1 / 81

ASSIST (Harrogate, Preston) October 1 & 2, 2003

Local Clinician Involvement in Clinical Information Systems: Necessity or Luxury – A Review of International Experiences. ASSIST (Harrogate, Preston) October 1 & 2, 2003. Questions to be discussed. Is it important to solicit meaningful physician input early and often and act upon it?

afya
Download Presentation

ASSIST (Harrogate, Preston) October 1 & 2, 2003

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Local Clinician Involvement in Clinical Information Systems:Necessity or Luxury – A Review of International Experiences ASSIST (Harrogate, Preston) October 1 & 2, 2003 Denis Protti - University of Victoria

  2. Questions to be discussed • Is it important to solicit meaningful physician input early and often and act upon it? • Does finding meaningful ways to engage physicians require creating an organizational climate and culture that respects the heart of medicine? • Is this the key to maintaining physician loyalty and involvement? Denis Protti - University of Victoria

  3. Some management teams believe that ideas should be well fleshed out and ready for implementation before discussing them with physicians. • When that occurs, do physicians feel their input is actually sought? • And if they recommend changes at that point, will it be difficult for management to retreat and follow another course of action? Denis Protti - University of Victoria

  4. How can one best square the need for centralised/standardised policy with getting local support and use? • Does the opinion of national clinical bodies matter? Denis Protti - University of Victoria

  5. Outline • The Danish Experience • The New Zealand Experience • An American Experience • The British Experience • NPfIT – Clinicians Involved? Denis Protti - University of Victoria

  6. The challenge of being an afternoon speaker Denis Protti - University of Victoria

  7. Outline • The Danish Experience • The New Zealand Experience • An American Experience • The British Experience • NPfIT – Clinicians Involved? Denis Protti - University of Victoria

  8. EPR in Danish Hospitals • 11/14 counties have an IT strategy for the health care sector. • As of 2001, there were a total of 52 EPR projects in the country. • The projects were in different phases and were controlled on different levels • Between 5% and 10% of all beds in Danish hospitals are covered by an EPR system. Denis Protti - University of Victoria

  9. What’s most interesting about Denmark is MedCom Denis Protti - University of Victoria

  10. Pre-MedCom • Late ’80s • A GP who also worked P/T in hospital biochemistry lab • Chief pathologist at the hospital • Head of IT in the county • Proposed a project for Funen County IT strategy • Electronically transmitting lab results Denis Protti - University of Victoria

  11. MedCom Today • Over 90% of 2000 GP clinics/practices are computerized • 86% use their computers to send and receive clinical EDI messages • 10% of non-users • Those who will retire in next 3 years • Those just starting without the capital (1-2 year delay) Denis Protti - University of Victoria

  12. MedCom Facts • Used by ¾ of the healthcare sector • >2,500 different organisations • All hospitals, all pharmacies, all laboratories and ~1,800 general practices take part • ~Two million messages a month are exchanged (over 60% of the total communication in the primary sector) Denis Protti - University of Victoria

  13. MedCom Facts (cont’d) Denis Protti - University of Victoria

  14. MedCom Facts (cont’d) • MedCom’s standardised messages implemented in 50 IT systems, including: • 16 doctor systems • 12 laboratory systems • 9 hospital systems • 4 pharmacy systems Denis Protti - University of Victoria

  15. MedCom Facts (cont’d) • Physicians pay for their own systems • Upcoming agreement with County Association and the PLO will mandate electronic communication • Specialists use of computers range from 40-90% depending on the county with their use of EDI clinical messages ranging from 15-70% Denis Protti - University of Victoria

  16. MedCom funders • 1/3 from Ministry of Health • 1/3 from County Association • 1/3 from Other Sources • Ministry of Social Services (recently) • Danish Doctors Association (early on only) • Dan NET • Danish Pharmacy Association Denis Protti - University of Victoria

  17. Seven Driving Forces • Communication benefits of MedCom • Improves dialog with hospitals • use to wait 5 days for results of tests (now almost as soon as it comes off the equipment) • Automatically notified when patient registered in an Emergency department • Discharge summaries now arrive within 1-3 days (use to be 4+ weeks) – standard set by Counties Denis Protti - University of Victoria

  18. Driving Forces (cont’d) • Out of Office Hours (OOH) system mandated • Started 1997 • GP available from 1600 - 0800 hours (could be up to 3 GPs present) • ~30 across the country – some based at hospitals • Negotiated by PLO and County Association • GPs doctors had to learn how to use a computer if they wanted to be paid Denis Protti - University of Victoria

  19. Driving Factors (cont’d) • Peer influence – collegial pressure • GPs go to see each others computers • PLO wrote conversion software to facilitate the transfer of patient data from one GP to another • Access to the Internet (2-3 times/day) • e.g. waiting times for x-rays for all clinics in Funen County • can see what procedures are done at each clinic • can decide with patient where they should go Denis Protti - University of Victoria

