CPOE:
WHY IS CANADA LOSING
THE RACE, BUT POISED FOR
A COMEBACK?
Jeremy Theal, CMIO, North York General Hospital
eHealth Conference, Ottawa • May 28, 2013
FACULTY/PRESENTER
DISCLOSURE
• Faculty: Jeremy Theal MD FRCPC
• Relationships with commercial interests:
• Grants/Research Support: Canada Health Infoway
• Speaker Honoraria:
Cerner Canada
Ontario Hospital Association
Provincial Health Services Authority
Vancouver Island Health Authority
• Consulting: Provincial Health Services Authority
DISCLOSURE OF NO
CONFLICT OF INTEREST
• The Canadian CPOE Toolkit/NYGH has received
financial support from Canada Health Infoway in
the form of development funding.
• No conflict of interest to declare:
• The Canadian CPOE Toolkit is a service available free of charge
to any publicly-funded Canadian healthcare institution
• North York General Hospital, as the host organization for the
Canadian CPOE Toolkit, does not receive any financial support
or financial gain from the Toolkit aside from the initial
development funding it received from Canada Health Infoway
• No products other than the Canadian CPOE Toolkit will be
discussed in this presentation
CANADA:
LOSING THE CPOE RACE
• US has 12x the proportion of sites at HIMSS Stage 4 and
above compared with Canada (38.3% vs 3.1%)
• Progression to HIMSS EMRAM Stage 4 and above is
associated with improved quality and safety outcomes
- Amarasingham R et al. Arch Intern Med 2009 169(2):108-14
- 2006 HIMSS EMR Sophistication Correlates to Hospital Quality Data
- 2012 HIMSS Analytics Report: Quality and Safety Linked to Advanced IT-Enabled Processes
WHY IS CANADA
FALLING BEHIND?
• Differences in funding, incentives and penalties
• Misunderstanding of definition of CPOE and its benefits
Amarasingham R et al. Arch Intern Med 2009 169(2):108-14
• Heterogeneity of implementation approaches
• Risk of negative patient and provider outcomes
• High quoted failure rate of CPOE projects (>30%)
• Lack of “critical mass” of successful projects in Canada
• Large amount of evidence-based content required for
both go-live and ongoing maintenance
• Limited sharing of content and expertise within the
public system, without incurring extra cost
WHY DO WE NEED
TO SUCCEED?
• Patients deserve better quality and safety of care
Baker GR, Norton PG. Canadian Adverse Events Study. CMAJ 2004 170(11): 1678-86
Berwick DM et al. The 100,000 Lives Campaign. JAMA 2006 295(3): 324-7
• Government expects evidence-based care,
and hospitals need to report detailed quality outcome data
Excellent Care for All Act, Leg Assemb Ontario 2010
Quality-Based Procedures, MOHLTC, Ontario 2012
• Healthcare providers need systems that provide evidence built
into clinical workflows, to improve quality and safety of care
Kawamoto K et al. Systematic review of clinical decision support system success factors. BMJ 2005
CPOE + CDS + EVIDENCE
= IMPROVED OUTCOMES
% Appropriate VTE Prophylaxis
100
90
80
70
60
50
40
30
20
10
0
96
84
65
50
17
2007
(GEERTS ET AL)
2007
(PAPER VTE
ORDER SET)
2010
(PRE-CPOE)
2010
(POST-CPOE NO
ALERT)
2012
(POST-CPOE
WITH ALERT)
CPOE + CDS + EVIDENCE
= IMPROVED OUTCOMES
Study population of all Medicine patients at NYGH with
primary discharge diagnosis of COPD or Pneumonia:
• Pre-CPOE (Jan-Sep 2010) n=520
• Post-CPOE (Jan-Sep 2011) n=511
.
A POTENTIAL SOLUTION:
CANADA MAKES A COMEBACK
• Canada compared with United States:
•
•
•
•
Healthcare based on single-payer (govt/taxpayer)
Not based on competition (challenge is accommodation)!
No competitive barriers to open information resource sharing
Can benefit from economies of scale
• Significant proportion of cost and time
required for CPOE implementation is due to:
• Development of evidence-based standardized clinical
content (order sets, clinical decision support)
• Workflow review, refinement and integration
• Adoption of content, workflows and system by clinicians
 These factors are
VENDOR-INDEPENDENT and MANDATORY FOR SUCCESS
Leverages the non-competitive structure
of Canadian healthcare to create a no-cost sharing
platform for Canadian CPOE development resources
• CPOE Implementation guide (>500 pages)
• Evidence-based CPOE order sets:
• Searchable library with >500 order sets
(over 50% no license restrictions)
• Specialties include:
Medicine, Surgery, Critical Care, Paediatrics
• Coming soon: Maternal-Newborn, Mental Health
• Multi-publisher sharing model:
• Each contributing organization shares content at no cost,
retains full ownership of all contributions
• Contributions pending from multiple organizations
TOOLKIT-AFFILIATED
ORGANIZATIONS
• North York General Hospital
• Alberta Health Services
• Brant Community Health Services
• Centre for Addiction and Mental Health (CAMH)
• Fraser Health Authority
• Humber River Regional Hospital
• London Health Sciences Centre
• North Bay Regional Health Centre
• Sunnybrook Health Sciences Centre
• St. Joseph’s Hospital, Toronto
• Provincial Health Services Authority
• Mackenzie Health Richmond Hill
• Ontario Hospital Association
• Canada Health Infoway
• St. Michael’s Hospital (pending)
• Ontario Shores Centre for Mental Health Sciences (pending)
• Vancouver Island Health Authority (pending)
THANK YOU
Join today at:
http://www.cpoe-toolkit.ca