Measurements and indicators for healthcare IT Leif Panduro Jensen, MD, MHM Director of Centre, Rigshospitalet, Copenhagen, DK

Measurements and indicators for healthcare IT Working group from January to December 2014 Representation by all 5 Danish regions Overall aims: Establish a national objective for the clinical IT workplace Prepare a first set of indicators for monitoring of health IT.

The vision The project's vision is aimed at making IT support for clinical work ambitious and measurable In order to carry out the vision, the project would: 1. Provide a basis for consistent patient care by identifying the regions' current level of healthcare IT and propose a roadmap forward for the five regions 2. Develop and test indicators for the regions' use of healthcare IT solutions 3. Underpin the regional ambitions for improved operational efficiency, patient quality and safety, and increased patient satisfaction on the basis of data and timely measurements and measurement concepts

From availability to effect of HIT – a journey Structure Process Outcome Professional quality Organisational quality Patient-perceived quality In hospitals the framework for improving quality is well known, originally proposed by Donabedian as ”structure – process – Outcome”, and later subdivided in the three perspectives of professional, organisational and patient percieved quality. This framework is very useful when discussing indicators in the health sector. In the case of health IT it also seems relevant to divide a view on maturity into availability (is the HIT service available at all, and to how many), usage (is it used or are the health professional prone to use non-IT tools instead) and Effect (what is the impact of HIT on all the above quality perspectives) Availability Usage Effect

EMR Adoption in Europe ... based on HIMSS European EMR Adoption Model EMR Adoption Model Scores, Mean per Country, Q2/2014 (based on data from the last 24 months, no weighting applied) Denmark1 (24) Austria (39) Germany (311) Italy (447) Netherlands (71) Spain (211) Turkey1 (143) Global Best Practice for Closed Loop Medication Administration (CLMA) – Global best practice includes • Bar code scanning of the patient and unit dose medication at the bed side, integrated with the EMAR (electronic medicine administration and recording) to update the EMAR in real-time and trigger alerts Europe2 (1,321) EMRAM Score (Means) Only public hospitals Excl. Denmark; incl. Austria (39), Belgium (2), Finland (3), France (18), Germany (311), Ireland (2), Italy (447), Netherlands (71), Norway (3), Poland (20), Portugal (18), Slovenia (2), Spain (211), Sweden (1), Turkey (143), Switzerland (7), UK (29) There are now two hospitals in Europe that have implemented the global best practice for CLMA – Galway Clinic in Ireland and Radboudumc in the Netherlands Source: HIMSS Europe Database, 07/25/2014

EMR Adoption in Europe ... based on HIMSS European EMR Adoption Model EMRAM Scores, % of Hospitals, Q2/2014 (based on data from the last 24 months, no weighting etc. applied) Stage Denmark Austria Germany Italy Netherlands Spain Turkey Europe* Stage 7 0.0% 0.3% 0.5% 0.2% Stage 6 0.7% 14.1% 4.7% 4.9% 2.6% Stage 5 100.0% 33.3% 9.6% 8.9% 42.3% 31.8% 7.7% 17.0% Stage 4 3.5% 1.6% 2.8% 6.2% 23.8% 5.6% Stage 3 3.4% 1.9% 4.2% 3.7% Stage 2 38.5% 33.1% 33.6% 39.4% 25.6% 50.3% 33.4% Stage 1 1.4% 9.5% 13.8% Stage 0 23.1% 45.3% 18.8% 19.9% 8.4% N 24 39 311 447 71 211 143 1,321 Mean 5.3 2.9 1.8 4.2 3.1 2.4 Median 2.5 2.1 1.3 2.2 X * Excl. Denmark,; incl. countries listed in the table above, plus: Belgium (2), Finland (3), France (18), Ireland (2), Norway (3), Poland (20), Portugal (18), Slovenia (2), Sweden (1), Switzerland (7), Turkey (143), United Kingdom (29) Source: HIMSS Europe Database, Q2/2014 (data from 7/2012 – 6/2014) Status as of 7/1/2014

