PITO has created several new programs to support the needs of specialists both in general and individual specialties and sub-specialties. These programs are designed to respond to the varying requirements by type of specialty (e.g. surgical, medical consultant, paediatrics, 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:
* Alternate Specialist Funding Program (NEW)
* Template Development Program
* Communities of Practice (Geographic)
* Communities of Practice (Specialty-specific)
* Hospital / Health Authority Interfacing
* Unique Integration and Documentation Requirements
NEW Alternative Specialist Funding Program
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, 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 physicians certified in one of the specialties defined by the Royal College of Physicians and Surgeons of Canada, and GPs who have completed a nationally accredited program in an area of specialization and approved by their local health authority for delivery of a specialized service or GPs practicing in a specialized group practice with specialist physicians (e.g. sports medicine, mental health and addictions).
The new program will be operational in September. Initial program details are provided in a PDF document. Further details will be posted on this web page in September.
* Alternative Specialist Funding Program Details
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
In addition to geographic COPs, 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:
* Interfacing of lab results from hospitals to EMRs
* Interfacing of imaging reports and hospital transcribed reports from hospitals to EMRs
* Access to the EMR from within the hospital
* Access to hospital information systems from the private office or home (remote access)
* Electronic preparation of OR booking forms from within the EMR
* Electronic preparation of diagnostic test requisitions from within the EMR
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 opportunities to better align the information technology solutions, particularly EMR, through a common solution.
eReferral
Many specialists cite the ability to receive electronic referrals and return electronic consult notes to be a critical factor for 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, these systems allow a GP 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, and 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.