benefits
!Saves time (less writing, fewer calls to pharmacies)
!User Friendly application
!Sets stage for migration to PIN
!Particularly beneficial for patients who were poor historians, or had literacy or language barriers
!Users stated that information about patient compliance and behavior was obtained
“ Physicians discovered through the Seniors Drug Profile that, after many years of treating regular patients,
their patients had been receiving medical treatment from other physicians that they were unaware of ”
Seniors Drug Profile Pharmaceutical Information Network Electronic Health Record
SDP Rollout
SDP PILOT
1999 2000 2001 2002 2003 2004 2005
March 1, 2004 3 Alberta Health and Wellness

4. What is PIN?
What is PIN? tool that:
An information sharing
8 links community physicians, pharmacists,
hospitals and other authorized health care
providers
8 provides online decision-support tools for
prescribing, dispensing, compliance
monitoring, research and policy
development.
8 communicates with existing physician
office and pharmacy systems, avoiding
duplication of data entry.
8 will ultimately enable electronic
prescriptions, providing further benefits
to health care providers and patients
alike.
March 1, 2004 4 Alberta Health and Wellness

5. PIN is conceptually simple
How is PIN delivered?
8 Central clinical data
repository
8 No duplicate data entry
8 Links existing heterogeneous
systems Central Clinical
Data
Repository
8Via a web browser
8System-to-system
March 1, 2004 5 Alberta Health and Wellness

6. PIN Pilot Profile
8 Implemented in 18 sites in two communities (Westlock &
Leduc) in 2002
– 12,119 prescriptions were recorded by 34 physicians
– 5,399 drug profiles were accessed by 154 users
8 Results of pilot evaluation were positive
– 90% of pilot users believe that PIN is valuable to their delivery of
care (7% undecided, 3% disagree)
– 80% of pilot physicians would recommend PIN to their peers
(20% not yet decided)
– Extended pilot
Seniors Drug Profile Pharmaceutical Information Network EHR
SDP Rollout
SDP PILOT PIN PILOT
1999 2000 2001 2002 2003 2004 2005
March 1, 2004 6 Alberta Health and Wellness

7. Things we learned:
8 Collection of explicit consent for purposes of care and
treatment is challenging to explain and administratively
burdensome (i.e. less than 1 % of the population decided
to opt out)
8 Implementation elapsed time is most influenced by site
readiness
8 Sell to clinicians first then to administrators
8 Need to do individual site assessments as sites have unique
work flows
8 Voluntary participation impacts take-up however improves
clinician ‘buy-in” over time
March 1, 2004 7 Alberta Health and Wellness

8. EHR
September 2002
The Minister announces that there will
be a provincial Electronic Health Record
by March 31, 2004
Seniors Drug Profile Pharmaceutical Information Network EHR
EHR 18-mo Strategy
SDP Rollout
SDP PILOT PIN PILOT
1999 2000 2001 2002 2003 2004 2005
March 1, 2004 8 Alberta Health and Wellness

9. ….. In 18 Months!!
Implementation Initiatives
March 1, 2004 9 Alberta Health and Wellness

10. EHR: What is It ?
What an EHR IS What an EHR IS NOT
8 Individual focused 8 Provider focused
8 Individual specific core data set 8 An operational system
where elements reside In multiple Operational systems feed data to populate the
sources EHR
8 Mechanism for sharing health data 8 A data collection system
about an individual 8 A single physical repository
8 Longitudinal health information 8 A Clinical Information System /
about an individual from multiple Electronic Patient Record nor Physician
sources Office System / Electronic Medical
Record, but they are interrelated
8 Support for clinical decision making
8 Accessible at all points of care in a EPR and EMR describe the record of the
timely manner periodic care provided mainly by one institution.
It is a complete patient record accessible from a
single, automated health care provider system.
March 1, 2004 10 Alberta Health and Wellness

11. EHR:What Did We Need to Think About
What an EHR IS
Individual rights
8 Individual focused Respect for privacy and ethical usage
8 Individual specific core data set
where elements reside in multiple
Identification of a user
sources Access controls
Record of users interaction
8 Mechanism for sharing health data
about an individual Governance
Stewardship of data
8 Longitudinal health information Standards
about an individual from multiple
Clinical acceptance
sources
Workflow impact
8 Support for clinical decision making Culture
8 Accessible at all points of care in a Readiness
timely manner Remote connectivity
Security
Education
March 1, 2004 11 Alberta Health and Wellness

