eHealth and Common Health Information
Informing prescribing decisions and improving patient care through the Digital Health Drug Repository (DHDR)
Julia Bickford*, Lori-Anne Huebner, Ted Alexander, Mohamed Alarakhia
eHealth Centre of Excellence
Background: Canada and the USA have the highest prescription opioid consumption in the world. Ontario had 638 opioid related deaths in 2013, and 3,241 ED visits in 2014. Increased opioid prescribing is associated with increased opioid-related mortality. Thus, better informed physician prescribing decisions are key to avoiding adverse drug events and improving patient safety. During the Fall of 2016, the Ministry of Health and Long-Term Care (MOHLTC) implemented an initiative to integrate the Digital Health Drug Repository (DHDR) through the connecting South West Ontario (cSWO) Regional Clinical Viewer, ClinicalConnectTM to further enhance the data and information (including narcotics information) currently available in the integrated electronic health record (EHR) in south west Ontario (SWO).
Objectives: Following a benefits realization approach, the objective of this work is to understand the organizational and clinical value of the DHDR in acute and primary care settings. In addition, a larger research proposal will be discussed.
Methods: Interviews and surveys were conducted with clinicians in order to understand how the DHDR has been integrated in to clinical workflow at two early adopter sites in Guelph, Ontario (Guelph General Hospital and Guelph Family Health Team).
Results: Emergency department physicians at the Guelph General Hospital found the DHDR to help prevent medication error. A case study with a primary care physician working at the Guelph Family Health Team illustrates how the DHDR helps him prescribe responsibly.
Conclusions: The DHDR is a reliable source of narcotic information which contributes to better-informed prescribing decisions and improved patient care and safety.
Medication Review of Medically Complex Patients using Standardized Data
Kathryn Flanigan*, Jillian Bauer*
Centre for Family Medicine
Objectives: Patients with complex chronic conditions consume the majority of health care services in Ontario. Identification of high health service users and providing more proactive care, may reduce admissions and healthcare costs.
When data such as diagnoses are standardized, it can then be searchable. At CFFM, clinicians have the opportunity to code, in a standardized manner, over 100 health conditions.
Method: Using the CFFM FHT's patient database, a predictive analytics model was used to generate a listing of 132 patients who were predicted at 75% chance or greater of accessing acute care services within the following 12 months. For manageability purposes, the list was further narrowed to 103 patients 65 years of age and older who were taking five or more medications (known as polypharmacy), as increasing age and polypharmacy are also major predictors of high health service use. The list was sent to respective physicians who judged which patients would benefit from a Medication Reconciliation and Review with a clinical pharmacist.
Results: To date, from 103 identified patients, 5 have died, 35 were deemed ineligible by the rostered physician (too ill, in long term care, palliative), 37 have been contacted, 15 have completed a medication review and 26 are to be contacted. Results of the medication review are in the process of being analyzed.
Conclusion: Medically complex patients were identified by predictive analysis for medication reconciliation and review. In future the same technique can be used to search for complex patients in order to provide more proactive care thereby hopefully reducing potential ER visits and hospitalizations.
Mental Health Encounters in Primary Care: How Clinicians Can Use Technology to Support Evidence Based Care
Mohamed Alarakhia, BSc, MD, CCFP; Stephanie Chin*, RPN, BSc, Dipl. HI; Lirije Hyseni*, MSc; Danika Walden, PMP, MSc
CFFM Care Innovations
Since January 2016, the eHealth Centre of Excellence (eCE) in Waterloo, Ontario has been leading project QBIC (Quality Based Improvements in Care) to enhance quality of care through EMR decision support tools that facilitate best practices in chronic disease prevention and management (CDPM). Recently, the eCE developed a Depression and Anxiety tool for the EMR to support clinicians in the screening and management of mental health with a focus on Depression and Anxiety. The tool incorporates guidelines developed by Health Quality Ontario, the Centre for Effective Practice and the Canadian Mental Health Association.
The objective of the presentation is to demonstrate the Depression and Anxiety tool and the link with tablets for mental health assessments incorporating PHQ-9, GAD-7, SDS and LEAPS, allowing for clinicians to gather, document and reference these metrics more efficiently at point of care. We will also demonstrate how the mental health metrics and trends can be viewed and accessed through the Mental Health Toolbar, which incorporates specific elements from the Depression and Anxiety tool and gives easy access to customized patient handouts, lab requisitions and other mental health resources. The plan for evaluating the organizational and clinical benefits of the tool will also be discussed.
Inventory of Tools in Comprehensive Geriatric Assessment in the WWLHIN
Julia Borges*, Dr. George Heckman, Jane McKinnon Wilson
University of Waterloo; Canadian Mental Health Association Waterloo-Wellington
Comprehensive geriatric assessments (CGAs) are considered the gold standard for determining a frail older adult's medical, psychological, and functional capability in order to develop an integrated plan for treatment and long-term follow-up. However, due to the heterogeneity of tools used in geriatric assessment across health professions, organizations and care settings, the effectiveness of CGAs across care settings for differing complexities of patients is largely unknown. This research surveys 20 different organizations or practitioners across the Waterloo-Wellington Local Health Integration Network (WWLHIN) in Specialized Geriatric Services, primary care and acute care to determine the tools used for assessing various aspects of an older adult's health, known as domains. Within a given domain, some organizations were not assessing at all, while others used "homemade" tools or an array of validated tools based on preferences and licensing. Overall, the vast heterogeneity of assessment and tools used among health professionals, within organizations and across organizations results in a lack of interprofessional, patient-centred care, and continuity of care. The WWLHIN must look to standardize CGA within the region in order to enable quality research and provide optimal patient-centred care for the region's growing complex geriatric population.