  20. Driving Factors (cont’d) • County Support • Provides GP with a diskette of all their patients when first starting (been doing since 1992) • Training done by data consultant – visit practice regularly • Help desk • Practioner coordinator for each specialty (psychiatry, general surgery, etc.) • Works 2 hours/month • Coordinates wishes of GPs to hospitals and vice-versa • IT agenda moved forward through them Denis Protti - University of Victoria

  21. Driving Factors (cont’d) 7. Standards set by MedCom • Contract signed with Counties and PLO obliging everyone to use them • Clinicians and vendors involved! • MedCom tests and certifies vendor systems • Steering committee of paying agencies meets every 3 months to review compliance data Denis Protti - University of Victoria

  22. The Danish GPs are so automated that Denis Protti - University of Victoria

  23. Outline • The Danish Experience • The New Zealand Experience • An American Experience • The British Experience • NPfIT – Clinicians Involved? Denis Protti - University of Victoria

  24. Denis Protti - University of Victoria

  25. New Zealand Facts • Over 95% of GP offices are using one of nine Practice Management Systems • 75% use their systems to electronically send and receive clinical messages such as laboratory results, radiology results, discharge letters, referrals, delivery of age-sex registers to their IPA/PHO, etc. • ~ 50% of GPs now use the Internet on a regular basis from their offices - including communicating with their patients. Denis Protti - University of Victoria

  26. New Zealand Facts (cont’d) • Specialists use of computers range from 30-90% depending on their region. The private specialist use of a full EMR is limited to 15-20%. • Like the Danes, GPs increasingly favor referring patients to specialists who are able to send information back to them electronically. Denis Protti - University of Victoria

  27. AGPAL ACCREDITED 2,200 New Zealand sites 1,200 Australian sites 1-800 support across Australasia Denis Protti - University of Victoria

  28. New Zealand Facts (cont’d) • Used by 75% of all healthcare sector organizations in New Zealand. • All hospitals, radiology clinics, private laboratories • ~1,800 general practices. • > 600 specialists, physiotherapists, other allied health workers • Over 3 million messages a month are exchanged, • 95% of the communication in the primary health care sector. Denis Protti - University of Victoria

  29. Driving Forces in New Zealand • Unlike the Danish success story, HealthLink received no government funding to initiate the service and its growth and success is based entirely on the market model of “supply and demand”. Denis Protti - University of Victoria

  30. Driving Forces (cont’d) • The development of IPA’s (Independent Practitioner Associations) encouraged the uptake of information technology in primary care in New Zealand. • IPAs paid the costs for their member GPs to access the HealthLink network as part of their membership services. • HealthLink facilitated change by offering an “electronic claiming only” service for claims submission free of charge for the first 6 months. Denis Protti - University of Victoria

  31. Driving Forces (cont’d) • The past decade has also seen the emergence of the new position of “Practice Manager” within a physician general practice. • The Practice Manager has become a pivotal person to assist with the installation, management and training for any physician office system. • The Practice Manager responsibilities include financial management, IT and the human resource function in larger practices. Denis Protti - University of Victoria

  32. HealthLink increasingly used to assist with chronic diseasemanagement Denis Protti - University of Victoria

  33. As a result of these applications of information technology in primary care: • Child immunization rates went from 75% to 95%. • Control of diabetes improved – for patients with HbA1c higher than 9 pre-enrolment was 34% and this was reduced to 7% post-enrolment • There was an 80% reduction in wait time for statins for diabetes patients. • There was a reduction in acute admissions - this was running at 9% per annum. By 2002, the growth rate was reduced to near 0%. Denis Protti - University of Victoria

  34. New Zealand’s critical success factors • A national health identifier NHI • Early adoption of HL7 • Development and acceptance of the 1993 Privacy Act and the 1994 Health Information Privacy Code along with “practical” implementation of these • Mandatory electronic claiming for GMS (government subsidies for GP care) • Collaboration with private and public organizations • Multi-vendor co-operation and understanding of the business opportunities Denis Protti - University of Victoria

  35. NZ critical success factors (cont’d) • Healthlink’s strategy has always been to work very closely with primary care physicians • to stay close to them and to support them. • HealthLink is intricately and comprehensively tied to the GPs • “like the parmesan in the spaghetti is how one observer described it”. Denis Protti - University of Victoria

  36. An interesting aside • At one stage the New Zealand Government spent several millions of dollars on an alternative product “The Health Intranet of New Zealand”. • This failed at the point where they tried to connect the Intranet to General Practice computer systems. • The GPs were very unhappy to let government representative agents touch their computers – making the Health Intranet impossible to implement on the ground. • The government agents had no understanding of how General Practice works Denis Protti - University of Victoria

