THE IMPACT OF HEALTH INFORMATION TECHNOLOGY ON FAMILY PHYSICIAN’S PRACTICE PATTERNS: A CROSS-SECTIONAL STUDY USING DATA FROM THE 2007 NATIONAL PHYSICIAN SURVEY

Objective: To evaluate the impact of health information technology on primary care physicians in Canada by the number of medical services and clinical procedures they offer, total direct patient care hours provided, and visit duration. Methods: We used nationally representative data from the 2007 National Physician Survey to examine the extent of Health Information Technology (HIT count and HIT type) on the scope of practice, total direct patient care hours, and length of office visits among family physicians/general practitioners. HIT count is defined as the number of HIT the physician uses and HIT type is categorical variable based on its features. Negative binomial regression models were used to assess the number of medical services and clinical procedures offered. Linear regression models were used to assess the total direct patient care hours and visit duration. Results: Multivariate analyses show a significant increase in the expected mean number of medical services offered, clinical procedures offered, direct patient care hours, and visit duration with each additional HIT the physician uses in his/her practice. The greatest positive impact was found among physicians who uses EMR-Plus HIT for medical services (8.8 percent, p\u3c0.01) and clinical procedures (8.7 percent, p\u3c0.01) when compared to non-HIT users. Physicians were found to increase their time spent per patient visit who use EMR HIT by 7.8 percent (p\u3c0.05) and EMR-Plus HIT by 6.8 percent (p\u3c0.01) when compared to non-HIT users. No significant association was found between the different HIT types physician uses and total direct patient care hours. Conclusion: The use of health information technology is found to be associated with an increase of medical services and clinical procedures offered, and duration of visit. Limited impact of HIT was found to be associated with total direct patient care hours. Further investigation of what components in HIT affects the workflow of family physicians is needed. Overall, careful consideration needs to be taken when investing and implementing HIT in Canada because there may be unintended consequences

Reviving Full-Service Family Practice in British Columbia

Describes innovative operational reforms made in the province's fee-for-service system to improve quality of care and reduce costs, including incentive payments for chronic disease management and enhanced training. Outlines lessons learned and challenges

Accelerating the National Implementation of Electronic Health Records in Canada

Trends such as the aging population, long wait times, rising costs, and labour shortages in health professions are notable challenges facing the sustainability of Medicare in Canada. Healthcare reform, especially in primary care, will ensure efficiency and equitable access to healthcare in. Information and communication technologies (ICTs) such as electronic health records (EHRs) will play a pivotal role in reforming and sustaining Medicare. EHRs make healthcare safer, cost efficient and more integrated, and are necessary for the wider application of ICTs in the health sector. EHRs enhance decision-making capabilities for both providers and patients, especially in managing chronic diseases. Notwithstanding the numerous advantages of EHRs, Canada is slow to adopt a nation-wide EHR system. This paper analyzed existing data to establish the factors that may help to accelerate the national implementation of electronic health records in Canada. It defined EHRs, discussed their advantages and disadvantages, and barriers to its full application. Also, it explored key strategies for accelerating EHR initiatives in Canada, and suggested action plans and time frames for doing so

Registered Nurses\u27 Intention To Use Electronic Documentation Systems: A Mixed Methods Study

