Physician eHealth

eHealth Ontario provides funding and other support for physicians and specialists to adopt Electronic Medical Record (EMR) systems, which enables ehealth to have a direct benefit on patient care.

The majority of patient health information is collected in the physician's office. The collection and management of this information electronically in EMR systems is an important foundation for a comprehensive electronic health record for all Ontarians. The ability to electronically exchange information between physicians and other health care providers will enable faster and better patient care.

The Physician eHealth program developed and oversees the EMR Adoption Program to broaden and accelerate physician adoption of EMRs. OntarioMD, a subsidiary of the Ontario Medical Association, is eHealth Ontario's partner for the delivery of the program to eligible physicians. Clinical value to physicians is enhanced by collaborating with OntarioMD and clinicians to accommodate ehealth priorities.

Physician eHealth also works on initiatives that will integrate EMRs with other systems to provide physicians with access to clinical information in a timely manner.

Benefits

Patient benefits:

• Improved access to appropriate patient information by the physician at the point-of-care
• Improved patient safety using alerts to reduce medication errors and provide proactive preventative care
• Timely and improved quality of care

Physician benefits:

• EMRs improve access to patient information in a standardized manner providing efficiencies and eliminating duplication of effort at the point-of-care
• Improved turnaround of information from point-of-care (hospital reports, electronic laboratory results) to the physician
• Better coordination of care between multiple practitioners and within health care teams
• Better security of patient health information than paper-based records
  

Health system benefits:

• Preventing errors avoids costly hospital encounters
• Better information to identify trends, facilitate forecasting and improve planning
  

Progress to date

Building on the success of the Physician IT Program, which resulted in over 3,000 primary care physicians adopting EMRs, eHealth Ontario launched the EMR Adoption Program in November 2009. Like the previous program, the EMR Adoption Program is a joint initiative between the Ministry of Health and Long-Term Care and the Ontario Medical Association. The program is available to all practice-based physicians (primary care physicians and specialists) and physicians funded under the previous program.

The number of electronic medical record adopters will increase by 5,700 to 9,000 physicians by March 31, 2012. This total includes 65 per cent of primary care physicians. At the end of the current program, 9,000 physicians will be on their way to using electronic medical records to care for approximately 10 million Ontarians.

The EMR Adoption Program consists of four components: a subsidy program, change management services, EMR specification management and certification and the OntarioMD.ca physician portal. For details on the EMR Adoption Program, please visit www.ontariomd.ca.

eHealth Ontario's Physician eHealth team also works with OntarioMD and the Local Health Integration Networks (LHINs) on other ehealth initiatives to support better patient care. One of the most requested integration opportunities is for physicians to receive their patients' hospital discharge reports electronically in their EMR. Hospital report solutions eliminate the paper processes (mail, fax and scanning) that were required to receive these reports, integrate information from the reports into EMR systems while reducing the time it takes for information to reach the physicians. Hospital report solutions funded by eHealth Ontario are now delivering patient hospital reports electronically from three hospitals to primary care providers.

eHealth Ontario's Physician eHealth program funded a series of collaboration projects in Local Health Integration Networks (LHINs) in 2010/11:

Southwest Physician Office Interface to Regional EMR (SPIRE) System
LHIN 2 South West

Continuity of care for patients has been improved by giving approximately 350 community physicians (61 sites) electronic access through their EMR to patients' hospital radiology reports, laboratory reports, medication lists and medical documents through the SPIRE solution. 27 hospitals are now sending their hospital reports to SPIRE, which identifies the patient's physician and then makes the reports available to the physician's EMR. Having these reports available in the EMR through SPIRE supports better care decisions in a more timely fashion. About 100,000 hospital reports are sent via SPIRE each month.

ClinicalConnect Portal Expansion
LHIN 4 Hamilton Niagara Haldimand Brant (HNHB)

ClinicalConnect is a secure provider portal giving physicians and health care providers real time access to their patients' records via the Internet any time from anywhere. It integrates health information regionally across the continuum of care and facilitates the sharing of this information to improve patient care. Physicians have the option to electronically download hospital data into their EMR.

