This document discusses the development and deployment of the Regional Cancer Program Formulary Software (RECAP-FS). It was created to automate the process of updating, editing, exporting, archiving, and printing chemotherapy regimen information in an efficient manner. An interim survey and web statistics showed positive results from its use. The document analyzes how characteristics of the innovation, number of users, communication structure, culture, and promotion efforts impacted adoption rates. It assesses the importance of "agents of change" in spreading the software beyond tipping point. Lessons learned from creating RECAP-FS are shared.
The IDN engaged in a collaborative project with its GPO called "30 in 2" to reduce its $700M annual supply spend by $30M within 2 years. Through centralizing processes, aligning physicians, analyzing spend, and optimizing contracts and vendor relationships, they achieved $45M in savings within 11 months, with $30M already implemented. Key was creating a customer-centric centralized supply chain through cross-organizational collaboration and communication. This reduced supply expenses as a percentage of net operating revenue to the lowest levels in the past decade.
Emerging hscrc methodologies case pohl (final)James Case
The document discusses emerging methodologies being developed by the HSCRC to incentivize population health management under a potential CMS model testing demonstration. It describes how existing methodologies like the Admission-Readmission Revenue program and Total Patient Revenue would need to be modified. New approaches under consideration include Population-Based Reimbursement and requesting authority for bundled payments, ACOs, and gain sharing. Significant effort will be required to translate these approaches to an all-payer environment in Maryland.
Marsha Powers presented a regional review of Tenet's Florida market. The market overview showed that Tenet operates hospitals across Palm Beach, Broward, and Miami-Dade counties, with a total of 3,483 beds. Tenet has targeted growth initiatives focused on key specialties to stem patient outmigration and develop new services. It also has an aggressive medical staff development program to recruit physicians and expand service lines. Operational efficiency initiatives aim to reduce costs through benchmarking, back office consolidation, and clinical case management while maintaining high quality performance.
The Quality Benchmarks Collaborative provides healthcare organizations a way to compare their clinical quality measure performance to peers in order to identify areas for improvement and accelerate adoption of electronic health records. By subscribing, organizations gain access to benchmarks compiled from measures reported to CMS and can monitor their results over time on a dashboard. McKesson's advisors help interpret the data and facilitate sharing of best practices. Linking this data to other information can provide insights into how electronic health record use impacts outcomes like length of stay and mortality.
The document provides a business plan for establishing the Northern Virginia Physician Alliance (NVPA) to acquire physician practices in rural areas near Washington D.C. The plan outlines objectives to expand services, a private non-profit structure, and competing healthcare systems seeking to acquire practices. It proposes acquiring rural primary care practices in Phase I, suburban primary care practices in Phase II, and specialty practices in Phase III. The plan details operations, marketing, implementation timeline, finances projecting growth and profitability, and metrics to measure success in areas like quality, satisfaction, and regulatory compliance.
This document discusses effective monitoring and evaluation (M&E) integration at the clinic level. It outlines three key lessons: 1) use metrics relevant to the specific clinic, such as denominators that reflect the clinic's patients; 2) make data collection part of daily clinic routines and document it in existing clinic tools; and 3) use monthly data reviews and analysis to identify service gaps and test ways to improve performance and close those gaps. The document provides examples of implementing these lessons from clinics in Kenya that successfully increased nutritional assessments of HIV-infected patients.
- The company reported an 11.4% increase in adjusted EBITDA for 2008 to $732 million, overcoming a $54 million loss in Medicaid funding. Excluding this loss, adjusted EBITDA growth would have been 19.6%.
- In Q4 2008, revenues increased 4.9% driven by a 6.6% rise in commercial managed care revenues, despite a 3.0% decline in commercial managed care admissions. Operating expenses rose only 0.8%.
- The bad debt ratio improved to 7.5% in Q4 2008 from a 7.6% ratio in Q3 2008, as uninsured admissions and outpatient visits declined nearly 6% and 11%, respectively.
The document discusses the need for a new patient-centered primary care model and summarizes the key elements of the patient-centered medical home (PCMH) model. The PCMH model aims to improve healthcare quality and access while reducing costs through care coordination, a team-based approach, and payment reforms that support primary care practices. It has received attention from medical organizations, insurers, politicians, and the media as a promising alternative to the current healthcare system.
The IDN engaged in a collaborative project with its GPO called "30 in 2" to reduce its $700M annual supply spend by $30M within 2 years. Through centralizing processes, aligning physicians, analyzing spend, and optimizing contracts and vendor relationships, they achieved $45M in savings within 11 months, with $30M already implemented. Key was creating a customer-centric centralized supply chain through cross-organizational collaboration and communication. This reduced supply expenses as a percentage of net operating revenue to the lowest levels in the past decade.
