With electronic medical record (EMR) adoption now well underway in BC, the BCMA and Ministry of Health Services have agreed to introduce several new programs to enhance EMR adoption and support through the PITO Program.
Approximately 5,500 - 6,000 BC physicians are candidates to adopt an EMR, over 40% of which are now using an EMR. Around 3,700 of the potential EMR users are GPs and 2,000 are specialists. Adoption is now high amongst GPs working in larger groups (almost 90%) and in rural settings (almost 100% in rural Communities of Practice such as Salmon Arm and Powell River); however, adoption is still relatively low in smaller GP practices, walk-in clinics, and specialist offices (see BCMJ July/August 2010) where new PITO programs and support are now planned including the following:
Post-Implementation Support
With almost 2,500 physicians now using EMRs to some degree, focus is shifting toward ensuring the greatest positive impact on patient care and office operations. Just adopting the EMR is only the start. The real opportunity lies in using the EMR fully and effectively to support activities such as chronic disease management, prescribing, and complex care processes.
The PITO Steering Committee and the General Practice Services Committee (GPSC) have been collaborating on a new joint initiative to establish a Post Implementation Support program to be delivered in collaboration between PITO and the Practice Support Program.
This fall a series of pilot projects will occur across the province, ranging from using the EMR to support chronic disease management to prescribing, mental health care, and office workflow optimization. This new program will combine the enhanced capability provided by the EMRs with the practice support framework of the Practice Support Program to deliver assessments, learning modules and action period incentives, including peer support and advanced EMR training.
Following the pilot projects this fall, an expanded program will be considered for 2011.
Specialist Program
To expand adoption amongst specialists, PITO has established a new Specialist Strategy. The Specialist Strategy includes funding for specialty-specific Communities of Practice, development of standardized templates, and a new EMR adoption program called the Alternative Specialist Funding Program. The new Alternate Program is a first of its kind in Canada, creating a flexible model that can adapt to the various clinical needs and medical practice settings of specialists. The new model will support the needs of specialists ranging from psychiatry to surgery, and practice settings ranging from community offices to hospital-based practices.
With the assistance of a wide group of BC specialists from every specialty and major subspecialty, PITO has conducted a comprehensive review of specialist requirements for EMR and technology. The findings demonstrate the widely varying needs between specialty types such as surgery, medical consultants, paediatrics, psychiatry, ophthalmology (see BCMJ May 2009 and October 2009), and particularly the graduated scale of EMR use from those who use relatively narrow functionality (e.g. psychiatry, surgery) to those using relatively full and sophisticated functionality (e.g. rheumatology, ophthalmology).
Rather than the standard “Complete EMR Offering” normally funded through PITO, the Alternative Specialist Funding Program allows the specialist to define the level of adoption they wish to achieve for their practice. Funding is incremental to the level of adoption (“Meaningful Use”) the specialist chooses and is based on the clinical impact that level of EMR use can support (e.g improving chronic care, avoiding adverse medication events, improving continuity of care). Specialists must achieve their chosen level of Meaningful Use to receive the funding associated with that level, but may select the EMR, hardware, and network solutions of their choice in order to achieve that level of Meaningful Use. The EMR must be ASP hosted.
Specialists may choose to participate in either the existing program or the new Alternative Specialist Funding Program. Initial program information is available on the PITO website at http://www.pito.bc.ca/cms/programs/specialists or from your PITO Local Relationship Manager (see contact information). The new program and associated funding will be operational in mid to late September, but funding can be retroactive as far back as April 1, 2010 for those achieving the criteria for Meaningful Use prior to the launch of the program in the fall (physicians must apply by November to be eligible for retroactive funding). Physicians who have already applied for PITO funding do not need to reapply. Those who have not yet done so can apply any time at http://www.pito.bc.ca/about-pito/application-form.php. Applications will be processed in the order they are received.
Electronic Referral (eReferral)
PITO has assisted physicians in 14 communities across the province to establish Communities of Practice (CoPs). These CoPs provide a venue to further the physicians’ shared quality improvement goals, provide peer support in the adoption of EMR, and explore opportunities to enhance exchange of information to support continuity of care through the adoption of common EMRs. Many of these CoPs are now mirrored by a local Division of Family Practice and often share common physician leadership.
CoPs in South Okanagan and Powell River have been piloting sophisticated new eReferral capabilities with very positive feedback, and the Kootenay-Boundary CoP is preparing for the same. As the pilots wrap up, the eReferral capability is being expanded to other CoPs including Kamloops and Cowichan Valley.
Local Physician User Groups (PUGs) and Continuing Medical Education (CME)
Physician leadership and peer support is critical to successful EMR adoption. Where a CoP does not already exist, PITO and the Local Physician Champions are establishing local Physician User Groups to further support Peer leadership and collaboration. One important aspect of the PUGs is regular CME events that include education tailored to both those contemplating EMR and expert EMR users seeking advanced education on specific topics. The CME events are fully accredited for CME credits and led by physicians experienced in EMR adoption. One successful session has already been held in Kelowna, and several more are planned for the fall and winter in communities including Courtenay/Comox, Port Alberni, Victoria, Vancouver, Surrey, Abbotsford, Delta, and Cranbrook. These events will be listed on the PITO website at www.pito.bc.ca, or you can contact your Local Relationship Manager for more information.