Ultimate Blogging Championship

Tag: Members Only

  • The Institute of Medicine publishes CEO Checklist for High-Value Health Care

    Participants in the IOM Roundtable on Value & Science-Driven Health Care have assembled lessons in A CEO Checklist for High-Value Health Care to describe touchstone principles, illustrated with case examples, central to sustaining and reinforcing continuous improvement in the face of rapidly increasing pressures, demands, and market changes.

    The Checklist’s 10 items reflect the strategies to improving quality and reducing costs. They describe the foundational, infrastructure, care delivery, and feedback components of a system oriented around value, and represent basic opportunities for health care delivery system CEOs and Boards to improve the value of health care in their institutions.

    A Checklist for High-Value Health Care

  • FHT Practice Solutions EMR User Group Priorities – June 2012 survey results

    The purpose of this survey was to identify priority issues common to all FHTs using Practice Solutions (PSS). The survey was distributed to all FHTs that had reported through a previous AFHTO survey that they use PSS in their clinics (n=57 FHTs).

    There were 3 elements to the survey:

    • Identify common issues across FHTs
    • Prioritize action items to focus the user group when working on common issues for FHTs
    • Feedback on “Account Manager” proposal

    Please find below the PSS User Group report on FHT PSS Priorities. It presents a list of the 10 most common issues experienced by PSS Users in terms of frequency of the problem and its detrimental impact on FHT operations.

    Following from these, the PSS Users identified the following four items as the priorities for action:

    1. Data Extraction: FHTs are interested in extracting data to inform quality improvement initiatives. Health Quality Ontario is defining data requirements for quality reporting. The user group will seek support from PSS to assist FHTs in accessing usable data.
    2. Interfaces (eg. Lab, e-prescriptions): FHTs are and will be involved in health systems planning and innovation, the EMR should be innovative as well. The user group would work with PSS to determine what works needs to move ahead, and what work needs to wait for province-wide or LHIN-wide rollouts.
    3. Communications: FHTs would like to have a single point of contact within PSS who will have the authority and ability to speak for FHT issues and will coordinate priority issues for FHT clients.
    4. FHT Working Environment: The user group will work with PSS to increase their awareness of and responsiveness to the fact that the FHT working environment is different from that for physicians working in more traditional environments.

    The report also indicates almost unanimous support among the responding PSS Users for an “Account Manager” approach to solving many of these issues.

     

     

  • Priority issues identified by PSS users in Family Health Teams

    Click here to access the PSS User Group report on FHT PSS Priorities. It presents a list of the 10 most common issues experienced by PSS Users in terms of frequency of the problem and its detrimental impact on FHT operations.

    Following from these, the PSS Users identified the following four items as the priorities for action:

    1. Data Extraction: FHTs are interested in extracting data to inform quality improvement initiatives. Health Quality Ontario is defining data requirements for quality reporting. The user group will seek support from PSS to assist FHTs in accessing usable data.
    2. Interfaces (eg. Lab, e-prescriptions): FHTs are and will be involved in health systems planning and innovation, the EMR should be innovative as well. The user group would work with PSS to determine what works needs to move ahead, and what work needs to wait for province-wide or LHIN-wide rollouts.
    3. Communications: FHTs would like to have a single point of contact within PSS who will have the authority and ability to speak for FHT issues and will coordinate priority issues for FHT clients.
    4. FHT Working Environment: The user group will work with PSS to increase their awareness of and responsiveness to the fact that the FHT working environment is different from that for physicians working in more traditional environments.

    This report was sent as the “Prioritized list” to OntarioMD CEO Brian Forster, as he requested, and to Dennis Ferencz (OMD’s head for change management and the peer leader program) whom Brian identified as AFHTO’s key contact.  Brian and Dennis will go through the list. OntarioMD has identified the following tactics for moving forward with the results:

    • For issues that indicate PSS is failing to meet any of the standards for the latest spec, OMD can send them a “cure letter”. If they don’t meet the spec, then their status is suspended and the vendor can’t proceed with any further installations.
    • If the issue is not related to the current specs, OMD could potentially add requirements to future specs to deal with it.
    • For other issues – e.g. finding solutions to common operational needs, addressing overall poor communications – OMD can use its relationship to add more pressure to get problems solved.
    • At the same time, OMD + the user group could go through staff of CMA + CMA Holdings (Brian Peter is President) to apply pressure.  (Apparently some PSS physicians have threatened to drop their CMA membership over this issue. If the other avenues fail, perhaps this threat could be organized more widely and escalated if needed.)

    The FHT PSS User Group will receive all updates on developments with OntarioMD and PSS.

