Medical Affairs: Innovations in the Calgary Health Region Dr Rollie Nichol, Calgary Health Region Sandra MacDonald Goy, Calgary Health Region Nicholas Tait, Social Sector Metrics Inc Catherine Keenan, Calgary Health Region
Calgary Health Region Context • One of the largest fully integrated, publicly funded health systems in Canada • $2.8 billion budget • Population of 1.2 million people, some of the fastest growing communities in the country • Over 29,000 employees, 3,000 physicians • Over 100 health care locations, including • 12 acute hospitals • 4 comprehensive health centres • 41 care centres • variety of community and continuing care settings
Calgary Health Region
Population Growth Population Growth in the Calgary Health Region 2004 - 2008 1,300,000 1,250,000 1,200,000 P o p u latio n 1,150,000 1,100,000 11.0% increase (n=125,448) in the population of the Calgary 1,050,000 Health Region between 2004 - 2008 1,000,000 2004 2005 2006 2007 2008
Physician Growth Physicians working in the Calgary Health Region 2004 - 2008 3200 3000 Number of Physicians 2800 2600 2400 23% increase (n=575) in the number of physicians practicing in the Calgary Health Region between 2200 April 2004 -April 2008 2000 4 4 5 5 6 6 7 7 8 4 5 5 6 6 7 7 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - - - - - - - - - - - - r l n r l n r l n r l n r t t t t u u u u p c p c p c p c p a a a a J J J J A O A O A O A O A J J J J
Panel Presentation • A Systematic Approach to Regional Physician Workforce Planning • e-Partners Project • Future Physician Workspace Project
A Systematic Approach to Regional Physician Workforce Planning Dr. Rollie Nichol, Calgary Health Region Mr. Nicholas Tait, Social Sector Metrics Inc.
Purpose Support Rational Decision Making • Internal • Meeting patient need • Aligning with infrastructure development and evolving service delivery models • External • Funding UGME/PGME expansion and mix • Increased provincial funding of APPs
Methodology Research 1. Adjusted Needs Models estimate the current and projected supply of physicians required for the perceived burden of disease. Based on an understanding of current and projected prevalence of disease and capacity of specific specialties to care for that disease burden e.g. GMENAC (Graduate Medical Education National Advisory Committee) 1979 and 1991; � Complex, data intensive 2. Demand-Utilization Models project supply of physicians required to provide health care services at current utilization levels. Projects future use based on forecast changes in demography & productivity; � Baseline is current utilization rates, identify current supply deficit (if any), project future need based on demography (adjusted) & programs – Calgary Health Region Adopted Modified Version; 3. Requirements Models are based on current Health Maintenance Organization staffing patterns; � Not applicable in Canadian context Socio-Demographic Models project the effects of socioeconomic and demographic factors on the 4. availability of future practice opportunities for physicians; � Market opportunity approach 5. A Physician Human Resource Strategy for Canada (03/2006) – incorporate “needs-based” factors; � Conceptual only 6. Comparative Ratios & Benchmarking is a fifth model that is an alternative to the four quantitative models above. This method uses physician to population ratio’s e.g. CIHI (not intended for PWP); � Simplistic
Policy Framework Assessment, Forecasting, Planning Evidence-based Needs Assessment Integration Supply Need Assessment Assessment • Balance Hours of Work & Lifestyle • Balancing the “need” for “@ 50 hour work week” appropriate access with the “demand” for immediate access • Sustainable Call Rotation “1:4 Guideline” • Current Demand plus Future Need • Alternate Care Providers Not “right time, right place” • Current Demand plus Future Demand • Defining an “FTE” @50 hours plus Hrs on Call
Summary Model Assessment, Forecasting, Planning Integration Supply Need Assessment Assessment Apply Apply Variables Variables Current Future Forecast Forecast Roster Supply Population Programs Current Utilization
Supply Assessment Model Supply Assessment Life Style/Work Week Age (survey, T&M study) Gender Apply Migration Departure Variables ( CIHI, Roster Analysis) Build Current Assess Future Roster Supply Data Sources (College, HA, etc.) Undergraduate (Medical Schools) Base Roster Matching (CaRMS) Counts Postgraduate (Residency Pgrms) Time/Motion Studies Practice Entry (CAPERS) Surveys (CMA, CFPC, etc.) Fellows Practice Profiles IMGs (CaRMS, CAPERS) FTEs Foreign
