Tuesday, July 07, 2009

Phase change

My moving date to the new office is August 22nd 2009. We are getting very busy with the many details that go into the move.

Informing everyone is very challenging. As soon as the date was set, we sent a letter to all the patients in the three practices in this office. I also periodically update my website (http://drgreiver.com), and we have the date and new address on our answering machine’s message.

We have been informed by eHealth Ontario that the new Internet connection will be ready on time; there will be several family practices, as well as the Family Health Team’s main clinical location (home office for Allied Health Professionals, program managers) all operating from the 7th floor at 240 Duncan Mill. About half of the physicians in the FHT are moving to the new office; all of us will be using the same EMR software, and all accessing the software remotely; there will be no server on the premises. My husband tells me that these days, many larger companies (including his) are distributed all over the place and no longer have a server with their corporate database on site; his is actually located in Cleveland. If you include all physicians moving in, Allied Health Professionals, support staff, medical students and Residents, we’ll have between 75 and 100 people accessing data remotely at the site. I hope we have a big enough connection for our size.

Our Family Health Team is actually fairly complex; it is composed of six smaller groups of family physicians (Family Health Networks or Family Health Organizations). Some of the groups had already chosen their EMR system before the formation of the FHT, which is why we ended up with two different systems. As well, some groups chose to transfer their software to the new provincial eHealth Ontario ASP server; my group had thought about it, but for reasons detailed earlier, decided to stay on our server at the hospital. Within our server, there are two groups, mine (with 14 physicians) and our sister Family Health Organization with 9 physicians. Even though we use the same server and the same database, we cannot share EMR data across our two groups.

17 colleagues in two different Family Health Organizations decided to go to the eHO ASP model, but as a single data base with shared data; they use the same EMR software as I do.

14 of my colleagues use another EMR software. Four are in one office as part of a FHO, with their server in the office. Ten physicians in a different FHO are dispersed and access a server located in one of the offices.

That makes 6 physician groups, two EMRs, 3 databases using one software application and two databases using a different software application. No wonder our Executive director is getting grey hairs! Even though we are now a mid-sized company as a FHT, our IT infrastructure does not make running programs in common very easy. In retrospect, I guess it may have been better to form Family Health Teams first, and then choose a common EMR and common database for all of us. However, primary care renewal initiatives happened at the same time as the EMR transformation, so things like this were bound to happen. We’re not the only FHT with this issue; a large FHT in Hamilton has 6 different EMRs. Maybe what will happen over time (perhaps a long period of time) is that we’ll eventually join our information in a single database (or maybe two databases, one for each EMR) so that we can actually run and track programs based on our actual data. I can’t imagine any mid-sized corporation not knowing how they are doing, and not having data for forecasting and planning purposes—and yet that is how we operate at the present time.

In any case, we are slowly starting to develop some Data Management skills in my group of 14; part of this is through participation in studies like CPCSSN, where we have a Data Manager to help us, part is through Quality Improvement collaboratives like QIIP. My practice has a Facilitator through QIIP, and she is helping us think about how to organize our data so it makes sense. There is no FHT Data Manager, which is a bit strange considering how much data we have.

For example, having some idea of what percentage of smokers are in our practices is useful if you want to think about planning a program for this. We have 9515 patients with data on smoking; of those, 1964 have been tagged as smokers (20%). I’m sure there are issues with inconsistent data entry, data errors, etc, but at least it is a start. We need to figure out how to identify patients who have no entry on smoking in their chart, and perhaps decide as a group to put a reminder or alert in the chart, so that the next clinician who sees that patient can ask them if they smoke or not.

As you can see, change in ongoing for me, for my practice Team, for my partners, and for our Allied Health Professionals. When I look at this ongoing diary, I guess one way to think about this is as a very slow motion train wreck. However, it does not feel like that to me at all; I prefer to think about it as a slow thaw towards a much more interesting state—ice to water. Phase change.