EMR NG
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The document discusses the need for next generation electronic medical records (EMRs) as current EMRs are not delivering hoped-for value and cannot be improved solely by vendors. It proposes a new solution architecture integrating EMRs, telehealth, clinical decision support systems, analytics, and research capabilities to create a learning health system. This system would provide team-based and population care, integrate multiple stakeholders, and accelerate EMR research and development to better address evolving healthcare demands.
EMR NG
- 1. Karim Keshavjee MD, MBA, CPHIMS Kashif Mirza MBBS, MSc Ken Martin MSc, CPHIMS EMR | EHR THE NEXT GENERATION
- 2. OUTLINE • The Problem • An evolving and demanding environment • Methods • Solution Architecture • Mock-ups of potential solutions • A pathway forward • Conclusion
- 3. THE PROBLEM • EHR | EMRs • Don’t deliver the value we hoped they would • Vendors can’t afford to do the necessary R&D to fix the problem • Spiraling costs threaten the sustainability of health care • A need for a new paradigm for EHR | EMRs
- 4. EVOLVING AND DEMANDING ENVIRONMENT • Continuous, rapid changes in evidence • Explosion of new technologies (Big Data, Genomics, Proteomics, mHealth apps, Diagnostics, Tablets) • Consumer movement amongst patients • Payers are looking for more value • Pay for performance and outcomes • Chronic disease explosion • 1% and 5% driving 50-80% of expenditures
- 5. PHYSICIANS NEED TO BE AIR TRAFFIC CONTROLLERS FOR THEIR PATIENTS …..A NEED FOR BETTER TOOLS
- 6. METHODS • Reflection and review of 15 years of projects • COMPETE I, II, III – EMR & CDSS implementation • CPCSSN - >750 Providers, ~1M patients, pan- Canadian Chronic Disease Surveillance Network • Heart and Stroke’s Hypertension Management • Several others • Interviews with over 90 health care stakeholders
- 7. Future Medical History 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Joe Schmoe M 45 (Jan-25-1966) (2 Joe Schmoe’s in database) Team Based Care Population Care Medication List Ramipril Propranolol Diltiazem ASA Indocid Garamycin Penicillin Problem List CAD Hypertension Gout Back pain Risk Factors Smoker Family History CAD –Father d. 58 HTN–Mother DM –Mother √ √ √ Dashboard Patient Engagement + + + + Depression Circle of CareCare Coordination Refer Specialist Refer TelehealthResearch CDSS
- 8. Circle of CareCare Coordination Refer Specialist Future Medical History 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Joe Schmoe M 45 (Jan-25-1966) (2 Joe Schmoe’s in database) Team Based Care Population Care Medication List Ramipril Propranolol Diltiazem ASA Indocid Garamycin Penicillin Problem List CAD Hypertension Gout Back pain Risk Factors Smoker Family History CAD –Father d. 58 HTN–Mother DM –Mother √ √ √ Dashboard Patient Engagement + + + + Depression Chest pain Date: May 1992 S: Chest pain O: Normal A:R/O CAD P: Refer Cardiology Angina Date: Oct 1992 S: Chest pain O: ECG abnormal A:CAD P: Diltiazem CAD Date: Jan 1993 S: Chest pain O: ECG abnormal A:CAD P: Propranolol Red Eye Date: Aug 2002 S: red eye, sticky O: No abrasion A:Bact Conjuntivitis P: Garamycin optic Refer TelehealthResearch CDSS
- 9. Future Medical History 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Joe Schmoe M 45 (Jan-25-1966) (2 Joe Schmoe’s in database) Team Based Care Population Care Medication List Ramipril Propranolol Diltiazem ASA Indocid Garamycin Penicillin Problem List CAD Hypertension Gout Back pain Risk Factors Smoker Family History CAD –Father d. 58 HTN–Mother DM –Mother √ √ √ Dashboard Patient Engagement + + + + Circle of CareCare Coordination Refer Specialist Depression Refer TelehealthResearch CDSS
- 10. Brain H&NEye Ear HeartLung Liver Stomach Spleen Intestine Colon Kidney Bladder Breast Prostate Ovary Uterus Depression Schizophrenia Anxiety PTSD Personality Pituitary Thyroid Diabetes Adrenal PCOU Limbs L Limbs FUTURE MEDICAL HISTORY
- 11. 2 2 4 10 4 0 4 2 0 2 4 6 8 10 MD Nurse Nurse Practitioner Pharmacist Social Worker Mental Health Worker Dietician Occupational Therapy TEAM-BASED CARE – CARE COORDINATION – CIRCLE OF CARE Refer Care Coordination Circle of Care
- 12. CIRCLE OF CARE Dr. Alex - FP Joe Schmoe Dr. Cardy- Cardio Nurse - Judy SW - SamanthaRemote Nurse Nancy Dr. Alex Dr. Cardy Samantha He lives alone. Anything we should be worried about? I’d dial back his BP control. 120 systolic may be too aggressive for him. Probably keeping it around 150 would be best. I’ll arrange Meals on Wheels and transport to his local church on Sundays. He didn’t get his license renewed this year
- 13. Age > Sex 0-5 6-18 19-50 51-64 65-80 >80 855 M 53 118 322 168 156 38 1049 F 56 121 426 205 172 69
- 14. PATIENT ENGAGEMENT Heart Lung Colon Prostate Depression Thyroid Diabetes Area of Risk Readiness Importance Comment Current Goal KOPRA for Change Smoking Counseling On Statin Regular PSAs Hx Fam Polyps Refuses colonoscopy In denial of Fam Hx On Rx Uncontrolled DM Risk PAM Literacy View Patient Portal
- 15. SIGN UP FOR NEW GUIDELINES
- 16. ENROLL PATIENTS INTO CDSS 16
- 17. SIGN UP FOR RESEARCH
- 18. SOLUTION ARCHITECTURE EMR 1 EMR 2 EMR 3 Routing Server Telehealth Server CDSS Forms Server Patient Portals Analytics ServerResearch Clinical Trials
- 19. CONCLUSION • EMR adoption has peaked in North America, significant penetration in primary care • EMRs as currently constituted are unlikely to help transform health care • EMR vendors are unable and can’t afford to do the necessary R&D • We need new governance structures that integrate multiple stakeholders • Learning Health Systems may be the right structures? • Governments, EMR vendors and researchers and academics need to consider new models of partnership that can accelerate R&D in the EMR space