vancouver division of family practice 2011 annual report
DESCRIPTION
Vancouver Division of Family Practice 2011 Annual ReportTRANSCRIPT
Vancouver
Annual Report
Covering the period October 2011 to September 2012 (including the 2011/12 Fiscal Year ending March 31/12)
Vancouver Division of Family Practice Annual Report 2011/2012 1
About the Vancouver DivisionThe Vancouver Division of Family Practice (VDoFP) has expanded substantially over the last year and after two full years of operation has established strong partner-ships with many key health care stakeholders in the Vancouver community.
We have 478 practicing family physician members and 62 resident members, representing more than 50 per cent of all family physicians in Vancouver (850 estimated total). Membership is voluntary and open to practicing family physicians, with or without hospital privileges, who deliver the majority of their services in BCMA District Three (Vancouver). This includes doctors who work on a sessional, fee-for-service, salaried or other basis, and deliver full services, specialized (obstetrical, ER, hospitalists) services or services at walk-in clinics. It also includes residents, who are an integral part of the health care system and whose fresh perspective on issues and solutions is valued. This year, the Division passed a motion to add one resident position on its Board of Directors.
Our mission Our mission continues to focus on improving the primary care system in Vancouver for the benefit of our patients and members alike. We also aim to provide leadership, guidance and support to family physicians in the Vancouver area in community care and other related facets of health care.
Our continued commitment to Vancouver Family Practice PatientsMuch of our work over the past year has centered on our four core projects: Information Technology, Continuity of Care, Mental Health and Sustainability of Practice. Within these projects, we seek to address gaps in care and needs that are not being met by the current system. Our approach has been and will continue to be full engagement with our partners in health care.
Our continued commitment to Vancouver Family PhysiciansSupporting our physicians in the community has always been a priority in the work that we do. When planning our projects and strategies, we continually seek to improve the way that medicine is practiced in Vancouver. Through member engagement, networking opportunities, CME events and other related opportuni-ties, we continue to support physicians.
Our priorities – projects in focusThe following core projects, established by the Division Board of Directors after consultation with members, continue to be a main focus for the Division:
• Information Technology (see page 8)
• Continuity of Care and Bi-Directional Communication with Hospitals and Specialist Groups (see page 9)
• Sustainability of Family Practice (see page 11)
• Mental Health (see page 12)
2 Vancouver Division of Family Practice Annual Report 2011/2012
On October 25, 2012, our Division celebrates its second Annual General Meeting. As an organization, we have grown immeasur-ably in both our profile and activities and, as a result, we have been inundated with
offers and requests for input and collaboration from our many partners in health care as well as suggestions from our own members.
As a Board, we strive to represent and support the incredibly diverse interests and passions of our members, while balancing this with strategic short and long term planning. Our goals remain the same:
1. Help our members practice the best medicine they can and make them feel supported and heard when they identify gaps in service
2. Identify strategic themes that resonate strongly with our members and engage our partners to address those concerns
This year we have worked incredibly hard to address shortcomings in Vancouver’s Mental Health system. Many meetings and processes have been undertaken and I thank those members who have persevered throughout this process. The innovation process is sometimes laborious.
We are also embarking on an initiative of engagement with several specialist groups. The aim is not only to improve the referral process but to improve communi-cation and collegiality and facilitate true shared care of our patients. I invite our members to become involved in this process. In order to bring more voices to the table in an expedited fashion, we will be forming E-Advisory
Message from the Board ChairGroups to provide dynamic feedback on issues that arise during the series of engagement meetings. The E-Advisory Groups’ only time commitment will be to complete the web-based surveys from time to time. We will use your feedback to help guide us in our engagement meetings.
We are also keenly aware of the importance and potential of EMRs to improve health care and facilitate communication. Our IT Committee will be providing additional support to assist members contemplating EMR adoption and those who already use EMRs and want to increase their functionality.
I want to reiterate the Board’s commitment to members’ issues. I encourage all members to continue to look for opportunities to become involved in the Division, whether it includes committee work, participating in CME opportunities or attending our social events and increasing collegiality within our Division.
