Report - Beyond Good Intentions Conference - Are we Getting Closer?

A recent conference in Montebello, Quebec sponsored by Canada Health Infoway and the Health Council of Canada entitled - BEYOND GOOD INTENTIONS: Accelerating the Electronic Health Record in Canada has resulted in a very interesting discussion document. An exerpt from the document reads as follows:

"No jurisdiction has achieved a fully automated, comprehensive EHR for its entire population. Hence there are no definitively proven strategies for problem-free implementation. However, a number of insights emerged from the conference, including:

• The transition period is invariably difficult. The initial preferences of users (e.g., text-based rather than structured data entry) may change over time. Flexibility is therefore essential.
• Moving to an EHR in its fullest form is not just a technical innovation; it is a cultural transformation. Change management is vital, and failure to build in processes for effecting the transformation will reduce both uptake and impact. In the words of one presenter, all of us – providers and managers in particular – need to complete the transition from resistanceto electronic information (historical position) to acceptance (current position) to addiction (can’t function without it).
• Implementation takes time, but can be accelerated once adoption and proven successes have reached a critical mass, or tipping point. At these stages, policy can drive faster change, e.g., by making certain resources available only through electronic portals.
• The data elements are the core of any system, and spending time and resources on  standardizing definitions and usage will go a long way toward creating information systems that yield valid and reliable measures of quality and performance.
• There will be far greater acceptance of provider-level IT if workflow is modified accordingly to gain improvements.
• Creating secure networks for communicating information in any form has proven to be hugely appealing to providers in almost every country. E-mail use grows very rapidly and is an effective vehicle for introducing providers to the world of electronic information.
• It is very important to structure contracts so that risks are appropriately shared, and purchasers do not pay for systems that don’t work. The NHS has taken a firm stance, and while it incurred delays because it changed a principal vendor, it did not take a huge financial hit.
• Leadership at all levels is crucial. Clinician leadership is essential but cannot be effective in isolation. There must be commitment from Boards and CEOs, the government, and thevarious sectors.
• Helping family doctors use the data generated by the EHR to analyze and improve their own practices will increase uptake. In Denmark, the counties fund data consultants who visit each practice 1-2 times per year to troubleshoot and help produce usable quality-oriented information on treatment patterns, etc.
• If providers perceive “early wins” in the process, they will be more likely to invest their own money and agree to standards.
• Some strategies to enhance adoption among providers include clinical stories, peer-to-peer training, demonstration clinics, mentorship, and protected time.
• Giving patients access to their EHR is the wave of the future. Experience to date inDenmark and the US has been uniformly positive. If the patient is to be at the centre of thesystem, the patient has to be included in the information network and given the capacity to contribute to and use the EHR, and to communicate with the care team."

To read the full document (.pdf format), click on this link

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