POSP Overview A Joint Initiative Alberta Health & Wellness – Alberta Medical Association Joint Vendor Session October 3, 2003.

POSP Overview

A Joint Initiative

Alberta Health & Wellness – Alberta Medical Association

Joint Vendor SessionOctober 3, 2003

AgendaAgenda

POSP vision & context background Phase 1 results change management Phase 2 critical success factors

POSP visionPOSP vision

“To establish a physician office information infrastructure that is integrated with the health information system and support development of an electronically-enabled information management culture within the physician community.”

Electronic health record

Physician office system:

Electronic medical recordIntegrated decision support

BillingSchedulingOffice productivity tools

Stand-alone information sources:LabsPharmaciesRadiologists

= Interface

Regional clinical systems - acute:MPI/ADTLabPharmacyERRadiologyHome careImmunizationSpeech Pathology

POSP and the “EHR”POSP and the “EHR”

Regional clinical systems – sub-acute and continuing care:Continuing care delivery systems, including case management, care protocols, clinical data and reports

Client/patient surveys

POSP…POSP… joint initiative of the Alberta Medical Association

and Alberta Health & Wellness provides three types of assistance to the

physician: financial assistance to defray the cost of

hardware/software information technology services change management services

targets improvement in products, services and business models

launched October 1, 2001 physicians enrolled as of March 31, 2003

will continue to be supported until March 31, 2005

future beyond 2005 to be determined through AMA/AH&W negotiations

planning “full steam ahead” for “Phase 2” & still accepting applications

POSP…POSP…

GovernanceGovernance

EvaluationHoward Research

POSPSubcommittee

Program DirectorProgram SupportAdmin. Assistant

Communications Standards, Infrastructure & Program Support

Change Management

AMA AH&W

Program Management Office

Finance Cttee.

POSP results to date...POSP results to date... 1,550 physician participants (Level 1 – 275; Level

2 – 1,275) standing offers for physician office system vendors

developed (1st in Canada); “2nd round” of requirements definition complete (VCUR)…a first in Canada physician led; 5 stakeholder groups national and regional participation

POS to POS interface feasibility study completed download of patient demographic data negotiated standing offers for Microsoft and Dell negotiated

POSP results to date…POSP results to date…

communications strategy and products developed external evaluation ongoing, first reports issued “first of its kind” change management program

general contractor model web-based tools (POSP Software Lab, electronic

“doctors’ lounge”) communication and knowledge products workshops (computer literacy, decision support, change

management, privacy impact assessments…) on-site consultations

What we’ve learned…What we’ve learned… this is a culture change, not an IM/IT project

face-to-face physicians out in front as owners

collaboration is key vendors health system stakeholders

PMO a critical success factor evaluation necessary but limited use in early

stages communication/understanding is the biggest

challenge

Change mgmt. delivery modelChange mgmt. delivery modelPOSP Program Director

Program SupportAdmin. Assistant

Standards, Infrastructure &

Program Support

CommunicationsChange ManagementManager

Shirley Leonard

AdvisorShelley McNeil

Expert Field Resources

Expert Field Resources

Expert Field Resources

Expert Field Resources

Sub-contractedExpert Field Resources

Sub-contractedExpert Field Resources

Sub-contractedExpert Field Resources

Sub-contractedExpert Field Resources

Advisor Ann Marie Barnhill

What we did (Phase 1)What we did (Phase 1) provided 289 on-site services to 736 POSP physicians in

165 clinics, including technology assessments, PIAs, workflow analysis, team building, readiness assessments

conducted 25 workshops with a total of 317 participants on computer literacy, PIAs, contract management, change mgmt., use of electronic decision support

facilitated 22 dispute resolutions developed and delivered a broad range of paper tools for

physicians and clinic staff developed several templates to be used by field

resources to standardize service delivery developed and provided web-based tools (Software Lab,

Doctors’ Lounge)

Site services…Site services…

Template Service Provider Delivery

Examples

Readiness Assessment Yes business analyst Current state of technical knowledge, automation, work flow etc.

