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BCHIMPS Education Session

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Current HA Clinician Engagement 10 min each (40 min) HA Reps ... Opportunism is vital. Simplicity is the best engagement feature. Clinicians want to be involved ... – PowerPoint PPT presentation

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Title: BCHIMPS Education Session


1
BCHIMPS Education Session
  • Primary Health Care,
  • Strategies for Engagement and Adoption

November 17, 2006
2
Panel Agenda ( approx 1.5 hrs)
  • Introduction 10 min - Alan
  • Current HA Clinician Engagement 10 min each (40
    min) HA Reps
  • Question 1 5 min each HA Reps (20 min)
  • Question 2 5 min each HA Reps ( 20 min)
  • Open Q A (15 min)

3
Introduction
  • What is Primary Health Care?
  • What does the patient experience (outside of the
    acute care setting) when in contact care system -
    in their family physician's office, in a
    community health centre, mental health clinic
    etc. ?
  • Why reform physician practice?
  • 2/3 of the costs incurred by a health region are
    incurred because of something a physician wrote
    down on a piece of paper .. You can try to save
    money on the other 1/3rd all you want.
  • How does Canada rank?
  • 2006 International Health Policy Survey

4
The Commonwealth Fund 2006 International Health
Policy Survey of Primary Care Physicians in Seven
Countries
  • The Commonwealth Fund
  • 2006 International Symposium on Health Care
    Policy
  • Washington, D.C., November 13, 2006
  • Cathy Schoen, Senior Vice President
  • Robin Osborn, Vice President and Director,
  • International Program in Health Policy and
    Practice

5
2006 International Health Policy Survey
  • Mail and telephone survey of primary care
    physicians in Australia, Canada, Germany, the
    Netherlands, New Zealand, the United Kingdom, and
    the United States.
  • Final samples 1003 Australia, 578 Canada, 1,006
    Germany, 931 the Netherlands, 503 New Zealand,
    1,063 United Kingdom, and 1,004 United States.
  • Conducted by Harris Interactive and
    subcontractors, and in the Netherlands by The
    Center for Quality of Care Research (WOK),
    Radboud University Nijmegen, from February 2006
    to July 2006.
  • Cofunding from The Australian Primary Health Care
    Research Institute, The German Institute for
    Quality and Efficiency in Health Care, and The
    Health Foundation.
  • Core Topics information technology and clinical
    record systems, access, care coordination,
    chronic care/use of teams, quality initiatives,
    and financial incentives.

Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
6
Primary Care Practices Use of Information
Technology and Clinical Information Systems
7
Figure 1. Primary Care Doctors Use of Electronic
Patient Medical Records, 2006
Percent
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
8
Figure 2. Electronic Medical Record System Access
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
9
Figure 3. Practice Use of Electronic Technology
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
10
Figure 4. Doctor Routinely Receives Alert
About Potential Problem with Drug Dose/Interaction
Percent
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
11
Figure 6. Patients Routinely Sent Reminder
Notices for Preventive or Follow-Up Care
Percent
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
12
Figure 7. Capacity to Generate Patient Information
Percent of primary care practices reporting easy
to generate
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
13
Figure 8. Primary Care Practices with Advanced
Information Capacity
Percent reporting seven or more out of 14
functions
Count of 14 EMR, EMR access other doctors,
outside office, patient routine use electronic
ordering tests, prescriptions, access test
results, access hospital records computer for
reminders, Rx alerts, prompt tests results easy
to list diagnosis, medications, patients due for
care.
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
14
Coordination of Care
15
Figure 13. Length of Time to Receive a Full
Hospital Discharge Report
Percent saying 15 days or more or rarely receive
a full report
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
16
Care for Chronically Ill Patients and Use of Teams
17
Figure 15. Capacity to Generate List of Patients
by Diagnosis
Percent reporting very difficult or cannot
generate
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
18
Figure 16. Doctor Routinely Gives Patients
with Chronic Diseases Plan to Manage Care at Home
Percent giving written plan
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
19
Figure 17. Use of Multidisciplinary Teams and
Non-Physicians
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
20
Quality Initiatives
21
Figure 19. Availability of Data on Clinical
Outcomes or Performance
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
22
Figure 23. Primary Care Summary and Implications
  • Striking differences across the countries in
    elements of primary care practice systems that
    underpin quality and efficiency.
  • Physicians in Australia, the Netherlands, New
    Zealand and the U.K. most likely to report
    multitask IT systems U.S. and Canada lag behind.
  • Reports indicate varying capacity to care for
    patients with multiple chronic conditions or
    coordinate care with decision support.
  • Integration and coordination are a shared
    challenge.
  • Widespread primary care doctor participation in a
    range of quality improvement activities although
    safety tracking systems are rare except in the
    U.K.
  • U.S. stands out for financial barriers and also
    has limited after-hours access.

Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
23
Figure 24. Opportunities to Learn to Inform
Policy
  • Country patterns reflect underlying strategic
    policy choices and extent to which policies are
    national in scope
  • Payment policies for quality and care management.
  • IT Investing in primary care capacity and
    interconnectedness.
  • After-hours access.
  • Chronic disease management and use of teams.
  • Primary care redesign is central to initiatives
    to improve health care system performance
    internationally.
  • Evidence that national system focus is
    essential to build capacity.
  • Striking country differences in primary care
    practices and national initiatives offer rich
    opportunities to learn.

Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
24
Acknowledgments
  • With appreciation to
  • Coauthors Phuong Trang Huynh, Michelle M. Doty,
    Jordon Peugh, and Kinga Zapert, On the Front
    Lines of Care Primary Care Doctors Office
    Systems, Experiences, and Views in Seven
    Countries, Health Affairs Web Exclusive (Nov. 2,
    2006)w555w571.
  • Developing and Conducting Survey Harris
    Interactive and Associates.
  • Conducting Survey in the Netherlands The Center
    for Quality of Care Research (WOK), Radboud
    University Nijmegen.
  • Cofunders The Australian Primary Health Care
    Research Institute, The German Institute for
    Quality and Efficiency in Health Care, and The
    Health Foundation.

Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
25
Acknowledgments
  • With appreciation to
  • Coauthors Phuong Trang Huynh, Michelle M. Doty,
    Jordon Peugh, and Kinga Zapert, On the Front
    Lines of Care Primary Care Doctors Office
    Systems, Experiences, and Views in Seven
    Countries, Health Affairs Web Exclusive (Nov. 2,
    2006)w555w571.
  • Developing and Conducting Survey Harris
    Interactive and Associates.
  • Conducting Survey in the Netherlands The Center
    for Quality of Care Research (WOK), Radboud
    University Nijmegen.
  • Cofunders The Australian Primary Health Care
    Research Institute, The German Institute for
    Quality and Efficiency in Health Care, and The
    Health Foundation.

Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
26
What is the history and current state of Primary
Health Care in the HA?
  • Approach
  • Activities

27
Where is the HA headed with Primary Health Care?
  • Tactical focus

28
Strategic Next Steps
  • Provincial alignment

29
Question 1 What is the HA biggest challenge?
  • What are you doing about it?

30
Question 2 How is the HA engaging patients?
  • Patient access to their own record
  • Patient entering information into their own
    record

31
Vancouver Island Health Authority Primary Health
Care Approach
Dr. Mary Lyn Fyfe Victoria Power-Pollitt BCHIMP
S November 17, 2006
32
Overview
  • VIHA PHC CDM Program
  • VIHA PHC Strategy 2006/07-2008/09
  • Physician Engagement Approaches, Successes in
    IM/IT
  • Lessons Learned

33
VIHA PHC CDM Program
  • Key theme - VIHA 5 Year Strategic Plan
  • Identified as Key Initiative (PHC CDM) by
    Senior Executive Team
  • Island-Wide Clinical Program established August
    2005
  • Co-Management Model

34
PHC CDM Program Mandate
  • Operations
  • 5 PHCOs, DECs, Nutrition Service, Collaboratives,
    PHC Networks, 3 PHCO contracts
  • Provider Engagement
  • Opportunities for improving supports to systems
  • Building networks
  • Policy Development
  • Strategic Plans Service Frameworks
  • Service Integration

35
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36
VIHA Primary Health Care Definition
  • The range of services individuals and communities
    receive on a regular, ongoing basis in order to
    stay healthy, get better, manage ongoing illness
    or disease, and cope with end of life.
  • .

