mary gibson

Physician Engagement- The POSP Experience: 

Physician Engagement - The POSP Experience BC Health Information Professionals Society November 17, 2006

Agenda: 

Agenda Program overview Change management Results Key learnings Challenges Testimonials

Program Overview: 

Program Overview

Overview: 

Overview Launched October 1, 2001 First of its kind in North America Tri-partite (AH&W, AMA and regional health authorities) program provides: Financial support (70/30 cost share arrangement) Change management services Mandated requirements for physician office systems (VCUR) Strategic investments in IT to move patient care/EHR agendas forward

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Pharmacists Community MDs Community DI PIN Registries Lab Results History AH&W Labs RHAs Lab results to community EMRs DI text & other reports to community EMRs Upload of dispensing information Portal 2006 HIE Capital Netcare Alberta Netcare

POSP mandate: 

POSP mandate To establish a physician office information infrastructure that is integrated with the health information system and which enables information exchange within the physician community and beyond.

Why? To support…: 

Why? To support… Improved patient care in the community in the regions through information exchange Professional development/knowledge management Practice management efficiencies

Participation alternatives: 

Participation alternatives 3 levels of participation Level 1 – computer in physician’s office with browser version of provincial EHR Level 1.5 – computer access at point of care with browser version of provincial EHR Level 2 – EMR integrated with provincial EHR and regional data at point of care

POSP “at a glance”: 

Service Agreement (Must be received 30 days from Intake) Enrollment (Must be received 120 days from Intake) Implementation Physician Declarations (Must be submitted 6 and 12 months after implementation) PIA (OIPC) (Must be received prior to “go live” date) Ongoing Change Management and Outreach activities Intake (Starts funding clock) Automation Readiness Assessment = site visit = physician submitted form Kick-off meeting (POSP, Vendor, Physician & RHA) = business process PIA Consultation (Must be completed prior to “go live” date) EHR Readiness Assessment (AH&W) Post Implementation Review (Completed after 6 month declaration) Ongoing Change Management and Outreach activities POSP “at a glance” Application

Program management office: 

Program management office

Service delivery vs. ‘admin.’ : 

Service delivery vs. ‘admin.’ Benchmarks: Repository: 10 – 15%; Repository/Coach: 15 – 25% Repository/Coach/Manager: 25 – 35% POSP program management office = repository/coach/manager model

Change Management Services: 

Change Management Services

Delivery: 

Delivery Approximately 12% of program budget POSP acts as general contractor Team lead & 7 change management advisors All clinics assigned to a change management advisor (approximately 150 clinics/per CMA) Clinics ranked in quartiles based on various risk factors & contact targets set

Delivery structure: 

Delivery structure

Required services: 

Required services Automation readiness assessments Kick-off meeting with vendor, physician Privacy impact assessment Post-implementation review Second round underway Physician-led (Yea!)

Elective services: 

Elective services Workflow analysis Total cost of ownership review Improving computer literacy Assistance with privacy impact assessment Review of vendor quotes and contracts Team building Technology assessments Project management Demo clinics Physician mentors

Business Requirements: 

Business Requirements Purpose Documentation to support common understanding of clinic’s business requirements When is it useful? Ideally before the clinic starts talking to the vendors What is it? On-site meeting: Field Resource and physicians and clinical staff representing all process areas of clinical operations Document: findings and recommendations

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Benefits Gives the clinic representative(s) confidence when speaking to the vendors regarding clinic’s requirements Comprehensive list of all business requirements broken down by mandatory, important, nice-to-have Supports informed decisions when choosing software Delivery Typically 1 to 4 hours on-site plus documented findings Often partnered with Workflow analysis or Technical Requirements Business Requirements

Business Requirements: 

Business Requirements

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Benefits Identifies issues and practical actions Supports informed decisions regarding improvements to the physical environment Delivery Typically 1 to 4 hours on-site Valuable discussions when clinic rep available for walk through Report may contain diagrams and photos Ergonomics

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Ergonomics Purpose Assist clinic in planning changes to the physical work environment When is it useful? Clinic planning construction or furniture changes to coincide with new system What is it? Site inspection Based on industry best practices Document: findings and recommendations

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Ergonomics: Areas of consideration Workers: accommodation for variations of size, strength, range of motion, and other physical characteristics Work Setting: parts, tools, furniture, displays, and other physical objects used to accomplish work tasks Work Environment: climate, lighting, noise, vibration, and other atmospheric conditions

Slide23: 

Ergonomics

Advanced Training: 

Advanced Training Purpose To assist physicians and clinic staff in achieving greater utilization of the functionality within their physician office system. When is it useful? When physicians / clinic staff are struggling with basic utilization. When physicians clinic staff are stable and want to ‘take it to the next level’. What is it? Financial assisted support for third-party or vendor supplied training not specified within their support agreement.

