May 16, 2012
Following a Clinical Adoption workshop held in November 2009, Canadian change management (CM) practitioners came together to develop a common approach for addressing gaps in e-Health CM practices. Through collaborative dialogue, the group, collectively known as the Pan-Canadian CM Network, conducted a current-state analysis and environmental scan of e-Health CM activities and methodologies. As a result, a National CM Framework was developed to promote a best practice model that supports users in their adoption of e-Health solutions. This article will review the six core framework elements required in a CM process to ensure adoption and achieved return on investment, highlighted by examples of practical Canadian applications.
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February 24, 2012
KEY MESSAGES:
- Health technology assessment (HTA) is a multidisciplinary area of applied research that produces high quality information about health technologies—drugs, medical technologies and health interventions. The HTA produces recommendations on whether a health technology should be considered, funded and adopted into practice. The goal is to use the research and recommendations from the HTA to inform decisions that will improve quality and cost-effectiveness of healthcare.
- In Canada, there are several well-established agencies at the national and provincial levels that successfully perform HTA. More and more, however, HTA units are being implemented in a local/ hospital-based setting, based on a growing awareness that the local context needs to be taken into account when assessing health technologies.
- Four different models for performing local/hospital-based HTA have been identified and are currently in use world-wide: the ambassador model; mini-HTA; internal committee; and HTA unit. Each has its own strengths and weaknesses. There is insufficient evidence available to adequately assess which of these models would be the best for Canadian hospitals.
- Research shows that local/hospital-based HTA may influence decision-making. There are reports from isolated experiences related to local/hospital-based HTA on hospital decisions and budgets, as well as positive perceptions from managers and clinicians.
- It is difficult to evaluate the overall impacts of HTA on the various levels of healthcare delivery, largely because most hospital-based HTA experiences are recent and there is a paucity of data. Further research is necessary to explore the conditions under which local/hospital-based HTA results and recommendations can have an impact on hospital policies, clinical decisions and quality of patient care.
- The potential exists to share expertise and methodologies between local/hospital-based HTA units. However, there are challenges in directly transferring research knowledge from one organization to another, given the specificity of the context from hospital to hospital.
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February 13, 2012
“If implemented appropriately, health IT can help improve health care providers’ performance, better communication between patients and providers, and enhance patient safety, which ultimately may lead to better care for Americans. Health IT is designed to help improve the performance of health professionals, reduce costs, and enhance patient safety. For example, the number of patients who receive the correct medication in hospitals increases when these hospitals implement well-planned, robust computerized prescribing mechanisms and use barcoding systems. However, poorly designed health IT can create new hazards in the already complex delivery of care.
In the wake of more widespread use of health IT, the Department of Health and Human Services asked the IOM to evaluate health IT safety concerns and to recommend ways that both government and the private sector can make patient care safer using health IT. The IOM finds that safe use of health IT relies on several factors, clinicians and patients among them. Safety analyses should not look for a single cause of problems but should consider the system as a whole when looking for ways to make a safer system. Vendors, users, government, and the private sector all have roles to play. The IOM’s recommendations include improving transparency in the reporting of health IT safety incidents and enhancing monitoring of health IT products.”
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February 3, 2012
“Good coordination of care in the ambulatory setting has the potential to reduce unnecessary or duplicative use of health services, prevent hospitalizations for ambulatory care–sensitive conditions, improve patient safety, and potentially reduce costs. Unfortunately, coordination failures are common across the health care system. Using performance measures can drive practice improvement, particularly if reimbursement aligns with measurement. However, there are few well-developed, standardized measures of care coordination. This study sought to develop electronic health record–based measures to assess the quality of coordination during the primary care physician-to-specialist referral process, one of the most common transitions across providers in health care. Using input from interviews with primary care physicians and experts, the authors developed a core set of five electronic measures for use in primary care and specialist settings. Through a preliminary evaluation, they determined that the measures are valid with practicing physicians and two are ready for implementation.”
Posted in READ Portal, Reports & Papers | Tagged with Cost effectiveness, e-health, Patient-centered care, Safety | No Comments
October 19, 2011
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“As every aspect of care and treatment becomes digitized and more easily shared, health organizations are facing an array of privacy and security challenges. The most frequently reported issue among providers was the improper use of protected health information (PHI) by an internal party, and improper file transfer containing PHI among health insurers and pharmaceutical and life sciences companies. Pharmaceutical and life sciences respondents appeared least aware about these issues—64% saying they did not know if their organization had experienced a privacy/security-related issue in the last two years.