     

  • Post-Drummond Report and Budget: Moving Forward with Implementation of Health Care Reforms

    Monday, June 11, 2012

    This conference explored recommendations made in both the Drummond Report and the Action Plan that proposed a new local integrated health model. This model sets out primary care as the focal point, with access to health services shifted away from emergency rooms towards community care and alternative forms of care.

    AFHTO’s Executive Director, Angie Heydon participated in a panel discussion, Moving Forward with Integrating Primary Care.

    Panelists:

    • Melissa Farrell, Director, Primary Health Care, Ministry of Health and Long-Term Care
    • Jan Kasperski, President and CEO, Ontario College of Family Physicians
    • Angie Heydon, Executive Director, Association of Family Health Teams of Ontario
    • Paul Huras, CEO, South East LHIN
    • Matthew Anderson, President and CEO, William Osler Health System- Brampton
    • Sandra Coleman, CEO, South West CCAC; Board Member, Ontario Hospital Association

    Please find Angie’s presentation for the conference here.

     

     

  • Article in June 9 National Post

    On June 9, 2012, the National Post ran a full-page spread on page A6 under the large headline “Unhealthy conflicts” and smaller headline – “Numerous irregularities found at Ontario’s Family Health Teams.” The online version is at — http://fullcomment.nationalpost.com/2012/06/08/ontario-government-faces-lawsuits-over-troubled-family-health-teams/

    In response, AFHTO has sent the following letter to the editor:

    Family Health Teams are all about improving care for patients.  Christie Blatchford said it herself — “Early evidence is that FHTs do result in better outcomes for patients, particularly those with complex medical problems such as diabetes.” Teams also work with specialists, hospitals and community agencies to make more efficient use of Ontario’s health resources.

    It is sad to see this progress overshadowed by the isolated allegations in Christie’s story. Improvement is based on evidence.   Family Health Teams continue to combine evidence, innovation, collaboration and learning to improve access to care, help patients achieve better health, and use the precious resources of our health system wisely.

    As the evidence of their value expands, let us hope these Teams can also expand so that all Ontarians can access high quality interdisciplinary primary health care.

    There is some good news in the article. In addition to Ms. Blatchford’s positive comments about FHTs in paragraphs 2-5, quotes from Minister Matthews and Phil Graham are highly supportive of our teams.  Unfortunately, the rest of the article uses allegations about two FHTs – one community-led and one physician-led – to “suggest there may be widespread gaps with oversight and real potential for abuse and even wrongdoing.”  The criticism is directed toward “conflict of interest” and at government processes for funding and oversight.

    AFHTO continues to champion all that FHTs have accomplished, and advocate for the support they need to improve and deliver optimal interprofessional care. On behalf of members, AFHTO has advocated for Ministry support to strengthen many aspects of FHT operations, including governance.

    AFHTO members want to govern their FHTs wisely. Members identified governance development as a priority at AFHTO’s November 2009 leadership retreat. This was followed up with a member survey in May 2010, then a proposal to government in January 2011. Participants in the October 2011 leadership program at the AFHTO Conference concluded that FHT governance has been improving, but still needs further development.

    Within our resources – two staff plus FHT volunteers – AFHTO will once again present a Leadership and Governance program for the 2012 conference in October. Board resources submitted by FHTs are posted on AFHTO’s members-only website. We also continue to seek external support to be able to ensure all FHT boards have access to the education and tools they need to support sound leadership and governance for their FHTs.

    Family Health Teams have so much to offer to patients and Ontario’s health system. AFHTO applauds you for all you have accomplished so far, and is here to support you in your work to provide high quality interdisciplinary primary health care to Ontarians.

  • Letter from AFHTO board re MOHLTC-OMA negotiations

    FYI — The letter below from the AFHTO  Board of Directors was sent this morning, Friday, May 18, 2012, to Susan Fitzpatrick, Assistant Deputy Minister of MOHLTC’s Negotiations and Accountability Management Division, and to Dr. Doug Weir, President, Ontario Medical Association.

    ……………………………………………………….

    May 17, 2012

    Ms. Susan Fitzpatrick Assistant Deputy Minister Negotiations and Accountability Management Division Hepburn Block 5th Flr, 80 Grosvenor St Toronto ON M7A1R3 Dr. Doug Weir, President Ontario Medical Association Ontario Medical Association 150 Bloor Street West, Suite 900 Toronto, Ontario, M5S 3C1

    Dear Ms. Fitzpatrick and Dr. Weir,

    The Association of Family Health Teams of Ontario is all about the TEAM in primary care. Our mission is to work with and on behalf of our members as the advocate, champion, network, and resource center for family health teams, to support them in improving and delivering optimal interprofessional care.

    The question of the Physician Services Agreement is a matter between the Ministry and the OMA, and therefore AFHTO’s position has been to remain neutral. With our mission clearly in mind, AFHTO has also been watchful as to the potential impact on the ability of FHTs to deliver optimal interprofessional care.

