An article by Rosemary Gray, HDC Enrolment and Engagement Manager
Canadian Healthcare Technology Magazine| Vol. 23. No. 1 | February 2018
(Pages 16 and 23)

Rather than a new eco-adventure, BCHIMPS is the British Columbia Health Information Management Professionals’ Society. They’ve been bringing together BC’s health informatics, IT, IM and clinical leaders for three decades to network, share experiences and participate in professional development opportunities such as the recent Fall Symposium, held in September at Vancouver’s Sutton Place Hotel.

This was the biggest BCHIMPS event to date, with a sold-out venue and more than 140 registrants in the room. When I walked into the corridor to fill my coffee cup, and returned to the room, it was like I crossed a force field that could barely contain the wall of positive energy, curiosity, and passion for making things better for the patients we serve in our health system.

The Triple Aim: The Institute for Healthcare Improvement’s (IHI’s) Triple Aim construct now has worldwide acceptance as an approach to optimizing health system performance. Canada has definitely bought in – the construct, even if not named, underpinned each speaker’s approach. The Triple Aim refers to the simultaneous pursuit of improving the patient (and provider) experience of care, improving the health of populations, and reducing the per capita cost of healthcare. Its power is that it is actually a single aim with three dimensions – you can’t achieve and sustain quality outcomes for patients and populations without working simultaneously in all three areas.

Dr. Jeremy Theal, CMIO for North York General Hospital, in Toronto, laid out the themes quite clearly. Patients deserve and demand better quality and safety – for instance, preventable deaths in hospital are inexcusable.

Quantitative measurement and reporting: Increasingly, there’s an emphasis on accountability for eHealth investment that relies on a measurement and reporting framework that supports the Triple Aim. We are starting to assess the quantitative impact of change, by measuring improvement (or lack of improvement) in terms of lives saved, costs avoided, harms prevented, patient outcomes improved, and provider experience of the change. These are the kinds of measures that are meaningful to providers, patients and other partners, and help us all to understand the tangible impact of investment.

Evidence-informed clinical decision making: There’s an increasing emphasis on the incorporation of clinical decision support into the day to day workflows of clinicians. Adoption of clinical standards is about making the best path to follow, the path of least resistance – the lessons are to make the right way, the easy way, and “don’t impede clinical workflow”. North York has had success with full adoption of several clinical best practice workflows by working with their clinicians to embrace many of the constructs of world-class health systems, such as Sweden’s Jonskoping County and InterMountain Healthcare in Utah.

Clinicians review their individual practice patterns and preferences and come to agreement as a group to co-design an acceptable workflow to support best practice and eliminate unwarranted variation.

Ownership: In the words of our world-class facilitator, Yoel Robens-Paradise, “What’s the Secret Sauce?”. The same answer echoed through the day – building local user ownership of the change is critical to success. It isn’t rocket science, but it continues to be elusive.

Local clinicians and informaticians must work together to co-design solutions to improve patient care, and workflows must support the improvement result you’re seeking – careful review and design by the users impacted by the workflows is essential.

As Dr. Jeremy Theal said, we must remember that it’s possible to achieve both positive and negative outcomes with the same tools, and the same vendors – the difference is in the team and the approach. The Island Health team from Nanaimo echoed the same sentiment – understand the user community and engage with them early to identify and develop solutions that the end users perceive will add value, and the solutions will be more likely to result in added value once implemented.

Island Health’s experience “pausing” the CPOE initiative, gave all the providers a chance to learn the many transcription and re-transcription steps of the manual paper processes, and deeply understand the risk to patients (and the wasted clinician and staff effort) introduced by so many opportunities for transcription error that can lead to patient harm.

Once providers saw the alternative, the value of automating became clear. In the words of Dr. Ben Williams, Island Health’s Executive Lead for Strategy and Engagement, “Keep going! It’s better for patients. Make improvements but keep going.”

Rosemary Gray is a member of the BCHIMPS Board.