Emerging hscrc methodologies case pohl (final)James Case
The document discusses emerging methodologies being developed by the HSCRC to incentivize population health management under a potential CMS model testing demonstration. It describes how existing methodologies like the Admission-Readmission Revenue program and Total Patient Revenue would need to be modified. New approaches under consideration include Population-Based Reimbursement and requesting authority for bundled payments, ACOs, and gain sharing. Significant effort will be required to translate these approaches to an all-payer environment in Maryland.
Marsha Powers presented a regional review of Tenet's Florida market. The market overview showed that Tenet operates hospitals across Palm Beach, Broward, and Miami-Dade counties, with a total of 3,483 beds. Tenet has targeted growth initiatives focused on key specialties to stem patient outmigration and develop new services. It also has an aggressive medical staff development program to recruit physicians and expand service lines. Operational efficiency initiatives aim to reduce costs through benchmarking, back office consolidation, and clinical case management while maintaining high quality performance.
The Quality Benchmarks Collaborative provides healthcare organizations a way to compare their clinical quality measure performance to peers in order to identify areas for improvement and accelerate adoption of electronic health records. By subscribing, organizations gain access to benchmarks compiled from measures reported to CMS and can monitor their results over time on a dashboard. McKesson's advisors help interpret the data and facilitate sharing of best practices. Linking this data to other information can provide insights into how electronic health record use impacts outcomes like length of stay and mortality.
The document provides a business plan for establishing the Northern Virginia Physician Alliance (NVPA) to acquire physician practices in rural areas near Washington D.C. The plan outlines objectives to expand services, a private non-profit structure, and competing healthcare systems seeking to acquire practices. It proposes acquiring rural primary care practices in Phase I, suburban primary care practices in Phase II, and specialty practices in Phase III. The plan details operations, marketing, implementation timeline, finances projecting growth and profitability, and metrics to measure success in areas like quality, satisfaction, and regulatory compliance.
This document discusses effective monitoring and evaluation (M&E) integration at the clinic level. It outlines three key lessons: 1) use metrics relevant to the specific clinic, such as denominators that reflect the clinic's patients; 2) make data collection part of daily clinic routines and document it in existing clinic tools; and 3) use monthly data reviews and analysis to identify service gaps and test ways to improve performance and close those gaps. The document provides examples of implementing these lessons from clinics in Kenya that successfully increased nutritional assessments of HIV-infected patients.
- The company reported an 11.4% increase in adjusted EBITDA for 2008 to $732 million, overcoming a $54 million loss in Medicaid funding. Excluding this loss, adjusted EBITDA growth would have been 19.6%.
- In Q4 2008, revenues increased 4.9% driven by a 6.6% rise in commercial managed care revenues, despite a 3.0% decline in commercial managed care admissions. Operating expenses rose only 0.8%.
- The bad debt ratio improved to 7.5% in Q4 2008 from a 7.6% ratio in Q3 2008, as uninsured admissions and outpatient visits declined nearly 6% and 11%, respectively.
The document discusses the need for a new patient-centered primary care model and summarizes the key elements of the patient-centered medical home (PCMH) model. The PCMH model aims to improve healthcare quality and access while reducing costs through care coordination, a team-based approach, and payment reforms that support primary care practices. It has received attention from medical organizations, insurers, politicians, and the media as a promising alternative to the current healthcare system.
This document summarizes a presentation on meaningful use of electronic health records (EHRs) given by Dr. Carl Dirks. It provides background on the national goal of universal EHR adoption by 2015 and the HITECH Act which provided $19 billion in incentives. It outlines the 3 stages of meaningful use, including core and menu objectives for stage 1, and discusses certification of EHR systems, incentive payment timelines, and other requirements to qualify for incentives. The conceptual approach to meaningful use focuses on improving quality, safety, efficiency, care coordination and population health.
Maureen Bisognano: An international perspective: Leading for better health careThe King's Fund
Maureen Bisognano, President and CEO, Institute for Healthcare Improvement, gives an international perspective on leading for better healthcare at The King's Fund Second Annual NHS leadership and Management Summit.
Joseph Dal Molin: Implementing VistA internationally: Myth-busting lessons fr...Nuffield Trust
In this slideshow Joseph Dal Molin, President of the E-cology Corporation and Chairman of WorldVistA, outlines Jordan’s health system and its approach to implementing VistA.
