BCHIMPS Education Session

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BCHIMPS Education Session

• Primary Health Care,
• Strategies for Engagement and Adoption

November 17, 2006
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Panel Agenda ( approx 1.5 hrs)

• Introduction 10 min - Alan
• Current HA Clinician Engagement 10 min each (40
  min) HA Reps
• Question 1 5 min each HA Reps (20 min)
• Question 2 5 min each HA Reps ( 20 min)
• Open Q A (15 min)

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Introduction

• What is Primary Health Care?
• What does the patient experience (outside of the
  acute care setting) when in contact care system -
  in their family physician's office, in a
  community health centre, mental health clinic
  etc. ?
• Why reform physician practice?
• 2/3 of the costs incurred by a health region are
  incurred because of something a physician wrote
  down on a piece of paper .. You can try to save
  money on the other 1/3rd all you want.
• How does Canada rank?
• 2006 International Health Policy Survey

4
The Commonwealth Fund2006 International Health
Policy Survey ofPrimary Care Physicians in Seven
Countries

• The Commonwealth Fund
• 2006 International Symposium on Health Care
  Policy
• Washington, D.C., November 13, 2006
• Cathy Schoen, Senior Vice President
• Robin Osborn, Vice President and Director,
• International Program in Health Policy and
  Practice

5
2006 International Health Policy Survey

• Mail and telephone survey of primary care
  physicians in Australia, Canada, Germany, the
  Netherlands, New Zealand, the United Kingdom, and
  the United States.
• Final samples 1003 Australia, 578 Canada, 1,006
  Germany,931 the Netherlands, 503 New Zealand,
  1,063 United Kingdom, and 1,004 United States.
• Conducted by Harris Interactive and
  subcontractors, and in the Netherlands by The
  Center for Quality of Care Research (WOK),
  Radboud University Nijmegen, from February 2006
  to July 2006.
• Cofunding from The Australian Primary Health Care
  Research Institute, The German Institute for
  Quality and Efficiency in Health Care, andThe
  Health Foundation.
• Core Topics information technology and clinical
  record systems, access, care coordination,
  chronic care/use of teams, quality initiatives,
  and financial incentives.

Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
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Primary Care PracticesUse of Information
Technology andClinical Information Systems
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Figure 1. Primary Care Doctors Use ofElectronic
Patient Medical Records, 2006
Percent
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
8
Figure 2. Electronic Medical Record System Access
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
9
Figure 3. Practice Use of Electronic Technology
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
10
Figure 4. Doctor Routinely Receives Alert
AboutPotential Problem with Drug Dose/Interaction
Percent
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
11
Figure 6. Patients Routinely Sent Reminder
Noticesfor Preventive or Follow-Up Care
Percent
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
12
Figure 7. Capacity to Generate Patient Information
Percent of primary care practices reporting easy
to generate
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
13
Figure 8. Primary Care Practiceswith Advanced
Information Capacity
Percent reporting seven or more out of 14
functions
Count of 14 EMR, EMR access other doctors,
outside office, patient routine use electronic
ordering tests, prescriptions, access test
results, access hospital records computer for
reminders, Rx alerts, prompt tests results easy
to list diagnosis, medications, patients due for
care.
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
14
Coordination of Care
15
Figure 13. Length of Time to Receivea Full
Hospital Discharge Report
Percent saying 15 days or more or rarely receive
a full report
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
16
Care for Chronically Ill Patientsand Use of Teams
17
Figure 15. Capacity to Generate List of Patients
by Diagnosis
Percent reporting very difficult or cannot
generate
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
18
Figure 16. Doctor Routinely Gives Patients
withChronic Diseases Plan to Manage Care at Home
Percent giving written plan
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
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Figure 17. Use of Multidisciplinary Teamsand
Non-Physicians
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
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Quality Initiatives
21
Figure 19. Availability of Data on Clinical
Outcomesor Performance
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
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Figure 23. Primary Care Summary and Implications

• Striking differences across the countries in
  elements of primary care practice systems that
  underpin quality and efficiency.
• Physicians in Australia, the Netherlands, New
  Zealand and the U.K. most likely to report
  multitask IT systems U.S. and Canada lag behind.
• Reports indicate varying capacity to care for
  patients with multiple chronic conditions or
  coordinate care with decision support.
• Integration and coordination are a shared
  challenge.
• Widespread primary care doctor participation in a
  range of quality improvement activities although
  safety tracking systems are rare except in the
  U.K.
• U.S. stands out for financial barriers and also
  has limited after-hours access.

Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
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Figure 24. Opportunities to Learn to Inform
Policy

• Country patterns reflect underlying strategic
  policy choices and extent to which policies are
  national in scope
• Payment policies for quality and care management.
  
• IT Investing in primary care capacity and
  interconnectedness.
• After-hours access.
• Chronic disease management and use of teams.
• Primary care redesign is central to initiatives
  to improve health care system performance
  internationally.
• Evidence that national system focus is
  essential to build capacity.
• Striking country differences in primary care
  practices and national initiatives offer rich
  opportunities to learn.

Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
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Acknowledgments

• With appreciation to
• Coauthors Phuong Trang Huynh, Michelle M. Doty,
  Jordon Peugh, and Kinga Zapert, On the Front
  Lines of Care Primary Care Doctors Office
  Systems, Experiences, and Views in Seven
  Countries, Health Affairs Web Exclusive (Nov. 2,
  2006)w555w571.
• Developing and Conducting SurveyHarris
  Interactive and Associates.
• Conducting Survey in the Netherlands The Center
  for Quality of Care Research (WOK), Radboud
  University Nijmegen.
• Cofunders The Australian Primary Health Care
  Research Institute,The German Institute for
  Quality and Efficiency in Health Care, andThe
  Health Foundation.

Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
25
Acknowledgments

• With appreciation to
• Coauthors Phuong Trang Huynh, Michelle M. Doty,
  Jordon Peugh, and Kinga Zapert, On the Front
  Lines of Care Primary Care Doctors Office
  Systems, Experiences, and Views in Seven
  Countries, Health Affairs Web Exclusive (Nov. 2,
  2006)w555w571.
• Developing and Conducting SurveyHarris
  Interactive and Associates.
• Conducting Survey in the Netherlands The Center
  for Quality of Care Research (WOK), Radboud
  University Nijmegen.
• Cofunders The Australian Primary Health Care
  Research Institute,The German Institute for
  Quality and Efficiency in Health Care, andThe
  Health Foundation.

Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians.
26
What is the history and current state of Primary
Health Care in the HA?

• Approach
• Activities

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Where is the HA headed with Primary Health Care?

• Tactical focus

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Strategic Next Steps

• Provincial alignment

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Question 1 What is the HA biggest challenge?

• What are you doing about it?

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Question 2 How is the HA engaging patients?

• Patient access to their own record
• Patient entering information into their own
  record

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Vancouver Island Health AuthorityPrimary Health
Care Approach
Dr. Mary Lyn Fyfe Victoria Power-Pollitt BCHIMP
S November 17, 2006
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Overview

• VIHA PHC CDM Program
• VIHA PHC Strategy 2006/07-2008/09
• Physician Engagement Approaches, Successes in
  IM/IT
• Lessons Learned

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VIHA PHC CDM Program

• Key theme - VIHA 5 Year Strategic Plan
• Identified as Key Initiative (PHC CDM) by
  Senior Executive Team
• Island-Wide Clinical Program established August
  2005
• Co-Management Model

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PHC CDM Program Mandate

• Operations
• 5 PHCOs, DECs, Nutrition Service, Collaboratives,
  PHC Networks, 3 PHCO contracts
• Provider Engagement
• Opportunities for improving supports to systems
• Building networks
• Policy Development
• Strategic Plans Service Frameworks
• Service Integration

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VIHA Primary Health Care Definition

• The range of services individuals and communities
  receive on a regular, ongoing basis in order to
  stay healthy, get better, manage ongoing illness
  or disease, and cope with end of life.
• .

