Nova Scotia’s common EHR revolutionizes access to patient information

The imminent deployment of a common Oracle-Cerner electronic health record (EHR) in Nova Scotia will revolutionize access to patient information that is currently housed in more than 80 different EHRs, databases and niche platforms across the province.Other jurisdictions, including Alberta, British Columbia and Quebec have either completed the deployment of a province-wide EHR, or are in the process of transitioning to one, but Nova Scotia’s One Person One Record (OPOR) Clinical Information System (CIS) is unique both because of its wider scope and it’s “big-bang” deployment timeline, according to Dr. Julie Maranda, chief medical information officer for the ground-breaking initiative.“British Columbia, for example, brought organizations in bit by bit and functionality by functionality and have been at it for 10 years, but we’re going to get the entire province up in one year,” she said.Read: Ontario privacy watchdog fines Windsor pediatrician and clinic for misuse of patient dataThe OPOR CIS is scheduled to go live at the IWK Health Centre, Nova Scotia’s pediatric and women’s health facility in Halifax on December 6, on May 9 next year in the province’s Central Zone and by the end of 2026 in its Eastern, Northern and Western Zones.The common EHR will be deployed at all 46 Nova Scotia hospitals and community health centres as well as all hospital-affiliated ambulatory care clinics and some long-term care facilities.Also unique is Nova Scotia’s decision to go with one instance of its OPOR CIS, which will make it easier to manage, upgrade and troubleshoot. “It does make it more complex in terms of the build in that you have to standardize and can’t have different versions for different people because that’s the way they like it, but ultimately it’s the better way to go,” said Dr. Maranda.One province-wide hospital information system will benefit patients who won’t have to repeat their stories or have unnecessary repeat lab and diagnostic imaging tests performed when they move from one acute care facility to another. Transparency and sharing of patient information in real-time will improve patient safety. It also does away with the need for interoperability and makes phoning and faxing for information unnecessary.Community-based primary care providers will continue using their own EMRs, which Dr. Maranda acknowledges is a gap in the current planning because it doesn’t give acute care access to patient information in primary care. “We all agree that would be ideal and has to change, but I think Nova Scotia is going to be well-positioned to start looking at how to bring family medicine closer into the loop.”The OPOR CIS is going to facilitate “a culture shift” from a proprietary provider-centred patient chart to a patient-centred chart, she predicted. There shouldn’t be a situation where one doctor has a chart about a patient and another doctor has a separate chart about the same patient, she remarked. It should be one chart no matter where a patient goes. “That’s the shift Nova Scotia is going to be able to make once this is in place.”While emergency docs and other acute care professionals won’t have access to a patient’s record in primary care, family doctors, nurse practitioners, pharmacists and allied health care providers, including physiotherapists and chiropractors have access to an enhanced health information exchange called the Provider Portal where they currently have access to information from existing hospital information systems from January 2023 onward. Once the OPOR CIS is live, they’ll have access to much more information. Patient information prior to January 2023 will continue to be available through SHARE, the province’s legacy health information exchange. “For primary care providers, the OPOR and the Provider Portal will simplify a lot of their work when it comes to searching for information,” said Dr. Maranda. “If your patient is in front of you now and you don’t have a result, having to chase it down and find where it is when you have 80 different systems across the province that you don’t have visibility into is almost impossible. When the entire province is on one system, you have one place to look and one system to log into, so it’s going to make it much simpler for primary care to have visibility into what’s happening with their patients.”A digital process is currently in place for primary care providers to receive reports for lab and diagnostic imaging tests they order. “The difficulty is if they need to see something they didn’t order. That’s where the Provider Portal comes in. You can look in the portal and see ‘oh, there was a chest X-ray done and there’s the result,’” said Dr. Maranda.Primary care providers currently receive faxed discharge reports for their patients, but if the patient sees a pharmacist, goes to a walk-in clinic to see a doctor who doesn’t know anything about them or doesn’t have a family doctor, discharge reports, lab and diagnostic imaging test results are accessible in the Provider Portal.“Nova Scotia is also quite rural, so it’s normal for primary care providers to also practise in acute care whether they’re doing emergency shifts, working as hospitalists or delivering babies,” she said. “They will also have access to the OPOR for those activities, so rather than open up eight different screens on their computer, they’re going to open up two—the CIS and their private EMR—so no matter what has happened to their patient, it’s going to be in one of them.”The introduction of a new system that will be used by 44,000 healthcare staff requires a comprehensive change management strategy, so Nova Scotia Health has established an entire division to bring everyone up to speed. For example, a detailed impact analysis for every workflow that will impact end-users identifies “what will be different, what we will stop doing and what’s not going to change,” said Dr. Maranda. Staff will undergo mandatory training for three months before using the system and change champions and peer mentors will receive extra training to work with transition teams and offer “at the elbow support” once the system is live.“Change is difficult but it’s long overdue and we can’t wait for this to be in place,” said Dr. Maranda.

Nova Scotia’s common EHR revolutionizes access to patient information

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