1. Group Communication & Point of Care Learning David Topps Medbiq 2009

2. Who are we? Academic Family Health Team Northern Ontario New service delivery model Removes fee-for-service pressures Collaborative practice Collaborative learning

3. Key messages Small changes make progressSmall changes make progress Information overloadInformation overload Health care is a Team Pursuit

4. 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

5. Group calendaring

6. Team Sites and wikis Clinical Practice Guidelines Care pathways –Lots out there –Whose do you use? –Allowing for customisation Optimised for local factors

7. Team Sites and wikis

8. Email vs. RSS –FHT for Practice blog –portal or wiki as a separate daily task? –Email overload vs. email as your life organiser

9. 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

10. Widgets

11. Dim stand_alone as Boolean Dim useful as Boolean IF stand_alone = True THEN NOT useful END IF

12. 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

13. 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

14. 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

15. 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

16. Dashboard click-through Information fatigue Irrelevant information…

17. Annoying as hell…

18. 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?

19. Ticklers & Reminders Same click-through problem Story from Sarasota –removal of all warnings

20. Ticklers for needed actions Find the right level of intrusiveness

21. Surprise Tickler

22. Screensaver

23. A Surprise Tickler Odd effect of Windows screensaver –Reminder that I am behind schedule –Educational slide shows for patients

24. Instant Messaging

25. 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?

26. IM Presence

27. 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”

28. Electronic Learning Prescriptions Reminders better than paper system PDA version not integrated to patient Now using the EMR to do this

29. Learning Rx in the EMR

32. Wrap-up Small changes Info overload –Sorry, that’s what I’ve just done to you!