QI in Action eBulletin #92: How Can Teams Help Meet The E-Service Needs of Patients?

In this issue

• What are Patients’ E-service Needs?   
• Prescription Renewals
• Consult with any Healthcare Provider Online (Email, Virtual Visits, etc.)  
• Specialist Referral Confirmations and Notifications
• How have Other Teams Implemented Digital Health Tools?   
• Digital Health Week and the QIDS-Essential Summary
• Resources
• Upcoming Webinars and Conferences

What are Patients’ E-service Needs?   
Canada Health Infoway conducted 4 public surveys throughout Canada between 2014 and 2018 to assess the availability, use and public interest in digital access to their health information and e-services.1 Some of the key takeaways from the survey results were:  

• The availability of e-services isn’t meeting the demands of Canadians  
• Canadians accessing their health information online has doubled between March 2017 to March 2018
• The four e-services that Canadians want the most are¹:  
  • Prescription renewal (4 million Canadians have lost or damaged a prescription and as a result 700,000 Canadians have gone without medication)  
  • Online access to health records
  • Specialist referral confirmations and notifications for confirmed appointments with specialists  
  • Online booking for appointments  

Survey data from Connecting Patients for Better Health 2018 report by Canada Health Infoway

However, over the years despite the increased interest for e-services, the access for the services has not increased.  

Prescription Renewals

• PrescribeIT allows providers to directly transfer prescriptions to the pharmacies of the patient’s choice. PrescribeIT fully integrates with existing electronic medical records (Telus PSS is live, OSCAR to be available early 2020) and pharmacy management systems. Health Canada has provided Canada Health Infoway the funding to create and launch PrescribeIT and it’s being provided at no charge to prescribers.
  • Benefits include:
    • Enhanced security and patient privacy: prescriptions sent through PrescribeIT are transmitted as data via an encrypted two factor authentication process and details entered directly into the pharmacy software.
    • Rx Dispense notifications in the EMR: Rx dispense, and cancellations notifications are sent to the EMRs when a PrescribeIT^TM order has been received and processed through the a PrescribeITTM enabled pharmacy.
    • Enhanced Communication: Replace fax or phone calls with secure messaging directly from the EMR (currently available for select PrescribeIT^TM enabled pharmacies)
    • Renew Rx Requests electronically from the EMR: Reduce administrative work in faxing/scanning renewals

Consult with any Healthcare Provider Online  

• Provider to specialist: eConsults are available through OTN for physicians and nurse practitioners to access specialist advice in a timely manner. Non-urgent matters have a response time of an average 2 days! This program also consists of Teledermatology and Teleophthalmology
  • A case study illustrating timely patient care through eConsult use in primary care, can be found here.
  • A case study illustrating the use of eConsult to support timely access to specialist advice, reducing anxiety and decreasing unnecessary referrals, can be found here.
• Patient to Provider: Interprofessional teams can sign up with ThinkResearch to access VirtualCare allowing family physicians, nurse practitioners, registered nurses, social workers, dietitians and other clinicians to host virtual visits.
  • Virtual visits are a way for patients and providers to communicate directly over a safe, secure, online platform via chat messaging, phone, or video.
  • Since the launch of this program, in collaboration with eCE and the Waterloo Wellington LHIN in March 2018 14,200 virtual visits have been provided.
  • Patient and provider-initiated visits are available
  • Admins (reception/nursing) can triage and book virtual visits, supporting clinical workflow
  • Visit transcripts and attachments can be exported to the EMR via HRM
  • A published case study illustrating the patient experience with virtual visits in primary care can be found here.
  • A published case study on the provider experience with virtual visits in primary care can be found here.
  • Use and benefits of provider-initiated virtual visits are highlighted within a published case study here.

Specialist Referral Confirmations and Notifications

• The eHealth Centre of Excellence (eCE) leads the System Coordinated Access (SCA) Program, outlined in the Ontario Health Teams: Digital Health Playbook (August 2019). The SCA Program deploys the Ocean eReferral technology developed from an innovation procurement (with a consortium consisting of ThinkResearch, CognizantMD and the Centre for Effective Practice) to delivering more than 60,000 eReferrals integrated from within primary care EMRs (Telus PSS, QHR Accuro, OSCAR).
  • Providers from the eight LHINs involved in the SCA procurement can gain access to this service within the existing government investment.
  • Learnings from System Coordinated Access in Waterloo-Wellington:
  • Over 38,000 were processed electronically over the last 12 months in Waterloo Wellington within the diabetes, diagnostic imaging and orthopedics referral pathways.
  • Additional services added include Home and Community Care, Mental Health and Addictions.
  • For the referrals sent, 33% of patients included their email address and were enabled to digitally access their referral status and efficiently book and confirm appointments.
  • Patient experience surveys results (N=2,060) show 80%-90% satisfaction.

How have Teams Implemented Digital Health Tools?   

• Teams provide Health Records Access Online and Online Appointment Booking in different ways. Some of the publicly available services are:
  • Multiple resources within the Ontario Health Teams: Digital Health Playbook, some of which may be of interest to you:  
    • Immunization Connect Ontario (ICON) is publicly available for patients to look up their immunization records. (The link to this varies depending on your location)  
    • Teams can reach out to EMR vendors to discuss the availability of these features.
  • There are several technology options available to implement online appointment booking. Some teams have reached out to EMR vendors for these features (ex: Medeo, HealthMyself). Some teams use standalone appointment booking software that aren’t integrated with EMRs. Another option is that teams have implemented an appointment booking email address through which patients can email appointment requests.
• Click here to read more about how teams are (Register for Digital Health webinars below for more information!):
• Increasing Patient e-communications
• Providing Online Booking for Appointments
• Providing Virtual Visits
• Increasing Access for Unattached Patients through Virtual Care
• Collaborating to Create and Distribute EMR Forms

Digital Health Week (Nov 11-17) and the QIDS-Essential Summary

Let’s celebrate all the digital health initiatives our teams have taken! You can also read about the Making and Meaning of the Quality Improvement Decision Support Program in the QIDS-Essential Summary.

Join the Digital Health Week conversation by tweeting #ThinkDigitalHealth and share your teams’ stories.

Resources:

• Ontario Health Teams: Digital Health Playbook
• Exploring the value, benefits and common concerns of e-booking – White Paper
• Canada Health Infoway dispels digital health myths
• Connecting Patients for Better Health: 2018
• Template for Consent to use Electronic Communication
• CMPA – Privacy and Confidentiality for Ecommunication Quick Tips

Upcoming Webinars and Conferences:
Digital Health Week – November 11-17, 2019

IHPs OHTs and Health System Transformation Webcast -Nov 14, 2019 12 – 1:30 pm

Toronto International Conference on Quality in Primary Care – Nov 16, 2019

The Digital Health Toolbox: Enabling High-Performance Teams in The Delivery of Integrated, Patient-Centred Care Webinar – Nov 28, 2019 12-1 pm

Increasing Access to Patients through Virtual Care Visits Webinar – Dec 10, 2019 12-1 pm

References:  
1 https://www.infoway-inforoute.ca/en/component/edocman/3564-connecting-patients-for-better-health-2018/view-document?Itemid=101

In Case You Missed It: Check out eBulletin #91 or other back issues here!
Questions? Comments? Contact us at improve@afhto.ca.