    The AFHTO board has reviewed the current situation in its meeting this week. In the interest of maintaining productive working relations among the Ministry, physicians and all members of primary care interprofessional teams, we encourage a return to fair and honest negotiations between government and the OMA regarding physician compensation.

    Looking at broader questions in the evolution of our health system, AFHTO is ready, willing and able to help shape further development of interdisciplinary primary care in Ontario. With 20% of Ontarians as patients, existing FHTs have created a critical mass of leadership and organization that can be leveraged to support planning and improvement in primary care delivery.

    With the cost and funding pressures facing the province of Ontario, the AFHTO board would also encourage government and all stakeholders to engage in a broad-based exploration of strategies to achieve, consistent with the Excellent Care for all Act:

    • Control of cost, and
    • Establishment of capacity such that there is the choice of primary care practice for every person in province, and
    • Assurance of quality to the expectations of the people of the province of Ontario.

    We offer best wishes to both the Ministry and the OMA in reaching an agreement that will serve patients well, and will be satisfactory to both parties. We look forward to participating with you and others to improve Ontario’s health system.

    Sincerely,

    Kavita Mehta, President

    Angie Heydon, Executive Director

     

    Copy to: AFHTO members

  • AFHTO’s EMR survey – March 2012 survey results

    The EMR survey was completed by 160 respondents from 121 FHTs (65% of all 186) in the period April 10 – 30, 2012. Thank you to all who took the time to respond.

    Click on the links below to find:

    Findings from responses indicate:

    • 93.7% of respondents use only 1 EMR system in their FHT, with 6.3% using 2 or more.
    • Almost half of FHTs (49%) use Practice Solutions Software (PSS) and account for 52.5% of all EMR users.
    • The next most-frequently used EMRs are OSCAR and Bell EMR (formerly xWave) with about 12% of FHTs for each, then HealthScreen and P&P Data Systems with about 6% of FHTs each.
    • Looking at aggregate scores for the 9 EMRs rated by more than one FHT:
      • 3 EMRs received average or good ratings in all evaluation questions (OSCAR, Jonoke and Accuro(R))
      • 3 EMRs receive average or poor ratings in all evaluation questions (Nightingale, HealthScreen and York-Med)
      • The remaining 3 had ratings ranging from poor to good (PSS, Bell and P&P)
    • About 91% of FHTs report their physicians and other staff are using the full range of functionalities (ie. scheduling, billing & patient charting), and 97% of FHTs have a messaging function for internal communication.
    • 95% of FHTs have remote VPN connection to the EMR, but only 46% can access the EMR via WiFi during hospital rounds and/or LTC visits and/or home visits.
    • Over 93% of FHTs use desktops in exam rooms, but only 39% use tablets or laptops during patient encounters.
    • Patient access to a Patient Portal or Patient Health Record is still in early stages, with about 15% of FHTs who have this in place. About 70% have printers in patient rooms.

    Respondents who had indicated an interest in being part of a user groups for their EMR received contact information of all others who had signed up for the same EMR user group.  Having been linked in this way, user groups are encouraged to act as resources for one another to learn how to get the most from their EMR, and join together as needed in working with their vendor.

  • First time release of data from 5-year FHT evaluation study

     

    The first set of data from the Ministry-sponsored five-year FHT evaluation study was released last week to 118 FHTs. These FHTs had participated in at least one of three 2009 surveys – facility, patient, and provider – conducted by the Conference Board of Canada evaluation team.

    In 2009, the 134 FHTs in waves 1 – 3 were invited to participate in these surveys. Last week all 134 received a request to complete the follow-up Facility Survey and to distribute the Provider Survey to everyone in the FHT who provides direct patient care.

    The 118 FHTs who had participated in at least one of the 2009 surveys also received a summary of those results – for their individual FHT and the aggregate for all responding FHTs.  The Conference Board researchers confirmed that individual results have been distributed solely to the respective FHT; the Ministry receives only aggregate data.

    The report combines responses from several questions to provide scores in the domains of access, comprehensiveness, teamwork, coordination, quality and chronic disease prevention and management. Almost all scores are expressed on a scale of 0-100. There is no cutoff between “good” and “bad”, but the ideal is to score 80 or above.

    The following report gives AFHTO’s observations on this first set of data.  The Ministry is currently compiling a more detailed report on the full set of results from the first three years of the FHT evaluation.