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VIHA Primary Health Care Strategy 2006/07
2008/09

• Enhancing and Extending PHC Services through
  partnerships
• Supporting infrastructure, networks and
  innovation

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VIHA PHC Strategy Initiatives

• PHC Developers
• PHC Provider Networks
• Enhanced PHC Priority Communities
• PHC Indicators
• Website development
• Aboriginal Health PHC Initiative
• Connecting / Supporting the Providers

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VIHA Chronic Disease Management Definition

• Working with individuals, families, and
  communities to help people maintain as much
  health and independence as possible through the
  prevention, early detection, and management of
  chronic health conditions.
• A range of different people in a variety of
  settings may provide chronic disease management
  services.

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VIHA CDM Plan 2006/07-2008/09

• Extending and Enhancing CDM programs services
  through partnerships
• Increasing access to current VIHA-operated CDM
  programs services
• Supporting partnerships, networks and innovation

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VIHA CDM Plan Initiatives

• Collaborative Program for Service Integration
• Service Frameworks for Integrated Care
• CDM Steering Committee
• Interdisciplinary Team CDM Education Support
• CDM Provider website

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Collaboratives Program for Service Integration

• How do we achieve our mandate?
• Establish contractual agreements with interested
  family physicians
• Provide on-going support for quality improvement
  initiatives
• Focusing on Diabetes, CHF, Depression and CKD.
• Our frameworks
• Expanded Chronic Care Model
• IHI improvement methodology

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Data example
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Congestive Heart Failure
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Congestive Heart Failure
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Chronic Kidney Disease
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Physician Engagement Approaches in IM/IT

• Expert Input/Participation and Communication
• IM/IT Committees
• National/Provincial Committees
• Canada Health Infoway Physician Advisory Panel
• Provincial eHealth committees including SPEED
• VIHA IM/IT Steering Committee (Executive Level)
• Primary care portfolio representation

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Physician Engagement Approaches in IM/IT

• IM/IT Committees
• Clinical Informatics Physician Advisory Panel
• Project Steering Committees Physician Leaders
• Portfolio and Medical Advisory Committees
• Communication Strategies
• Leverage Physician User Group experience

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Success in Primary Care Physician Engagement and
IM/IT Adoption Comox Valley St. Josephs Hospital

• An integrated viewer for laboratory, diagnostic
  image reports, transcribed documents and
  PharmaNet using Concierge
• Success
• Clinical Adoption Demonstrated Value
  -integrated, accessible, intuitive, safer
• Statistics
• 42/45 (92) Primary Care Physicians
• 32 (65 ) have adopted EMRs
• 30/30 Specialists

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Success in Primary Care Physician Engagement and
IM/IT Adoption Comox Valley St. Josephs Hospital

• Decommissioned external paper distribution
• Return on Investment
• Cost per report
• Concierge 0.08-0.10
• Mail 0.30 to 0.50

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Building On Success

• Engagement successes in regional PACS, Comox
  Valley
• Opportunities for Primary Care Physicians in
  South Island
• Web Result and Booking Project
• Interim projects while PITO and iEHR/PLIS get
  developed
• Welcoming Physician Portal
• Access to Patient -centric, web enabled Cerner
  Outreach PowerChart Light
• Emergency Room visit notification
• Provider-centric Laboratory, Diagnostic Imaging
  and Document Reporting
• eBooking for Diagnostic Images
• Access to CME/On Call Scheduling etc.

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Primary Health Care and IM / IT Lessons Learned

• Communication and developing meaningful
  interfaces is key
• One size does not fit all, flexibility is
  important and scheduling is a challenge
• Demonstration of value through efficiency and
  patient care is critical to successful engagement
  and adoption
• Opportunism is vital
• Simplicity is the best engagement feature
• Clinicians want to be involved

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Thank You Questions?
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Primary Health CareStrategies for Engagement
and Adoption

• BCHIMPS November 17, 2006

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What is the history and current state of Primary
Health Care in the HA?

