Event Report - Electronic medical records: Are we ready for data analytics?

This roundtable event was organized by the Rogers Healthcare Group, and sponsored by the Ontario Medical Association and OntarioMD.Participants:Moderator: William Pascal, principal, RichardWarren & Associates, and former chief technology officer, Canadian Medical AssociationDr. Javed Alloo, IT lead, East GTA Family Health GroupDr. Anne Duvall, lead physician, Barrie Family Health OrganizationBrian Forster, chief executive officer, OntarioMDDr. Michelle Greiver, family physician, North York Family Health TeamSarah Hutchison, chief information officer and executive director, engagement and program delivery, Ontario Medical AssociationGlenn Lanteigne, former chief information officer, South West LHIN Cluster; director, COACH Board; chief executive officer, TecTonicKen Martin, information and technology manager, Canadian Primary Care Sentinel Surveillance NetworkFor years, electronic medical records (EMRs) have held the promise of revolutionizing healthcare, by generating large volumes of personal health information that can be analyzed to better inform clinical decision-making, population health management and new care delivery models.But before those benefits could start to be realized, two key steps needed to happen. First, the digital infrastructure for capturing patient data had to be put in place in healthcare facilities across the country. Second, as patient data was collected into EMRs, a system of health information exchange needed to be developed to allow the data to flow among clinicians and across administrative groups.In many jurisdictions across Canada, the first phase — amassing data — is well on the way to completion. The second — data exchange — is still in its infancy, but all jurisdictions are making investments in this capability. Now it’s time to consider how to unleash the innovative power of EMRs by enabling advanced analysis of the data that’s captured and exchanged in the first two stages.As part of an annual workshop held since 2010, the Rogers Healthcare Group recently brought together a small group of physicians and healthcare IT experts who are helping to shape the EMR agenda in Canada. The 2013 workshop explored what is needed to leverage all the patient data being captured in EMRs to fulfill the intended goal of creating a healthier patient population in Canada.This year’s workshop was moderated by William Pascal, former chief technology officer of the Canadian Medical Association and currently a principal with RichardWarren & Associates, and sponsored by the Ontario Medical Association and OntarioMD.From the discussion, one thing is evident: the desire exists to utilize EMRs more effectively in delivering better care, but first the healthcare system must overcome data quality challenges and create formal policies around how patient data will be used.The current environmentBy March 2014, about 75% of family physicians will be on EMRs, at least in Ontario, said Brian Forster of OntarioMD. When it comes to how the Canadian healthcare system is currently performing on analyzing and reporting data collected from EMRs, Pascal was clear: “We’re in the red. The problem is that the data analytic infrastructure isn’t in place, data standards are not consistently used, and we lack a data management culture. In addition, decision support tools are still immature.”While data management is a serious challenge in the EMR industry, Dr. Anne Duvall believes leaders in the field must stop to consider the perspective of doctors and do more to engage and support them.“All of this has to work on the ground or it’s not going to work. If we don't engage the primary care physician, then it’s not going to go anywhere,” she said. “Physicians didn’t go to medical school to do data entry. They went to look after patents. For them to have data discipline can be a tough concept.”Doctors will not spend the time and effort required to capture and enter all the data that other stakeholders would like unless they appreciate the value of the data from their individual practice perspective and how it can help improve patient care, she said, and not from a top-down policy point of view. In addition, she noted, physicians in primary care do not have the resources to analyze patient data.Sarah Hutchison of the Ontario Medical Association said the OMA has demonstrated strong leadership in advancing EMR adoption across the province."Now we have to capture the learning from physicians who are further along in their EMR experience,” she said, “and use that information to help all members of the profession to get on board. There’s a collective interest and benefit in moving this along. However, understandably, physicians want to see the data, the evidence that this will improve their own practices, before they will be willing to participate in a system-wide initiative. We must not burden physicians with additional business processes in their practice unless we can show a value to them. If we can demonstrate that value, then we’ll see positive results.”The most efficient strategy to boost physician compliance with EMRs, said healthcare IT executive Glenn Lanteigne, is to develop tools around their workflow that will help them achieve the desired results.