Alan Brookstone, MD eHealth Consultant Lead Physician Vancouver Coastal Health Primary Care IT Strategies The Physician Voice

What is the Physician Voice? The External Voice… Caregiver Advocate Advisor Educator Leader Peer And the Inner Voice…

The External Voice…

Caregiver

Advocate

Advisor

Educator

Leader

Peer

And the Inner Voice…

The Inner Voice What’s in it for me? I have to be heard What this means in terms of my local situation and my patients? How do I protect my patient’s right to privacy? How do I adopt technology without becoming overwhelmed?

What’s in it for me?

I have to be heard

What this means in terms of my local situation and my patients?

How do I protect my patient’s right to privacy?

How do I adopt technology without becoming overwhelmed?

Canada Area of Canada - 9,984,670 sq km Population (2007) - 33.3 Million Area of British Columbia - 944,735 sq km Population (2008) - 4.1Million Physicians (2006) - 8,635 Area of Singapore - 692.7 sq km Population (2007) - 4.6 Million Physicians (2007) – 7,600

Area of Canada - 9,984,670 sq km

Population (2007) - 33.3 Million

Area of British Columbia - 944,735 sq km

Population (2008) - 4.1Million

Physicians (2006) - 8,635

Area of Singapore - 692.7 sq km

Population (2007) - 4.6 Million

Physicians (2007) – 7,600

Physician Characteristics Independent Advocate for patient care Many run small businesses Appreciate the ‘Art’ as well as the ‘Science’ How do physicians adopt and use technology in their practices?

Independent

Advocate for patient care

Many run small businesses

Appreciate the ‘Art’ as well as the ‘Science’

How do physicians adopt and use technology in their practices?

Where do Physicians fit in the Big Picture of eHealth? Activity is currently taking place at multiple levels simultaneously Internationally Nationally Provincially Regionally Primary care Renewal projects, Regional EHR Locally Clinical info systems in local hospitals, DI, labs etc. Private sector How do nations and physicians make good decisions regarding uptake and use of technology including EMRs?

Activity is currently taking place at multiple levels simultaneously

Internationally

Nationally

Provincially

Regionally

Primary care Renewal projects, Regional EHR

Locally

Clinical info systems in local hospitals, DI, labs etc.

Private sector

How do nations and physicians make good decisions regarding uptake and use of technology including EMRs?

The Environment is Changing Healthcare costs are rising at an unsustainable rate Patient expectations are changing Using EMR/EHR creates new opportunities but also new challenges SUCCESS requires a team approach plus a Common Vision Government, Medical Associations, Funding Organizations Physicians, other clinical providers

Healthcare costs are rising at an unsustainable rate

Patient expectations are changing

Using EMR/EHR creates new opportunities but also new challenges

SUCCESS requires a team approach plus a Common Vision

Government, Medical Associations, Funding Organizations Physicians, other clinical providers

Primary Care Doctors’ Use of Electronic Patient Medical Records, 2006 Percent Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians Commonwealth Fund study - Practice Use of Electronic Technology Percent reporting routine use of: AUS CAN GER NET NZ UK US Electronic ordering of tests 65 8 27 5 62 20 22 Electronic prescribing of medication 81 11 59 85 78 55 20 Electronic access to patients’ test results 76 27 34 78 90 84 48 Electronic access to patients’ hospital records 12 15 7 11 44 19 40

Source: 2007 Commonwealth Fund International Health Policy Survey Overall Views of the Health Care System in Seven Countries, 2007 Percent reported: AUS CAN GER NETH NZ UK US Only Minor Changes Needed 24 26 20 42 26 26 16 Fundamental Changes Needed 55 60 51 49 56 57 48 Rebuild Completely 18 12 27 9 17 15 34

Conceptual Cycle of ICT Adoption & Use by Physicians

What is an Electronic Medical Record? The EMR is a Provider Centric tool Generally a physician will use this system with each and every patient encounter and will record detailed encounter information, some of which is sensitive and not appropriate to share with all other providers. This is also the system where patient results, (e.g. laboratory, diagnostic imaging, and other reports ordered by a provider), are delivered to that provider's electronic in-box, (i.e. this information is "pushed " to the provider, negating the need for the provider to go out and seek it).

The EMR is a Provider Centric tool

Generally a physician will use this system with each and every patient encounter and will record detailed encounter information, some of which is sensitive and not appropriate to share with all other providers.

This is also the system where patient results, (e.g. laboratory, diagnostic imaging, and other reports ordered by a provider), are delivered to that provider's electronic in-box, (i.e. this information is "pushed " to the provider, negating the need for the provider to go out and seek it).

EMR Myths & Realities MYTH : If only we could find the ‘perfect’ Electronic Medical Record (EMR), everything would fall into place (‘killer app mentality’) REALITY : EMRs are ‘mission critical’ applications that are required to work 100% of the time every 10 minutes in primary care. Dr. Karim Keshavjee COMPETE Project - Hamilton Ontario

MYTH : If only we could find the ‘perfect’ Electronic Medical Record (EMR), everything would fall into place (‘killer app mentality’)

REALITY : EMRs are ‘mission critical’ applications that are required to work 100% of the time every 10 minutes in primary care.