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Delivery Onsite training provided by the vendor Onsite physician mentoring Off site training through a third-party Potential Benefits Increased comfort / satisfaction with automation Increased efficiency throughout the office Access to ‘new’ information (e.g. population mgmt reports) Advanced Training

Technical Assessment: 

Technical Assessment Purpose Overview of clinic’s current technical status and recommendations for the clinic’s technical future When is it useful? Before the clinic starts talking to the vendors or when they are experiencing technical challenges What is it? On-site meeting: Field Resource and key physicians and/or staff Document: findings and recommendations

Technical Assessment: 

Technical Assessment Technical Assessment document includes: Observations: current state of the clinic Equip location: current + proposed with eye to new workflow Network wiring/wireless: existing plus constraints (i.e. cement walls, etc) Server storage considerations Hardware considerations re: network, server, UPS, desktop/thin client/laptop, printing, scanning, etc System Management & Privacy considerations Etc.

Technical Assessment: 

Technical Assessment Benefits Gives the clinic personnel a common understanding (and lexicon) of their existing technical environment and proposed future state Supports informed decisions when choosing software and hardware Delivery Typically 1 to 4 hours on-site plus documented findings Often partnered with Business Requirements or Workflow Analysis

Workflow: 

Workflow Purpose Assess current workflow, identifying issues affecting current effectiveness, Create a map of the ideal process and identify resources required to support the redesign When is it useful? First step, before vendor selection Mature clinic looking to take performance to next level Clinic stressed as result of poorly executed implementation What is it? Cross-functional workshop

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Benefits Develops a shared understanding of operations and priorities Identifies important product requirements Promotes informed product selection Prepares clinic to make implementation choices Identifies business decisions that must be made e.g. staffing Builds buy-in for the project Delivery As many staff and physicians as possible Minimum one half day for workshops, may be several sessions Workflow

Workflow: Current Processes: 

Workflow: Current Processes

Workflow: Ideal Process: 

Workflow: Ideal Process

Dispute Resolution: 

Dispute Resolution Purpose Assist parties in resolving issues that are impeding success with automation. When is it useful? When a dispute is evident or when parties appear to be moving apart. What is it? Facilitated meeting(s) with key physicians, staff, vendors or other parties.

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Delivery Facilitated meetings Time extremely variable Potential Benefits All parties able to move forward Dispute Resolution

Program Results: 

Program Results

Information sources:: 

Information sources: Operational data Post-implementation reviews Far more than surveyed during external evaluation Matched with independent assessment by field resources External evaluation of program delivery and impact of POSP on clinical outcomes Baseline data collected (April/02 – June/03) On-line surveys and case studies 2nd evaluation completed August 2005 Based on interviews (management consultant and physician teams) of statistically valid sample of POSP participants

Target market: 

Target market Approximately 5,700 physicians in Alberta Roughly 10% (552) are facility-based (e.g., anesthesia, emergency medicine, general pathology) Roughly 2/3 located in Calgary/Edmonton; 1/3 in non-metro regions (NB re: Supernet) 67% are general practitioners, 33% specialists

Physician participation: 

Physician participation As of August/06: 3,336 active participants (65% of ‘eligible’ physician population) Level 2 – 2,747 (83%); Level 1.5 – 407 (12%); and Level 1 – 182 (5%); percentages relatively constant since start of Phase 2 1074 clinics 625 Level 2 physicians haven’t selected a vendor yet (18% of POSP population but most of these (430) are in ‘large groups’ (e.g., Dept. of Medicine) Physician retention high (88%) to date

Results (cont.): 

Results (cont.) POSP participation to date matches population of Alberta physicians in terms of gender, age and, generally, specialty Majority of physicians (83%) are choosing Level 2 – Electronic Medical Record + billing + scheduling, integrated with provincial & regional data Physician participation in Calgary (32% of Calgary physician population) lags physician participation in Capital (41%) Due to greater functionality in Capital? Culture? Physician leaders?

Automation progress: 

Automation progress

Post-implementation reviews: 

Post-implementation reviews % of Phase 1, Level 2 physicians visited in ‘Round 1’ (856) meeting program outcomes re: use of technology is high (80%)

Post-implementation reviews - detail: 

Post-implementation reviews - detail

Physician rating of value: 

Physician rating of value

Field resource assessment: 

Field resource assessment

External evaluation (Aug. ’05): 

External evaluation (Aug. ’05) Physicians are using office automation: Staff are using it too: Overall physician satisfaction with program is high First in Canada; leader world-wide; results in Alberta quantum higher than in jurisdictions without a program

External evaluation (cont.): 

