ATHABASCA UNIVERSITY – CENTRE FOR INNOVATIVE MANAGEMENT Ontario’s eHealth Strategy AU MBA Applied Project APRJ-699 Ontario’s eHealth Strategy and Implications in Primary Care: Does the Strategy Have the Necessary Components to Succeed? Frances Murphy, Student No. 2500137 May 31, 2010 Applied Project Supervisor: Teresa Rose, PhD Word Count: 24,237 MurphyF-APRJ-Final 2 Table of Contents Abstract......................................................................................................................................................4 1.0Introduction ......................................................................................................................................6 1.1HealthcareExpenditures.........................................................................................................................7 1.2InformationTechnology:anEnablertoHealthOutcomesandEfficiency .............................9 1.3OntariosHealthcareITEnvironment.............................................................................................. 11 1.4TheRoleofPrimaryCareinOntariosHealthcareSystem....................................................... 12 1.5OntarioseHealthStrategy ................................................................................................................... 13 1.6WillOntarioseHealthStrategyBeSuccessfulInfluencingAdoptionofHealth InformationTechnologyinPrimaryCare?............................................................................................ 13 2.0ResearchPurpose,ResearchQuestionsandAssumptions............................................ 13 2.1ResearchPurpose.................................................................................................................................... 13 2.2ResearchQuestions ................................................................................................................................ 14 2.3Assumptions.............................................................................................................................................. 14 3.0LiteratureReview.........................................................................................................................16 3.1LiteratureReviewParameters ........................................................................................................... 16 3.2LiteratureSearchSourcesandCriteria ........................................................................................... 17 3.3LiteratureReviewDomains................................................................................................................. 19 ͵Ǥ͵Ǥͳ ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͳͻ ͵Ǥ͵ǤͳǤͳ ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ʹͳ ͵Ǥ͵ǤͳǤʹǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ʹͷ ͵Ǥ͵ǤʹǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤʹͺ 4.0OntarioseHealthStrategy ........................................................................................................ 36 4.1eHealthStrategyandeHealthOntario............................................................................................. 36 4.2OntarioMDandthePhysicianeHealthProgram.......................................................................... 38 4.3TheStrategyandthePrimaryCareChangeEnabler:eHealthOntarioandOntarioMD 40 5.0OpportunitiesandChallengesforOntario .......................................................................... 40 5.1ConsiderationsandChallengesforHITAdoptioninOntariosPrimaryCare Environment..................................................................................................................................................... 40 5.2ConsiderationsandChallengesforHITAdoptioninOntariosPoliticalEnvironment .. 47 5.3FundingOpportunitiesandChallengesforHITAdoption ........................................................ 49 6.0HowDoesOntarioseHealthStrategyMeasureUp?.........................................................49 6.1ValueoftheeHealthStrategy.............................................................................................................. 50 6.2ResourcesandCapabilities.................................................................................................................. 55 6.3StructureandManagementSystems................................................................................................ 55 6.4Environment ............................................................................................................................................. 56 ͸ǤͶǤͳ ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͷ͹ ͸ǤͶǤʹǦ ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͷͻ ͸ǤͶǤ͵ ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͷͻ 6.5eHealthStrategyChangeManagementandAdoptionPracticesforPrimaryCare.......... 59 7.0RecommendationsforOntario ................................................................................................ 61 8.0Conclusion....................................................................................................................................... 62 9.0References....................................................................................................................................... 63 Appendix................................................................................................................................................. 74 MurphyF-APRJ-Final 3 List of Figures Figure 1: Provincial Health Expenditures as a % of Provincial Expenditure, 1975-1976 to 2005-2006............................................................................................8 Figure 2: Ontario Health Spending and Economic Growth as a Proportion of GDP……..9 Figure 3: Primary Care Physician Practices – Use of High Function Electronic Information…………………………………………………………………….….…...…..10 Figure 4: Comparison of Health Information Technology in Practice Size Categories…26 Figure 5: Duncan’s Framework: Assessing Environmental Uncertainty as Applied to EMR Implementation in Ontario……………….........................................................48 List of Tables Table 1: Categories of Literature Sources Reviewed…….………..……………………....17 Table 2: Barriers to EMR Adoption Compiled in Development of this Research Paper..27 Table 3: Common Change Success Factors Across Models and Authors…......……….30 Table 4: OntarioMD EMR Adopter Funding………………...............................................39 Table 5: Ontario’s Primary Care Models….………………………….................................44 List of Appendices Appendix: Table 6: Demonstration of Change Success Factors in Ontario’s eHealth Strategy……………….……………………………………………………………………71 MurphyF-APRJ-Final 4 Abstract Ontario is spending 46% of its budget on health, a number that is expected to increase over the next two years (Ontario Ministry of Finance, 2010). Data shows that more Ontarians wait too long for cancer surgery, diagnostic scans, specialists, or for space in a long term care facility (Ontario Health Quality Council, 2009). Over 7% of adults in the province don’t have a family doctor; the average Emergency Room visit is 7.3 hours; Ontarians experience 217,000 adverse drug events annually; and $300,000 million in preventable hospital costs can be saved and reinvested in the health system by providing better preventative care for patients with diabetes (eHealth Ontario, 2009). One method of addressing these fiscal and health system pressures is to advance health information technology to support efficiency gains and improve the health of the citizens of Ontario. In 2009 Ontario developed the eHealth strategy for the province, focusing on clinical and foundational priorities developed through engaging with Ontario’s stakeholders and learning from the efforts of other jurisdictions. One of the foundational priority projects identified is Physician eHealth, a program that provides primary care physician offices in Ontario with electronic medical record systems (EMRs), an element the strategy suggests is an absolute requirement for eHealth to have clinical impact. Ontario’s eHealth Strategy is very aligned with two other initiatives, OntarioMD’s EMR Adopter Program, established by Ministry of Health and Long Term Care through collaboration with Ontario Medical Association, and the province’s health strategy, which has a focus on primary care reform and chronic disease prevention and management. Healthcare is a complex industry. Other industries such as banking and the airline industry have been able to use information technology to drive transformation, resulting in more efficient use of resources, cost-savings and increased revenues, often demonstrating increasing client satisfaction with products and services. Use of health information technology has been cited frequently as a way of improving health outcomes and generating efficiencies in health spending. And yet Canada and Ontario’s ability to harness information technology in support of health system improvements is lagging behind other countries. In a 2009 Commonwealth Fund Survey of primary care physicians in