Joseph Dal Molin presented at the Nuffield Trust seminar: Sharing international experience: Is implementing the VA's electronic health record system an option for the NHS? in July 2012.
MAFP Quality Reporting for Cash-CMS Incentives and Your Bottom Linelearfieldinteraction
This document discusses quality reporting incentives from CMS and their impact on physician practices. It outlines the requirements and incentives for three separate CMS programs - Meaningful Use, PQRS, and e-Prescribing. Participation in these programs can provide incentives, but failure to participate may result in payment penalties beginning in 2015. The document provides an overview of each program's objectives, measures, and reporting options to help physicians incorporate quality reporting into their practices.
The Science of Launching and Achieving Growth in Oncologyaccenture
We have conducted research to understand how oncology companies are responding to New science, more treatment choices and changing economics. Visit https://accntu.re/2Jn72wq to learn our key takeaways for launching and achieving growth in oncology.
This document provides an introduction to key performance indicators (KPIs) and quality assurance in healthcare in Malaysia. It discusses Malaysia's vision for a healthy nation with an efficient and equitable healthcare system. It defines quality assurance and outlines factors that determine high quality healthcare facilities and services. The document then presents KPIs that can be used to assess performance in clinical governance and resource management at the state health department level. Several dimensions and examples of KPIs are provided for patient-centered services, clinical/technical effectiveness, clinical risk management, staff health, and human resource and financial management.
Insights into the Canadian eHealth Landscape - MaRS Future of MedicineMaRS Discovery District
In recognition of the need to develop a national digital health strategy and to co-ordinate activity across the country, the Conference of Deputy Ministers established Canada Health Infoway in 2001.
This lecture describes Infoway’s role and the progress that it and its jurisdictional partners have made over the last decade. It outlines the challenges to achieving our collective goal of using technology to improve the health of Canadians and describes key enablers that must be in place for us to be successful. It also contains the results of recent public opinion research conducted with Canadians and healthcare providers and outlines the priorities for moving forward and the opportunities for action.
Supporting Individuals with Intellectual and Developmental Disability During the First 100 Days of the COVID-19 Outbreak in the U.S.
BrightSpring Health Services Chief Medical Officer Dr. William Mills presents on BrightSpring's ongoing response to COVID-19 and how the organization is mitigating risks for our patients, clients, and team members.
Research-Driven Solutions for Innovative State PolicyAcademyHealth
This document discusses health services research and its goals of determining what works best, for whom, under what circumstances, and at what cost. It outlines Arkansas' efforts to improve its health system, including establishing a governance structure and setting objectives around improving population health, patient experience, and controlling costs. It also presents data on variation in costs between providers for different medical conditions/procedures, showing opportunities for improving value through care standardization.
The document discusses the Value-Based Payment Modifier (VM) program which adjusts Medicare payments for physicians and other eligible professionals based on quality and cost of care. Key points:
- The VM assesses quality and cost of care provided under Medicare and adjusts payments accordingly.
- For 2015 it applies to groups with 100+ eligible professionals, expanding to groups of 10+ in 2016 and all physicians by 2017.
- Eligible professionals include physicians as well as other practitioners. Physicians are subject to the VM payment adjustments while other practitioners are included in defining group size.
- The VM is related to other quality programs like PQRS and EHR incentives, with varying incentives and payment adjustments based on participation
This document discusses disruptive innovation in patient-centered healthcare and outlines challenges facing healthcare systems. It notes that healthcare costs are concentrated among a small portion of patients and are growing due to aging demographics. Healthcare spending is also not efficiently allocated, with less than 10% spent on direct point-of-care services. The document advocates investing in electronic health records, telehealth, and other information technologies to improve care coordination and outcomes while reducing costs. It argues healthcare systems should innovate with the patient's needs and health outcomes as the priority.
This presentation provides an overview of NeoGenomics, a cancer genetic testing company. Key points include:
- NeoGenomics has experienced consistent historical growth in the number of cancer tests performed and annual revenue.
- The company focuses on fast-growing cancer genetics testing and has strategic partnerships with oncologists and hospitals.
- Management aims to continue expanding the test menu and achieving operating leverage to accelerate cash flow and earnings.
The presentation provides an overview of NeoGenomics, a cancer genetic testing company. It highlights the company's consistent historical growth in tests performed and revenue. The management team has significant experience in large cap clinical laboratories. The company aims to continue expanding its test menu and market share through new product development and partnerships within the fast-growing cancer genetic testing industry.
