Physician Engagement The POSP Experience

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Physician Engagement- The POSP Experience

• BC Health Information Professionals Society
• November 17, 2006

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Agenda

• Program overview
• Change management
• Results
• Key learnings
• Challenges
• Testimonials

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Program Overview
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Overview

• Launched October 1, 2001
• First of its kind in North America
• Tri-partite (AHW, 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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AHW
RHAs
Labs
Registries
PIN
Alberta Netcare
Lab Results History
Portal 2006
Capital Netcare
Upload of dispensing information
Lab results to community EMRs
HIE
Pharmacists
DI text other reports to community EMRs
Community DI
Community MDs
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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.
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Why? To support

• Improved patient care
• in the community
• in the regions
• through information exchange
• Professional development/knowledge management
• Practice management efficiencies

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Participation alternatives

• 3 levels of participation
• Level 1 computer in physicians 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

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POSP at a glance
Post Implementation Review (Completed after
6month declaration)
Intake (Starts funding clock)
Automation Readiness Assessment
PIAConsultation (Must be completed prior to go
live date)
Kick-off meeting (POSP, Vendor, Physician RHA)
EHRReadinessAssessment (AHW)
Ongoing Change Management and Outreach activities
Service Agreement (Must be received 30 days from
Intake)
Application
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
business process
site visit
physician submitted form
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Program management office
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Service delivery vs. admin.
POSP program management office
repository/coach/manager model
Benchmarks Repository 10 15
Repository/Coach 15 25 Repository/Coach/Manag
er 25 35
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Change Management Services
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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

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Delivery structure
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Required services

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

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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

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Business Requirements

• Purpose
• Documentation to support common understanding of
  clinics 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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Business Requirements

• Benefits
• Gives the clinic representative(s) confidence
  when speaking to the vendors regarding clinics
  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

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Business Requirements
SAMPLE
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Ergonomics

• 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

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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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ErgonomicsAreas of consideration

• Workersaccommodation for variations of size,
  strength, range of motion, and other physical
  characteristics
• Work Settingparts, tools, furniture, displays,
  and other physical objects used to accomplish
  work tasks
• Work Environmentclimate, lighting, noise,
  vibration, and other atmospheric conditions

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Ergonomics
SAMPLE
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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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Advanced Training

• 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)

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Technical Assessment

• Purpose
• Overview of clinics current technical status and
  recommendations for the clinics 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

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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.

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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

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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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Workflow

• 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

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Workflow Current Processes
SAMPLE
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Workflow Ideal Process
SAMPLE
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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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Dispute Resolution

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

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Program Results
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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

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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

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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 havent 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

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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?

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Automation progress
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Post-implementation reviews

• of Phase 1, Level 2 physicians visited in
  Round 1 (856) meeting program outcomes re use
  of technology is high (80)

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Post-implementation reviews - detail
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Physician rating of value
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Field resource assessment
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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

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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

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External evaluation (cont.)

• Office processes have changed (whos 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

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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

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Evaluators conclusions

• Keys to POSPs 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

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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)

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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

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Learnings
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Content

• Clinical operational value in stand-alone
  EMR.value increases exponentially with EHR
  content
• Prioritieslab, 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

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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

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Challenges
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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
• Wont 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 (gt1/3 of POSP
  participants) will hit the 48-month cap by
  November/06

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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

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Testimonials
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What the docs are saying
Now its 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
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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
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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
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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
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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
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Its about people, not technology
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Thank You!Mary Gibsonmarygibson_at_shaw.ca(780)4
66-2613