PITO has created several new programs to support the needs of specialists (in general, or individual specialties and sub-specialties). These programs are designed to respond to varying requirements by type of specialty (e.g. surgical, medical consultant, pediatrics, psychiatry, ophthalmology) and practice setting (e.g. community private office, hospital-based ambulatory practice).
Program summaries and details are provided below for each of the following programs:
Alternative Specialist Funding Program
With the assistance of a wide group of BC specialists from every specialty and major sub-specialty, PITO has conducted a comprehensive review of specialist requirements for EMR and technology. The findings demonstrate widely varying needs between specialty types such as surgery, medical consultants, pediatrics, psychiatry and ophthalmology (see BCMJ May 2009 and October 2009). They also show the graduated scale of EMR use, ranging from those using 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.
The Alternative Specialist Funding Program is available to:
Detailed documentation can be found in the Document Library.
Template Development Program
One of the greatest barriers to adoption and effective use of EMRs by specialists has traditionally been the cost and time required to develop clinical documentation, referral and requisition templates specific to their specialty or sub-specialty.
The Template Development Program supports groups of physicians who wish to add additional functionality to their EMRs by creating custom clinical data entry tools and/or the ability to electronically generate complex organization-specific requisitions (e.g. OR booking).
Funding is available for both large and small groups of physicians to design and develop templates for common use. The template program is vendor neutral, with funding to support physicians in defining the template itself, and separate funding available to reimburse physician costs to have their EMR vendor add that template to the EMR.
Geographic Communities of Practice
Many specialist physicians practicing in defined geographic communities, particularly smaller cities or towns in rural areas, are working closely with their GP colleagues to enhance continuity of care by participating in the Community of Practice (COP) program. Through the COP program, GPs and specialists in a community implement the same EMR program to create opportunities for enhanced electronic referrals and data exchange, and local physician user groups.
There are active Communities of Practice throughout BC in communities such as the Cowichan Valley, Richmond, Maple Ridge, Mission, Squamish, Kootenay-Boundary, White Rock, South Okanagan, Kamloops, Powell River, and Salmon Arm.
Specialty-Specific Communities of Practice
COPs may be specific to an individual specialty across a wider geographic area, usually across a health region or the province. Like geographic COPs, specialty-specific COPs select the same EMR for use within their group. Their interests tend to be in enhancing opportunities for template development, customization, training, research, etc.
Hospital (Health Authority) Interfacing
Many of the EMR/IT requirements unique to specialists relate less to the EMR itself and more to the interactions specialists have with hospitals and health authorities.
PITO is working on behalf of physicians with the five geographic health authorities and the Provincial Health Services Authority (PHSA) on important interface points including:
PITO is also supporting several physicians and their local health authorities and hospitals in considering situations where the physician practice is particularly integrated with the operations of the hospital, and both the physician and hospital are interested in finding a common solution that will align IT systems, particularly EMR.
eReferral
Many specialists cite the ability to receive electronic referrals and return electronic consult notes as a critical factor in making the change to electronic medical records.
Communities of Practice have been pilot testing eReferral capabilities within their chosen EMR solution, with very positive feedback.
These solutions go far beyond sending a letter back and forth. Instead, they allow GPs to attach relevant data and alerts to the referral, which the specialist can import into their EMR to pre-populate their medication list, problem list, allergies, and lab results. This eases the data entry burden on the specialist, and encourages them to enter new diagnoses, allergies and prescriptions which can then be sent back to the GP attached to the consult note to update the patient’s longitudinal chart.
In parallel, efforts are underway to establish the necessary standards so that disparate EMR programs can send and receive referrals and consults and transfer associated structured data.
Unique Integration and Documentation Requirements
Extensive consultation and assessment has shown that the underlying EMR requirements of most specialists are the same. Through flexible template tools, the unique documentation needs of individual specialties can be effectively met.
A very few specialties make far greater use of diagnostic and other devices within the office setting, and make more extensive use of templates and drawing tools in their clinical documentation.
The most intensive regarding all three of these characteristics is Ophthalmology. PITO is working with the BC Society of Eye Physicians and Surgeons (BCSEPS) and a joint working group of Ophthalmologists to define the unique requirements.