Value Based Purchasing: From Rule to Reality - One Hospital’s Journey - Susan...marcus evans Network
St. David's Medical Center in Austin, Texas has undergone a cultural transformation to improve performance on value-based purchasing metrics like core measures and HCAHPS scores. They evolved from focusing only on reporting metrics to developing an organizational culture where everyone takes accountability for living the values of patient excellence. Tactics used include staff education, process improvements, physician engagement, and emphasis on accountability at all levels. As a result, St. David's saw improvements such as reducing core measure misses to near zero and increasing HCAHPS scores over 4%. Sustaining this culture will be key to higher performance and financial rewards under value based purchasing in the future.
This investor presentation by Cancer Genetics, Inc provides an overview of the company and its proprietary genomic testing programs. CGI has locations in the US, India, and China serving biopharma, clinical, and research clients. It has launched 7 proprietary diagnostic products focused on hematologic and urogenital cancers, and is working to validate additional next generation sequencing panels. CGI's tests provide information to aid in diagnosis, prognosis, and therapeutic decision making for cancers like CLL, cervical cancer, and kidney cancer. The company is collaborating with academic centers to further develop and validate its genomic tests.
Baptist Health Systems: Uses Technology to Improve Medication Management, Eli...clinicalsolutions
Baptist Health Systems uses McKesson Nursing Documentation to improve medication management and administration.
http://www.mckesson.com/en_us/McKesson.com/For%2BHealthcare%2BProviders/Hospitals/Nursing%2BSolutions/Nursing%2BSolutions.html
Robert Parson has over 15 years of experience in leadership roles in the healthcare industry. He has a proven track record of guiding medical products from concept to commercialization and ensuring quality and regulatory compliance. Parson has expertise in areas such as strategic planning, regulatory affairs, clinical research, and pharmacoeconomics. He holds advanced degrees from the University of California San Diego, Rochester Institute of Technology, and Purdue University.
Baystate Health marketing at Harvard UniversityRenown Health
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How to Interpret Trends in the Kalyan Rajdhani Mix Chart.pdfChart Kalyan
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This document summarizes a presentation on meaningful use of electronic health records (EHRs) given by Dr. Carl Dirks. It provides background on the national goal of universal EHR adoption by 2015 and the HITECH Act which provided $19 billion in incentives. It outlines the 3 stages of meaningful use, including core and menu objectives for stage 1, and discusses certification of EHR systems, incentive payment timelines, and other requirements to qualify for incentives. The conceptual approach to meaningful use focuses on improving quality, safety, efficiency, care coordination and population health.
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Maureen Bisognano, President and CEO, Institute for Healthcare Improvement, gives an international perspective on leading for better healthcare at The King's Fund Second Annual NHS leadership and Management Summit.
Joseph Dal Molin: Implementing VistA internationally: Myth-busting lessons fr...Nuffield Trust
In this slideshow Joseph Dal Molin, President of the E-cology Corporation and Chairman of WorldVistA, outlines Jordan’s health system and its approach to implementing VistA.
Joseph Dal Molin presented at the Nuffield Trust seminar: Sharing international experience: Is implementing the VA's electronic health record system an option for the NHS? in July 2012.
MAFP Quality Reporting for Cash-CMS Incentives and Your Bottom Linelearfieldinteraction
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The Science of Launching and Achieving Growth in Oncologyaccenture
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This document provides an introduction to key performance indicators (KPIs) and quality assurance in healthcare in Malaysia. It discusses Malaysia's vision for a healthy nation with an efficient and equitable healthcare system. It defines quality assurance and outlines factors that determine high quality healthcare facilities and services. The document then presents KPIs that can be used to assess performance in clinical governance and resource management at the state health department level. Several dimensions and examples of KPIs are provided for patient-centered services, clinical/technical effectiveness, clinical risk management, staff health, and human resource and financial management.
Insights into the Canadian eHealth Landscape - MaRS Future of MedicineMaRS Discovery District
In recognition of the need to develop a national digital health strategy and to co-ordinate activity across the country, the Conference of Deputy Ministers established Canada Health Infoway in 2001.
This lecture describes Infoway’s role and the progress that it and its jurisdictional partners have made over the last decade. It outlines the challenges to achieving our collective goal of using technology to improve the health of Canadians and describes key enablers that must be in place for us to be successful. It also contains the results of recent public opinion research conducted with Canadians and healthcare providers and outlines the priorities for moving forward and the opportunities for action.
Supporting Individuals with Intellectual and Developmental Disability During the First 100 Days of the COVID-19 Outbreak in the U.S.
BrightSpring Health Services Chief Medical Officer Dr. William Mills presents on BrightSpring's ongoing response to COVID-19 and how the organization is mitigating risks for our patients, clients, and team members.
