SOUTH WEST PRIMARY CARE ALLIANCE: OXFORD FEBRUARY 1, 2018

Sub Regional Clinical Lead: Dr. Jitin Sondhi Primary Care Alliance Co-Chair: Dr. Gerry Rowland

Agenda • Review of Previous Minutes

• Meeting scheduling • Review of SRIT • Partnering For Quality (Rachel LaBonte) • CEP Presentation (Brief Review) • Econsult (Shelley Brown: Canceled due to illness) • Regional Updates

• Funding for Diabetic Foot Ulcers • Virtual Visit

• What do we want in Oxford for education?

SRIT Overview • Priority Areas of Focus

• Improve access to inter-professional resources through collaboration and partnerships.

• Create a shared understanding of current initiatives and available programs and resources.

• Improve access to assisted living and supportive housing through knowledge transfer and accountability.

• Improve transitions for complex patients being discharged from hospital through system partnerships and collaboration.

• Webinars completed January 22nd and 23rd.

PARTNERING FOR QUALITY PROGRAM: Presentation to the Primary Care Alliance - Oxford February 1st, 2017 Presented by: Rachel LaBonte, Program Lead - Partnering for Quality

Partnering for Quality (PFQ) Program

PFQ is a Regional Program that supports a quality improvement approach to chronic disease management and prevention within all models of primary care with a focus on: o Effective and efficient use of Information Management (IM) and Information

Technology (IT)

o Facilitate practice efficiency/improvement by providing a variety of quality improvement supports

o Strengthening partnerships between system partners (Home and Community Care, cSWO, Diabetes Education Programs, Mental Health and Addictions etc.) and;

o Support patients in self-care by partnering with the South West Self-Management Program

Who are we?

Danielle Denomme – Quality Improvement Coach

Wendi Jerrett – Digital Health Coach

Lindsay Sleeth – Quality Improvement Coach (Feb 12th)

Kevin Newcombe – Digital Health Coach

Phil Dalton – Digital Health Coach (Feb 12th) Rachel LaBonte, Program Lead

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Digital Health & Data Quality

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

I use standards for codingdisease types and inputting

clinical data to my EMR

I use standardized texting toinput data to my EMR

I validate/audit data entry tomy EMR

My EMR does not offer this functionality

No - needs improvement No - no plan to use this feature for this purpose

Yes - needs improvement Yes - works well

Total % Using This Functionality

Insights:

• Focus group participants emphasized that they often do not have effective processes for standardizing nomenclature, applying diagnostic codes or auditing data quality.

• Participants identified inconsistent data entry as the greatest single barrier to using their EMRs’ reporting tools for CDPM, preventative care, and quality improvement.

40% 62% 61%

Partnering for Quality Program - Primary Care EMR Needs Assessment - 2014

Intermediate/Advanced EMR Functionality: Nomenclature Consistency & Data Quality Management

8 8

Some outcomes

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Some Outcomes

4/20/2017, 61%

5/5/2017, 62%

6/1/2017, 66%

7/6/2017, 68%

8/8/2017, 69%

9/18/2017, 73%

10/31/2017, 75%

12/11/2017, 76%

60%

62%

64%

66%

68%

70%

72%

74%

76%

78%

Documented Smoking Status

Documented

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What we do – our ‘menu’ at a glance

Practice Efficiency

• EMR Optimization • Data Integrity • Digital Health (eConsult;

Clinical Connect etc.) • Observation (patient flow

through clinic) • Access (patient

scheduling) • Prevention and

Screening • Population Health

Management • Practice Improvement

(Quality Improvement)

Patient Centered Care

• Understanding Patient Experience

• Academic Detailing (support re: pharmacotherapy)

• Self-Management • Coordinated Care

Planning

Practice Management

• Team Functioning • Policy/Procedure

Resources • New Primary Care

Orientation • Privacy and

Confidentiality Support

• Health and Safety • Infection Control • Employee

management (recruitment etc.)

