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Presentation by Dr. Alan Brookstone delivered at the Singapore 2008 Health IT Summit

Veröffentlicht in: Gesundheit & Medizin, Karriere
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  1. 1. Alan Brookstone, MD eHealth Consultant Lead Physician Vancouver Coastal Health Primary Care IT Strategies The Physician Voice
  2. 2. What is the Physician Voice? <ul><li>The External Voice… </li></ul><ul><ul><li>Caregiver </li></ul></ul><ul><ul><li>Advocate </li></ul></ul><ul><ul><li>Advisor </li></ul></ul><ul><ul><li>Educator </li></ul></ul><ul><ul><li>Leader </li></ul></ul><ul><ul><li>Peer </li></ul></ul><ul><li>And the Inner Voice… </li></ul>
  3. 3. The Inner Voice <ul><li>What’s in it for me? </li></ul><ul><li>I have to be heard </li></ul><ul><li>What this means in terms of my local situation and my patients? </li></ul><ul><li>How do I protect my patient’s right to privacy? </li></ul><ul><li>How do I adopt technology without becoming overwhelmed? </li></ul>
  4. 5. Canada <ul><li>Area of Canada - 9,984,670 sq km </li></ul><ul><li>Population (2007) - 33.3 Million </li></ul><ul><li>Area of British Columbia - 944,735 sq km </li></ul><ul><li>Population (2008) - 4.1Million </li></ul><ul><li>Physicians (2006) - 8,635 </li></ul><ul><li>Area of Singapore - 692.7 sq km </li></ul><ul><li>Population (2007) - 4.6 Million </li></ul><ul><li>Physicians (2007) – 7,600 </li></ul>
  5. 6. Physician Characteristics <ul><li>Independent </li></ul><ul><li>Advocate for patient care </li></ul><ul><li>Many run small businesses </li></ul><ul><li>Appreciate the ‘Art’ as well as the ‘Science’ </li></ul><ul><li>How do physicians adopt and use technology in their practices? </li></ul>
  6. 7. Where do Physicians fit in the Big Picture of eHealth? <ul><li>Activity is currently taking place at multiple levels simultaneously </li></ul><ul><ul><li>Internationally </li></ul></ul><ul><ul><li>Nationally </li></ul></ul><ul><ul><li>Provincially </li></ul></ul><ul><ul><li>Regionally </li></ul></ul><ul><ul><ul><li>Primary care Renewal projects, Regional EHR </li></ul></ul></ul><ul><ul><li>Locally </li></ul></ul><ul><ul><ul><li>Clinical info systems in local hospitals, DI, labs etc. </li></ul></ul></ul><ul><ul><li>Private sector </li></ul></ul><ul><li>How do nations and physicians make good decisions regarding uptake and use of technology including EMRs? </li></ul>
  7. 9. The Environment is Changing <ul><li>Healthcare costs are rising at an unsustainable rate </li></ul><ul><li>Patient expectations are changing </li></ul><ul><li>Using EMR/EHR creates new opportunities but also new challenges </li></ul><ul><li>SUCCESS requires a team approach plus a Common Vision </li></ul><ul><ul><li>Government, Medical Associations, Funding Organizations Physicians, other clinical providers </li></ul></ul>
  8. 10. Primary Care Doctors’ Use of Electronic Patient Medical Records, 2006 Percent Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
  9. 11. Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians Commonwealth Fund study - Practice Use of Electronic Technology Percent reporting routine use of: AUS CAN GER NET NZ UK US Electronic ordering of tests 65 8 27 5 62 20 22 Electronic prescribing of medication 81 11 59 85 78 55 20 Electronic access to patients’ test results 76 27 34 78 90 84 48 Electronic access to patients’ hospital records 12 15 7 11 44 19 40
  10. 12. Source: 2007 Commonwealth Fund International Health Policy Survey Overall Views of the Health Care System in Seven Countries, 2007 Percent reported: AUS CAN GER NETH NZ UK US Only Minor Changes Needed 24 26 20 42 26 26 16 Fundamental Changes Needed 55 60 51 49 56 57 48 Rebuild Completely 18 12 27 9 17 15 34
  11. 13. Conceptual Cycle of ICT Adoption & Use by Physicians
  12. 14. What is an Electronic Medical Record? <ul><li>The EMR is a Provider Centric tool </li></ul><ul><li>Generally a physician will use this system with each and every patient encounter and will record detailed encounter information, some of which is sensitive and not appropriate to share with all other providers. </li></ul><ul><li>This is also the system where patient results, (e.g. laboratory, diagnostic imaging, and other reports ordered by a provider), are delivered to that provider's electronic in-box, (i.e. this information is &quot;pushed &quot; to the provider, negating the need for the provider to go out and seek it). </li></ul>
  13. 15. EMR Myths & Realities <ul><li>MYTH : If only we could find the ‘perfect’ Electronic Medical Record (EMR), everything would fall into place (‘killer app mentality’) </li></ul><ul><li>REALITY : EMRs are ‘mission critical’ applications that are required to work 100% of the time every 10 minutes in primary care. </li></ul><ul><li>Dr. Karim Keshavjee COMPETE Project - Hamilton Ontario </li></ul>
  14. 16. Goal: Patient Centric Shared Care SHARED CARE PLAN
