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

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

3. POSP 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. ”

4. Electronic health record Physician office system: Electronic medical record Integrated decision support Billing Scheduling Office productivity tools Stand-alone information sources: Labs Pharmacies Radiologists = Interface Regional clinical systems - acute: MPI/ADT Lab Pharmacy ER Radiology Home care Immunization Speech Pathology 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

5. 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

6.  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…

7. Governance Evaluation Howard Research Evaluation Howard Research POSP Subcommittee POSP Subcommittee Program Director Program Support Admin. Assistant Program Director Program Support Admin. Assistant Communications Standards, Infrastructure & Program Support Change Management Change Management AMA AH&W Program Management Office Finance Cttee.

8. POSP results to date...  1,550 physician participants (Level 1 – 275; Level 2 – 1,275)  standing offers for physician office system vendors developed (1 st in Canada); “2 nd 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

9. 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

10. 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

11. Change mgmt. delivery model POSP Program Director Program Support Admin. Assistant POSP Program Director Program Support Admin. Assistant Standards, Infrastructure & Program Support Communications Change Management Manager Shirley Leonard Change Management Manager Shirley Leonard Advisor Shelley McNeil Advisor Shelley McNeil Expert Field Resources Expert Field Resources Expert Field Resources Expert Field Resources Expert Field Resources Expert Field Resources Expert Field Resources Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Sub-contracted Expert Field Resources Advisor Ann Marie Barnhill

12. 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)

13. Site services… TemplateService Provider Delivery Examples Readiness AssessmentYesbusiness analystCurrent state of technical knowledge, automation, work flow etc. Work flow analysisYesbusiness analystCurrent and projected work flow diagramming Technology assessment (pre-application selection) Yestechnical analystCurrent state of technology on-site prior to selecting an application Technology assessment (post-application selection) Yestechnical analystTechnology gap analysis between what is and what is required Individual consultationsNospecialistsHR, PIA, facilitation project manager Clinic specific offeringsNofacilitatorsOn-site work shop customized planning session Post-implementation review In Development project managerIdentification of any shortfalls in the go-forward activities and maximization of automation use

14. Lessons 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

15. Lessons 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

16. Phase 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

17. 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

18. Phase 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

19. POSP 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

20. Phase 2 “milestones” Physician outreach activities (ongoing) Application Intake Service Agreement EnrollmentImplement’nPhysician Declaration Post- implementation review EHR readiness assessment Automation readiness assessment = site visit = physician submitted form 3-way meeting (POSP, vendor, physician)

21. Interplay of POSP intake & EHR roll-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

22. Critical 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

23. Questions?

24. VCUR 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-Party Letter Third-Party Letter Testing Alberta Wellnet POSPThird-party Organization EHR Interoperability Conformance Status Letter