Webinar Series April 6, 2016

Benchmarking end-of-life care practices for elderly people receiving primary care (CFN-funded CORE Grant) Francis Lau, PhD, MBA, MSc University of Victoria

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Welcome Our Webinar Format Benchmarking end-of-life care practices for elderly people receiving primary care (CFN-funded CORE Grant)

• Our webinar series showcases CFN-supported research on frailty and late-life issues • 20+ CFN webinars in 2016 • Webinar & slides posted on CFN website: www.cfn-nce.ca

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Please note: TVN is now… Canadian Frailty Network www.cfn-nce.ca 2016-04-06

Research Update • 2016 Summer Student Awards • Doubled to 20 awards • Application window closed • Announcement this month

• New, one-year 2016 Fellowships • Announced, posted to CFN website

• ACE Collaborative • 18 acute-care hospitals • Funded teams announced last week

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Q-&-A session • Follows Dr. Lau’s presentation • Submit your Qs online during presentation • We will answer as many Qs as time permits • Webinar is recorded and available for viewing online within 1-2 days

www.cfn-nce.ca 2016-04-06

Presenter Benchmarking end-of-life care practices for elderly people in primary care (CFN-funded CORE Grant)

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PhD in medical sciences with specialization in medical informatics Professor in School of Health Information Science, University of Victoria Recipient of CIHR-Infoway E-Health Chair to examine health information system deployment in Canada Extensive background in business, computing and medical sciences, with 14 years in health IT industry Research interests: health information system evaluation, clinical vocabularies and palliative care informatics

www.cfn-nce.ca 2016-04-06

Francis Lau PhD, MBA, MSc

April 6, 2016 Webinar

Knowledge Translation Project Benchmark End-of-life Care for the Elderly in Primary Care Sep 1/2012-Aug31/2015

Francis Lau1, Doris Barwich2 Neil Hilliard3, Bruce Hobson4 Morgan Price5 1University of Victoria, 2BC Centre for Palliative Care, 3Fraser Health, 4Private Practice, 5UBC 1

Outline 1. 2. 3. 4. 5. 6.

Project Objectives Project Stages / Methods Selected Findings Lessons Learned Next Steps References

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1. Project Objectives Overall • 30-month project to introduce EMR-supported best practices in EOL care in primary care in BC • Can palliative approach be integrated into EMRs to enhance EOL care in ways that are measureable, scalable, sustainable?

Specific • Identify EMR-supported tools and requirements, develop and implement EMR tools, and evaluate uptake and impact • Identify extent of EOL care documentation in existing EMRs, gaps, recommendations and next steps

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2. Project Stages / Methods • • • • •

Stage-1 Assessed current EOL care Stage-2 Developed EMR tools for EOL care Stage-3 Disseminated EMR tools Stage-4 Evaluated EMR tools Stage-5 EOL care documentation in EMRs

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3. Selected Findings • BC General Practice Services Committee Practice (GPSC) Support Program (PSP) EOL learning module • EMR functional requirements blueprint • Specific EMR tools • Web-based distribution of EMR tools • Summary of results 5

3. Selected Findings • BC General Practice Services Committee Practice (GPSC) Support Program (PSP) EOL learning module • EMR functional requirements blueprint • Specific EMR tools • Web-based distribution of EMR tools • Summary of results 6

http://www.gpscbc.ca/what-we-do/professional-development/psp/modules/end-of-life

Partnership of BC Government and Doctors BC

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BC GPCS PSP EOL Care Algorithm

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BC GPCS PSP EOL Care Algorithm Patient summary

Registration of patients as EOL patients and their transition stage

Assessment tools (e.g. PPS, ESAS) Doctor support (billing codes, contacts, custom resources)

EOL care plans (including advance care plans)

EOL forms, resources, and patient handouts

Symptom management

Family and grief resources

Reports 13

3. Selected Findings • BC General Practice Services Committee Practice (GPSC) Support Program (PSP) EOL learning module • EMR functional requirements blueprint • Specific EMR tools • Web-based distribution of EMR tools • Summary of results 14

http://ehealth.uvic.ca/eolmodule

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EMR-EOL Functional Requirements Blueprint

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3. Selected Findings • BC General Practice Services Committee Practice (GPSC) Support Program (PSP) EOL learning module • EMR functional requirements blueprint • Specific EMR tools • Web-based distribution of EMR tools • Summary of results 19

