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Engaging Physicians….If I Knew Then What I Know

Now

COACH 2007Quebec City, Province of Quebec

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My objective today

Share experience Propose ‘next steps’ on the path

to transformation Stimulate discussion

1996 2000 2007

2015

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Pharmacists

Community MDs

Community DI

DIS

Registries

Lab Results History

MinistryLabs

RHAs

Lab results to community EMRs

DI text & other reports to community EMRs

Upload of dispensing information

HIAL

Portal

HIE

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Governance

Health SystemObjectives

EHR Governance Business

FunderProviders,

StakeholdersMinistry Regions Physicians

Physician Automation

Initiative

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Governance conclusions

Investing time to develop a shared vision and trust among health system stakeholders prior to launching a physician engagement strategy is desirable.

The physician automation initiative should be governed as part of the provincial/territorial iEHR governance structure.

The vision, mandate, outcomes and deliverables for a physician engagement initiative should be clearly articulated; performance relative to the outcomes should be part of regular reporting to the governance body and the outcomes, initiative design and delivery evaluated on a regular basis.

Responsibility for the physician automation initiative should be delegated to the provincial/territorial medical association.

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Funding

Physician automation should be paid for with public funds.

Physician automation should be funded by the public health system only as long as it is for regional health authorities and the Ministries of Health.

The same % of physicians should be funded as is the case for regional health authorities.

Either physician automation should be funded as part of iEHR infrastructure (rather than through the physician funding agreement) or it should be insulated from the ‘normal’ negotiating time horizon/upheavals.

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Approach A physician engagement initiative directed to the

entire physician community is likely to gain momentum more quickly than one limited to primary care.

Provision clinical data in the following order: EMR (integrated billing, scheduling, EMR), lab, drugs, DI, hospital/regional reports, referral/consultation.

Combination of view access and EMR-integrated data required.

Proficiency timeline is longer than you might expect. Start now while you work on the other elements of iEHR infrastructure.

Go slow with clinical decision support. You still need a scanning/document management

solution!

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Getting uptake Support from the medical Colleges is very helpful

in engaging physicians in the adoption and use of technology.

A physician-led outreach effort (combination of presentations and demo clinics) is a critical component of a physician engagement strategy (don’t bother with the ‘value proposition’).

Written communications should be clear and concise and use traditional physician-focused communication channels.

Be honest about the amount of ‘sweat equity’ required & that there will be ‘bumps in the road’.

Nothing works except face-to-face!

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Delivery Part of the ‘quid pro quo’ for funding & support

should be insistence on use of an ASP solution(s). Put physicians out front at all stages of

engagement: outreach, mentoring, and post-implementation reviews.

Where physicians operate in hospital/regional facilities, their IT support staff need to be engaged from the start.

Privacy and security are a journey! The physician community will need an IM/IT

support ‘entity’ in perpetuity (or until I retire, whichever comes first).

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Delivery

The physician engagement initiative should provide comprehensive support, including administration, communication, change management services and technical resources. Benchmark: 12% - !5% of total initiative

The culture of the delivery organization is an important factor in the success or failure of a physician engagement initiative.

Staffing model and skill sets required by such an organization will change over time…plan for this!

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Transition services Change management support is required at all

stages of the automation journey. Transition services should be developed for all

profile types (early adopters to late adopters) at the same time, since each practice which adopts technology can be expected to include the normal technology-adoption ‘bell curve’.

Relationship-based, personalized (‘high touch’) attention and support for physicians are key in promoting the use of information technology.

A combination of ‘required’ and ‘elective’ change management services is desirable. Be flexible in the design and delivery of services.

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Looking ahead

Figuring out what data to share and data standards

It’s a jungle out there!

National EMR requirements

Single conformance testing entity/process

Provincial release plans

Peer-to-peer network & feedback loop

Next generation ‘meta project’

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Summing up

We can’t afford to be dogmatic

Room for competing views, alternative approaches

May not be one ‘absolute’ right way

Even if there were….

Try, evaluate, adjust, share

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What physicians are sayingWhat physicians 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

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What physicians are sayingWhat physicians 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 physicians are sayingWhat physicians 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 physicians are sayingWhat physicians 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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What physicians are What physicians are sayingsaying

“I think we're stepping to a new level. We'll look at the patient differently than we ever have — more comprehensively.”

Dr Fraser Armstrong, Family Practitioner

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What physicians are What physicians are sayingsaying

“You can no longer say, 'I don't like computers.' Our patients are leading the way with questions about the Internet. They have said, 'Come along with us.'"

Dr Tim Kolotyluk, Family Practitioner

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ItsIts about people, not about people, not technology…technology…