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Aude Motulsky



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    OS25 - You've Got Mail, But No Paper! (ID 40)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 1
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      OS25.01 - Adoption and Perceived Usefulness of Health Information Exchange (ID 290)

      Aude Motulsky, École de santé publique de l'Université de Montréal; Montreal/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Health information exchanges (HIE) are seen as an essential technology for improving healthcare quality and efficiency by allowing patient-centered data exchange over time and across organizations. The objective of this study was to describe the adoption and the perceived usefulness of an HIE in the province of Quebec, four years after its full implementation.


      Methodology/Approach:
      A mixed method study was conducted, including longitudinal descriptive analysis of usage data obtained from the Quebec Ministry of Health from Jan 1st 2017 until Dec 31st 2017, combined with in-depth case studies from 5 primary health care organizations using different commercial electronic medical record (EMR) systems. Data collected in each case included interviews with users (n=66). The number of users by role and by tool were described, as well as a detailed analysis of the weekly accesses by physicians.


      Finding/Results:
      Up to October 2017, a total number of 47 928 individuals had received a security certificate to access the HIE, including 14 127 physicians and 17 932 nurses. However, only 68% of these physicians and 48% of these nurses actually accessed the HIE in October 2017, while 86% of these pharmacists accessed it. For physician users, two types of tools were available to access the HIE, depending on their availability in their work place: an EMR integrated with the HIE, or a Web Viewer. While 50% of general practitioners and 49% of nurse practitioners have accessed the HIE using an integrated EMR, only 11 % of specialists have used an integrated EMR to access the HIE. The number of weekly accesses by physicians to the medication domain (Fig 1A) was higher when using an EMR in the outpatient setting (O-EMR). This was confirmed with the case study indicating that the advanced feature of importing granular medication data into the EMR was only possible using an O-EMR. For the lab domain (Fig 1B), the level of use was similar for O-EMR and Viewer, and lower for EMR in acute care. For images (Fig 1C), the level of use was higher using the Viewer application. This might be related to the fact that the image was only accessible using the Viewer application. Perceived benefits were reported by users across all dimensions of care performance, including accessibility, efficiency, quality and safety, as well as patient experience. capture d?e?cran 2018-10-16 a? 20.57.20.png


      Conclusion/Implications/Recommendations:
      This HIE was used by a diverse group of healthcare professionals and was able to offer concrete perceived benefits in primary care. Our results suggest that the availability of the advanced features of HIE/EMR integration was essential to stimulate adoption and perceived benefits.


      140 Character Summary:
      The adoption and perceived usefulness of Health information exchange in Quebec was evaluated four year after the full implementation of the system.

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    OS30 - What's New in Medication Management (ID 51)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 1
    • Coordinates: 5/29/2019, 10:30 AM - 12:00 PM, Room 200 C
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      OS30.05 - Implementation of electronic prescribing in Quebec (ID 402)

      Aude Motulsky, École de santé publique de l'Université de Montréal; Montreal/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Since 2013, Quebec has been operating a centralized e-prescribing network allowing the electronic transmission of prescriptions between prescribers from primary care and pharmacies across the entire province. The objective of this study was to describe the implementation of the system.


      Methodology/Approach:
      A longitudinal descriptive analysis of aggregated usage data, obtained from the Ministry of Health, from July 2017 to March 2018 was performed. An observational exploratory study was also conducted in a typical pharmacy, selected from the region with the highest utilization in the province, to estimate the proportion of different types of prescriptions. All prescriptions dispensed from Monday June 11 until Friday June 15 2018 were collected from the pharmacy registry and analyzed according to their type (manuscript, verbal, fax, printed, electronic).


      Finding/Results:
      In March 2018, 3 946 prescribers sent an electronic prescription (eRx) through the system using a certified EMR. Figure 1 presents the proportion of prescriptions that were dispensed, sent electronically and retrieved electronically from July 2017 to March 2018. On average, only 11% of prescriptions were sent electronically by the prescribers. From those electronic prescriptions, 14% of them were retrieved in pharmacies, Hence, only 1.9% of all dispensed prescriptions in the province were electronically transmitted and retrieved. In a typical pharmacy of LanaudiŠre, 34% of all dispensed prescriptions were eRx (Table 1). Interestingly, another 20% of prescriptions were printed using a certified EMR, but were not transmitted to the eRx system, and pharmacists had to enter the prescriptions manually. This observation suggests that despite an increased adoption of the electronic prescribing system, its transmission feature might be an issue. Figure 1. Adoption of electronic prescribing by prescribers (eRx sent) and by pharmacists (eRx retrieved) in comparison to the total amount of Rx dispensed in the Province, July 2017 ? March 2018 Table 1. Proportion of each type of dispensed prescriptions in a typical pharmacy in the region with the highest adoption by prescribers Prescription type Proportion (%) Manuscript 23 Typewritten form 6 Fax 15 Verbal 2 EMR generated - printed only 20 EMR generated - printed and electronically transmitted 34


      Conclusion/Implications/Recommendations:
      The adoption of the e-prescribing system is low, both by prescribers and pharmacies. This observation might be in part attributable to the incomplete implementation of the system, where pharmacists are asked to wait for the paper copy of the prescription to electronically retrieve it. Further work is needed to facilitate adoption and increase the potential of a now promising technology that has managed to overcome many of the pitfalls of such systemic networks.


      140 Character Summary:
      This study demonstrates that the adoption rate of e-prescribing by prescribers and dispensers in Quebec is still low. The transmission feature seems to be an issue.

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