While each industry sector has specific privacy and security issues four guidelines provide a common strategy for providers, health insurers, and pharmaceutical/life sciences firms to move forward in this environment:
- Integrate privacy, security, and
compliance approaches and
frameworks
- Make minimum controls and
standards a prerequisite to play
- Deputize all workers as
privacy champions
- Make privacy part of the consumer
experience and brand.”
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October 18, 2011
‘Change management (CM) is about supporting people through change. The term “change management” includes a wide range of activities and means different things to different people; there are tangible and measurable elements to CM, as well as less tangible elements, such as behaviours and culture change, which are just as crucial to overall project success. Canada Health Infoway (Infoway) established the Pan-Canadian Change Management Network (Network) to support improvements in CM with information and communications technology (ICT) for health projects. These members have defined CM as:
“…a strategic and systematic approach that supports people and their organizations in the successful transition and adoption of electronic health solutions. The outcomes of effective change management activities include solution adoption by users and the realization of benefits.”’
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September 27, 2011
“Background: Available studies have shown few quality-related advantages of electronic health records (EHRs) over traditional paper records. We compared achievement of and improvement in quality standards for diabetes at practices using EHRs with those at practices using paper records. All practices, including many safety-net primary care practices, belonged to a regional quality collaborative and publicly reported performance.
Methods: We used generalized estimating equations to calculate the percentage-point differ- ence between EHR-based and paper-based practices with respect to achievement of composite standards for diabetes care (including four component standards) and outcomes (five standards), after adjusting for covariates and accounting for clustering. In addition to insurance type (Medicare, commercial, Medicaid, or uninsured), patient-level covariates included race or ethnic group (white, black, Hispanic, or other), age, sex, estimated household income, and level of education. Analyses were con- ducted separately for the overall sample and for safety-net practices.
Results: From July 2009 through June 2010, data were reported for 27,207 adults with diabetes seen at 46 practices; safety-net practices accounted for 38% of patients. After adjustment for covariates, achievement of composite standards for diabetes care was 35.1 percentage points higher at EHR sites than at paper-based sites (P<0.001), and achievement of composite standards for outcomes was 15.2 percentage points higher (P=0.005). EHR sites were associated with higher achievement on eight of nine component standards. Such sites were also associated with greater improvement in care (a difference of 10.2 percentage points in annual improvement, P<0.001) and outcomes (a difference of 4.1 percentage points in annual improvement, P=0.02). Across all insurance types, EHR sites were associated with significantly higher achievement of care and outcome standards and greater improvement in diabetes care. Results confined to safety-net practices were similar.
Conclusions: These findings support the premise that federal policies encouraging the meaning- ful use of EHRs may improve the quality of care across insurance types.”
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September 21, 2011
The Guide to Reducing Unintended Consequences of Electronic Health Records from the Agency for Healthcare Research and Quality aims to teach healthcare providers how to avoid the risks and pitfalls of electronic health care records.
“EHRs can offer many benefits to health care providers and their patients, including better quality of medical care, greater efficiencies, and improved patient safety. However, even if these benefits are achieved, you will almost certainly face some unanticipated and undesirable consequences from implementing an EHR. Such consequences are often referred to as unintended consequences.
Unintended consequences can undermine provider acceptance, increase costs, sometimes lead to failed implementation, and even result in harm to patients. However, if you learn to anticipate and identify unintended consequences, you will be in a better position to make effective decisions, clarify tradeoffs, and address problems as they arise.”
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September 20, 2011
“There are many benefits associated with the use of electronic health records (EHRs). One of the expected benefits of EHRs is data interoperability, which would allow health data to be transferred electronically from one EHR system to another…”
“This paper compares the interoperability approaches of three countries: Taiwan, Denmark and Canada. The work maps out how various countries have addressed the interoperability problems as well as what factors affect decisions and the result, and in what manner. The key findings are as follows: (1) the federal government’s ability to mandate standards affects choice of interoperability strategy, (2) e-Health status influences choice of interoperability strategy, and (3) differences in geography, population and demographics affect the selection of national strategies toward interoperability.”
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September 8, 2011
Incentives to increase adoption and meaningful use of electronic health records (EHRs) anticipate a quality-related financial return. However, empirical data showing either quality improvement or cost savings from EHR adoption are scarce. Available studies have shown few quality-related advantages of current EHR systems over traditional paper-based medical-record systems. Projected cost savings are mostly based on models with largely unsupported assumptions about adherence to and the effect of fully functional EHR systems. Data are particularly scarce on EHR adoption by “priority primary care providers” — health care professionals practicing in small groups and those serving vulnerable populations, as such providers are defined in the Health Information Technology for Economic and Clinical Health (HITECH) Act. EHR adoption by such providers is supported by the national network of Health Information Technology Regional Extension Centers.
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