Group Communication &

Point of Care Learning

David Topps

Medbiq 2009

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

Group calendaring

Team Sites and wikis

• Clinical Practice Guidelines

• Care pathways– Lots out there

– Whose do you use?

– Allowing for customisation

• Optimised for local factors

Team Sites and wikis

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

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…

Annoying as hell…

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?

Ticklers & Reminders

• Same click-through problem

• Story from Sarasota – removal of all warnings

Ticklers for needed actions

Find the right level of intrusiveness

Surprise Tickler

Screensaver

A Surprise Tickler

• Odd effect of Windows screensaver– Reminder that I am behind schedule

– Educational slide shows for patients

Instant Messaging

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?

IM Presence

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

Learning Rx in the EMR

Learning Rx in the EMR

Learning Rx in the EMR

Wrap-up

• Small changes

• Info overload– Sorry, that’s what I’ve just done to you!