37
VIHA Primary Health Care Strategy 2006/07
2008/09
  • Enhancing and Extending PHC Services through
    partnerships
  • Supporting infrastructure, networks and
    innovation

38
VIHA PHC Strategy Initiatives
  • PHC Developers
  • PHC Provider Networks
  • Enhanced PHC Priority Communities
  • PHC Indicators
  • Website development
  • Aboriginal Health PHC Initiative
  • Connecting / Supporting the Providers

39
VIHA Chronic Disease Management Definition
  • Working with individuals, families, and
    communities to help people maintain as much
    health and independence as possible through the
    prevention, early detection, and management of
    chronic health conditions.
  • A range of different people in a variety of
    settings may provide chronic disease management
    services.

40
VIHA CDM Plan 2006/07-2008/09
  • Extending and Enhancing CDM programs services
    through partnerships
  • Increasing access to current VIHA-operated CDM
    programs services
  • Supporting partnerships, networks and innovation

41
VIHA CDM Plan Initiatives
  • Collaborative Program for Service Integration
  • Service Frameworks for Integrated Care
  • CDM Steering Committee
  • Interdisciplinary Team CDM Education Support
  • CDM Provider website

42
Collaboratives Program for Service Integration
  • How do we achieve our mandate?
  • Establish contractual agreements with interested
    family physicians
  • Provide on-going support for quality improvement
    initiatives
  • Focusing on Diabetes, CHF, Depression and CKD.
  • Our frameworks
  • Expanded Chronic Care Model
  • IHI improvement methodology

43
Data example
44
Congestive Heart Failure
45
Congestive Heart Failure
46
Chronic Kidney Disease
47
Physician Engagement Approaches in IM/IT
  • Expert Input/Participation and Communication
  • IM/IT Committees
  • National/Provincial Committees
  • Canada Health Infoway Physician Advisory Panel
  • Provincial eHealth committees including SPEED
  • VIHA IM/IT Steering Committee (Executive Level)
  • Primary care portfolio representation

48
Physician Engagement Approaches in IM/IT
  • IM/IT Committees
  • Clinical Informatics Physician Advisory Panel
  • Project Steering Committees Physician Leaders
  • Portfolio and Medical Advisory Committees
  • Communication Strategies
  • Leverage Physician User Group experience

49
Success in Primary Care Physician Engagement and
IM/IT Adoption Comox Valley St. Josephs Hospital
  • An integrated viewer for laboratory, diagnostic
    image reports, transcribed documents and
    PharmaNet using Concierge
  • Success
  • Clinical Adoption Demonstrated Value
    -integrated, accessible, intuitive, safer
  • Statistics
  • 42/45 (92) Primary Care Physicians
  • 32 (65 ) have adopted EMRs
  • 30/30 Specialists

50
Success in Primary Care Physician Engagement and
IM/IT Adoption Comox Valley St. Josephs Hospital
  • Decommissioned external paper distribution
  • Return on Investment
  • Cost per report
  • Concierge 0.08-0.10
  • Mail 0.30 to 0.50

51
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52
Building On Success
  • Engagement successes in regional PACS, Comox
    Valley
  • Opportunities for Primary Care Physicians in
    South Island
  • Web Result and Booking Project
  • Interim projects while PITO and iEHR/PLIS get
    developed
  • Welcoming Physician Portal
  • Access to Patient -centric, web enabled Cerner
    Outreach PowerChart Light
  • Emergency Room visit notification
  • Provider-centric Laboratory, Diagnostic Imaging
    and Document Reporting
  • eBooking for Diagnostic Images
  • Access to CME/On Call Scheduling etc.

53
Primary Health Care and IM / IT Lessons Learned
  • Communication and developing meaningful
    interfaces is key
  • One size does not fit all, flexibility is
    important and scheduling is a challenge
  • Demonstration of value through efficiency and
    patient care is critical to successful engagement
    and adoption
  • Opportunism is vital
  • Simplicity is the best engagement feature
  • Clinicians want to be involved

54
Thank You Questions?
55
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56
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57
Primary Health Care Strategies for Engagement
and Adoption
  • BCHIMPS November 17, 2006

58
What is the history and current state of Primary
Health Care in the HA?
  • Primary Health Care Goals
  • Improved access to a continuum of Primary Health
    Care Services
  • Improved quality and appropriateness of care
  • Increased focus on prevention and health
    promotion
  • Direct contribution to Primary Health Care
    research and evaluation
  • Alignment of people, process and technology
    enablers in support of organizational goals
    required to optimize outcomes
  • Early Lesson Learned Effective business,
    clinical and information technology partnership
    is critical to success

