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Tammy Degiovanni



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    OS08 - The Road to Digital Health Adoption (ID 12)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Health Business Process
    • Presentations: 1
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 7
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      OS08.03 - A Novel EMR Benefits Realization Program in the Canadian Context (ID 400)

      Tammy Degiovanni, Children's Hospital of eastern Ontario; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Implementing an enterprise-wide, integrated EHR solution is one of the largest and most complicated investments any hospital or health system can make to transform care and achieve better outcomes. Formally quantifying these benefits requires a structured approach against pre-established targets. As a small, independent, non-case costing academic pediatric institution in Canada, we encountered some notable barriers as we set out to establish a Benefits Realization governance structure and program that would achieve targets delineated in our Board-approved Total Cost of Ownership forecast. First, quantifiable Benefit Realization has been infrequently explored internationally in publicly funded systems where no competitive advantage to build/expand business and market share exists. Financial benefits in our environment must be gained through decreasing demand for services and efficiencies resulting in decreased costs, whether FTE?s, supplies or infrastructure. Next, Benefit Realization has typically been evaluated as part of a large system initiative as opposed to at a local level. Finally, most Benefits Realization programs succeed as a fully resourced, parallel structure to the implementation and operations team; this was not possible in our environment.


      Methodology/Approach:
      Based on best practices from other organizations, but tailored to the fiscal realities of our institution, we created a Benefits Realization governance model that was clinically led yet grounded in financial and statistical rigour. This structure was embedded within existing operational committees and targeted quantifiable clinical, operational, and academic benefits that aligned with the organization?s existing strategic directions. Where relevant, benefits that aligned to specific General Ledger cost centers were tracked and tallied against our targets. A graphicly-pleasing quarterly report to the Board of Directors dually served as accountability and as a key communication and engagement tool within the organization.


      Finding/Results:
      By creating a governance structure embedded within operations, we garnered benefit ownership and buy-in to achieve the targets. Further, by driving nine targeted core benefits while also collecting and evaluating smaller incremental benefits with rigor, the organization could rally around the effort, further reinforcing the vision and mission of both the EHR implementation and the hospital strategic directions. Tools were created that fostered operational leadership and engagement and allowed Benefit Realization to fundamentally link to and drive corporate strategy. The Board report template was repurposed to support other communication channels. Through initiatives solidly linked to the General Ledger, we demonstrated efficiencies through permanent cost reductions to meet the Benefit Realization targets within our Total Cost of Ownership. Further, we linked these initiatives to improvements throughout the organization to demonstrate the power of an integrated EHR as the foundation for change.


      Conclusion/Implications/Recommendations:
      Formal Benefit Realization following an EHR implementation is often a requirement and can be seen as an academic exercise parallel to the project and operations. However, by embedding the governance structure and linking solidly to the strategic directions of the organization, large scale and smaller incremental benefits can fuel the transformation. By sharing stories, fostering buy-in, and ensuring rigour, smaller organization can meet their Benefit Realization goals across clinical, operational, academic, and financial perspectives.


      140 Character Summary:
      Benefit Realization strategy within existing governance and linked to corporate directions to identify clinical, operational, academic, and financial benefits

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    OS13 - My Information, My Access! (ID 22)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 1
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      OS13.01 - Implementation and Impacts of a Pediatric Patient Portal Launch (ID 423)

      Tammy Degiovanni, Children's Hospital of eastern Ontario; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      A pediatric patient portal was piloted in Fall 2014 and launched November 2016 in attempt to increase patient/family engagement in their care and provide a secure means of communication with the health care team. We aim to continuously evaluate key process indicators (KPI) and end-user feedback both quantitatively and qualitatively.


      Methodology/Approach:
      Evaluation of the pilot guided expansion of portal functionality to include messaging to the health team and patient entered information (e.g., new allergies, medications, questionnaires). Annual evaluation, KPI data and a partnership with a second pediatric hospital enhanced the value-added features for families.


      Finding/Results:
      The portal is available to all patients/families and 2-way messaging is live in 30% of teams (~800 messages exchanged each month) and expanding to all clinics. Number of accounts is increasing steadily with highest uptake in clinics with complex patients populations (e.g., 47% of complex care clinic patients). Portal-user feedback has been positive: ? 94% viewed health information ? 94% agreed that registration was easy and that the portal was easy to use ? 92 % agreed that portal health information was accurate and 93% understood it ? 91% agreed that they received test results in a timely way and 91% agreed that they were easy to understand ? Of those sending secure messages, 91% felt the response was timely and 94% found it helpful ? Due to the portal, 54% avoided a call to a clinic and 31% avoided a clinic visit. ? 76% agreed that the portal helped them feel more prepared for next clinic visit We underestimated the profound impact on families who have described the portal as their lifeline. since it relieves their burden of compiling and cataloguing information. Integrating the use of a patient portal also required shifting the culture of how the chart is regarded ? moving from a communication tool for the clinical team to a shared resource of information. Youth access needed to be contemplated ensuring that youth consent and control access to their information. Providers? worry about the increased workload related to questions about information seen in the portal and messages received was not realized. Nurses report streamlined documentation and efficiency with messaging. Providers note that their clinical visits have been reshaped. With less time spent reviewing information, more time can be spent to address important issues and solidify care plans. Errors in the chart noted by families was a worry of providers, but have been found to build trust and ultimately increases EMR accuracy and potentially patient safety.


      Conclusion/Implications/Recommendations:
      Patient portals are becoming more common place and require a shift in culture to embrace the benefits. We expected positive patient/family feedback and clinician apprehension. We did not predict the impact that families describe or the change in the exam room. Early adopters sharing their stories can assist with change management. Pediatric patient portals provide an impetus ensure that activation strategies consider the need for appropriate proxy and youth access. Functionality that allows for communication and updates from families facilitates a truly shared communication tool that leads to empowerment.


      140 Character Summary:
      We describe launch and evaluation of a pediatric patient portal with functionality to review and add information as well communicate with the health care team.

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