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Summary of Research Ellen Balka, Ph.D, PI. Knowledge to Action: Supporting Continuity of Care and Practice Research through Secondary use of EMR data. Amount Requested, Year 1: $100,000 Summary of Research Proposal Summary of Research Background: In 2003, the Vancouver Coastal Health Authority (VCH) chose Mid-Main Community Health Centre (Mid-Main) as one of the clinics to receive primary health care renewal funds. A portion of the funding has been used to purchase and implement an electronic medical record (EMR) system that has some capacity to support chronic disease management through patient registries. In implementing their electronic medical record, Mid-Main has had ongoing contact with Elaine Grenon, Director of New Practice Design with the VCH Primary Health Care Network. In addition, Mid-Main has worked with Dr. Ellen Balka (professor and research scientist at Vancouver Coastal Health) who is the principal investigator of ACTION for Health, a 4-year, $3 million project that has focussed on the role of technology in the production, consumption, and use of health information. Since 2003, several ACTION for Health research projects have been carried out at Mid-Main, including a project which investigated the implementation and use of Wolf Medical Systems’ electronic medical record. The proposed project seeks to build on existing partnerships between Mid-Main, Wolf Medical Systems, VCH, and Balka’s research group through 3 related ‘knowledge to action’ projects of interest to all parties. Objectives: Project objectives are to support the translation of knowledge to action through: 1. Demonstration of enhanced use of data from electronic medical records in support of continuity of care in clinical settings and practice research. This project will focus on building capacity within Mid-Main to increase use of electronic record data to support practice improvement initiatives, particularly those targeted at the population of people who live with 3 or more chronic conditions within the cardiovascular and respiratory clusters, and people with persistent mental illness, who have been identified by VCH as using disproportionately high levels of health service resources. 2. Knowledge translation (KT) from research literature to local users (Mid-Main and VCH) and from local users (Mid-Main) to decision makers (VCH) and technology producers (Wolf), and subsequently potential electronic record adapters, about challenges related to enhanced use of electronic records for management of patients with multiple chronic conditions. 3. Translation of primary research results into good practice guidelines. In B.C., the Ministry of Health has developed a chronic disease management toolkit (CDM Toolkit) used by Mid-Main and other practices. Plans for management of patients with multiple co-morbidities involve increased use of the CDM Toolkit. Primary research will be undertaken in order to better understand how the CDM Toolkit is being used, and identify issues associated with data sharing between clinics and the CDM Toolkit. Results will be disseminated as a good practice guide, suitable for use by clinics. Hypothesis: That knowledge translation activities will result in evidence of practice changes at Mid- Main, evidence of utilization of research results by VCH, and reflected in software (Wolf). Research Plan • Objective 1: Develop a base-line understanding of use of EMR data at Mid-Main through observation and interviews; develop a plan for increased use of EMR data with Mid-Main; implement the plan; evaluate extent to which KT activities contributed to practice changes (through document analysis, observations, and interviews). • Objective 2: Through on-going engagement, respond to informational needs of potential research users. Collect data about appropriateness of materials produced through post-use evaluation of research materials, and interviews with potential users aimed at assessing utilization. • Objective 3: Conduct interviews with Mid-Main and other CDM Toolkit users about use of the CDM Toolkit; develop good practice guide (GPG) to support implementation of the CDM Toolkit; evaluate GPG through post-use surveys and interviews. 9 Ellen Balka, Ph.D, PI. Knowledge to Action: Supporting Continuity of Care and Practice Research through Secondary use of EMR data. Amount Requested, Year 1: $100,000 Summary of Progress Summary of Progress During tenure of a 41/2-year, $3 million Social Sciences and Humanities Research Council of Canada grant (2003-2008) that has addressed a range of issues related to the production, consumption, and use of health information in varied settings (the ACTION for Health program), Dr. Balka has built excellent relationships with both the Mid-Main Community Health Centre and Vancouver Coastal Health. The Mid-Main Community Health Centre (Mid-Main) implemented an electronic medical record (EMR)1 with funds that were administered through Vancouver Coastal Health’s Primary Healthcare Transition Fund, and in this context, Mid-Main worked with Elaine Grenon at Vancouver Coastal Health during the EMR implementation. Balka’s research team has conducted a long term ethnographic study of the introduction and use of the EMR, which was developed by Wolf Medical Systems, a company located in Surrey, British Columbia. As an early adapter of the Wolf EMR (an EMR that was approved for use by practices that received Primary Healthcare Transition Funds), both Elaine Grenon and Mid-Main have had ongoing contact with Brendan Byrne (President, Wolf Medical Systems). In the last year, Balka’s research team has initiated contact with Dr. Byrne and shared information from ACTION for Health research undertaken at Mid-Main which addressed the EMR, with him. Hence, the basis for productive relationships required to foster successful knowledge translation are already in place. Balka’s team has developed several reports at the request of Mid-Main (see http://www.sfu.ca/act4hlth/practitioners/index.html for examples) and a good knowledge translation relationship currently exists between Balka and Mid-Main. In her capacity as the Director of the Centre for Health Services and Policy Research, Dr. Black has had contact with several of the doctors at Mid- Main who engage in research. Drs. Balka and Black share many common interests, including interests in electronic medical records, data quality, and continuity of care. This project has yielded an opportunity for them to begin formally working together. Both Balka and Black have had ongoing contact with Vancouver Coastal Health. Balka holds a position as a senior research scientist there, and Black, through both her role as the director of the Centre for Health Services and Policy Research and as a researcher, has had ongoing contact with several people at VCH. Any research referred to in this proposal that was conducted as part of ACTION for Health and was undertaken at Mid-Main, is complete. 1 Electronic medical records (EMR) are digital records that document the course of patients’ health care, while being a medium of communication among healthcare professionals for current and future care of the patients (American Medical Record Association, 1984). 10 Ellen Balka, Ph.D, PI. Knowledge to Action: Supporting Continuity of Care and Practice Research through Secondary use of EMR data. Amount Requested, Year 1: $100,000 Response to Previous Reviews Response to previous reviews Not Applicable. 11 Ellen Balka, Ph.D, PI. Knowledge to Action: Supporting Continuity of Care and Practice Research through Secondary use of EMR data. Amount Requested, Year 1: $100,000 Research Proposal Research Proposal Introduction A recent newspaper article indicated that as many as 1/3 of British Columbia’s population—1.3 million people—have chronic conditions such as diabetes, heart disease, or lung disease. This population consumes “80 per cent of the combined budgets of hospitals, the Medical Services Plan and PharmaCare.” (Feyerman, 2007, p. A-1). In the same article, the provincial Minister of Health, George Abbott, pointed out that “by concentrating on individuals who use the system most often, we can improve their overall health and well-being and reduce pressures and costs across the health system” (Feyerman, 2007, p. A-1). The article goes on to detail a variety of financial incentives that the province has put in place in efforts to entice doctors to invest more time in chronic disease management. Taking advantage of several of the recently announced incentives will require general practice offices to computerize their patient records and share data about management of chronic diseases with the Province through the province’s Chronic Disease Management (CDM ) Toolkit, which is a web-based resource that gives authorized doctors, nurses, and other care providers access to tools and information incorporating proven best practices for the treatment and management of chronic conditions. The project outlined here will demonstrate the impact of sharing clinical information through eHealth solutions on continuity of care and practice patterns of healthcare providers, and will contribute to knowledge generation about best practices for the secondary use of EMR data to support practice and health system performance management and research. Building on existing relationships, this project focuses on research issues of interest to and generated by a community health clinic, a regional health provider, a research team and a software developer, and the translation of knowledge from primary and secondary research to research users,
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