Operationalizing “Model delivers Model delivers “ “Baseline Baseline” ” “ Supply Assessment “Department addresses other parameters “ Department addresses other parameters” ” e.g. Colon screening 50+ e.g. Colon screening 50+ e.g. Teaching model e.g. Teaching model
Needs Assessment Model Need Assessment Growth Sustainability Apply Expansion Age Variables Gender Priorities Migration Multi-cultural Population Programs Demographic Infrastructure Socio-Economic Capacity Health Status Access Morbidity Services Referral Patterns Education Research Data Sources Technology
Operationalizing “Model delivers Model delivers “ “Baseline Baseline” ” “ Need Assessment “Department addresses other parameters “ Department addresses other parameters” ” e.g. new hospital e.g. new hospital e.g. minimally invasive surgery e.g. minimally invasive surgery e.g. core services in remote areas e.g. core services in remote areas e.g. diabetes e.g. diabetes e.g. deficit indicator or 1x catch up indicator e.g. deficit indicator or 1x catch up indicator e.g. Expansion of Undergraduate & Post- e.g. Expansion of Undergraduate & Post -Graduate Graduate e.g. Full- -time academic funded position 50% protected time time academic funded position 50% protected time e.g. Full Less: [population growth] Less: [population growth]
Automating Baseline Plan
Modelling Scenario Planning & Sensitivity Analysis
ePartners Project Sandra MacDonald Goy, Calgary Health Region
Purpose The ePartners Project will deliver: • Business process and customer service improvements • A Medical Staff appointments solution (replacement of the existing Medical Staff database) • An authoritative, integrated source of information for the Provider Registry • Integration with the Oracle Financial system ePartners will not deliver: • Technology and information related to patient/client care • Duplication of Oracle Financial systems
ePartners Concept Diagram Regional Clinical Departments Physician Relations Communications Demographics Finance Medical Staff Contracts Physicians Appointments & & Applications Applications & Finance Recruitment Allied Health Contracts Regional Credentialing Contract Review Portal Reports Medical Staff ARPs Office Workforce Plans Account Status Demographics Workflow Notifications Invoice Entry Chief Medical Officer e-Partners Communications
ePartners Project Timeline • Defined business requirements & issued RFP Jan – Dec. 2006 • Contract negotiations completed January 2007 • Oracle selected as product • Impac selected as the vendor for implementation • Approved separate Operating Org configuration Oct 2007 • User acceptance testing/regression testing June 2008 • Configure for Production July 2008 • Limited production access September 2008 • Data migration/data entry • Passive feed to Regional Provider Registry • Implementation with governing offices October 2008 • Begin rollout to regional departments 2009
ePartners Project Status Appointments & Credentialing • Configuration complete May 2008 • Automated workflow development deferred Finance & Contracts • Configuration complete May 2008 • Automated workflow development deferred Communications • Implementation deferred until regional delivery channels in place (eg. Enterprise fax upgrade, paging system replacement) Self Service (Portal) • Roll out deferred in order to ensure data integrity and system functionality established
Business Process Redesign Example – Physician Contact Information (Risk Management) “AS IS” and “TO BE” mapping completed • Regional Medical Staff Office (RMSO) • Health Records Services (HRS) - Transcription Services • IT Access Office Business Roles Confirmed • Data entry responsibilities for internal providers – ePartners Governing Offices – Regional Medical Staff Office (RMSO), – Medical Education Office (MEO) – Allied Health Office • Data entry responsibilities for external providers – ePartners (HRS) • Data integrity (back end validation) - HRS
Risks • Project timelines • Managing risks • Managing expectations • Communications • Transition to business & service owners
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