12. EHR 18-month Strategy
• Identify a person
• Add a person – newborn, new resident, visitors
• Update demographic information
• Record history
• Post Office address standards
• Determine the insurance eligibility
• Publish and subscribe for changes
• View and sort lab test results history
• Multiple lab sources
• Deliver lab test results physician’s EMR
• Available for ordering and copied physicians
• View active medication profiles
• View and record allergy and intolerance information
• Prescribe medication
• Look up medications and drug interactions
• Dosage checking
• Medication dispensing information
• Multiple renewals
• Integration with physician and pharmacy systems
March 1, 2004 12 Alberta Health and Wellness

13. Relationships Between the 18- month EHR and Other Systems
Portal
•Single Sign On
•Authentication & Authorization
•Audit Trail
•Person Search
Patient EHR
Summary System
eMPI Demographics EMR
to
Drugs LAB System
Person Lab
Identification PIN Results
(PPHI)
Pharmacy Systems
March 1, 2004 13 Alberta Health and Wellness

14. Privacy and Security
Technical Administrative
8 Authentication (Two-factor – Common:
SecurID Fobs) 8 Privacy Impact Assessment (PIA)
8 Authorization (Need to know 8 Training
principle, Record of use) 8 User ID Registration Process
8 Encryption 8 Confidentiality Agreements
8 Audit Logs 8 Self-Assessment Tool
8 Firewall Secure Network:
8 Intrusion Detection 8 Policies
8 Anti-virus – Minimum Connectivity
Requirements (Level 1)
– Level 2 2004/2005
– Level 3 2005/2006
Internet:
8 2 Factor ID (FOB)
8 COACH guidelines
March 1, 2004 14 Alberta Health and Wellness

15. Rollout - EHR Campaign Based
Campaign = 1 or more health care facilities and surrounding area
servicing home care, community physicians and pharmacists
8 Urban Divided into several communities. Each community has a health care
facility, however there may be exceptions (i.e. No hospital in the
community, but is considered a community due to its large population and
geographic area).
8 Rural Could be grouped to include more than one health care facility to make
effective use of implementation resources.
Physicians Pharmacy
Patient
Hospital Homecare
March 1, 2004 15 Alberta Health and Wellness

16. Physician Office System Program (POSP)
! Joint initiative of Alberta Health & Wellness, the Alberta
Medical Association and Alberta’s health authorities (2003)
! Learning in action . . .
• first of its kind in Canada
• formal evaluation function
! Undertaking at the physician, not the organization level
! Targets improvement in products, IMIT services and business
processes
Seniors Drug Profile Pharmaceutical Information Network EHR
SDP Rollout EHR 18-mo Strategy
SDP PILOT POSP PIN PILOT POSP II
1999 2000 2001 2002 2003 2004 2005
March 1, 2004 16 Alberta Health and Wellness

17. Governance – Relationship Model
Governance: Decision Making Structure
Alberta Health & Wellness
Health Regions/Boards Physician
Physician
• Council of CEOs Office
Office
Systems
Systems
Physicians
Program
Health IM/IT
Health IM/IT • CPSA Program
Governance • AMA
Governance
Council
Council Pharmacists
• ACP
• RxA
Public Representation
Provincial
Provincial EHR Data
EHR Data Information
Information Information
Information
Telehealth
Telehealth Stewardship
Stewardship Management
Management Technology
Technology
Committee
Committee Committee
Committee Committee
Committee Committee
Committee
Project Coordination --Alberta Wellnet
Project Coordination Alberta Wellnet
March 1, 2004 17 Alberta Health and Wellness

18. Multi-stakeholder Governance
Advantages:
4 Increases stakeholder engagement
4 Helps to increase perspective & manage multiple agendas
4 Opens communication channels – government isn’t always the translator
Critical Success Factors:
8 Senior Chair
8 Incumbents are Decision Makers
8 Balanced Representation
8 Membership – Critical Few
8 Quarterly meetings – at least
March 1, 2004 18 Alberta Health and Wellness

