COACH Column: Innovation through Collaboration: Evolving a Canadian EMR Adoption & Maturity Model

Taking Health Informatics Mainstream – once a “blue sky” idea when our pioneering health informatics (HI) predecessors first articulated COACH’s vision statement, we are now beginning to see our future unfolding.

We have made huge progress, yet we have so much more to do…The early years of our eHealth journey were characterized by “invention”, with new technologies, architectures, standards and concepts of interoperability being introduced and a major focus placed on developing the required infrastructure, strategies, policies and governance. As our industry matures and pressures on our healthcare system mount, we are now very aware of our challenges in sustaining the continuing level of investment we will need to fully realize the promise of eHealth across all facets of the health system, including active engagement by consumers.

The need for “innovation” (i.e., the use of a better ideas or methods) is becoming much more important as we focus on both wider and deeper adoption in realizing the true value of eHealth. As we enter this stage of maturity, the practice of HI is uniquely challenging because of the complexity of the business of healthcare itself. The downstream impact of technology on healthcare processes, and ultimately on health outcomes, is affected by a number of intertwining factors, and the pressure is on us to demonstrate clear impact on patients’ health. In this very challenging environment, I am energized by the opportunities we have at COACH to serve as a catalyst for innovation as we focus on advancing the practice of HI.

EMR Adoption Models
Sixteen months ago in this column, Lydia Lee wrote about COACH’s early work on adoption models, and emphasized their value in providing a “means to measure, benchmark, assess and report on eHealth utilization.” This extended our previous thinking about using a consistent approach in measuring the extent of adoption and the systems functionality being implemented, introducing the idea that we must also strive to incorporate a “3rd dimension” – health outcomes.

Electronic medical records (EMRs) have been a major focus for eHealth investment and while we are still lagging many OECD countries, 57% of primary care physicians are now at least using computerized patient charts.1


We know, however, that EMR adoption is, in itself, a journey. The benefits to physicians, and most importantly to patient outcomes, occur only through innovative approaches to integrating information technology seamlessly into care processes and delivering the right types of change management support.

This model is valuable in not only assessing the uptake and use of EMRs, but also paves the way for collaboration on subsequent innovations such as the development of tools for measuring the impact of our EMR programs on healthcare processes and outcomes.

The need to not only measure the number of adopting care providers, but more importantly, the increasing maturity of their use of EMRs in delivering the promised benefits, was recognized by the EMR programs in four provinces, each of which began model development through parallel efforts. Responding to this need and building on our 2011 White Paper on e-Health Adoption, COACH has facilitated collaboration with these “early adopter” jurisdictions. The resultant convergence of their early work is the foundation of the Canadian EMR Adoption and Maturity Model White Paper, recently released to COACH members and other key stakeholders. This model is valuable in not only assessing the uptake and use of EMRs, but also paves the way for collaboration on subsequent innovations such as the development of tools for measuring the impact of our EMR programs on healthcare processes and outcomes. Innovation here will be vital in providing critical evidence to measure progress, continuously improve our EMR programs and support future investment. By drawing on the diverse experience and innovative thinking of these early adopters, a “convergence” of knowledge was created through this collaborative process. The result will also now be leveraged by other provinces in the earlier stages in their EMR programs.

Innovation – We need to Get Better at Connecting, Collaborating & Converging!
The development of the Canadian EMR Adoption & Maturity Model White Paper has been an excellent case study in how we can very effectively harness the collective forces for innovation within our diverse and talented HI community.
It is increasingly important that we converge and embed our new HI learning and knowledge into best practices which we can deploy to drive widespread eHealth adoption. Our experience at COACH demonstrates that there are three important steps involved and I encourage you to think about how similar approaches could be applied within your own organization or community.

The EMR Adoption & Maturity Model initiative began with identifying the early innovators and then providing a forum for them to connect on an issue of importance for our eHealth agenda. Connecting innovators can occur in a variety of ways. At COACH we foster connections both through formal means such as our volunteer committees and forums for particular segments (telehealth, emerging professionals, senior executives and, coming soon, clinicians), as well as through more informal professional development offerings, conferences, events, and communities of interest. Social media, including our LinkedIn groups, is also a channel we are starting to utilize very successfully. I encourage you to check these opportunities out on our website and to think about how you can foster connections at the local level within your community.

COACH’s Strategic Plan “Values collaboration through sharing of health informatics knowledge and experience with others.” We believe this is essential to the continuous improvement and advancement of our profession through best practices, guidelines, standards and knowledge. Our Guidelines for the Protection of Health Information, for example, are updated at regular cycles by our member experts, with special editions also being developed for emerging areas such as patient portals by drawing in added expertise.

Our most recent experience with the EMR Adoption & Maturity Model provides further evidence of the benefits of connecting innovators, who are working to address similar challenges, but often in relative isolation and with limited local resources. Collaboration accelerates learning, results in a richer product, and in turn can spawn the next cycle of innovation. There are many more opportunities for us to connect as a HI community at local, provincial and national levels and I encourage all of us to think about opportunities for greater collaboration within our communities.

In the current environment the pressure to deliver value through our eHealth initiatives has never been greater. Concepts such as “lean” healthcare and other methods of continuous quality improvement are gaining momentum in the delivery of healthcare. We must similarly not be afraid to try new things, but evaluate what works and have the courage to make quick course corrections. Let’s exploit our talents and experience as a HI community – becoming more adept at learning from each other and converging our thinking into innovative best practices. Our innovations can then be spread, deployed and continually refined much more effectively through successful eHealth implementations if we practice our 3 ‘C’s!

Feedback Welcome
As always, I welcome your feedback on this column and would like to invite your ideas about how we can best foster new innovations in HI practices within our industry, as well as any other ideas or questions you have about COACH or HI. Please contact me through the COACH office, info@coachorgcom, or via Twitter at @COACH_HI.

1 2012 Commonwealth Fund International Health Policy Survey

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