Respectfully submitted,
Dr. Terry ChangChair, Vancouver Division of Family Practice
Vancouver Division of Family Practice Annual Report 2011/2012 3
Our Division is now well established as an organization and is actively pursuing the priorities our member physicians have helped us identify.
As we move forward, I strongly encourage all members to remember that we each have the ability to do things in our day to day practice of medicine that will aid in the achievement of the Division’s goals and help transform the health care system we work in.
For example, our prescribing and referral patterns have bearing on our communication and relationships with our specialist colleagues. Our use of EMRs can help ensure the availability of consistent medical information at every patient encounter.
The Division offers a means for us to coordinate our actions and make significant transformation to the
From my perspective as the Division’s Physician Lead, I view our biggest successes over the past year as the working relationship we have developed and the progress we are making collaboratively with Vancouver Coastal Health. Among the highlights are the headway we are making on improving access to Mental Health resources in Vancouver, and the cooperative approach we took to discussing and then reviewing applications to the BC Ministry of Health for nurse practitioner positions. We continue to bring forward our members’ concerns such as two-way communications with the hospital when our patients are admitted, and IT issues between hospital and family physician offices.
The year brought many changes, including the addition of new Board members who were not engaged in the Division’s inception. They have brought with them fresh ideas and, because we deliberately took our time to gel as a group and define our common priorities, the transition has been a positive one. I look forward to the continued evolution of our Board as other members step up to lead the Division forward, and I thank fellow
Message from the Vice-Chair
Message from the Physician LeadBoard members who are leaving the Board and will still be active within the Division.
We have greatly missed the energy and organizational skills of our Executive Director, Toby Kirshin, who went on sick leave at the end of the fiscal year. We have been very grateful for the support we have received from Interim Executive Director Halla Elmobayad and our Office manager, Ainslie Still, but are very much looking forward to having Toby back with us soon.
The Board is very pleased that we continue to attract new members. We recognize that we have a very diverse group of members from all walks of family practice, and we do our best to try to represent everyone’s varying needs and interests.
Regards,
Dr. Patricia MirwaldtPhysician Lead
health care system we practice within. But true change requires each of us to do some reflection, not just about how we manage our day to day work but also about our shared longer term focus.
I encourage all members to engage in the Division’s work. Consider participating in a working group, attend CME events and get to know more of your peers at our networking events. I thank you for your contributions so far and look forward to the opportunity to work more with each of you in the coming year.
Regards,
Dr. Rita McCracken Vice-Chair
Over the last year, the Vancouver Division has grown in many promising and positive ways. In addition to an increase in membership, the Division’s project portfolios
have expanded substantially into areas of health care that impact the quality of care for patients and the work satis-faction for family physicians.
Much of this work has been propelled by the efforts of the Division’s Executive Director, Ms.Toby Kirshin, who has been working hard with the Board, our members and other partners in the Vancouver region.
In joining the Division as the Interim Executive Director in late summer of this year, I immediately felt the devotion and determination of the Board which made it
easy for me to identify with the visions and goals of the organization. I am committed to bringing these projects and ideas to fruition and, in the many months to come, I foresee promising outcomes and more growth in our membership and project portfolios.