Research-Driven Solutions for Innovative State PolicyAcademyHealth
This document discusses health services research and its goals of determining what works best, for whom, under what circumstances, and at what cost. It outlines Arkansas' efforts to improve its health system, including establishing a governance structure and setting objectives around improving population health, patient experience, and controlling costs. It also presents data on variation in costs between providers for different medical conditions/procedures, showing opportunities for improving value through care standardization.
The document discusses the Value-Based Payment Modifier (VM) program which adjusts Medicare payments for physicians and other eligible professionals based on quality and cost of care. Key points:
- The VM assesses quality and cost of care provided under Medicare and adjusts payments accordingly.
- For 2015 it applies to groups with 100+ eligible professionals, expanding to groups of 10+ in 2016 and all physicians by 2017.
- Eligible professionals include physicians as well as other practitioners. Physicians are subject to the VM payment adjustments while other practitioners are included in defining group size.
- The VM is related to other quality programs like PQRS and EHR incentives, with varying incentives and payment adjustments based on participation
This document discusses disruptive innovation in patient-centered healthcare and outlines challenges facing healthcare systems. It notes that healthcare costs are concentrated among a small portion of patients and are growing due to aging demographics. Healthcare spending is also not efficiently allocated, with less than 10% spent on direct point-of-care services. The document advocates investing in electronic health records, telehealth, and other information technologies to improve care coordination and outcomes while reducing costs. It argues healthcare systems should innovate with the patient's needs and health outcomes as the priority.
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- The company focuses on fast-growing cancer genetics testing and has strategic partnerships with oncologists and hospitals.
- Management aims to continue expanding the test menu and achieving operating leverage to accelerate cash flow and earnings.
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St. David's Medical Center in Austin, Texas has undergone a cultural transformation to improve performance on value-based purchasing metrics like core measures and HCAHPS scores. They evolved from focusing only on reporting metrics to developing an organizational culture where everyone takes accountability for living the values of patient excellence. Tactics used include staff education, process improvements, physician engagement, and emphasis on accountability at all levels. As a result, St. David's saw improvements such as reducing core measure misses to near zero and increasing HCAHPS scores over 4%. Sustaining this culture will be key to higher performance and financial rewards under value based purchasing in the future.
This investor presentation by Cancer Genetics, Inc provides an overview of the company and its proprietary genomic testing programs. CGI has locations in the US, India, and China serving biopharma, clinical, and research clients. It has launched 7 proprietary diagnostic products focused on hematologic and urogenital cancers, and is working to validate additional next generation sequencing panels. CGI's tests provide information to aid in diagnosis, prognosis, and therapeutic decision making for cancers like CLL, cervical cancer, and kidney cancer. The company is collaborating with academic centers to further develop and validate its genomic tests.
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http://www.mckesson.com/en_us/McKesson.com/For%2BHealthcare%2BProviders/Hospitals/Nursing%2BSolutions/Nursing%2BSolutions.html
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The document describes how Baystate Health redesigned its cancer care program through a partnership between marketing and physicians to improve the patient experience, which led to increased patient satisfaction, physician referrals, and program volumes. Key steps included engaging patients and staff in the design process, aligning marketing and operations around a brand focused on expertise and relationships, and transforming the culture to deliver on promises to patients.
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Overview
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Power Grid Model
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HCL Notes und Domino Lizenzkostenreduzierung in der Welt von DLAUpanagenda
Webinar Recording: https://www.panagenda.com/webinars/hcl-notes-und-domino-lizenzkostenreduzierung-in-der-welt-von-dlau/
DLAU und die Lizenzen nach dem CCB- und CCX-Modell sind für viele in der HCL-Community seit letztem Jahr ein heißes Thema. Als Notes- oder Domino-Kunde haben Sie vielleicht mit unerwartet hohen Benutzerzahlen und Lizenzgebühren zu kämpfen. Sie fragen sich vielleicht, wie diese neue Art der Lizenzierung funktioniert und welchen Nutzen sie Ihnen bringt. Vor allem wollen Sie sicherlich Ihr Budget einhalten und Kosten sparen, wo immer möglich. Das verstehen wir und wir möchten Ihnen dabei helfen!
Wir erklären Ihnen, wie Sie häufige Konfigurationsprobleme lösen können, die dazu führen können, dass mehr Benutzer gezählt werden als nötig, und wie Sie überflüssige oder ungenutzte Konten identifizieren und entfernen können, um Geld zu sparen. Es gibt auch einige Ansätze, die zu unnötigen Ausgaben führen können, z. B. wenn ein Personendokument anstelle eines Mail-Ins für geteilte Mailboxen verwendet wird. Wir zeigen Ihnen solche Fälle und deren Lösungen. Und natürlich erklären wir Ihnen das neue Lizenzmodell.