  15. 17. The Keys to Success <ul><li>Belief in a common vision </li></ul><ul><li>Collaboration </li></ul><ul><li>Innovation </li></ul><ul><li>Common data standards </li></ul><ul><li>Staying the course </li></ul><ul><li>Leading peers by example </li></ul>
  16. 18. This is a Complex Process <ul><li>One size does not fit all </li></ul><ul><li>Business and clinical processes need to be facilitated between GPs and between GPs and Specialists e.g. Referrals </li></ul><ul><li>The Triangle of: </li></ul><ul><ul><li>People </li></ul></ul><ul><ul><li>Process </li></ul></ul><ul><ul><li>Technology </li></ul></ul>
  17. 19. Vendor Landscape Max Sys Medchart <ul><li>AB, NS, ON, NT </li></ul><ul><li>Nightingale </li></ul><ul><li>AB, ON </li></ul><ul><li>Jonoke </li></ul><ul><li>Practice Solutions </li></ul><ul><li>NS Only </li></ul><ul><li>Dymaxion </li></ul><ul><li>ON only </li></ul><ul><li>ABELsoft </li></ul><ul><li>AlphaGlobal IT </li></ul><ul><li>AssistMed </li></ul><ul><li>Asystar </li></ul><ul><li>Healthscreen </li></ul><ul><li>HTN </li></ul><ul><li>McMaster (Oscar) </li></ul><ul><li>Omni-Med </li></ul><ul><li>P&P Data Systems </li></ul><ul><li>PCI </li></ul><ul><li>York-Med </li></ul><ul><li>xwave </li></ul><ul><li>AB Only </li></ul><ul><li>Microquest </li></ul><ul><li>Optimed </li></ul><ul><li>TELIN </li></ul><ul><li>Cerner </li></ul><ul><li>CureMD </li></ul><ul><li>Deltaware </li></ul><ul><li>EPIC </li></ul><ul><li>Global Biometrics </li></ul><ul><li>IQMedX </li></ul><ul><li>KATSI </li></ul><ul><li>Logibec </li></ul><ul><li>Logiscels Info Data </li></ul><ul><li>LSS Data Systems </li></ul><ul><li>Max Sys </li></ul><ul><li>Medchart </li></ul><ul><li>MedOffIS </li></ul><ul><li>Medical Software Canada </li></ul><ul><li>MediPlus </li></ul><ul><li>Medware </li></ul><ul><li>Misys </li></ul><ul><li>Optimed </li></ul><ul><li>Purkinje </li></ul><ul><li>RISE </li></ul><ul><li>Scripnetics </li></ul>Provincial Certifications Non-Certified <ul><li>AB, BC, ON </li></ul><ul><li>CLINICARE </li></ul><ul><li>Wolf </li></ul><ul><li>BC Only </li></ul><ul><li>Intrahealth </li></ul><ul><li>Osler </li></ul><ul><li>AB, BC </li></ul><ul><li>EMIS </li></ul><ul><li>MedAccess </li></ul>Source: Branham Group
  18. 21. Amplifying the Physician Voice <ul><li>Communication </li></ul><ul><li>Collaboration </li></ul>
  19. 22. Physician Engagement Requires <ul><li>A structured mechanism to communicate and facilitate change </li></ul><ul><li>Identification, support and conversion of early adopters into… </li></ul><ul><li>Champions and Agents for ‘Spread’ within local communities </li></ul><ul><li>Involvement of care providers and support staff </li></ul>
  20. 23. To have an Effective Voice <ul><li>Need to understand </li></ul><ul><ul><li>Overall goals </li></ul></ul><ul><ul><li>Timelines </li></ul></ul><ul><ul><li>When it is appropriate to be involved </li></ul></ul>
  21. 24. Role of Communication <ul><li>During early technology adoption, communication is critical </li></ul><ul><li>Identify local needs </li></ul><ul><ul><li>Influenced by political, historical issues and local programs </li></ul></ul><ul><ul><li>Allow users to stratify themselves appropriately </li></ul></ul><ul><ul><li>Provide dynamic feedback to leadership to ensure programs effectively deployed </li></ul></ul>
  22. 25. VCH Physician Clinical IT Adoption Model
  23. 26. VCH - Physician User Groups (PUGs) <ul><li>Geographic, Departmental, Special Interest </li></ul><ul><li>Understanding of specific community needs </li></ul><ul><li>Required facilitation and support </li></ul><ul><li>Allowed communication through </li></ul><ul><ul><li>Face to face meetings </li></ul></ul><ul><ul><li>Virtually - Internet and email </li></ul></ul><ul><ul><li>Teach, learn or share </li></ul></ul><ul><li>Led by a respected peer </li></ul>
  24. 27. Physician User Groups <ul><li>Provided structure </li></ul><ul><li>Required an e-mail address </li></ul><ul><li>Allowed physicians to be passive observers until the time was right! </li></ul><ul><li>Allowed ‘disconnected’ physicians to reconnect with minimal risk </li></ul>
  25. 28. Function
  26. 30. Current - Provincial <ul><li>PITO – Physician Information Technology Office </li></ul><ul><li>Approximately 25 Physician User Groups led by respected peers </li></ul><ul><li>Peer-to-Peer network supported by funding from Canada Health Infoway </li></ul>
  27. 31. Collaboration <ul><li>Physicians need to get involved </li></ul><ul><li>Help guide solution and system design </li></ul>
  28. 33. The Physician Voice <ul><li>Without </li></ul><ul><ul><li>Support </li></ul></ul><ul><ul><li>An understanding of context </li></ul></ul><ul><ul><li>Belief in a future vision </li></ul></ul><ul><li>The inner voice dominates, and </li></ul><ul><li>The external voice is ineffective </li></ul><ul><li>“ Attitude is a little thing that makes a big difference” Sir Winston Churchill </li></ul>
  29. 34. Thank you <ul><li>Alan Brookstone, MD </li></ul><ul><li>[email_address] </li></ul>