Canada is slower at adopting electronic health records with only 1% of Canadian Hospitals at HIMSS EMRAM level 6 or higher compared to 32% in the U.S. Clinicians understand the benefits; elimination of transcription and illegibility errors, accessibility to real-time clinical data for decision making and the safeguards that clinical decision support tools offer, however, what is lacking are the levers to drive incentive, motivation, and commitment to a different, more proactive care model.
A measured approach to success
Proudly, Canada does have some early adopters who have successfully implemented solutions to improve care and have quantified the value of investment. Through the eCare project, North York General Hospital (NYGH) improved the prevention of nosocomial Venous Thromboembolisms, reduced preventable patient deaths, and prevented medication errors and unintended medication discrepancies. Through the HIMSS Davies award submission, the hospital was able to measure the value which positively informs a business case for patient safety.
Similarly, the Centre for Addiction and Mental Health (CAMH) streamlined opioid antagonist therapy through electronic order sets that reduced referral times, improved medication safety for patients with schizophrenia, and improved discharge medication reconciliation rates. Sonia Pagilaroli, the Chief Nursing Officer at Cerner Corporation — the largest vendor with the highest global EHR market share — explains that by using EHRs, clinicians are guided through clinical workflows with relevant information and decision-making support. “As the clinician interacts with the system, we promote clinical efficiency to fit organization specific workflows,” she says. “While our focus is the implementation and adoption of EHRs, it is the measurement of patient outcomes, as seen by NYGH and CAMH, that will shift the care delivery paradigm.”
Canada really has an opportunity to […] adopt new solutions geared at improving clinician experience.
Sonia Pagliaroli, Chief Nursing Officer at Cerner Canada
Avoiding the data collection burden
Looking at Canada’s EHR adoption rates through a positive lens, the country is well positioned to learn from lessons learned. Namely, getting ahead of some of the unintended consequences of an over-designed system and the burden it places on clinicians. “Overdesign is not done intentionally, but without the necessary change approval governance structures and design guiding principles in place, it is easy to add content without re-evaluating the complete workflow impact,” says Pagliaroli.
Recognizing this, the United States Congress recently directed the U.S. Department of Human Health Services (HHS) through the 21st Century Cures Act to find ways to reduce EHR-related burdens that affect health care delivery.
What will be important going forward is making sure that EHRs are evaluated for usability and efficiency. “We are currently working on establishing nursing data standards with a close eye on limiting the amount of unnecessary or redundant information gathered giving nurses time back for direct patient care,” says Pagliaroli. “We have seen some great work at Island Health in British Columbia where they reduced the Nursing Admission Intake Assessment from 150 questions to 45. This process of redesign engaged front line nurses in a full day workshop where they were provided supporting data such as associated policies and documentation utilization audit data to help inform the redesign.”
Pagliaroli urges clinicians to remember that patients should reap the biggest benefits of implementing a more proactive approach. “As we all have different roles to play on this journey towards leveraging technology to improve patient care, let’s take this moment to adopt lessons learned and embrace the integration of standard nomenclatures, best practice tools, and validated clinical decision support to enhance — rather than hinder — the delivery of high-quality health care to our most important partner, the patient.”
