Group Communication Point of Care Learning David

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 messages • Small changes make progress • Information overload Health care is a Team Pursuit

Change 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 • Po. C group Info. Buttons • 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!