Nehmen Sie an diesem Webinar teil, bei dem HCL-Ambassador Marc Thomas und Gastredner Franz Walder Ihnen diese neue Welt näherbringen. Es vermittelt Ihnen die Tools und das Know-how, um den Überblick zu bewahren. Sie werden in der Lage sein, Ihre Kosten durch eine optimierte Domino-Konfiguration zu reduzieren und auch in Zukunft gering zu halten.
Diese Themen werden behandelt
- Reduzierung der Lizenzkosten durch Auffinden und Beheben von Fehlkonfigurationen und überflüssigen Konten
- Wie funktionieren CCB- und CCX-Lizenzen wirklich?
- Verstehen des DLAU-Tools und wie man es am besten nutzt
- Tipps für häufige Problembereiche, wie z. B. Team-Postfächer, Funktions-/Testbenutzer usw.
- Praxisbeispiele und Best Practices zum sofortigen Umsetzen
Diffusion of innovation beyond the tipping point m goulbourne 2007
1. DIFFUSION OF INNOVATION BEYOND THE TIPPING POINT:
The Case of the Regional Cancer Program Formulary Software
i-Society 2007
Merrillville, Indiana, USA
Michelle Goulbourne
Goulbourne Research and Consulting
2. Overview
Describe the development and deployment of the Regional
Cancer Program Formulary Software (RECAP-FS).
Summarize results of an interim survey and web statistics.
Discuss the impact of each the following variables on the
rate of RECAP-FS adoption: (i) characteristics of the
innovation, (ii) the number of people involved in the
innovation decision, (iii) communication network structure
(iv) cultural context and (v) promotion efforts.
Assess the importance of key ‘agents of change’ in taking
RECAP-FS beyond the tipping point to the level of cultural
change.
Share lessons learned.
3. What is a Formulary?
In Ontario, oncology formularies contain the systemic
therapy regimens approved for use for cancer patients.
Regimens are based on published Cancer Care Ontario
Clinical Practice Guidelines (Formulary) and
institutionally approved treatments that are supported
by evidence (Non-formulary).
The formulary when compiled usually takes the form of a
printed handbook.
Despite best efforts once printed, these paper
formularies are soon out of date.
The process of keeping the regimen details up to date is
a labour intensive process involving almost all clinical
pharmacist s.
4. Collaborative Formulary Maintenance
Dynamic reciprocal relationship
BR
CN SK
GI 11 DSTs SA Pharmacy
GU DST Chairs and ME Formulary and
Coordinators Therapeutics
GY Committee
LU
HN HE
CCO Guidelines
5. The Formulary Updating Process
Disease Site Team Based Model
Previous Formulary
Pharmacist 1 Pharmacist 2 Pharmacist 3 Pharmacist 4 Pharmacist 5
BR LU SK GY GI Other
Formulary and Therapeutics Committee
RECAP Formulary
6. Quality Gap
In Oncology pharmacy services, a quality gaps is said to have existed
because pharmacy services did not have the tools they need to:
1. Translate guidelines and clinical processes into regimens in an efficient
way (5 pharmacists involved in the updating process), and
2. Disseminate this information to staff, patients, families and other
stakeholders in a timely, cost effective way.
When quality gaps exist time is spent searching, checking, re-doing and/or
waiting.
These gaps in quality prevent us from; 1) enhancing the quality of
evidence and its use, (2) providing appropriate patient centered care, (3)
improving patient health status and outcomes, and (4)ensuring health
system sustainability and equity.
Quality gaps prevent us from creating value.
7. Innovation
An innovation is an idea, practice, or object that is
perceived as new by an individual or other unit of
adoption…The perceived newness of the idea for the
individual determines his or her reaction to it. If an idea
seems new to the individual, it is an innovation. (Rogers,
2003, p.12)
8. Diffusion
The process by which an innovation is communicated
through certain channels over time among the members of
a social system. Diffusion is a special type of
communication concerned with the spread of messages
that are perceived as new ideas. (Rogers, 2003, p.35)
10. Why Create RECAP-FS?
Automate the process of editing, updating, exporting,
archiving and printing chemotherapy regimen
information.
Add efficiency and cost effectiveness to the process of
disseminating regimen information in a timely manner.
Enhance oncology community access to the latest
regimen information.