    Median scores – the middle number with an equal number of responses above and below – indicate the following for FHTs overall in 2009:

    • Patients report the median wait for minor health problems was 0.5 days and they generally have little or no difficulty accessing care (median score of 81). However, the overall median patient score for accessibility of care was 73.
    • Overall, providers report that several critical aspects of teamwork are in place, with median scores of 82 for the way in which team members communicate and interact, 78 for collaboration with members of their immediate team, and 74 for collaboration among all providers in the FHT.
    • When it comes to coordination and quality, both providers and patients gave relatively high scores for factors internal to the FHT. Examples include median patient scores of 90 for their experience of interaction with their health care provider and for care coordination within the FHT, 94 for satisfaction with their providers and care, 84 for cultural competency, and 79 for family-centredness. Providers seem to be somewhat harsher in looking at themselves in these same domains, with median scores of 80 for care coordination within the FHT, for satisfaction with their role and FHT team; 74 to 76 on their interactions with patients and family-centredness, and 65 for their cultural competency.
    • Related to the operation of their FHT, providers gave a median score of 80 for the extent to which their FHT has key governance-related policies in place, 73 to the extent to which their FHT uses data to support patient services and care, and 56 to the extent to which they are participating in quality improvement activities.
    • Patients gave relatively high scores related to some aspects of chronic disease prevention and management (CDPM) – median score of 82 for satisfaction with the services they receive for their chronic diseases and 85 for their level of confidence in self-management. In addition 93% of patients with the relevant chronic conditions reported their blood pressure was under control, and 83% said likewise for blood sugar. The lowest median score in the whole report, however, was 31 for questions related to services received to manage their chronic disease (e.g. lists, reminders, treatment plans). One would expect this score to improve with time as FHTs have further developed and strengthened CDPM programs since the early days of setting up multidisciplinary programs.
    • External linkages are also expected to strengthen as the FHTs mature. Median scores were relatively low in these early days, with an overall median score of 55, presumably since FHTs were focused on getting their teams up and running. Patients gave an aggregated median score of 46 on questions related to their FHT’s community orientation. Providers gave a median score of 63 to their experience of patient care coordination with external providers; interestingly though, patients gave this a median score of 95.
    • The results also point to room for improvement when it comes to discussions about health and well-being (e.g. diet and exercise, medications, preparation for aging). Median score from the patient survey was 66, and 71 in the provider survey.

    Outside of the few areas listed above, median scores are above 70.  While FHTs overall may be performing relatively well, the scores for individual FHTs range from 25 to 100 for most items.  FHTs that received these individualized reports may find some additional areas for improvement.

    Three years later the three surveys are being repeated.  The results will be valuable in showing how FHTs as a whole are developing over time.  Participating FHTs will have the added advantage of seeing how their individual performance is evolving.

    FHTs that have received the 2012 facility and provider surveys are encouraged to complete them.  If you require the link to the survey or have any questions, please contact the evaluation team through Garry Armitage at 1-888-689-1847 or g.armitage@malatest.com .

    BACKGROUND

    MOHLTC contracted the Conference Board of Canada to conduct an evaluation of the FHT initiative over the period from Dec. 2008 to Nov.2013. The study has included key informant surveys, site visits, patient focus groups and administrative data analysis, in addition to the two rounds of facility, provider and patient surveys in 2009 and 2012. Comparative data is also being collected from Community Health Centres and Family Health Groups. The evaluation domains are:

    • Access
    • Comprehensiveness of care
    • Coordination and continuity of care
    • Information management systems to support quality and coordination
    • Interprofessional team functioning and effectiveness
    • Quality and appropriateness of care
    • Health promotion and chronic disease prevention and management

    In 2009, all FHTs were invited to participate in facility and provider surveys. As well, randomly selected FHTs were invited to participate in site visits and patient surveys. In total: 84 per cent of FHTs responded to the facility survey; over 800 FHT providers, including physicians, registered nurses, mental health workers, nurse practitioners, dietitians, pharmacists, and others responded to the provider survey; and more than 2,600 FHT patients shared their views about the care they receive at their FHTs through the patient survey.

     

  • Changes to services system for adults with developmental disabilities

    Patients with developmental disabilities or their caregivers may ask FHTs about changes in the collection of personal information and/or how it may affect their services. Developmental Services Ontario (DSO) recently launched a province wide database to collect, store and access service information for adults with developmental delays. Service providers across the province have been asked to provide patient information to the database.

    DSO has provided the following resources to assist in responding to potential inquiries:

     

     

    Thank you to the Mount Forest Family Health Team for sharing this information.

  • Smoking cessation – online tool to support patients

    The Break It Off Mobile Application – a behaviour modification tool to help smokers kick the habit –  allows patients to identify triggers, deal with cravings, track their progress, and call a Smokers’ Helpline Quit Coach directly through the application. It can be downloaded onto Apple and Android devices.

     

    This is part of the Canadian Cancer Society’s “Break It Off” digital campaign to promote tobacco cessation using the metaphor of ending a personal relationship. The website also offers a resource hub for patients to learn about proven quit methods, such as phone counselling, patches, gums, and inhalers.