group communication & point of care learning david topps medbiq 2009
TRANSCRIPT
Who are we?
• Academic Family Health Team
• Northern Ontario
• New service delivery model
• Removes fee-for-service pressures
• Collaborative practice
• Collaborative learning
Key messagesKey messages
• Small changes make progressSmall changes make progress
• Information overloadInformation overload
Health care is a Team Pursuit
Change FatigueChange Fatigue
The remedy, say the experts, flies in the face of the revolutionary approach to change… be less preoccupied with large-scale transformation, and focus instead on small improvements.
• Nick Morgan, Harvard Business School, 2001
• http://hbswk.hbs.edu/item/2485.html
Team Sites and wikis
• Clinical Practice Guidelines
• Care pathways– Lots out there
– Whose do you use?
– Allowing for customisation
• Optimised for local factors
Email vs. RSS
– FHT for Practice blog
– portal or wiki as a separate daily task?
– Email overload vs. email as your life organiser
Dashboards & Widgets
• Associated with Business Intelligence– Another oxymoron?
• Heavily oriented towards financial
• Expensive
• Be careful what you measure– Sad example of NOSM metrics
• GIGO collection
• Dreadful display axes – actually misleading
Widgets
Dim stand_alone as Boolean
Dim useful as Boolean
IF stand_alone = True
THEN NOT useful
END IF
Widgets
• IF standalone THEN NOT useful– Need to integrate with EMR
• Who wants to type in parameters again into a Creatinine Clearance calculator? – the data is already there in the EMR
• Same challenge for PDA tools– Classic case call handover utility
• Often sought
• Sometimes downloaded
• Seldom used
Widget standards
• PoC group InfoButtons• Have defined some standards
• Will this help?
• Integrate with other programs• Which will require an interface standard
• But problems for EMR vendors
Problems for EMR vendors
• Add-ins– Tend to be clunky
– Expensive to maintain
– Not much influence on purchasing decision
• So why put in the investment?– Same challenge with the promises from most EMR
vendors about having a PDA interface
• So… don’t reinvent the interface
• Think what data you need to use/send/receive
Gadget Inspector
• Just being a Google Gadget is fashionable– But is not enough in itself to be other than
just cute
– For many things that are created, you would be better off with a link to a web page
Dashboard click-through
• Information fatigue
• Irrelevant information…– users quickly learn to ignore the messages
• Finding the optimum level– MS has been trying to find this for years
– Remember Clippit the paper clip?
A Surprise Tickler
• Odd effect of Windows screensaver– Reminder that I am behind schedule
– Educational slide shows for patients
Instant Messaging
• In-house system– Useful IF you are watching the screen
– Staff still mostly knock on the door• Odd, since this is more intrusive
• Explore the psych barriers here?
Presence systems
• Great for close-knit developer team– Extreme example in Learning Commons
– real-time video 24/7
• Physicians more independent – resistant to being “watched”
Electronic Learning Prescriptions
• Reminders better than paper system
• PDA version not integrated to patient
• Now using the EMR to do this