Blog

By Chandi Chandrasena MD CCFP FCPC, Chief Medical Officer, OMD 

HRM: How We Got Here 

From award-winning technology to the one of the main causes of inbox burden 

Health Report Manager (HRM®), when it first became available to community-based physicians and nurse practitioners, was a welcome change from receiving hospital reports by mail and fax. Over the years, encouraged by the positive feedback of going digital from users, and the cost savings of reduced faxing and mailing, more hospitals worked with OntarioMD (OMD) to use HRM and kept adding more report types to reduce the paper reports they had to deliver. HRM became the Canada Post of hospital and specialty clinic reports. Like Canada Post, HRM delivers a wide variety of items directly to users. 

However, without standards or guidelines, hospitals and other sending facilities were able to send reports without any parameters. The reports became long, duplicative, and hard to read and understand. These issues impacted patient safety and increased administrative burden. The technology won awards in its early days, but the quality of the reports cannot be considered award worthy.  

It soon became clear that so many digital reports were becoming too much of a “good thing “and were consuming too much clinician time. Clinicians must review every report for important patient information that could impact patient safety. Reviewing all those reports during the day when clinicians saw patients was impossible for most clinicians. They continued their review after clinic hours, into the night. That’s like reading every word of every letter, junk mail and flyer that Canada Post delivers to you.  

Better Hospital Reports = Better HRM Experience 

OMD listened to clinician feedback and took action. We worked with many stakeholders – the Ministry of Health, Ontario Health, the Ontario Medical Association, the CPSO, the Ontario Hospital Association, hospital information system (HIS) vendors, individual hospitals, and EMR vendors – to bring everyone together who could have an influence on hospital reports to the HRM Task Force. The Task Force produced a set of recommendations for hospitals and another set for EMR vendors to make improvements so that clinician users would have an easier time managing the reports they receive and save time reviewing each one. 

I want to share some important lessons learned from the HRM Task Force so users can have a better understanding of the situation: 

1. Involve the Community and Co-design the Solutions: Survey users to understand the problem accurately from the community lens and to properly scope out a solution. Include key community physician leaders and nurse practitioners in provincial, regional and local discussions. 

2. Collaboration is Key: It was very beneficial to bring all the stakeholders, especially the hospitals, to one table. Collaboration and guidance need to happen regularly, not just at the implementation phase. That’s how we can all contribute to making digital health tools like HRM continuously better.  

3. Mandatory Commitment: Hospitals have many competing IT priorities and unique environments. It’s essential to prioritize work that has a direct impact on users, and potentially patients, and increases clinician administrative burden. The HRM Task Force underlined the need for mandatory commitment from hospital clinical leadership and subject matter experts. Without mandatory commitment, there is often no action.  

4. Alignment, Support and Change Management: Hospitals must consider multiple dependencies and the effect on the community every time they implement a change. Stakeholders within the hospital must all be on side with it. Money and resources must be approved for the change. Training and change management support is needed for hospital report authors. Is there an HIS upgrade going on that will affect reports sent through HRM? HIS upgrades have a huge effect on reports delivered to clinicians through HRM. All these factors must be considered and aligned, and that can be a tall order before clinicians can see positive changes to their management of hospital reports.  

5. OMD Has Limited Influence: OMD has limited ability to influence hospital changes, but we can advocate for improvements. Remember, HRM is the Canada Post of hospital reports. It doesn’t write the reports, and it can’t stop the volume of reports hospitals decide to send through HRM. What OMD can do is provide hospitals with best practices for sending reports through HRM. That’s what we’ve done in the HRM Task Force recommendations. However, OMD can’t make the recommendations mandatory. Only health system decision-makers can do that. We have no influence on HIS like we do with vendors with certified EMRs, nor can we influence hospitals’ technology roadmaps. 

What’s Going On Now and What’s Next?  

• We’re working with a few hospitals who are keen to understand,  assess, and implement some Task Force recommendations like suppressing faxes if clinicians use HRM, and formatting changes that would put the most important patient information on page 1 of every hospital report. We’ve recruited several HRM users to test these changes. Once the pilot ends, we’ll gather lessons learned and share the results with you and other hospitals to help them with implementation. 

• We kicked off a pilot on July 27 with a limited number of HRM users. This pilot will test HRM users’ ability to manage their report type preferences, specifically for eNotifications. eNotifications will be turned off for a subset of these users for six months. At the end of the six months, they can either opt back in to receive eNotifications or keep them turned off.  

• OMD continues to engage with hospitals and other Task Force stakeholders to keep the dialogue on the HRM Task Force recommendations going through a new HRM Improvement Recommendations Advisory Committee (HI-RAC). This is where stakeholders will report on the actions they’re taking for HRM users to see improvements. It is also where stakeholders and users can co-design digital and non-digital solutions.  

• OMD is encouraging hospitals to consider the impact on clinicians whenever they make a change to their HIS and to let clinicians who receive their reports know in advance when an HIS change is coming. What does the change mean for hospital reports and the clinician’s review workflow? Proactive communication doesn’t make things easier for clinicians, but at least it helps them prepare for the change.  

I’m excited about the work we’ve done so far to improve your experience with hospital reports, and by association, with HRM.  

I’m excited for the digital advocacy and work that has been done to improve the experience with hospital reports. Although much more needs to be done, we have moved the needle forward and are continuing to push.  

Changes are happening on a small scale at first, but I’m confident that once everyone sees the results, they will see that clinicians and hospitals benefit from the recommendations.   

My Ask of You 

I encourage you to: 

1. Read the two reports on the HRM Task Force recommendations to understand what has been done.  

2. Let hospitals know about your concerns and how their report volumes or formatting are impacting your administrative burden and on patient care. Work with them to develop a plan around the HRM Task Force recommendations. 

3. Voice your concerns at the provincial, regional and local level.  

If OMD, clinician associations and regulators, and YOU, as users, are all aligned in our quest to make hospital reports better and decrease clinicians’ report burden, we will make a stronger case for hospitals to implement the HRM Task Force recommendations sooner. 

I’m always interested in your thoughts! If you have a comment, please share it in the Share your thoughts with us! box at the bottom of this page.