  37. NZ critical success factors (cont’d) • HealthLink employs nurses to act in liaison roles with General Practice, and so provide direct contact with the GPs. • HealthLink provides a help desk that has become the GP’s first point of contact when requesting help with their EMRs - like the Danes. • HealthLink has also stayed very close to the GP system providers – again like the Danes. Denis Protti - University of Victoria

  38. NZ critical success factors (cont’d) • HealthLink spend a lot of effort on demonstrator and beta testing sites. • They also work closely with the physician EMR vendors to debate projects thoroughly at all stages – before during and after implementation. • Many of the HealthLink initiatives were a result of demand of the primary care physicians • e.g. discharge summary from hospitals, radiology test results (DI), orders (still in progress), delivery of claiming data – i.e. responding to market needs Denis Protti - University of Victoria

  39. The Kiwi docs are getting ready for Denis Protti - University of Victoria

  40. Outline • The Danish Experience • The New Zealand Experience • An American Experience • The British Experience • NPfIT – Clinicians Involved? Denis Protti - University of Victoria

  41. But first Selected observations from the American literature Denis Protti - University of Victoria

  42. “Much research has been done in an attempt to identify the key factors that predict EPR/EHR implementation success. Over 150 factors have been identified, but only two, top management support and user involvement are consistently associated with successful implementations.” Sittig D The Importance of Leadership in the Clinical Information System Implementation Process November 2001 http://www/informatics-review.com/thoughts/leadership Denis Protti - University of Victoria

  43. “Experience suggests several factors that may increase acceptance and use of clinical information systems by physicians. First, broad physician involvement in the selection and implementation of the system from the outset is essential. Systems with no real sponsorship from the medical staff are likely to fail.” Anderson J Increasing the Acceptance of Clinical Information Systems MD Computing; Jan-Feb; 16(1): 62-5; 1999 Denis Protti - University of Victoria

  44. “Clinician ‘buy-in’ will require that their involvement is substantial and real. The project team must have strong clinician representation from the outset and throughout the project, including the planning, implementation, and post-implementation phases. Clinicians need to believe that the decisions they make matter.”   Krall M Achieving Clinician Use and Acceptance of the Electronic Medical Record 1998 http://www.kaiserpermanente.org/medicine/permjournal/winter98pj/emr.html Denis Protti - University of Victoria

  45. “The need for physician involvement with clinical information systems has been advocated since the first installations in the 1960’s. Even though the initial systems were rather rudimentary, the systems that were backed by strong physician leadership have been able to evolve and develop into sophisticated tools as information technology has become integrated into all facets of clinical care.” Schneider M et al Physician Involvement in Clinical Systems—A Cost-Effective Investment HIMSS Proceedings, Session 125 2000 Denis Protti - University of Victoria

  46. Whether or not the CPR project leader is a physician, heavy involvement of physicians is common to all awardees, as members of both the CPR project staff and governing committees. Physicians with direct roles in the CPR efforts typically continue to devote at least some of their time to clinical practice, which appears to be important to retaining credibility with the medical staff. Metzger JB et al Lessons Learned from the Davies Program 2000 http://www.cpri-host.org/davies/nuggets.html Denis Protti - University of Victoria

  47. One Particularly Relevant American Experience • Kaiser Permanente (KP) is a not-for-profit group model HMO (Health Maintenance Organization) with headquarters in Oakland, California. • The organization is divided into regional service areas spanning the United States from Hawaii to the East Coast. • It has used a centralized organizational model for their business and information technology operations since 1997. • Kaiser has eight million members and 80,000 care-givers across all regions (2/3 in California). Denis Protti - University of Victoria

  48. The Kaiser Permanente Colorado Region’s CIS implementation began with 2 medical office pilot sites (80 physicians and 80,000 members) in 1997 and was successfully completed (500 additional physicians and 250,000 additional members) between March and October, 1998. • The region has achieved full CIS usage and has eliminated use of its paper records for all but archival purposes. Denis Protti - University of Victoria

  49. Kaiser’s research findings • 80 percent of the success of system implementations the size and complexity of KP-CIS is attributable to managing human factors. • Commitment from, and involvement of clinicians in the implementation of a project is of utmost importance. • Involvement is best achieved by soliciting active participation from both providers and staff from project initiation through project closure and beyond. • . Denis Protti - University of Victoria

  50. The KP approach • When Kaiser Permanente undertakes any project, the project leaders develop a series of Guiding Principles that provide direction during the entire project to the project team and to the larger KP community. • Once defined and accepted by executive management, these guiding principles are communicated throughout Kaiser Permanente. Denis Protti - University of Victoria

More Related