South Island MSA – IHealth Questions and Answers

With the help of the Doctors of BC, the MSA has been meeting weekly with IHealth leadership to emphasize the importance, value, and definition of early engagement in making the roll-out better and ultimately making their workload easier.

Members of the South Island MSA have varying degrees of clarity about the current IHealth status, expectations, and rollout plans.  This list of themes and questions reflects discussions among members of the Medical Staff and at the South Island MSA IHealth Committee.  Context for each theme is provided in italics.

General Concepts

While most physicians are comfortable with the concept and use of EMRs in community medical offices, the concept and application of an EHR is not as well known.  Many physicians have questions about EHR and organizational basics.

1. What are the effects of an EHR on a) patient care and patient outcomes, and b) physician workload? How was this determined?
2. What improvements have been made to the platform since the Nanaimo roll-out? How will these changes impact the roll-out?
3. How can physicians on the front line easily find answers to questions they might have?
4. An organization structure would help me understand who to contact for what. This should include who is in charge of Templates, Equipment, Training, as well as leadership vs. region/site.  “I’m getting a different name or Zoom invite every few days.”

ClinDoc

Many physicians have heard that IHealth is coming but the expression ‘ClinDoc’ is not known to them.

1. What does ClinDoc entail?
2. Divisions have been given dates for when they are being rolled out…but what does that actually mean?
3. What is the rationale for rolling out ClinDoc and CPOE separately?

Hardware Issues

Especially at Victoria General Hospital, physical space and workstations are already at a premium.  Physicians are feeling worried that, with an increased amount of computer time required for their clinical work, they will be held up from seeing patients and/or will have to wander the hospital looking for a computer to use.

1. How many extra computers/workstations will be available, and where will they be located? We understand that a needs study was done to determine this number.  Could this be released?
2. Will computers be available on a first come, first served basis or will they be reserved for certain groups. If so, which ones?
3. Will we be able to use our own computers and tablets? Will the current WiFi be able to handle the increased load, or will it be upgraded?
4. It is understood that a card-based system exists to sign into a workstation. Will this be available?

Training

Physicians are feeling concerned and worried that time for becoming fully upskilled is short.

1. When will ClinDoc training take place for each wave? When will the various training modules be available?
2. Four hours has been allotted for ClinDoc training. Does that include the time necessary to set up templates and training on Dragon Dictate?
3. If individuals need more than four hours of training, will additional funding be available?
4. Will funding be available to Departments/Divisions to develop discipline-specific templates for ClinDoc?
5. My group does call on a weekly basis. What supports will be available for those who are not working in hospital during the designated onboarding period?
6. Will tutoring sessions be available outside of regular working hours – evenings and weekends?
7. I am in Internal Medicine – third wave – but consult on patients on Rehabilitation wards – first wave. Will I be able to continue to use paper progress notes on rehabilitation wards until I am on-boarded?
8. Will transcription still be available, to help buffer the transition? For how long?  Can I use transcription for everyday progress notes until I feel comfortable with ClinDoc?
9. Will Autotext be taught as part of the ClinDoc training?

System use/Personalization

As is often the case, physicians are discussing successes and challenges that groups who are further along in IHealth implementation are facing.

1. Some groups have reported that template development is taking a long time, especially for groups where a few people are doing the work for everyone. How can this be compensated?  Will there be funding for development of CPOE Order Sets?  If yes and there is excess, can this be used to compensate ClinDoc template development?
2. The Problem List has been reported to be a frustrating, ineffective tool. Why should it be used instead of free text?

Workload

With an already heavy clinical workload, there is concern that IHealth with increase pressures on physicians.

1. Which areas will get supernumeraries? How were these areas selected?
2. What workload supports will be available for those areas who do not have supernumeraries?
3. We understand reducing bed capacity is not considered feasible. Are there other ways that workload can be reduced?
4. Will there be a pause in the Surgical Renewal program during implementation?
5. It is thought that supernumeraries may not be needed for ClinDoc rollout. Can the funding for these be put towards additional supernumeraries for CPOE instead?
6. There is concern about increased cognitive load during rollout. What activities or actions are planned to mitigate this?

Culture

Physicians would like to be not just informed about what is going on, but also to be involved in decisions being made about their workplace.  Some have worked in other regions and have significant experience with other EHRs.

1. What measures are you taking to ensure that the implementation process is transparent?
2. How are you going to engage front-line physicians in implementation and ensure that they have a voice in the process?