19. EHR Data Stewardship – Building a Trust Relationship
8 Key understandings:
– Its duties and responsibilities must reflect current legislative provisions that
define the rules related to the appropriate access, use and disclosure of health
information
– The role of the EHR Data Stewardship Committee must work within a
framework that complements and enhances existing organizational mandates
and responsibilities (e.g. professional regulators, custodian responsibilities,
etc.)
– It is a requirement of stakeholders to have a say in the further propagation of,
or access to, data they are contributing to the provincial EHR
March 1, 2004 19 Alberta Health and Wellness

20. Applying the Framework to the EHR
Participating Stakeholder
Custodians AH&W Organizations
College
Physicians RxA
Pharmacies College
AMA
Health
Council
Authorities
of CEOs
Public
Information Information
Manager Agreement* Exchange Protocol EHR Ministerial
Authorizes use of EHR Guides use of data by Order
Binds both parties to custodian and wellnet
Data
Establishes DSC
follow the Information e.g. who can access the Stewardship
Exchange Protocol data, how research Committee
requests are handled, Manages the
etc. protocol
Becomes appendix
to agreement
Alberta Wellnet (AH&W)
Information Manager
Manages the data in accordance with the Information Exchange Protocol
March 1, 2004 20 Alberta Health and Wellness

21. Major achievements also made in 2003 achievements
TOOL INITIATIVE ACHIEVEMENT OUTCOMES
! Tri-partite governance Accessibility
POSP Phase II
POSP Phase II ! 3 levels of participation Efficiency
Accessibility ! Target of > 2,500 new MDs (68% of
Alberta’s physicians by March/06)
Patient Safety
Efficiency
CH EHR
CH EHR ! Regional EHR (netCARE)
implemented
CHR Clinical
CHR Clinical ! Regional EHR (Eclypsis) selected
System and project initiated Accessibility
System Patient Safety
Efficiency
Non Metro
Non Metro ! Regional EHR (Meditech) selected
Clinical Systems
EHR
and project initiated
Clinical Systems
• Wave 1 – pilot complete Alberta Cancer
Alberta Cancer
• Wave 2 – SDP replacement ! ICCN (Optx) implemented
to be completed Mar 04 Board
Board
• Wave 3 – Pharmacy/MD
implementation underway
• Drumheller first community to Privacy
Privacy
! EHR Data Stewardship Committee Accessibility
go live
• Infoway Funding partnership
established for PIN Security
Security Accessibility
! Minimum Connectivity
Requirements
March 1, 2004 21 Alberta Health and Wellness

22. Governance Process Used to Define Next Steps
IM/IT Governance Council
IMC IM/IT(EHR) March 16, 2004
STRATEGIC PLAN I • Overview
• Develop & Forward • Domains • Seek Endorsement
Recommendations • Goals in Principle
• Outcomes
• Stakeholder Impact
ITC
Input
and Review
IM/IT(EHR)
STRATEGIC PLAN II
• Costed
• Funding Sources & Gaps Pharmacy
• Further Plan Development Council of CEOs & Physician Organizations
March-June 2004
• Review • Review
• Seek Commitment • Seek Commitment
in Principle in Principle
IMC
• Input and IM/IT Governance Council
Recommendation
• Final Review
Stakeholder Signoff • Approve Provincial Plan
Annual
Refresh
March 1, 2004 22 Alberta Health and Wellness

23. IM/IT Strategic (EHR) Plan 2004-2007
SCOPE
Person
• Provincial review of Client Registry Strategy
Directory
• Capture discharge meds
Drugs, & • Health region System-to-System 2005-2007
Allergies • Batch dispensing 2004-05
• ACB dispensing
• Triplicate Prescription
• Implement in Business Intelligence Environment
• All provincial lab data made available (CHR,
Lab CHA, ACB, Non Metro, Prov Lab, CBS)
Results • Agreed to Standards in place
• Lab Test Results Delivery (LRD) and Lab Test
Results History (LTRH) available to up to 60% of
MD population
• Order Entry of lab tests available
• DI Text Report Standards in place (exam codes,
Diagnostic message specs, report formats, diagnostic codes)
Imaging • DI Text Reports Delivery and History available
• DI PACS images available from source systems
• Provider – Single source of truth of provider
Registries
information
• Facility – Uniform, consistent & accurate
identification of facilities across health system
Clinical Text
• Access to clinical text reports and history
Draft Reports
(Discharge, Operative, Consultation reports)
March 1, 2004 23 Alberta Health and Wellness