• Primary Health Care Goals
• Improved access to a continuum of Primary Health
  Care Services
• Improved quality and appropriateness of care
• Increased focus on prevention and health
  promotion
• Direct contribution to Primary Health Care
  research and evaluation
• Alignment of people, process and technology
  enablers in support of organizational goals
  required to optimize outcomes
• Early Lesson Learned Effective business,
  clinical and information technology partnership
  is critical to success

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Approach

• Engage formal and informal
• EMR implementation EOI Primary Care IT
  Strategy Physician User Groups (PUGS)
• Lead VCH Direct Programs and Services
• Role and process redesign in Community Health
  Centres/Clinics
• Program development self management
• Implementation of IT enablers for Primary Care
• Program evaluation
• Support - Services Provided by Others
• Improved practice management
• Quality Improvement collaborative model
  chronic disease management prevention and
  promotion
• Development and delivery of IT enablers to
  Primary Care
• Influence
• development of policy standards funding

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Engagement and Adoption Tactics

• Engagement
• Physician User Groups geographic /interest
  based groups virtual and face to face
  meetings simple IT tools focus on low
  pressure/high value engagement
• Peer to Peer Communication
• Clinical Champions
• Direct clinician involvement in strategy, program
  and policy development, planning, design,
  development, delivery and evaluation
• Compensation for participation in projects
• Listen well listen frequently
• Adoption
• Effective change management - communication,
  change readiness, training and education, reward
  and recognition, evaluation
• Understand what changes, when and to whom
• IT Adoption Model 4 levels Where am I now?
  Where do I want/need to be? What are my options
  to get there?

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Where is the HA headed with Primary Health Care?

• Value driven, outcome focused program and project
  structure - start with the end in mind
• Increased process participant involvement in
  all project phases - planning, definition,
  design, implementation and evaluation
• Leveraging existing people, process and
  technology capabilities to support continuum of
  care and population health needs

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Strategic Next Steps

• Ongoing alignment with Ministry of Health 9
  Priority Initiatives
• Ongoing alignment with Provincial eHealth
  facilitating increased user readiness supporting
  ongoing clinician engagement sharing tools and
  expertise

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Question 1 What is the HA biggest challenge?

• Funding for the evolving role of the HA in
  Primary Health Care

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How is the HA engaging patients?

• Indirectly through care providers
• Directly through
• patient satisfaction measures
• HA involvement in Conversation on Health
  sessions
• Patient portal early planning stages will
  include direct engagement of patients

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For more detailed information

• Contact
• Diane Gerwin, Project Director
• VCH IMIS Primary Care IT
• Phone [phone] X 63819
• Email diane.gerwin_at_vch.ca

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Fraser HealthPrimary Health Care Framework and
Initiatives

• Laurie Gould, Executive Director
• Primary and Chronic Care
• November 2006

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Primary Care Renewal

• Success Demands
• Information Technology
• Full Electronic Medical Record
• Shared Multidisciplinary Care
• Internal-multidisciplinary care
• External-interdisciplinary in-reaching
• Management Support
• Change Management support
• Knowledge Management
• Data analysis and reporting

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Strategic Intent of FHs Primary Health Care
Initiative

• To achieve individual and population health
  outcomes through planned care, improved access
• Achieve clinical practice standardization and
  integration amongst GPs
• To achieve improved provider satisfaction
• To reduce acute care utilization and emergency
  visits relative to chronic diseases and an aging
  population

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Primary Health Care Renewal Initiative Primary
Care Model Delivery Vision

• Improvements Achieved
• Integrate providers
• Improve access
• Manage complex and chronic conditions
• Promote self-management
• Improve information management systems

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Enhanced Full Service Family Practices (EFPs)

• Maple Ridge
• BCST Family Practice
• Abbotsford
• Clearbrook Family Practice
• Gateway Health and Wellness Clinics
• Chilliwack
• Promontory Family Practice
• Newcombe House Family Practice
• Langley
• Murrayville Family Practice
• Brookswood Family Practice
• Fort Family Practice
• Langley Primary Health Care Associates
• Four Oaks Family Practice
• White Rock/South Surrey
• Morgan Creek Family Practice
• Whiterock Medical Associates
• George Street Family Practice
• Oceanside Family Practice

• Project governed by FH
• Established Physician Steering Committee
• Develop partnership for renewal
• Provide direction and input
• Implementation by Project Coordinators
• Background in primary care
• Implementation supported by specialist resources
  as required
• Committed to 10 practices to learn in an
  innovation lab setting in order to create a
  model for the future.

