2018-11-20

When does Clinical System Design stop?

The enthusiasm, energy and productivity of Area Councils (AC) and Specialty Workgroups (SWG) continues to amaze us. Alberta Health Services (AHS) witnesses extraordinary collaboration, reduction of unhelpful variation and informational integration. Indeed, more important than any clinical information system (CIS) configuration may be the principles, relationships, and processes learned through clinical system design (CSD). Growing new ways of designing and optimizing clinical content (documentation, decision and inquiry supports) helps AHS mature as a learning healthcare organization.

ACs and SWGs understand that essential specialty CSD should wrap up as 2018 comes to a close, leaving January 2019 for unfinished or deferred issues. All specialty CSD decisions need to be recorded by a hard deadline of February 8, 2019. This milestone is critical to readying the CIS for testing and training.

So, if specialty CSD must deliver by February 8, 2019 and the value of specialty CSD is as an enduring process, then what becomes of CSD once testing and training start? The short answer is that CSD continues indefinitely. It must. There is no other way to ensure that the CIS grows with AHS, both helping AHS to learn and optimizing what works best.

Appreciating that CSD is a core Connect Care activity, today’s time-boxed work just gets us to a starting line. It allows a basic CIS to be built; enough to illustrate the value of CSD and to teach skills for meaningful use.

The really valuable CSD work begins once the CIS is deployed. Accordingly, we have begun planning systematic processes for tackling all the “parking lot” issues left over from CSD build; and anticipating all the new needs arising post-launch. The appetite for new uses of CSD tools will be great, priorities must be set and design capacity must continue to grow.

2018-11-19

In-System Inquiry guided by the Clinical Improvement Lifecycle

We've previously posted about how Connect Care in-system inquiry tools can help AHS grow as a learning healthcare organization.

Key characteristics of a health system that can learn include:

  • Every patient’s characteristics and experience are available for study
  • Best practice knowledge is immediately available to support decisions
  • Improvement is continuous through ongoing study (closed loop)Inquiry happens routinely and economically
  • Curiosity and inquiry is valued and embedded in organizational culture
Connect Care in-system reporting and analytics tools will provide AHS staff with the ability to create and use real time data about patients, populations and the health system as a whole. This data can then be transformed into information that guides evidence-informed decisions in service of continuous clinical improvement.

Clinical information system (CIS) facilitated clinical improvement emulates continuous quality improvement lifecycles. Today’s internal and external evidence generates tomorrow’s ideas which are then critically examined to evaluate the impact of the change and stimulate ideas for further clinical improvement. A simple clinical improvement lifecycle can help guide Connect Care planning for in-system inquiry.

2018-11-18

What level of in-system inquiry maturity do we need?

As part of Reporting Content Review, Alberta Health Services (AHS) analysts help clinical information system (CIS) users design reports, dashboards and visualizations that will be deployed through self-serve, in-system, analytics tools supporting decision making. The possibilities are limitless... early configuration work is intimidating to say the least.

It can help to envision a stepwise progression towards the reporting maturity AHS needs to attain HIMSS Level 6 and 7 recognition. Early in-system reports, dashboards and visualizations should focus on gaining insight about user on-boarding and adoption. Soon, data becomes available to support tracking minimum acceptable CIS use. Once use is solid, attention can shift to indicators of meaningful use and charting quality. Thereafter, gaining insight from internal evidence about health processes and outcomes becomes possible. Appreciating this can help prioritization of in-system reporting capabilities for launch and the months that follow.

2018-11-17

How does Connect Care align with AHS strategic analytic priorities?

The Strategy for Research, Innovation and Analytics (RIA) lays out Alberta Health Services (AHS) roadmap for becoming an organization skilled at helping its people create, acquire and transfer knowledge to raise the standard of healthcare delivered to all Albertans. Connect Care is a key enabler. The Connect Care clinical information system (CIS) promotes curiosity, inquiry and research with in-system tools for data exploration, practice surveillance and hypothesis testing.