Sincerely,
Halla ElmobayadInterim Executive Director
Message from the Executive Director
Halla Elmobayad
Toby Kirshin
4 Vancouver Division of Family Practice Annual Report 2011/2012
Vancouver Division of Family Practice Annual Report 2011/2012 5
The following are the members of the Division’s Board of Directors for 2011-2012:
• Dr.TerryChang–BoardChair
• Dr.PatriciaMirwaldt–PhysicianLead
• Dr.RitaMcCracken–ViceChair
• Dr.JohnRidley–Treasurer
• Dr.RosannaVellecaLima-Secretary
• Dr.CraigGoldie
• Dr.JamesLai
• Dr.DouglasMcGregor
• Dr.MargaretMcGregor
• Dr.LilahRossi
Committees, Working Groups and Advisory Groups of the Board
CoMMuniCaTions
• Dr.TerryChang
• Dr.RitaMcCracken
• Dr.PatriciaMirwaldt
infoRMaTion TECHnology
• Dr.PatriciaMirwaldt(Chair)
• Dr.TerryChang
• Dr.CraigGoldie
• Dr.JamesLai
sHaRED CaRE sPECialisT iniTiaTivE
• Dr.RitaMcCracken(Chair)
• Dr.TerryChang
• Dr.FionaDuncan
Staff• Ms.HallaElmobayad–InterimExecutiveDirector
• Ms.TobyKirshin–ExecutiveDirector
• Ms.AinslieStill–OfficeManager
Board of Directors
finanCE
• Dr.JohnRidley(Chair)
• Dr.TerryChang
• Dr.PatriciaMirwaldt
noMinaTions
• Dr.CraigGoldie
• Dr.LilahRossi
• Dr.LilahRossi
• Dr.JoyRussell
• Dr.JoanneYang
Dr. Terry Chang
Dr. Rita McCracken
Dr. Rosanna Velleca Lima
Dr. Douglas McGregorDr. James Lai
Dr. Patricia Mirwaldt
Dr. John Ridley
Dr. Lilah RossiDr. Margaret McGregor
Dr. Craig Goldie
6 Vancouver Division of Family Practice Annual Report 2011/2012 Vancouver Division of Family Practice Annual Report 2011/2012 7
Board
Mental Health
Engagement with Mental Health
Services
Physician Data Initiative
Shared Care Executive
Recruitment/Retention
BCMACBT initiative IT Committee
EMR recruitment
Home is Best Initiative
Office Cost Saving Initiatives
PublicWebsite Provincial Divisions
Residential Care
Alternate Payment for MDs
Special Interest/Patient Groups
Newsletter/Email Interdivisional /VCH
Community of Practice
Specialist Shared Care Initiatives
Cardiology
Respiratory Med
Urology
Psychiatry
PHC Int Med
EMR User Groups
EMR PITO Projects
CSC/Hospital/VCH Information/Communications
Divisions of FPSustainability MoH
IT/EMR Communication (Clinical) Membership Government and External Engagement
Executive Director
IT – Information Technology
EMR – Electronic Medical Records
CSC – Collaborative Services Committee
VCH – Vancouver Coastal Health
FP – Family Practice, or Family Physician
PITO – Physician Information Technology Office
CBT – Cognitive Behavioural Therapy
PHC – Providence Health Care
MoH – Ministry of Health
BCMA – BC Medical Association
Division Projects Organizational Flow Chart
8 Vancouver Division of Family Practice Annual Report 2011/2012
Information Technology and EMRsiT CoMMiTTEE MEMbERs
• Dr.PatriciaMirwaldt(Chair)
• Dr.EricCadesky
• Dr.TerryChang
• Dr.CraigGoldie
• Dr.StanKaron
• Dr.SamKrausz
• Dr.DamonRamsey
• Dr.CharlesWebb
Communities of Practice (COP)VDoFP has recently finalized its funding agreement with the Physician Information Technology Office (PITO) and will now be establishing a Community of Practice (COP) that encompasses all EMR users in Vancouver. In doing so, we are joining the growing network of COPs throughout the province. A COP is a group of physician practices using a common vendor for all their electronic medical records, to increase their meaningful use.
The Division COP is vendor neutral and will be inclusive of all clinicians employing EMRs, including specialists. We have surveyed the physician practices in our area to determine the rate of EMR use and the types of EMRs being used. With this information the IT Committee has created a strategic plan that will enable us to support members already using EMRs as well as those that have not yet adopted one.
Our goal is to offer user groups specific to each EMR, whether PITO-sponsored or not, and provide support and education so that EMRs can be used as a powerful and efficient tool in the delivery of excellent and efficient health care. Effective EMR use can also help us achieve our other Division goals: enhance communica-tions between patient care providers, improve chronic disease management and health promotion activities, improve office efficiency and sustainability, enhance physician practice quality improvement opportunities, and increase overall patient safety and satisfaction.