Dr. Karim Keshavjee COMPETE Project - Hamilton Ontario

Goal: Patient Centric Shared Care SHARED CARE PLAN

The Keys to Success Belief in a common vision Collaboration Innovation Common data standards Staying the course Leading peers by example

Belief in a common vision

Collaboration

Innovation

Common data standards

Staying the course

Leading peers by example

This is a Complex Process One size does not fit all Business and clinical processes need to be facilitated between GPs and between GPs and Specialists e.g. Referrals The Triangle of: People Process Technology

One size does not fit all

Business and clinical processes need to be facilitated between GPs and between GPs and Specialists e.g. Referrals

The Triangle of:

People

Process

Technology

Vendor Landscape Max Sys Medchart AB, NS, ON, NT Nightingale AB, ON Jonoke Practice Solutions NS Only Dymaxion ON only ABELsoft AlphaGlobal IT AssistMed Asystar Healthscreen HTN McMaster (Oscar) Omni-Med P&P Data Systems PCI York-Med xwave AB Only Microquest Optimed TELIN Cerner CureMD Deltaware EPIC Global Biometrics IQMedX KATSI Logibec Logiscels Info Data LSS Data Systems Max Sys Medchart MedOffIS Medical Software Canada MediPlus Medware Misys Optimed Purkinje RISE Scripnetics Provincial Certifications Non-Certified AB, BC, ON CLINICARE Wolf BC Only Intrahealth Osler AB, BC EMIS MedAccess Source: Branham Group

AB, NS, ON, NT

Nightingale

AB, ON

Jonoke

Practice Solutions

NS Only

Dymaxion

ON only

ABELsoft

AlphaGlobal IT

AssistMed

Asystar

Healthscreen

HTN

McMaster (Oscar)

Omni-Med

P&P Data Systems

PCI

York-Med

xwave

AB Only

Microquest

Optimed

TELIN

Cerner

CureMD

Deltaware

EPIC

Global Biometrics

IQMedX

KATSI

Logibec

Logiscels Info Data

LSS Data Systems

Max Sys

Medchart

MedOffIS

Medical Software Canada

MediPlus

Medware

Misys

Optimed

Purkinje

RISE

Scripnetics

AB, BC, ON

CLINICARE

Wolf

BC Only

Intrahealth

Osler

AB, BC

EMIS

MedAccess

Amplifying the Physician Voice Communication Collaboration

Communication

Collaboration

Physician Engagement Requires A structured mechanism to communicate and facilitate change Identification, support and conversion of early adopters into… Champions and Agents for ‘Spread’ within local communities Involvement of care providers and support staff

A structured mechanism to communicate and facilitate change

Identification, support and conversion of early adopters into…

Champions and Agents for ‘Spread’ within local communities

Involvement of care providers and support staff

To have an Effective Voice Need to understand Overall goals Timelines When it is appropriate to be involved

Need to understand

Overall goals

Timelines

When it is appropriate to be involved

Role of Communication During early technology adoption, communication is critical Identify local needs Influenced by political, historical issues and local programs Allow users to stratify themselves appropriately Provide dynamic feedback to leadership to ensure programs effectively deployed

During early technology adoption, communication is critical

Identify local needs

Influenced by political, historical issues and local programs

Allow users to stratify themselves appropriately

Provide dynamic feedback to leadership to ensure programs effectively deployed

VCH Physician Clinical IT Adoption Model

VCH - Physician User Groups (PUGs) Geographic, Departmental, Special Interest Understanding of specific community needs Required facilitation and support Allowed communication through Face to face meetings Virtually - Internet and email Teach, learn or share Led by a respected peer

Geographic, Departmental, Special Interest

Understanding of specific community needs

Required facilitation and support

Allowed communication through

Face to face meetings

Virtually - Internet and email

Teach, learn or share

Led by a respected peer

Physician User Groups Provided structure Required an e-mail address Allowed physicians to be passive observers until the time was right! Allowed ‘disconnected’ physicians to reconnect with minimal risk

Provided structure

Required an e-mail address

Allowed physicians to be passive observers until the time was right!

Allowed ‘disconnected’ physicians to reconnect with minimal risk

Function

Current - Provincial PITO – Physician Information Technology Office Approximately 25 Physician User Groups led by respected peers Peer-to-Peer network supported by funding from Canada Health Infoway

PITO – Physician Information Technology Office

Approximately 25 Physician User Groups led by respected peers

Peer-to-Peer network supported by funding from Canada Health Infoway

Collaboration Physicians need to get involved Help guide solution and system design

Physicians need to get involved

Help guide solution and system design

The Physician Voice Without Support An understanding of context Belief in a future vision The inner voice dominates, and The external voice is ineffective “ Attitude is a little thing that makes a big difference” Sir Winston Churchill

Without

Support

An understanding of context

Belief in a future vision

The inner voice dominates, and

The external voice is ineffective

“ Attitude is a little thing that makes a big difference” Sir Winston Churchill

Thank you Alan Brookstone, MD [email_address]

Alan Brookstone, MD

[email_address]