Vendors 3 Tool Versions

OSCAR Intrahealth Profile Telus Med Access

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OSCAR

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Home

Care Plan

Family and Grief

Pain (symptoms)

Profile

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Template for Palliative Care Plan

Visit Template Assessment Tools

Template Components

Med Access

EOL Indicator Reports

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3. Selected Findings • BC General Practice Services Committee Practice (GPSC) Support Program (PSP) EOL learning module • EMR functional requirements blueprint • Specific EMR tools • Web-based distribution of EMR tools • Summary of results 24

http://ehealth.uvic.ca/eolmodule

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3. Selected Findings • BC General Practice Services Committee Practice (GPSC) Support Program (PSP) EOL learning module • EMR functional requirements blueprint • Specific EMR tools • Web-based distribution of EMR tools • Summary of results 28

Summary of Results • • • • • • •

65 downloads Aug/2015: OSCAR-38, Med Access-16, Profile-11 Med Access EOL tools now in province-wide template library OSCAR EOL tools now in OSCAR eForm library for all users Profile EOL tools via website, indicator subset via dashboard 23 participants in 2 rounds of feedback on EMR tools Tools used – assessment, symptoms, registry, guidelines, ACPs Participant comments ... – –

“I believe it is very thorough and I look forward to using it as I anticipate it will trigger standards of care reminders” “I find it resourceful for PPS algorithm handouts, nice to have all in the same spot and not searching for all the forms”

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4. Lessons Learned • Providers wanted to adopt EMR tools for EOL care but no time to engage due to competing priorities and demands • Lack of vendor attention have led to inconsistent documentation and inability to identify EOL patients • Need to standardize EOL documentation, harmonize with chronic care to reduce provider cognitive overload • Alignment with provider organizations responsible for large scale change to adopt, scale up and sustain EMR-supported EOL care • Realistic time frame and funding provision needed in large scale KT projects

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5. Next Steps • Have had inquiries from health region on access, use and support of EMR tools for EOL care • GPSC PSP has agreed to develop content and EMR for EOL care in 2016-17 work plan • Content update request process being developed by PSP, e.g. new version of BC palliative care benefits program registration form • When EMR tools ready, update providers on PSP EOL module who have taken but not used EOL module or EMR tools? • Engage Doctors BC and Divisions of Family Practice to coordinate disseminate efforts? • Evaluate return on value of next steps? Apply RE-AIM framework? (Reach, Efficacy, Adoption, Implementation and Maintenance) 31

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Bakken, S., Ruland CM. Translating clinical informatics interventions into routine clinical care: How can the RE-AIM framework help? Journal of American Medical Informatics Association 2009; 16:889-98

6. References • Bakken, S., Ruland CM. Translating clinical informatics interventions into routine clinical care: How can the RE-AIM framework help? Journal of American Medical Informatics Association 2009; 16:889-98. • eHealth Observatory. EMR EOL Care Module. URL: http://ehealth.uvic.ca/eolmodule • General Practice Service Committee. Practice Support Program - Professional Development Learning Modules. URL: http://www.gpscbc.ca/what-we-do/professionaldevelopment/psp/modules/end-of-life

• TVN EOL KT Project. EOL Care Workflow and Functionality Blueprint. URL: http://ehealth.uvic.ca/eolmodule

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Acknowledgement

This KT project was funded by the Canadian Frailty Network which is supported by the Government of Canada through the Networks of Centres of Excellence program (formerly known as the Technology Evaluation in the Elderly Network) 34

Webinar Satisfaction Survey and Future Webinars Brief survey will pop up on your screen within next few seconds. Your responses provide us with feedback on how we can improve the webinar series. Upcoming webinars – register on twitter @CFN_NCE Wednesday, April 20, 2016 at 12 noon ET Evaluation of integrated clinician e-tool and practice support system to complete acute care, QOL assessments of frail, older adults – results of CFN-funded Catalyst Grants – Richard Sawatzky, Trinity Western University

Wednesday, May 4, 2016 at 12 noon ET Frailty measure for persons with intellectual, developmental disabilities – results of CFN-funded Knowledge Synthesis Grant – Hélène OuelletteKuntz, Queen's University

Wednesday, May 18, 2016 at 12 noon ET Pilot of e-commerce, mobile device to improve physical transfers of nursing home residents – results of CFN-funded Catalyst Grant – Greta Cummings, University of Alberta

Webinar slides available at: cfn-nce.ca/news-and-events/webinars www.cfn-nce.ca 2016-04-06