Our approach will be to help provide objective information on all EMR solutions available to help members make informed decisions: features, a dvantages, costs and supplier information for each.
We also plan to provide a directory of technical support resources to assist with purchasing, set-up, and ongoing support, as well as optimization for existing EMR users.
Physicians Data CollaborativeThis year, with a contribution of $70,000, our Division joined 22 other divisions throughout the province in the establishment of the Physicians Data Collaborative (PDC), a very exciting initiative aimed at enabling individual physicians to ask specific questions about their practices and similar practices that will make differences in their day to day care of patients.
The PDC is a not-for-profit organization working to enable the collaborative use of clinical data to improve patient care.
The PDC will create a frontline physician-driven, divisionally owned and controlled distributed data network with the potential to achieve the following:
• Enableclinicalqualityimprovementactivities and continuing medical education (CME) reflective practice
• Answerclinicalandresearchquestionsofinterest to frontline practicing physicians
• Answerpopulationhealthquestionstoassistwithhealth system management and improve patient care
• Providedatatodriveandevaluatedivisionalinitiatives,and support divisional funding applications
Vancouver Division Physician Lead, Patricia Mirwaldt, serves as the treasurer and as the VDoFP representative on the PDC’s physician Board of Directors, which will manage the project.
Vancouver Division of Family Practice Annual Report 2011/2012 9
Shared Care Specialty Groups sHaRED CaRE aDvisoRy gRouP
• Dr.RitaMcCracken(Chair)
• Dr.TerryChang
• Dr.FionaDuncan
• Dr.LilahRossi
• Dr.JoyRussell
• Dr.JoanneYang
The Shared Care project has invested significant time over the course of the past year in getting to know and strengthening relationships with our specialist colleagues in Vancouver.
A large part of our work is building rapport and truly understanding the nature and scope of work that different specialists are doing and want to do. At the same time, we are building their understanding of the goals and work of family doctors, with an eye to aligning our interests and making improvements with how we communicate and work with one another.
The most important outcome of our work to date is learning that real change requires this investment of time in listening to one another. It is rewarding work, because although it can be slow, the end result is both strong relationships and effective project outcomes.
We have had good interest from other Vancouver family practitioners to help with this important work, and have developed an approach through which we will train some of our Vancouver family practice colleagues so that they are comfortable and qualified to have conversations with different groups of specialists.
Additionally, we have developed some tools that build on the existing forms we use for referrals and consult letters that we are presenting to specialists during our meetings with them as demonstrations of the kind of solutions we are interested in pursuing together.
Continuity of Care and Communication Although both tools have been used only minimally so far, they are proving to be useful conversation starters.
For the past several months, the Advisory Group has been meeting with cardiologists at Vancouver General Hospital and are using this relationship as a prototype for our work with other specialist groups and to train four other Division members.
We are also creating E-Advisory Groups, through which other Division members will be able to join a temporary email list and provide their thoughts and comments on what the Advisory and Working Groups are doing.
The Vancouver Collaborative Services Committee (CSC)The Vancouver CSC is the vehicle through which Vancouver family doctors, represented by the Division, collaborate with our partners in the Vancouver primary care system, including Vancouver Coastal Health , the General Practice Services Committee (GPCS: BCMA and Ministry of Health), and Providence Health Care (PHC).
The CSC is the forum for discussing issues of concern for patient care outcomes, co-determining priorities and co-designing solutions. Additional representation from patients and others in the community is called upon as needed.