ClinicalConnect will enable the delivery of ehealth applications and services in two LHINs representing over 2 million patients by its ability to integrate with provincial data sources. It already links data from 27 hospitals in Hamilton, Niagara, Haldimand, Norfolk, Burlington, Brantford, Kitchener (St. Mary's), Cambridge and Guelph. It includes Hamilton Juravinski Cancer Centre Oncology notes and HNHB Community Care Access Centre (CCAC) information. Data on visits, radiology reports, pharmacy and allergies as well as lab results, admissions and demographics for 310,000 patients is also available from St. Joseph's Hospital. West Lincoln Hospital, Waterloo Wellington CCAC, Grand River Hospital and Cancer Centre data will be available through the portal in 2011.

Other features of the portal include the McMaster Plus "1Stop" search service for medical text and literature.

Patient Results Online (PRO) Expansion
LHIN 7 Toronto Central

PRO allows health care providers to electronically share 15 different reports, including allergies, diagnostic imaging, hematology, biochemistry, progress notes and discharge summaries from the University Health Network, Mount Sinai Hospital, St. Michael's Hospital, St. Joseph's Health Centre and LifeLabs. Having health care providers share information benefits patients with chronic diseases who receive care from multiple locations.

The use of the PRO viewer was expanded to seven additional primary care organizations, including Community Health Centres (CHCs), a medical clinic and a group of physicians that provide care for the homeless population in Toronto. Through this expansion, an additional 240 users, including 151 physicians, now have access to patient information through PRO. Additionally, Toronto East General Hospital and Sunnybrook Health Sciences Centre are now contributing patient results into PRO, increasing the number of results available by 90 per cent.

Timely Discharge Information System (TDIS)
LHIN 9 Central East

The Timely Discharge Information System (TDIS) sends consultation reports, pre-admission reports, emergency reports, discharge summaries, progress reports, delivery notes, history and physical reports, operative reports, mental health letters and patient notes electronically from the Scarborough Hospital, Rouge Valley Hospital, Peterborough Regional and Lakeridge Health Corporation to 100+ physicians with EMRs in the Central East LHIN. Approximately 7,600 reports are transmitted each month using this valuable tool.

Phase II of this project is underway which will double the number of physicians receiving reports and will increase the total number of hospitals contributing reports to nine.

BASE - Building Access to Specialists through e-Consultation Pilot Project
LHIN 11 Champlain

The e-Consultation pilot project was leveraged for family physicians and endocrinologists by engaging 20 specialists from 10 different specialty areas, 35 family physicians and four nurse practitioners to provide effective and timely advice regarding treatment, need for referral, etc., through a secure web-based tool using existing investments in the LHIN. The project technology facilitated electronic consultation between family physicians and specialists to improve care to the patients in the area.

Hospital Report Manager Expansion
LHIN 12 North Simcoe Muskoka

The Hospital Report Manager solution has expanded from the initial phase which enabled patient hospital reports (diagnostic imaging reports, medical reports and consults) to be sent electronically from the Royal Victoria Hospital in Barrie to the Barrie and Community Family Health Team. The solution has now expanded within the LHIN to include Royal Victoria Hospital reports being sent to the Georgian Bay Family Health Team.

Georgian Bay Family Health Team is also now receiving reports from the Collingwood General and Marine Hospital. The Headwaters Health Care Centre is now sending hospital reports electronically to Orangeville Family Health Organization and the Highlands Health Network. Physicians now have these valuable reports in their EMRs to support better care decisions, including follow-up care, in a more timely fashion. Approximately 55,000 reports are sent to the Hospital Report Manager solution each month.

Physician Office Integration
LHIN 14 North West

The Physician Office Integration (POI) made hospital reports available to 168 physicians and nurse practitioners electronically from 12 hospitals in the North West LHIN.

The project enabled a patient's health records and diagnostic test reports to be sent from a Hospital Information System (HIS) to the Electronic Medical Record (EMR) in the patient's primary care provider's office. The POI program now benefits over 150,000 patients as information flows from 12 hospitals to 25 clinics.

21,000 patient reports are transmitted electronically each month via this system saving approximately 1,100 hours of clinical administrative staff time that used to be spent sorting, filing, scanning, distributing and other manual processing of these reports. In addition, reports are stored in the clinic EMR are fully integrated and therefore available for viewing together with pertinent data, such as notes created at the clinic. The data from the reports can be used for graphing and trend analysis.

Next steps

eHealth Ontario's Physician eHealth team will continue its oversight of the EMR Adoption Program and monitor its progress and realization of annual targets for EMR adoption. It is also exploring opportunities with existing provincial health information systems and health care providers to integrate them with EMRs to give physicians the information they need to assess a patient and provide excellent care.