Enhance patient care. (e.g. Booking clerks will have a up-
to-date resource to check nursing times enhance
patient/work flow.)
12. Value
“…should occur in the prevention, diagnosis, and treatment of
individual health conditions. It is at this level that true value is
created – or destroyed – disease by disease and patient by patient.
It is here where huge differences in cost and quality persist. And it
is here where competition would drive improvements in efficiency
and effectiveness, reduce errors and spark innovation.”
Porter and Olmsted Teisberg, 2004
13. Creating Value in Operational Terms
Infrastructure needs to be in place that will allow us to take full
advantage of the potential of information, evidence and ideas in the
health care system.
Need information management and technological systems in place that
will facilitate improvements in our ability manage the potential benefits
of health care technologies.
“…give health care providers access to the latest and best information on
new treatments or drugs, improve the quality and safety of care within the
health care system, and most importantly, empower patients to maintain
their own health.”
Commission on the Future of Healthcare, 2002
15. Electronic Formulary to Enhance Quality
The Regional Cancer Program Formulary Percentage of Stage 1 and 2 Lung Cancer Patients Treated with
Software (RECAP-FS) is just one example Systemic Therapy in Accordance to Evidence
Made Available by CCO, Mid-2004**
of a project that seeks to help close this 100% 100%
particular quality gap in oncology. 100%
86%
95%
84%
91%
80%
System Drivers 60% 50%
40%
Increase EBCPG use in Regimen Creation 20%
Increase guideline adherence 0%
All centres Centre A Centre B Centre C Centre D Centre E Centre F
Manage Costs Cancer Centres
Annual Expenditures and Number of Approved Drugs for the New
Local Level Goals Drug Funding Program 2000-2006*
Millions
$140 $133
1. Facilitate the provision of the best $120
available evidence based clinical care $100
$83
$80
$63
2. Enhanced patient status and outcomes $60
$42
$52
$59
$40
3. Contribute toward health system $20
14 16 16 18 18
sustainability $0
14
FY00/01 FY01/02 FY02/03 FY03/04 FY04/05 FY05/06
Year
17. Patient Centric Model
Medical Care Process Factors
BR Patient Factors determine placement within
These process factors are a disease site based treatment framework
the major care steps that are CN HN where disease management is based on
needed to facilitate desired
DST stage. For example, in the Breast disease
medical outcomes. site group assessment decisions are made
for surgery, adjuvant radiotherapy, adjuvant
GI Disease Stage LU systemic therapy, etc.
GU Formulary Regimens MY Medical Care
Processes Factors are
documented in detailed
GY Detailed Care Paths SA paths.
Outcomes
HE Standardized Care Efficient Resource Utilization SK Analyses are
facilitated as
patient medical
Enhanced Patient Enhanced Quality of Enhanced Patient factors and
process factors
Safety Patient Care Outcomes are
documented.
18. Project Schedule
Phase I
Phase II
-April 03 project starts Phase III
-March 04 Test Survey
-1st Beta arrived July 03
- Aug 03 to Feb 04
-May 04 Regimen Review
- Dec 04-Jan05 Training
sessions
Phase IV
-Completed database update. - May 05-Aug 05 Beta - Nov 05 Launch
Database population
Testing Handbook, Software
and Icons
Apr 2003 – Mar 2004 - Dec 2004 - Nov 2005 –
Feb 2004 Dec 2004 Aug 2005 Dec 2005
19. Beta Testing
Building Capacity, Developing an Oncology Community
More than 40 staff from HHS and our community oncology
locations participated in the software testing process.
Beta testing served many purposes:
1. It engaged clinical and non-clinical staff at all levels in
the software creation process.
2. Provided the mechanism through which post-go-live
clinical champions were developed.
3. Increased staff knowledge about technology and
practical computer skills.
20. Tester Comments
Tester comment on the design, utility and functional specifications of
RECAP-FS® prior to its formal deployment directly contributed to the
success of this initiative. A few comments from beta tester evaluations
are below:
“Well laid out and functional.”
“I learned more about computers in the past hour than I have in the past
few years…”
“Not only will I be able to access up-to-date info faster, so will physicians.”
“Information will be accessible on the computer, where I do most of my
work.”
22. RECAP-FS Main Menu
RECAP-FS® is used to create regimens for chemotherapy or combined modality
treatments. Produce a preformatted formulary for publication with the click of a button.
Generate dynamic reports containing a few or all of the variables in the database.
25. e-Health Desktop Icons
The Regional Cancer Program e-Health Desktop Icons Software installs
three oncology information tools on the users computer desktop.