Connect Care aligns directly with the AHS RIA Roadmap by:
  • Making real time data available to care providers and managers
  • Providing front end access to analytics tools
  • Building analytics literacy and frontline interpretive capacity
  • Stimulating curiosity and question formulation
  • Providing effective ways to capture, translate and apply knowledge at the point of care
  • Allowing innovation in care to be introduced with changes in behavior and outcomes measured in real time
AHS builds improvement capacity in the workforce by allowing it to use its own data and identify opportunities to improve; where improvement is about the experience of healthcare as much as patient, organizational and system outcomes.

2018-11-16

What is a learning healthcare organization?

A Learning Healthcare System is a system in which, "science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience."
Learning healthcare organizations demonstrate both an ability to use 'external evidence' (arising from the study of populations other than one's own) and an ability to use 'internal evidence' (about what works best in one's own context).  They use this evidence to generate hypotheses, strategically apply change to clinical and operational practices and evaluate the impact of the change on outcomes and behaviours. Characteristics of a health system that can learn include:
  • Every patient's characteristics and experience are available for study
  • Best practice knowledge is immediately available to support decisions
  • Improvement is continuous through ongoing study (closed loop)
  • Inquiry happens routinely and economically
  • Curiosity and inquiry is valued and embedded in organizational culture
Connect Care in-system reporting and analytics tools will provide AHS staff and stakeholders with the ability to create and use real time data about patients, populations and the health system as a whole.  This data can then be transformed into information that guides evidence-informed decisions in service of continuous clinical improvement.

2018-11-15

Understanding Connect Care Reporting Tools

Connect Care Area Councils and Specialty Workgroups have begun a new stream of ​specialty clinical system design (CSD) work focusing on 'Reporting Content Review'. The work is covered in detail in the CSD updates blog.

For those not involved in CSD activities, this is still a good time to learn a little of the language and opportunity associated with powerful in-system inquiry support tools to be made available to users.

2018-11-14

Mackenzie Health Excels with Epic

It is encouraging to witness successes of other Canadian Epic clients.

Mackenzie Health (Toronto GMA in Ontario) launched just over a year ago, summer of 2017. They have since attained stage 6/7 in most areas and now have reached the coveted 7/7 EMRAM recognition in ER and ICU.

2018-11-13

Connect Care Physician Area Trainers

We have previously posted about Connect Care Provincial Physician Trainers (PPTs) and are thrilled to be screening a number of excellent applicants for these formal physician roles. New PPTs already progress through clinical information system (CIS) and curriculum courses and certifications. A few months from now, recruitment begins for the Area Physician Trainers (APTs) who will focus on the needs of specific clinical areas and specialties under the guidance of PPTs.

Prescriber training is facilitated by prescribers wherever possible. APTs fan out to make this possible across specialties and geographies. They support power users and super users (see informal physician contributions) while also directly helping Connect Care users through the launch and personalization stages of implementation (starting just under a year from now!).

The CMIO office will work with AHS Zones to determine the number of APTs required for successful launch. The APT cohort may include trainers who focus on a few specialties while others focus more on a few waves. Our current APT need estimates range from 25-30 per wave.

Further collaboration and planning with AHS zones will bring precision to the APT plan. Nonetheless, the time is right to think about persons who may be well suited to this role.

2018-11-12

Prescriber Training Primer

We have previously described Connect Care's training strategy for prescribers (including physicians).

Work is progressing well. An recent consultation with provincial medical leaders allowed validation of key principles and processes.

A new backgrounder provides an orientation to the emerging Connect Care Prescriber Training Program:

2018-11-11

Results & Reports Routing Workgroup Formed

A key Connect Care deliverable is de-fragmentation of AHS-managed health information flows. This includes “closed loop” results and report routing, where investigations and interventions are tracked from ordering to action, with verified delivery of the right information to the right person. Achieving informational continuity within AHS is essential. In addition, the right information needs to be routed to, received by and attested to by practitioners using non-AHS legal records of care.

Again, we have a complex area impacting diverse groups. Accordingly, a workgroup reporting to the Connect Care Portals Committee (which has multi-stakeholder connections) has started work. This will affect both configuration and change management. Sid Viner and Dominic Order co-chair, again with good clinician representation. Query cmio@ahs.ca as needed.