59
Approach
  • Engage formal and informal
  • EMR implementation EOI Primary Care IT
    Strategy Physician User Groups (PUGS)
  • Lead VCH Direct Programs and Services
  • Role and process redesign in Community Health
    Centres/Clinics
  • Program development self management
  • Implementation of IT enablers for Primary Care
  • Program evaluation
  • Support - Services Provided by Others
  • Improved practice management
  • Quality Improvement collaborative model
    chronic disease management prevention and
    promotion
  • Development and delivery of IT enablers to
    Primary Care
  • Influence
  • development of policy standards funding

60
Engagement and Adoption Tactics
  • Engagement
  • Physician User Groups geographic /interest
    based groups virtual and face to face
    meetings simple IT tools focus on low
    pressure/high value engagement
  • Peer to Peer Communication
  • Clinical Champions
  • Direct clinician involvement in strategy, program
    and policy development, planning, design,
    development, delivery and evaluation
  • Compensation for participation in projects
  • Listen well listen frequently
  • Adoption
  • Effective change management - communication,
    change readiness, training and education, reward
    and recognition, evaluation
  • Understand what changes, when and to whom
  • IT Adoption Model 4 levels Where am I now?
    Where do I want/need to be? What are my options
    to get there?

61
Where is the HA headed with Primary Health Care?
  • Value driven, outcome focused program and project
    structure - start with the end in mind
  • Increased process participant involvement in
    all project phases - planning, definition,
    design, implementation and evaluation
  • Leveraging existing people, process and
    technology capabilities to support continuum of
    care and population health needs

62
Strategic Next Steps
  • Ongoing alignment with Ministry of Health 9
    Priority Initiatives
  • Ongoing alignment with Provincial eHealth
    facilitating increased user readiness supporting
    ongoing clinician engagement sharing tools and
    expertise

63
Question 1 What is the HA biggest challenge?
  • Funding for the evolving role of the HA in
    Primary Health Care

64
How is the HA engaging patients?
  • Indirectly through care providers
  • Directly through
  • patient satisfaction measures
  • HA involvement in Conversation on Health
    sessions
  • Patient portal early planning stages will
    include direct engagement of patients

65
For more detailed information…
  • Contact
  • Diane Gerwin, Project Director
  • VCH IMIS Primary Care IT
  • Phone (604)875-4111 X 63819
  • Email diane.gerwin_at_vch.ca

66
Fraser Health Primary Health Care Framework and
Initiatives
  • Laurie Gould, Executive Director
  • Primary and Chronic Care
  • November 2006

67
Primary Care Renewal
  • Success Demands
  • Information Technology
  • Full Electronic Medical Record
  • Shared Multidisciplinary Care
  • Internal-multidisciplinary care
  • External-interdisciplinary in-reaching
  • Management Support
  • Change Management support
  • Knowledge Management
  • Data analysis and reporting

68
Strategic Intent of FHs Primary Health Care
Initiative
  • To achieve individual and population health
    outcomes through planned care, improved access
  • Achieve clinical practice standardization and
    integration amongst GPs
  • To achieve improved provider satisfaction
  • To reduce acute care utilization and emergency
    visits relative to chronic diseases and an aging
    population

69
Primary Health Care Renewal Initiative Primary
Care Model Delivery Vision
  • Improvements Achieved
  • Integrate providers
  • Improve access
  • Manage complex and chronic conditions
  • Promote self-management
  • Improve information management systems

70
Enhanced Full Service Family Practices (EFPs)
  • Maple Ridge
  • BCST Family Practice
  • Abbotsford
  • Clearbrook Family Practice
  • Gateway Health and Wellness Clinics
  • Chilliwack
  • Promontory Family Practice
  • Newcombe House Family Practice
  • Langley
  • Murrayville Family Practice
  • Brookswood Family Practice
  • Fort Family Practice
  • Langley Primary Health Care Associates
  • Four Oaks Family Practice
  • White Rock/South Surrey
  • Morgan Creek Family Practice
  • Whiterock Medical Associates
  • George Street Family Practice
  • Oceanside Family Practice
  • Project governed by FH
  • Established Physician Steering Committee
  • Develop partnership for renewal
  • Provide direction and input
  • Implementation by Project Coordinators
  • Background in primary care
  • Implementation supported by specialist resources
    as required
  • Committed to 10 practices to learn in an
    innovation lab setting in order to create a
    model for the future.

