Newfoundland and Labrador on verge of province-wide EHR

By April, Newfoundland and Labrador will have 100% of its community pharmacies connected and delivering data into HEALTHe NL, its provincial electronic health record. Moreover, it will have all four of the province’s health authorities feeding various types of data into the record by next summer.

That means healthcare professionals across the province – from St. John’s in the east to Labrador City in the northwest – will have access to critical patient information in a matter of seconds.

These developments are just some of the latest in Newfoundland and Labrador’s journey to the province-wide, electronic health record, a goal it calls, “One Patient, One Record.”

“In the next 12-18 months, we will have one of the most comprehensive provincial EHRs in the country,” says Gillian Sweeney, VP of Clinical Information Systems and Quality at the Newfoundland and Labrador Centre for Health Information, the lead agency for implementing the system.

On tap for the near future: e-referrals, e-prescribing and a patient portal. “We are scoping them out,” says Sweeney.

The province has already achieved a great deal. Sweeney outlined the progress that’s been made and the plans for the future in a recent webinar, titled “The Holy Grail of Healthcare: One Patient, One Record.” (It can be accessed at: http://web.orionhealth.com/holy-grail-of-healthcare-registration.html)

Of course, the investments in HEALTHe NL have been made to enhance patient care. By providing accurate clinical information, clinicians will be able to make faster and better decisions about patient treatments and care plans. Almost one-third of Newfoundland and Labrador’s 6,500 healthcare professionals have signed onto the system, and more are expected as the capabilities of the solution quickly grow.

Currently, there are six sources of information that feed into the clinical data repository, which has been built for the province by Orion Health. It is at the heart of Healthe NL, along with the viewer, which was also supplied by Orion Health. The six sources of data include:

• Client Registry
• Pharmacy Network
• Provider Registry
• Community health (such as immunizations)
• Hospital Meditech systems (includes lab results, DI reports, encounter notes, etc.)
• PACS (for diagnostic images)

“We were the first in the country to introduce a client registry,” observes Sweeney, noting the solution accurately identifies patients and links data between systems. “It provides real-time authentication at the point of care.”

The province was also one of the first in Canada to have a PACS repository; about 99 percent of the imaging in Newfoundland and Labrador is digital, and 55 million studies are stored in the provincial PACS each year.

Meditech is used at hospitals in each of the four Regional Health Authorities, but different versions have been implemented. That has created an integration challenge, but the NLCHI intends to have them all connected to HEALTHe NL by next summer.

Pharmacies have proven to be a very important source of data. Of the province’s 202 pharmacies, 136 are now feeding data into HEALTHe NL, and the goal is to have them all in the system by April.

On another front, the NLCHI has also launched a physician EMR project, which is designed to link physician systems to HEALTHe NL. EMRs for doctors in the province are supplied by Telus Health. Sweeney said co-leaders in the project are the Department of Health and Community Services and the Newfoundland and Labrador Medical Association.

“Partnerships with vendors, professional associations and RHAs have all been critical to getting the project off the ground.”

The EMR program is known as eDOCSNL, and the first phase of integration with the EHR includes the client and provider registries, laboratory results, diagnostic imaging and clinical documents. The plan calls for a November 2016 rollout of this initial phase.

For its part, HEALTHe NL is currently experiencing robust usage, with 260,000 transactions per month being exchanged between the four RHAs and the client registry.

Sweeney notes that constantly checking and maintaining the integrity of data is a crucial function. As far back as 2002, the province created a registry integrity unit to ensure data quality and accuracy. In one six-month period in 2016, the unit resolved 11,000 tasks to maintain the accuracy of information – which goes to show how important this activity really is.

NLCHI is continually tracking how clinicians are using HEALTHe NL. Interestingly, the major users are nurses. Indeed, fully 75 percent of the users are nurses, followed by physicians (10 percent), pharmacists (8 percent), licensed practical nurses (4 percent) and nurse practitioners (3 percent).

To date, the system has been used mostly to obtain DI reports (41 percent) and medication profiles (23 percent). Significantly, the volume of requests for medication data has recently overtaken DI reports, Sweeney notes.

The addition of many community pharmacies this year has helped drive up the requests for medication profile information, as more patient information was available.

As one nurse told the NLCHI, “I have been using HEALTHe NL for the list of medications on a daily basis and printing them for the physicians. It really helps to have access to this information in the ER.”

Access to lab reports (14 percent) was next, followed by clinical documentation (7 percent) and immunization records (3 percent).

Health professionals have benefited hugely from the availability of DI reports, as in the past, these reports were often sent out by mail. Now, they are available to clinicians as soon as radiologists have entered their reports.

Of the 6,500 healthcare professionals in the province, 2,007 are currently using HEALTHe NL. Of them, 623 are considered ‘active users’, those who have logged on at least three times in the last three months.

Sweeney expects to see usage jump next year when all four RHAs are connected and more hospital information is available. “That’s when we will see even greater benefits.”