“Changing physician workflow is a long process,” he says. “So let the physicians work the way they work and develop ways to extract data reliably.” Once doctors experience the value of quality EMR data, they are more likely to be compliant with entering it during or after patient visits.The quality of dataBut disengaged doctors are not the only roadblock to achieving optimal EMR benefits. A larger one, said Forster, is quality of data. “We need to understand the data that comes in. In order for that to happen, it needs to be standardized. How do we get tools that detect the quality, ensure it’s correct when it first enters the system, and clean up data already in the system, without burdening physicians?”Ken Martin of the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) said liberating the data is much harder than many realize. Data in EMRs is organized in different ways, partially coded, and contains a lot of free text. Each EMR system has its own way of handling the different types of data. So when data from multiple EMRs or sites is brought together for analysis, the only way to realize any insights or value is to be able to compare them directly, and that cannot happen until the data organization and content are standardized.There are tools that help overcome this challenge, but it’s still a factor that’s slowing down the liberation and use of EMR data, Martin said. CPCSSN is currently liberating data from 12 different EMR products at many sites across Canada and is performing meaningful use in areas of research, chronic disease surveillance, clinical practice/quality improvement and health analytics.Another obstacle is how well the data accurately reflects the patient’s reality. “If the data is going to be used for healthcare policy, we need to ensure it’s real data,” said Dr. Duvall. “For example, if you’re looking at hypertension, but you can collect data on only 30% of patients because of how the data is entered in the EMR, then this data isn’t a true reflection of your patient population.”The risk with incorrect or incomplete data is that significant healthcare policy or funding decisions could be made based on the flawed information and, in the long term, that could do more harm than good for the system.Hutchison said accountability and reporting, along with data governance and data stewardship, are critical elements in the EMR conversation, and a key focus for the OMA.“As we expand the possibilities with technology and data analytics, it raises other questions, not just about the use of data for primary care, but well beyond that. We need to be thoughtful about what the data can be used for. Also, how do we prepare physicians for anticipated changes in data accountability and transparency? If we don’t get the governance right, confidence will be undermined, and physicians won’t participate. The next 18 months will be very critical to the analytics agenda moving forward.”The way forwardDespite the challenges of the current environment, the workshop participants were positive about the possibility of overcoming them.Dr. Michelle Greiver said to move ahead on EMR analytics and reporting, the first thing the system needs is standardization. “Let’s decide on content standards so even if there is a local project, its data is portable. Then we need funding for analysts. If there is no good, sustainable funding, then all of this will stay at the local level.”In addition, Martin said the industry needs more demonstration projects. CPCSSN is working on two such projects for Canada Health Infoway.“Bring the analytics tools into the practice environment so the results are more real-time instead of sending it out and bringing it back,” he said. This will create a more positive impact on doctors and healthcare leaders, who will then share the successes.Dr. Duvall said she would like to build on the success of existing programs. “Is there a way to spread them in the system? Could I apply for a pot of money from the government that I can pay to [a successful program] to come in and teach it at my care facility?”Leveraging success in this manner would also help educate physicians on the value of their EMRs.“We’re all different pieces of the puzzle. We can all solve different parts of the problem together,” said Dr. Javed Alloo. One thing everyone needs to do, however, is focus on outcomes, value to patients and the care they receive. That will drive decisions around analytics best practices, data governance and healthcare policies, he said.The motivation to see EMR data freed for its intended use is strong in the healthcare system. Even though there are challenges, there are feasible solutions too.“At the end of the day, we want the data,” said Pascal. “We want real-time feedback on how we’re doing.” It’s time to free the data and release the potential of EMRs.

Event Report - Electronic medical records: Are we ready for data analytics?

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