Enhanced Family Practices
  • Independently owned/operated
  • 3 or more physicians
  • Full range multi-disciplinary team based on
    population requirements
  • Proactive care
  • Fee for Service/Blended fee structure
  • Previously known as Primary Health Care
    Organizations (PHCOs)

71
Primary Care Renewal Initiative High Level
Implementation Approach
Initial Change Mgmt
Information Systems
Chronic Disease Prevention/ Mgmt
Patient Centered Primary Care Networked primary
care providers
72
Clinical Information System
  • Organize patient and population data to
    facilitate efficient and effective care
  • Include clinically useful and timely information
    on all patients in a registry
  • Provide reminders and feedback for providers and
    patients
  • Identify relevant patient subgroups and provide
    proactive care
  • Facilitate individual patient care planning
    through the registry.

73
Primary Care Renewal Initiative Integrated
Systems Vision
  • Key Solution Attributes
  • Completed privacy and security compliance of
    software functionality for practice information
    within central hub addressed patient consent
  • Ability for practices to enter/exit central hub
  • Maintenance of Master Patient and Master Provider
    lists
  • Interface to provincial registries
  • Amalgamation of patient data for single medical
    record across
  • Primary Care EMR, whether Intrahealth or other
    vendor
  • Any and all other health sources
  • EMR Viewer for real time consolidated patient
    data
  • Secure internet-based patient access for self
    management

Enhanced Family Practices
Accession (Patient access for self-management)
Provider EMR Viewer
Other Health Sources (e.g. Hospitals, Home
Community Care, Mental Health)
Practice data screen
Master Patient Index
Master Provider List
Large, real-time pipe
Other practice/EMR software
Various Authority, Provincial or Federal systems
and Registries
Intrahealth
74
Central Management Support Strategy
  • Issues
  • How to deliver effective transition of practices
    to the FSFP service delivery model and
  • underlying practice and technology reforms,
    without incurring excessive individual costs and
  • risks of adopting inefficient variations of
    the model
  • How to ensure continued alignment with
    provincial and health authority objectives
  • How to support MDs in change management
    strategies
  • How to collect and analyze data to support
    ongoing quality assurance and to quantify quality
  • improvements
  • Required
  • Central body to provide products ,services and
    support to practitioners inclusive of
  • Project coordinators that work with the practices
    in a partnership
  • Knowledge management
  • Data analysis

75
Lessons Learned
  • Change management for both IT and Practice
    redesign is key
  • All stakeholders in the practice/service must
    have a collective vision and be on-board as
    there is a significant investment in time and
    effort
  • Dont underestimate the need for basic support.
  • Training should be ongoing, not a one-time effort
  • Leadership is key, both from the practice level
    and Health Authority level
  • Online access to lab and other diagnostics is
    essential
  • Relationships, Relationships, Relationships
  • This is about everyone working together to
    advance primary care renewal
  • Trust between providers
  • You dont know what you dont know!
  • Data reporting at the individual and practice
    level is key
  • The providers need to identify data indicators
    relevant to their population

76
Issues We Are Facing Today….The Wish List
  • The need to interface the community physician
    information system(s) with Meditech to ensure
    continuity of information
  • Permanent funding for
  • information technology central hub
  • multidisciplinary teams to support GPs in the
    management of chronic conditions
  • case management support (shared care)
  • ongoing change management support
  • training for the primary care team in patient
    self-management
  • Recruitment of change management support staff
  • Time
  • Hurry up and wait

77
Thank you
78
BCHIMPS
  • Interior Health current state

79
Primary Health Care
  • The management of relationships between health
    care providers for the health and wellbeing of
    the patients/clients/communities they jointly
    serve.
  • CONNECTIVITY

80
IH models
  • PHC organizations
  • Chronic disease integrated networks
  • Shared care
  • Collaborative care
  • Physician office redesign support
  • Integrated information network
  • Self care initiatives

81
IH PHC/IMIT principles
  • Focus on improving health of clients
  • Free flow of information
  • Electronic health record
  • Patient-centric thinking

82
IMIT Initiatives
  • IH-wide EHR with physician office access
  • Patient Care Inquiry
  • PHC integrated settings
  • evaluation
  • Chronic disease integrated networks
  • South Okanagan integrated system pilot
  • Physician engagement network

83
IMIT Initiatives
  • Patient lab data portal
  • Valley Medical Labs diabetes project
  • Telemonitoring project
  • Wound care project
  • PACS
  • e Medical library Portal
  • health care workers
  • IH residents

84
Where is IH going?
  • Inconsistent messaging from province on PHC
    direction.
  • Shift in direction to support of and modification
    of primary care physician offices
  • Significantly impacted by recent fiscal restraint
    pending provincial clarity on direction.
  • Some IT based initiatives proceeding, some
    deferred.