Enhanced Family Practices

• Independently owned/operated
• 3 or more physicians
• Full range multi-disciplinary team based on
  population requirements
• Proactive care
• Fee for Service/Blended fee structure

• Previously known as Primary Health Care
  Organizations (PHCOs)

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Primary Care Renewal InitiativeHigh Level
Implementation Approach
Initial Change Mgmt
Information Systems
Chronic Disease Prevention/ Mgmt
Patient Centered Primary Care Networked primary
care providers
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Clinical Information System

• Organize patient and population data to
  facilitate efficient and effective care
• Include clinically useful and timely information
  on all patients in a registry
• Provide reminders and feedback for providers and
  patients
• Identify relevant patient subgroups and provide
  proactive care
• Facilitate individual patient care planning
  through the registry.

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Primary Care Renewal InitiativeIntegrated
Systems Vision

• Key Solution Attributes
• Completed privacy and security compliance of
  software functionality for practice information
  within central hub addressed patient consent
• Ability for practices to enter/exit central hub
• Maintenance of Master Patient and Master Provider
  lists
• Interface to provincial registries
• Amalgamation of patient data for single medical
  record across
• Primary Care EMR, whether Intrahealth or other
  vendor
• Any and all other health sources
• EMR Viewer for real time consolidated patient
  data
• Secure internet-based patient access for self
  management

Enhanced Family Practices
Accession (Patient access for self-management)
Provider EMR Viewer
Other Health Sources (e.g. Hospitals, Home
Community Care, Mental Health)
Practice data screen
Master Patient Index
Master Provider List
Large, real-time pipe
Other practice/EMR software
Various Authority, Provincial or Federal systems
and Registries
Intrahealth
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Central Management Support Strategy

• Issues
• How to deliver effective transition of practices
  to the FSFP service delivery model and
• underlying practice and technology reforms,
  without incurring excessive individual costs and
• risks of adopting inefficient variations of
  the model
• How to ensure continued alignment with
  provincial and health authority objectives
• How to support MDs in change management
  strategies
• How to collect and analyze data to support
  ongoing quality assurance and to quantify quality
  
• improvements
• Required
• Central body to provide products ,services and
  support to practitioners inclusive of
• Project coordinators that work with the practices
  in a partnership
• Knowledge management
• Data analysis

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Lessons Learned

• Change management for both IT and Practice
  redesign is key
• All stakeholders in the practice/service must
  have a collective vision and be on-board as
  there is a significant investment in time and
  effort
• Dont underestimate the need for basic support.
• Training should be ongoing, not a one-time effort
• Leadership is key, both from the practice level
  and Health Authority level
• Online access to lab and other diagnostics is
  essential
• Relationships, Relationships, Relationships
• This is about everyone working together to
  advance primary care renewal
• Trust between providers
• You dont know what you dont know!
• Data reporting at the individual and practice
  level is key
• The providers need to identify data indicators
  relevant to their population

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Issues We Are Facing Today.The Wish List

• The need to interface the community physician
  information system(s) with Meditech to ensure
  continuity of information
• Permanent funding for
• information technology central hub
• multidisciplinary teams to support GPs in the
  management of chronic conditions
• case management support (shared care)
• ongoing change management support
• training for the primary care team in patient
  self-management
• Recruitment of change management support staff
• Time
• Hurry up and wait

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Thank you
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BCHIMPS

• Interior Health current state

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Primary Health Care

• The management of relationships between health
  care providers for the health and wellbeing of
  the patients/clients/communities they jointly
  serve.
• CONNECTIVITY

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IH models

• PHC organizations
• Chronic disease integrated networks
• Shared care
• Collaborative care
• Physician office redesign support
• Integrated information network
• Self care initiatives

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IH PHC/IMIT principles

• Focus on improving health of clients
• Free flow of information
• Electronic health record
• Patient-centric thinking

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IMIT Initiatives

• IH-wide EHR with physician office access
• Patient Care Inquiry
• PHC integrated settings
• evaluation
• Chronic disease integrated networks
• South Okanagan integrated system pilot
• Physician engagement network

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IMIT Initiatives

• Patient lab data portal
• Valley Medical Labs diabetes project
• Telemonitoring project
• Wound care project
• PACS
• e Medical library Portal
• health care workers
• IH residents

84
Where is IH going?

• Inconsistent messaging from province on PHC
  direction.
• Shift in direction to support of and modification
  of primary care physician offices
• Significantly impacted by recent fiscal restraint
  pending provincial clarity on direction.
• Some IT based initiatives proceeding, some
  deferred.