BACKGROUND: Home care in Ontario has become the fastest growing sector and cornerstone of the healthcare system. As a result of the increased shift to the home care sector in Ontario, there have been several health information technology (HIT) initiatives to improve the quality and delivery of health care services to patients. This is exemplified with the province-wide development and implementation of electronic documentation systems (EDS). Electronic documentation systems have the potential to ensure timely, up-to-date and comprehensive patient health and care-related information is available and accessible to healthcare providers such as registered nurses regardless of their physical location. Access to patient health and care-related information supports high-quality nursing care, decision-making, and care delivery processes. Despite the benefits of EDS (i.e., improved workflow, reduced diagnostic and laboratory tests and adverse drug events), low intention by registered nurses to use these systems is well documented. Existing evidence suggests that an expressed intention to use HIT such as EDS is a direct predictor and antecedent of behavioural usage. Despite the growing efforts to understand registered nurses’ perceptions and overall intention to use EDS in practice, there is limited knowledge about registered nurses’ intention to use EDS in the context of home care practice. AIMS: The purpose of this study was to understand and examine factors that influence nurses’ intention and overall perception of using EDS in their home care practice. The conceptual model framing this study was adapted from the Unified Theory of Acceptance and Use of Technology (UTAUT) to delineate the relationships among factors that influence registered nurses’ intention to use EDS in home care practice. METHOD: A sequential, explanatory mixed methods design, using a sample of nurses from Ontario who are currently practicing within the home care sector were recruited to address the study’s objectives. Data were collected using both quantitative (online survey) and qualitative (semi-structured individual telephone interviews) methods. Quantitative data were analyzed with descriptive statistics and hierarchical multiple regression analysis and qualitative data were analyzed with content and inductive thematic analysis. RESULTS: Individual, technological and organizational / environmental characteristics were found to influence nurses’ intention, level of comfort and experience with EDS usage in home care practice. Additional factors found to influence home care nurses’ experience with EDS usage included: the development and employment of workarounds, the influence of nurse-patient interaction amidst system usage, and the ability to provide input towards the system design. CONCLUSION: Nurses play a significant role in the delivery of home health care services to Ontarians. The findings highlight the importance for: a) further exploration of the most appropriate model and / or adaptation of a model identifying a range of factors influencing nurses’ intention to use EDS in different healthcare contexts; b) continued integration of nursing informatics competencies within nursing curricula; c) an organizational culture that supports the use of EDS in nurses’ home practice (i.e., enlisting user champions and providing adequate training and IT support); and d) having representation of nurses in the EDS design and / or implementation processes through a user-centered design approach

An Evaluation of the Determinants of Job Satisfaction in Canadian Family Physicians

Physicians as a group appear to be satisfied with their work. However, there are some gaps in our current understanding of the determinants that impact the job satisfaction of Canadian family physicians. This thesis examined determinants of family physician job satisfaction using in-depth interviews with family physicians to achieve a broad perspective on their job satisfaction. This was complemented by a multivariate analysis that examined the professional and work-life balance satisfaction of physicians across this country. The findings from this research confirm the significance of a number of factors to the professional and work-life balance satisfaction of family physicians. Novel findings included an overall dissatisfaction with electronic medical record use and increased satisfaction of focused practice family physicians. Addressing the factors that contribute to family physician satisfaction can have a significant impact on physician recruitment, retention and on patient outcomes

Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

<p>Abstract</p> <p>Background</p> <p>Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models.</p> <p>Methods</p> <p>This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC) through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models.</p> <p>Results</p> <p>The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69%) than in fee-for-service (45%) practices (Adjusted Odds Ratio (AOR) = 2.4 [95% CI 1.4-4.2], p = 0.001). Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006), and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007). Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices had the greatest gaps in care, most noticeably in diabetes care and weight management.</p> <p>Conclusions</p> <p>This study adds to the evidence suggesting that primary care delivery model impacts quality of care. These findings support current Ontario reforms to move away from the traditional fee-for-service practice.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00574808">NCT00574808</a></p

Quality improvement financial incentives for general practitioners

This report reviews outcomes of intervention programmes targeting reductions in potentially avoidable hospitalisations (PAHs) and/or avoidable Emergency Department presentations (ED presentations) among people with chronic disease. The focus is on the role of primary health care and where possible programmes targeting specific vulnerable populations, namely Indigenous Australians, rural and remote residents and those at socioeconomic disadvantage. This report also aimed to examine tQuality improvement includes aspects of self-reflection and benchmarking, with continued evaluation to identify where additional improvements to practice can be made. Measures of the quality of care are typically structure (e.g. related to an organisation’s operations), process (e.g. clinical guidelines or care pathways) or outcomes-based (e.g. physiological indicators). Improvements can be measured in relative or absolute terms. The likelihood of engaging with incentives and the behavioural responses of health professionals are affected by the different characteristics of financial incentives, which may be directed at networks of practices, individual practices, or specific health care professionals. Payments may be offered as a bonus or addition to usual earnings, or may be withheld if practices do not achieve desired outcomes. Payments may be prospective or retrospective and may be linked to fixed thresholds or individual patients.ends in PAHs and ED presentations among people with chronic disease

Digital communities: context for leading learning into the future?

In 2011, a robust, on-campus, three-element Community of Practice model consisting of growing community, sharing of practice and building domain knowledge was piloted in a digital learning environment. An interim evaluation of the pilot study revealed that the three-element framework, when used in a digital environment, required a fourth element. This element, which appears to happen incidentally in the face-to-face context, is that of reflecting, reporting and revising. This paper outlines the extension of the pilot study to the national tertiary education context in order to explore the implications for the design, leadership roles, and selection of appropriate technologies to support and sustain digital communities using the four-element model

International Profiles of Health Care Systems, 2011

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views