External evaluation (cont.) Benefits of automation for physicians: Better information recall (readable, not lost) Less wasted staff, physician time Improved patient recall Management of labs easier Prescriptions, especially repeats, easier – fewer pharmacy questions Referral/consult letters easier, more complete Patients like it Improved quality of professional life

External evaluation (cont.): 

External evaluation (cont.) Office processes have changed (who’s behind Door #1?): Workflow altered but so far little in the way of staff savings Note: this is different for Phase 2 physicians where we encourage starting with workflow analysis prior to selection of a vendor/product Productivity savings offset by: Learning new processes Need to scan paper (solutions in sight) Physician productivity has improved, but not significantly Connectivity (clinical content) and basic computer skills are greatest needs expressed by physicians

External evaluation (cont.): 

External evaluation (cont.) Vendor satisfaction is quite variable; issues of: System crashes Hardware-software compatibility Software not robust enough Software oriented to GPs not specialists Inadequate support services Perception that vendors oversold their products Vendor community has not ‘rationalized’ as anticipated More vendors, larger international vendors, regional vendors

Evaluator’s conclusions: 

Evaluator’s conclusions Keys to POSP’s results: VCUR (mandated physician office system requirements) Involving vendors Allocating funding & attention to change management Tri-lateral involvement (Ministry, regions, physicians) Clinical content Active (coach/manager model) program management office

Program results: 

Program results Grant funding increase implemented based on reference price review (2004) Clinic site security/system management assessment completed Well received by clinics Serious areas of concern identified; follow-up visits to at-risk clinics completed; next round planned Privacy Impact Assessment (PIA) push complete, privacy compliance officer hired, funding suspended to ‘incent’ compliance, mandatory PIA visit introduced Net result: compliance significantly improved 30% to 88%)

Program results: 

Program results Clinical decision support summit February 2006 Definition and framework approved; Quick wins identified Getting the Most from Your EMR focus group in May, 2006 Procurement ‘toolkit’ for physicians released VCUR v2 complete; product list released April 18th - currently 12 vendors/26 apps. Conversion of patient data – content standard and messaging specification to enable physicians to ‘switch’ systems Major risk mitigation strategy for physicians having/wanting to change vendors Emphasis on effective conformance testing

Learnings: 

Learnings

Content: 

Content Clinical & operational value in stand-alone EMR….value increases exponentially with EHR content Priorities…lab, drugs, DI (text), referral/consultation Physician preference for integration of ‘core’ data Concerns re: data completeness need to be addressed ‘Look and feel’ important Go slow re: introduction of clinical decision support

Engagement processes: 

Engagement processes Need to address entire physician community Physician-led outreach Criteria-based selection of mentors Ongoing analysis & follow up Enlist support of College Financial support Relationship-based, personalized, face-to-face service works best Prompt and effective issue management Use of ‘traditional’ communication channels

Challenges: 

Challenges

Challenges: 

Challenges Lab, drugs and DI Not available yet province-wide Delay in roll-out of integrated EHR/EMR solution Program hiatus during negotiations # 2 negotiating priority for physicians Won’t go back to paper but will they ‘evergreen’? Program management office concentrating on helping existing participants move to more effective use of technology Post-48 month funding question Approximately 1,200 physicians (>1/3 of POSP participants) will hit the 48-month cap by November/06

Challenges: 

Challenges System management How will this get done/ Where will ongoing support come from? Increasing complexity of EHR world Data integrity End-to-end conformance testing Data stewardship Coordinating delivery of change management services Regional solutions Physician load Access to high-speed bandwidth Clinical decision support Primary care networks Nascent provincial IM/IT strategy

Testimonials: 

Testimonials

What the docs are saying: 

What the docs are saying “Now it’s so easy and so accessible to get the information you need to make decisions on patient care, it truly makes our job much easier and makes patient care much better and safer.” Dr. Michael Chatenay, Surgeon

What the docs are saying: 

What the docs are saying “This is the way medicine is going and if you don't go there, you'll miss out in a lot of the exciting things that will be happening in medicine. Dr Steve Edworthy, Rheumatologist

What the docs are saying: 

What the docs are saying “Within the next decade at least, I think it will be the norm... if you're planning to stay in practice, this is something you will need to do.” Dr Heidi Fell, Family Practitioner

What the docs are saying: 

What the docs are saying “All physicians have to do is call POSP and they can be taken through everything they need to start.” Dr Norm Yee, Family Practitioner

What the docs are saying: 

What the docs are saying “Answering phone calls, chasing down requests for tests that were done a week ago, we don't have to do that... and that's been a real plus for us.” Dr Bill Anderson, Radiologist

Its about people, not technology…: 

Its about people, not technology…

Thank You!Mary Gibsonmarygibson@shaw.ca(780)466-2613: 

Thank You! Mary Gibson marygibson@shaw.ca (780)466-2613