External Supports

• Ontario MD • South West Wound

Care • South West Palliative

Care Network • Cancer Care Ontario • Home & Community

Care • cSWO • Thehealthline.ca • Mental Health &

Addictions • Diabetes Education • Public Health

AIM: Train, Coach and provide resources to all primary care (Practice Facilitation) GOAL: To improve practice efficiencies and Chronic Disease Prevention and Management

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Partnering for Quality – Quick stats • Partnerships with 77 Primary Care “teams”

o Over 362 Primary Care Physicians/Nurse Practitioners o Over 1000 additional stakeholders (Allied Health Providers, Data

Support Staff, Community Services etc.). As of March 2017 (% of actively engaged teams) • 75% have ‘EMR Champions” • 65% of have “Quality Improvement Champions” • 89% of teams using EMR to integrate referral processes • 17% are at various stages of implementing advanced access* • 16% increase in teams using CD measures to improve outcomes

* Known to PFQ implementing advanced access

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***** New Primary Care Physician/Nurse Practitioner Orientation

• Recommendation from the “Understanding Health Inequities and Access to Primary Care Report” (Primary Health Care Capacity)

• Practice Facilitation used to wrap around new clinicians (PFQ Program)

o Facilitate set up of eEnablers (i.e. HRM, OLIS, eConsult and Clinical Connect) o Support with initial access to ‘EMR sandbox’ o Support with initial vendor training o Linking clinicians to community resources – integrating EMR functionality where

applicable (i.e. referral forms, templates etc.) o Early application of data standardization o EMR/eEnabler optimization & evaluation o Practice set up/efficiencies

www.effectivepractice.org

Primary care academic detailing service

South West LHIN

Academic detailing

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Health care providers… working together to discuss…

objective, balanced, evidence-informed information on best practices…

based on the provider’s expressed needs… at a location and time that is convenient for the provider.

• Starting March 2018, family physicians across the South West LHIN will be offered one-on-one educational outreach visits to discuss clinical best practices – Detailers will also work to connect family physicians to additional

provincial and regional supports

• Visits: – Visit 1 (Mar – Jul 2018) à Supporting patients with CNCP on long-term

opioid therapy – Visit 2 (Aug – Dec 2018) à Supporting patients with CNCP considering

opioid therapy – Visit 3 (Jan – Apr 2019) à Supporting patients with CNCP and

problematic opioid use – Visits 4/5+ (Mar 2019+) à to be informed by participant feedback and

aligned with provincial and LHIN priorities

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Primary care service

Academic detailer

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Nicole Seymour, BScPharm, PharmD, ACPR, RPh Nicole Seymour has experience as a clinical pharmacist with London Health Sciences Centre’s Acute Care of the Elderly, outpatient Nephrology, and inpatient Mental Health programs. She has also worked with Thames Valley Family Health Team as a clinical pharmacist.

She obtained her pharmacy degree from the University of Waterloo and then went on to complete her hospital pharmacy residency at London Health Sciences Centre. She received her Doctor of Pharmacy degree from the University of Waterloo.

To sign up for a visit go to: https://thewellhealth.ca/academic

detailing

EConsult • To be rescheduled at next PCA • Example of consult case attached at end of presentation

for those interested

Diabetic Foot Ulcers (Offloading Devices)

SOUTH WEST LHIN WAIT TIMES FOR HIP AND KNEE REPLACEMENT - Q2 FY 2017-2018

- 90 P refers to the 90th percentile. This measurement shows the amount of days that have passed before 90 percent of patients have their consult or surgery Note: This data is based on patients who were referred for consult over a year ago, current wait times may differ from what is displayed. For more information contact the South West LHIN at 1-519-640-2591

Why is this information useful? Providing regional wait times data will help physicians and patients select a surgeon referral that incorporates the patient's preferences including length of wait, surgeon and location.

The data is organized in a table containing the 90th percentile total wait time by surgeon for HIPS and KNEES. Provincial Wait time targets are 364 days. The green bars represent waits that are within target ranges, the red bars represent wait times that are outside of target ranges.

Total Wait Times (Days) – 90th Percentile for Q2 FY 2017-18 (July - September) Physician Facility Dr. Adlington Grey Bruce Health Services 227 224

Dr. Bigham Woodstock General Hospital 535

Dr. Cervinka St. Thomas Elgin General Hospital 277 361

Dr. Guy Stratford General Hospital 546 501

Dr. Haider Grey Bruce Health Services 241

Dr. Henning Grey Bruce Health Services 392 395

Dr. Howard London Health Sciences Centre 501 611

Dr. Lanting London Health Sciences Centre 505 516

Dr. MacDonald London Health Sciences Centre 3 39 3 43

Dr. Manwell Grey Bruce Health Services 318

347

Dr. McCalden London Health Sciences Centre 354 402

Dr. Naudie London Health Sciences Centre 501 496

Dr. O'Neill Woodstock General Hospital 535 499

Dr. Pototschnik Stratford General Hospital 514 516

Dr. Rajgopal Strathroy Middlesex General 819 817

Dr. Schemitsch London Health Sciences Centre 661 869

Dr. Van Houwelingen St. Thomas Elgin General Hospital 252 3 42

Dr. Vasarhelyi London Health Sciences Centre 465 475

Dr. Xenoyannis Woodstock General Hospital 363 311

0 100 200

300 400 500 600 Total Wait Time (HIP)