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PCI access

• 900,000 physician hits per year.
• Physician access
• 78 from within IH facilities
• 64 from external site (office/home)
• Access purpose (MD 25 of accesses)
• 45 for lab data
• 19 for reports
• 18 for radiology
• 7 visit history
• 5 demographics

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PHC integrated settings

• Meditech based office system

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Project Background

• Modules Phase 1 2
• Billing
• Registration Scheduling
• Basic Clinical Documentation (EAR)
• Meditech Modules Phase 3
• Advanced Clinical Documentation
• Physician Workload Management (PWM)
• Prescription and Ambulatory Order Management
  (AOM/RXM)

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Implementation
Phase 1 and 2
Phase 3
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PHC organizationBasic Clinical Documentation
Module (cont)

• Overall Functionality
• 29 satisfied
• 47 dissatisfied due to
• no summary of a patients plan of care
• no comprehensive view of a patients past health
  care information
• too many screens to go through
• poor user interface

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Basic Clinical Documentation Module (cont)

• Effects on Clinical Practice
• 86 agreed the electronic chart is easier to read
• 38 review other providers notes more often
• 29 could manage clinical information better
• 85 would not recommend the product to other
  providers but
• 67 disagreed with the following statement
• IF I COULD GO BACK TO PAPER-BASED RECORDS I
  WOULD

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Results

• Billing Module
• did not simplify billing process
• prone to more errors than the previous system
• increased the time spent on the billing process
• Registration Scheduling Module
• integrated with Meditech
• one time registration
• Benefits of electronic scheduling

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Results

• Basic Clinical Documentation Module
• evaluated by 21 health care providers
• Physicians
• Nurse Practitioners
• PHC nurses
• Chronic Disease Nurses
• Social Workers
• Respiratory Therapists

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PHC evaluation

• Still underway, but in one site, physician
  utilization of hospital beds were 44 that of
  peers in the community.
• not solely attributable to IT integration.

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Chronic disease improvement networks

• Operational in three settings
• Shared EHR access.
• Differing systems, not conversant with other
  systems
• Multidisciplinary teams
• Clinic function at one site has deferred
  equivalent of two hospital beds.

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South Okanagan Integrated pilot

• Included physicians in the community
• using electronic medical summaries developed by
  the physicians themselves.
• Health care facility (hospital and LTC)
• Pharmacy
• Lab information
• Evaluation due in next few months

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Physician engagement Network

• List of high users of IT systems
• Interest not great in developing formal network
• Concern about operationality of IH EHR and
  interaction with office practices

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ePatient portal

• Encrypted view of information and detailed audit
  of system accesses. Secure high-encryption SSL.
• One time password (OTPG) registration technology
• General announcements and health advisories
• Patient Demographics
• Lab Results with statistics, target ranges and
  dynamic graphing for AIC, INR, Lipids
• E-Mail Notification of new lab results
• Integrated with Interior Health's E-Medical
  Library for patient access to reliable medical
  resources.

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ePatient portal

• Only in one area
• limited uptake to date
• Not highly supported by MDs
• 9 participating
• only 4 promoting
• only 3 with patients
• Slow dissemination planned

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Telehealth initiatives

• CHF patient monitoring in conjunction with BC
  Nurseline
• Wound care via Internet transferred digital
  photos
• PACS

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Valley Medical Diabetes Project

• Private lab
• Recall system for A1C and routine prescribed lab
  testing for diabetics based on Canadian
  guidelines
• Started small in Central Okanagan,now available
  to most docs.
• Patients notified of results.

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eLibrary

• Accessible by all health care workers and all
  residents who have registered into Meditech
  system
• Access to reference materials, search engines,
  some journals.
• Also health care professional access to journal
  on-line libraries.
• Utilization dwindling?
• journal access for health care workers
• more Internet information readily available
• may close portal in near future.

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e- medical library