85
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86
PCI access
  • 900,000 physician hits per year.
  • Physician access
  • 78 from within IH facilities
  • 64 from external site (office/home)
  • Access purpose (MD 25 of accesses)
  • 45 for lab data
  • 19 for reports
  • 18 for radiology
  • 7 visit history
  • 5 demographics

87
PHC integrated settings
  • Meditech based office system

88
Project Background
  • Modules Phase 1 2
  • Billing
  • Registration Scheduling
  • Basic Clinical Documentation (EAR)
  • Meditech Modules Phase 3
  • Advanced Clinical Documentation
  • Physician Workload Management (PWM)
  • Prescription and Ambulatory Order Management
    (AOM/RXM)

89
Implementation
Phase 1 and 2
Phase 3
90
PHC organization Basic Clinical Documentation
Module (cont)
  • Overall Functionality
  • 29 satisfied
  • 47 dissatisfied due to
  • no summary of a patients plan of care
  • no comprehensive view of a patients past health
    care information
  • too many screens to go through
  • poor user interface

91
Basic Clinical Documentation Module (cont)
  • Effects on Clinical Practice
  • 86 agreed the electronic chart is easier to read
  • 38 review other providers notes more often
  • 29 could manage clinical information better
  • 85 would not recommend the product to other
    providers but
  • 67 disagreed with the following statement
  • IF I COULD GO BACK TO PAPER-BASED RECORDS I
    WOULD

92
Results
  • Billing Module
  • did not simplify billing process
  • prone to more errors than the previous system
  • increased the time spent on the billing process
  • Registration Scheduling Module
  • integrated with Meditech
  • one time registration
  • Benefits of electronic scheduling

93
Results
  • Basic Clinical Documentation Module
  • evaluated by 21 health care providers
  • Physicians
  • Nurse Practitioners
  • PHC nurses
  • Chronic Disease Nurses
  • Social Workers
  • Respiratory Therapists

94
PHC evaluation
  • Still underway, but in one site, physician
    utilization of hospital beds were 44 that of
    peers in the community.
  • not solely attributable to IT integration.

95
Chronic disease improvement networks
  • Operational in three settings
  • Shared EHR access.
  • Differing systems, not conversant with other
    systems
  • Multidisciplinary teams
  • Clinic function at one site has deferred
    equivalent of two hospital beds.

96
South Okanagan Integrated pilot
  • Included physicians in the community
  • using electronic medical summaries developed by
    the physicians themselves.
  • Health care facility (hospital and LTC)
  • Pharmacy
  • Lab information
  • Evaluation due in next few months

97
Physician engagement Network
  • List of high users of IT systems
  • Interest not great in developing formal network
  • Concern about operationality of IH EHR and
    interaction with office practices

98
ePatient portal
  • Encrypted view of information and detailed audit
    of system accesses. Secure high-encryption SSL.
  • One time password (OTPG) registration technology
  • General announcements and health advisories
  • Patient Demographics
  • Lab Results with statistics, target ranges and
    dynamic graphing for AIC, INR, Lipids
  • E-Mail Notification of new lab results
  • Integrated with Interior Health's E-Medical
    Library for patient access to reliable medical
    resources.

99
ePatient portal
  • Only in one area
  • limited uptake to date
  • Not highly supported by MDs
  • 9 participating
  • only 4 promoting
  • only 3 with patients
  • Slow dissemination planned

100
Telehealth initiatives
  • CHF patient monitoring in conjunction with BC
    Nurseline
  • Wound care via Internet transferred digital
    photos
  • PACS

101
Valley Medical Diabetes Project
  • Private lab
  • Recall system for A1C and routine prescribed lab
    testing for diabetics based on Canadian
    guidelines
  • Started small in Central Okanagan,now available
    to most docs.
  • Patients notified of results.

102
eLibrary
  • Accessible by all health care workers and all
    residents who have registered into Meditech
    system
  • Access to reference materials, search engines,
    some journals.
  • Also health care professional access to journal
    on-line libraries.
  • Utilization dwindling?
  • journal access for health care workers
  • more Internet information readily available
  • may close portal in near future.

103
e- medical library
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