Once installed, this software gives users immediate access to an always
up to date e-Book Formulary, over 160 Medication Information Sheets
(MIS) and over 200 Systemic Treatment Record summaries (STR).
26. Closing the Quality Gap With RECAP-FS
The RECAP-FS project was completed in the fall of 2005.
The software stores over 200 active formulary, non-formulary and
clinical trial regimens in its database.
1000 handbook sized copies of the Formulary were printed and
distributed to staff across the Cancer Centre, Hamilton Health
sciences and community oncology satellite locations.
This project suggests that technological innovations such as RECAP-
FS® can facilitate the development of positive and sustainable
changes in the culture and practice of health professionals.
27. Web Statistics
2006-2007 Pharm acy Services Web Statistics
1800
1600
1400
1200
Visits
1000
800
600
400
200
0
Systemic Treatment Record Medication Information e-Book Formulary RECAP-FS
Web Page
Mar-06 Apr-06 May-06 Jun-06 Jul-07 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07
2 click access to information 3 or more clicks to access information
Changes at the cultural level, that see staff regularly access and use formulary
resources, have a positive impact on patient safety and the quality of patient care.
28. Summary
Using RECAP-FS® to generate online treatment information such as
the Regional Cancer Program e-Book Formulary and other free
online treatment information has allowed the Cancer Centre to share
evidence based best practices with patients, students, and clinical
staff within the global oncology community.
Since its formal implementation in the fall of 2005 more than 600
users across Hamilton Health Sciences and the community oncology
affiliates have access to the latest oncology information via RECAP-
FS® and the RECAP e-Health Desktop Icons Software.
Transitioning from novelty to sustained changes in day-to-day
clinical practice is an important task. Usability has been an
important factor contributing to the use of some of the tools to
access information.
Each month over two thousand hits are registered on the RECAP website pages
and 90% of hits are linked to the pages that are accessed via the two-click
informational icons.
29. Tipping Point
The Tipping Point is that magic moment when an idea,
trend or social behavior crosses a threshold, tips, and
spreads like wildfire.
Gladwell, 2000
31. Online Survey
Evaluations completed one year after implementation suggest that
the Regional Cancer Program Formulary Software (RECAP-FS®) and
the RECAP Desktop Icons Software both play important roles in:
1. Helping pharmacy services attain their goal to disseminate best
practices in a way that helps to ensure the equitable and consistent
provision of high quality cancer care.
2. Providing information in a timely way so that healthcare teams can
work more effectively towards enhancing patient safety and
outcomes.
32. User Evaluations
- 1 Year after Implementation
Despite the promotion of electronic health information 52%
of respondents indicated that they preferred the printed
handbook formulary.
46% of respondents reported that they consulted the printed
formulary every day.
81% of respondents received email updates announcing new
regimens were online.
46% reported reviewing the regimens online and 36% printed
or saved the regimen file.
64% reported that the RECAP-FS tools have had a positive
impact on the way they perform their work.
33. Beyond the Tipping Point
The Regional Cancer Program Formulary Software (RECAP-FS®)
project sheds light on factors that impact on a tools rate of adoption
and sustained clinical use over time.
- Early staff involvement in the project and, the development of lead staff across sites
is critical in developing tools that meets and exceeds staff practice needs.
The transition of an electronic tool from novelty to sustained changes
in day-to-day clinical practice is an important goal.
- Usability is an important facilitator in this process. During the first year of
implementation over two thousand hits were registered on the RECAP website
pages each month.
- 90% of the web hits were to pages that are accessed via the two click informational
icons.
This project suggests that technological innovations such as RECAP-
FS® can facilitate the development of positive and sustainable
changes in the culture and practice of health professionals.
Changes at the cultural level, that see staff regularly access and use
formulary resources, have a positive impact on patient safety and the
quality of patient care.
34. Key Learnings
1. Staff capacity building is needed for system change.
2. Develop clinical leaders during the course of the project
to enhance the likelihood of successful multi-site
software implementation.
3. Regional e-Health initiatives can have a positive region-
wide as well as a global impact. This potential needs to
be considered and incorporated into project goals.
36. References
Commission on the Future of Health Care (2002). Building on Values: The
Future of Health Care in Canada. Ottawa: Government of Canada.
Gladwell, M. (2000). The Tipping Point. New York, Time Warner Book Group.
Rogers E. (2003). Diffusion of Innovation, Fifth Ed., New York, The Free Press.
Porter, M. E. and E. Olmsted Teisberg (2004). Redefining Competition in
Health Care. Harvard Business Review.