Work flow analysis Yes business analyst Current and projected work flow diagramming

Technology assessment (pre-application selection)

Yes technical analyst Current state of technology on-site prior to selecting an application

Technology assessment (post-application selection)

Yes technical analyst Technology gap analysis between what is and what is required

Individual consultations No specialists HR, PIA, facilitation project manager

Clinic specific offerings No facilitators On-site work shopcustomized planning session

Post-implementation review

InDevelopment

project manager Identification of any shortfalls in the go-forward activities and maximization of automation use

Lessons LearnedLessons Learned delivery model (POSP acting as contractor, use of

private sector sub-contractors located in the physicians’ communities) is the right one flexible ensures consistency, quality captures learnings cost-effective

need to make much greater use of physicians as mentors, demo providers, field resources and marketing agents

need to increase the marketing of Change Management services to ensure that physicians understand what is available to them and how they can access services and products

need to develop a comprehensive training strategy for POSP

Lessons LearnedLessons Learned training and ongoing physician evaluation of field

resources is key to providing best practice services the vendor dispute process works well but we need to

find ways to reduce the number of disputes need to find more effective ways of helping physicians

through the procurement phase need to prepare physicians for HIA compliance as they

procure and implement their POS to avoid having physicians using the majority of their Change Management entitlement on PIA completion

Phase 2 work planPhase 2 work plan

develop a marketing plan to increase awareness about change management allocations and services

focus on face-to-face communication in traditional physician venues

publicize the matrix of services with standard time allotments/costs so physicians can better determine what services and products they can acquire through their Change Management funding

coordinate with Alberta Wellnet, regions

Marketing

Phase 2 work plan

form Physician Advisory Group for Change Management wind-up Phase 1 “regional champions” role and replace

with: physician mentors physician field resources

identify “demo clinics” which physicians can visit to see automation in use

involve physicians in Change Management marketing

Involve physicians

Phase 2 work planPhase 2 work plan

with other stakeholders (regions, Alberta Wellnet, CPSA, universities) develop a framework for training re: use of information technology in a clinical context; conduct gap analysis and address

determine the scope of training and identify delivery mechanisms (CME depts., web-based training, workshops, other) for POSP

work more closely with CME departments to get credits granted for training offerings to provide further incentive for physicians to participate

Develop comprehensive training program

POSP Phase 2POSP Phase 2 outreach to physician community a significant

and ongoing Program activity strategic investment in “value add” information

technology initiatives for physicians POS to POS transfer of patient information DI (potential)

revise outcomes for POSP participants implement VCUR new emphasis on getting POSP out to the

physician offices 4 visits, over and above services from field resources

Phase 2 “milestones”Phase 2 “milestones”

Physician outreach activities (ongoing)

Application

Intake

Service Agreement

Enrollment Implement’n PhysicianDeclaration

Post-implementation

reviewEHR readiness

assessment

Automation readiness

assessment

= site visit = physician submitted

form

3-way meeting (POSP, vendor, physician)

Interplay of POSP intake & EHR Interplay of POSP intake & EHR roll-outroll-out

Physician Applies to

POSP

POSP readiness

assessment

EHRIAG priority setting

process

POSP selection process (sections, LCPI, new grads, EHR targets, etc.)

POSP intake

Information flows to EHRIAG

Critical success factorsCritical success factors system-to-system integration (EMR/EHR) lab results delivery data stewardship/information exchange

protocols privacy/security

privacy impact assessments a requirement under the Health Information Act

early physician compliance “slow” POSP working closely with Office of Information &

Privacy Commissioner (OIPC) gap analysis conducted (Mar/03) of all participating

clinics; follow up complete

Questions?Questions?

VCUR Conformance Testing OverviewVCUR Conformance Testing Overview

EHR Interfaces: e.g. PIN, Person Directory etc.

Core VCUR 2004 Requirements: e.g. EMR, Security etc.

‘Independent’ Conformance Testing Agent

Third-party Interfaces:e.g. Billing, Laboratory Test

Results Delivery etc.

POS Vendors

Third-PartyLetter

Third-PartyLetter

Testing

AlbertaWellnet

POSP Third-partyOrganization

EHR Interoperability Conformance Status Letter

EHR Interoperability

Conformance Status Letter