EMR Adoption World-Wide ... based on HIMSS European EMR Adoption Model EMR Adoption Model Scores, Means per Segment, Q2/2014 (based on data from the last 24 months, no weighting applied) In North America Closed Loop Medication Administration (CLMA) is a requirement of Stage 5, and PACS is a requirement of Stage 6 Denmark (24) Europe1 (1,321) US2 (5,447) Canada2 (640) Middle East (123) Singapore (7) X Australia (271) EMRAM Score (Means) Excl. Denmark; incl. Austria (39), Belgium (2), Finland (3), France (18), Germany (311), Ireland (2), Italy (447), Netherlands (71), Norway (3), Poland (20), Portugal (18), Slovenia (2), Spain (211), Sweden (1), Turkey (143), Switzerland (7), UK (29) The EMRAM algorithm differs from the European countries, United Arab Emirates, Saudi Arabia and Australia Source: HIMSS Europe Database, 07/25/2014

EMR Adoption World-Wide ... based on HIMSS European EMR Adoption Model EMRAM Scores, % of Hospitals, Q2/2014 (based on data from the last 24 months, no weighting applied) Stage Denmark Europe* US** Canada** Middle East Singapore Australia Stage 7 0.0% 0.2% 3.2% Stage 6 2.6% 15.0% 0.6% 13.6% 85.7% Stage 5 100.0% 17.0% 27.5% 0.5% 16.7% 5.9% Stage 4 5.6% 15.3% 3.6% 3.7% 14.3% 0.7% Stage 3 25.4% 32.5% 0.4% Stage 2 33.4% 28.9% 19.7% 58.3% Stage 1 13.8% 2.8% 14.5% Stage 0 23.8% 4.9% 19.4% 15.2% 31.0% N 24 1,321 5,447 640 123 7 271 Mean 5.3 2.4 4.3 2.0 3,1 5.7 1.8 Median 2.2 2.1 2.9 6.1 X * Excl. Denmark,; incl. countries listed in the table above, plus: Belgium (2), Finland (3), France (18), Ireland (2), Norway (3), Poland (20), Portugal (18), Slovenia (2), Sweden (1), Switzerland (7), Turkey (143), United Kingdom (29) ** The EMRAM algorithm differs from the European countries, United Arab Emirates, Saudi Arabia and Australia Source: HIMSS Europe Database, Q2/2014 (data from 7/2012 – 6/2014) Status as of 7/1/2014

EMR Adoption in Denmark ... based on HIMSS European EMR Adoption Model EMR Adoption Model Scores, Means per Bed Size Segment Denmark1 (24) Important Deficiencies: CLMA Decision support System integration Small (1 – 199 beds) (2) Medium (200 – 499 beds) (9) Large (>500 beds) (13) X EMRAM Score (Means) Only public hospitals Source: HIMSS Europe Database, 07/25/2014

Deliverables from the project Functionality available IT support of core processes (User satisfaction) EMRAM-measurement of availability of IT at all Danish hospitals 17 proposals to immediately implementable indicators A large number of immature indicators A set of indicators for internal performance management as well as for governmental monitoring Concept for development of indicators Report on data-driven management and benefit realization Analysis of the future organization of indicator management Three reports on data-driven management

How useful was the EMRAM assessment? The EMRAM assessment was very useful ! Creating a baseline assessment for further improvement Revealing our strenghts and ”weak spots” But it could be more consistent and comprehensive One model for USA+Cananda, another for the rest of the world On the 4 stages of introducing EMR-functionality only the first is measured available at all widespread available adopted in clinical practice documented clinical impact on effectiveness, quality and safety End-user experience is not part of the EMRAM evaluation

Director of Centre, MD, MHM Thank you Leif Panduro Jensen Director of Centre, MD, MHM leif.panduro.jensen@regionh.dk