700 800 900 0 100 200 300

400 500 600 Total Wait Time (KNEE)

700 800 900

Where the most recent data was not available, we have used the 90P for the fiscal year

Virtual Visit Overview • Solution for patient and primary care engagement via

secure messaging, audio and video

Virtual Visits Project Summary

• 1 year Proof of Concept • Creating a solution for patients and primary

care providers to communicate directly over a safe, secure, online communication system

• Modalities include secure messaging, audio, and video

• Potential benefits may include: • Reduced avoidable in-person visits • Patient and clinician satisfaction • Enhanced practice efficiency

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Examples of Common Virtual Visits

• Back pain • Bronchitis • Burns • Cold and flu symptoms

• Cough/sore throat/strep throat

• Diarrhea • Poison ivy • Rash

• Pink eye

• Seasonal allergies • Shingles • Sinus infection

• Simple UTI • Follow up on lab results

• Prescription Renewal

• Chronic Disease Management (Own

• PCP)

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Virtual Visits Project Update

1/14/2018

Where we are today:

• Innovation Procurement method used • Design Contest

• Negotiations with preferred vendor completed

• Contract awarded to Think Research Corporation

• eCE working with Primary Care Providers and OTN to develop clinical model and workflow

• Engaging with clinicians for continuous f db k

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1/14/2018

Clinical Model

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Remuneration Model

• Designed exclusively for the purposes and duration of the OTN- managed virtual primary care pilot.

• Designed with input of physicians, designed to be fair, equitable and to align with current OHIP Schedule of Benefits fee codes where appropriate.

• All virtual visits (video, phone, messaging) will need to be completed through the virtual platform to maintain security and allow tracking for evaluation.

• All remuneration will be managed and disbursed by OTN (physicians will not submit claims through OHIP). Physicians will receive payments on a monthly schedule

1/14/2018

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Remuneration Model

PILOT PARTICIPATION STIPEND • Participation in the first 12 months of the pilot - $1800 • Acknowledges extra time and effort for adopting and

adjusting workflows and evaluation

RATES FOR SECURE MESSAGING/PHONE • Minor Phone Messaging assessment - $15 • Intermediate phone/messaging assessment - rates

reflective of A001

RATES FOR SECURE VIDEO • Visits completed using video equivalent to an in-person

visit and will align with rates listed in the OHIP Schedule for the given service. Remuneration for Virtual Visit based on

practice type and premiums (such as A007) also to be considered. 2

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Adolescent Mental Health

Future Meetings • As of today we continue with a fixed q8week schedule

and move dates upon demand if needed?

Brainstorm • What are ideas, concerns, wishes?

Sign in to econsult at: https://otnhub.ca

Select the method of login that you have been assigned.

Please enter your login details. - For ONEID users please enter

your ONEID username and password

To initiate an eConsult select the

A new eConsult case will open. To Select a specialist: - In the Specialist field, begin entering

the specialty name. Ie. Psychiatry

A list of eConsult specialists in the named specialty will appear. This list will also include the location of these specialists. Select the specialist you would like to send the eConsult to.

indicating there are restrictions present. Select the down arrow to view these restrictions.

eConsult Case restrictions may include: - Geographical boundaries - Patient eligibility limitations - Etc.

Next complete the required patient information.

significant subject line. Please enter the eConsult details in the box below.

You may also include relevant attachments (ie. labs, consult notes, images, etc.) - In order to add documents from PS Suite, you

must save the documents before they can be imported.

- Please see subsequent slides for further detail.

- Now that the EMR files have been attached to your eConsult, be sure to delete them from the

saved to

- eConsult

Now that the eConsult has been sent the case will be

Please note before you receive a response from the specialist you do have the option to: cancel, add a note or change the specialist on your eConsult case.

Once the specialist responds to your eConsult case: - You are notified via email that you have a case

pending -

You may then mark the case as complete or request further clarification from the specialist if needed

You will be prompted to confirm if a referral was avoided

Once the case is completed it will be moved to the - At this time it is recommended that you export

the eConsult case as a PDF in order to document it in your EMR

- To do so: Press the PDF icon in the top right corner

- This will generate a PDF of the eConsult

Save the PDF of the eConsult case to your designated eConsult folder on your computer

In order to import the eConsult case: - Select the patient - - Complete the required information - Note: please delete the eConsult case from the temporary eConsult folder on your desktop Congratulations you have successfully

completed an eConsult!