10 Vancouver Division of Family Practice Annual Report 2011/2012
The CSC partners are guided in their work by the objectives of the Triple Aim:
• Animprovedpatientorproviderexperienceofcare
• Animprovementinpopulationhealth
• Thefinancialsustainabilityofthesystem
Over the past year, the Vancouver CSC has taken on several key issues:
1) Physician to physician communication, with a focus on improving communication around the transition from hospital care to community family practitioner offices
2) Mental health services, including increased access and faster referrals
3) Residential care innovation looking to better support the physicians currently providing care in residential care locations through CME, and develop Shared Care models to help reduce transfer of residential care patients to the ER
CSC members include:
vanCouvER Division of faMily PRaCTiCE
• Dr.TerryChang–(Co-ChairofCSC),BoardChair
• Dr.PatriciaMirwaldt–PhysicianLead
• Dr.JamesLai–BoardMember
vanCouvER CoasTal HEalTH (vCH)
• MaryAckenhusen–(Co-ChairofCSC), Chief Operating Officer
• CaroleGillam–ExecutiveDirector,PrimaryCare
• JoanneBezzubetz–ExecutiveDirector, Community Health
• VivianEliopoulos–ExecutiveDirector, Vancouver, Acute Services
PRoviDEnCE HEalTH CaRE
• DianneDoyle–PresidentandChiefExecutiveOfficer
• DavidThompson–VicePresident,SeniorsCare&Clinical Support Services
PRovinCial Divisions of faMily PRaCTiCE/gPsC
• BrianEvoy–ExecutiveLead
Residential CareCoMMiTTEE MEMbERs
• Dr.MargaretMcGregor
• Dr.LarryBarzelai
• Dr.DouglasMcGregor
• Dr.DuncanEtches
• Dr.ThomasHo
In recent months, the Division has begun a project with our Collaborative Services Committee (CSC) partners aimed at improving care for the more than 7,000 frail elderly patients living in long term care facilities in Vancouver, and supporting the family physicians who work there.
Our proposal, which has recently been approved by the CSC, involves developing a community of support for family physicians working in care facilities, mentoring younger physicians interested in residential care facility work, and identifying the systemic barriers to attracting and retaining family physicians in this area of practice. Our goal, which is shared by Vancouver Coastal Health and Providence, is to help improve health outcomes and
reduce unnecessary hospital transfers for these patients through good primary care.
This project is a priority for the Division because it has the potential to fill a major care gap for a highly vulnerable population in our region.
Vancouver Division of Family Practice Annual Report 2011/2012 11
Website & Online Resources - UpdateWe have been working with the Provincial Division of Family Practice staff team at the BCMA to transfer the Vancouver Division website onto the provincial server and are optimistic that this will help enhance member communication through new online tools.
One of the main benefits of this for members of the Division is a free subscription to the UpToDate® web resource. UpToDate® is an evidence-based clinical decision support tool developed by physicians to help health care practitioners make the best decisions at the point of care.
In addition to UpToDate®, the site also offers:
• Ourexistinglocummatchingservice,whichhasproven to be the most popular tool on our website
• Ageneralforumtoolwhichwillenablenetworkingand discussions with colleagues on topics of interest, and can also be used to schedule meetings
• Asearchabledirectory,whichwill display email addresses when consent is given
• AccesstoGoToMeeting,whichallows video conferencing
• ConnectivitytotheotherDivisions through new website tools
Family Practice Sustainability
External Communication CampaignInJanuary2012,theDivisionlauncheditsfirstexternalcommunications effort. Combining print and outdoor advertising with a campaign website, the campaign was entitled“TalktoYourGP.”
The campaign objectives were two-fold: to help patients better understand the central role their family doctor plays in their long-term health management, to encourage them to communicate with their doctor about care they receive in hospital or from other care providers so that the physician can maintain their medical records, advocate for them and coordinate their care with other health professionals when needed, and provide them with comprehensive, longitudinal care.
The media buy resulted in a total of nearly 16 million impressions by our target audience.
12 Vancouver Division of Family Practice Annual Report 2011/2012
Mental Health Working Group: Under the Vancouver Collaborative Services Committee (CSC)vanCouvER Division
• Dr.PatriciaMirwaldt
• Dr.BobBluman
vanCouvER CoasTal HEalTH
• Dr.RolandoBarrios
• JoanneBezzubetz
• LauraCase
• MariaCorral
• JenniferDuff
• ErinGable
• Dr.SomaGanesan
PRoviDEnCE HEalTH CaRE
• Dr.MariaCorral
The Vancouver Division of Family Practice is committed to working together with our partners to improve access to metal health services in Vancouver.
Over the last year the Division has been working in partnership with Vancouver Coastal Health (VCH) to look at system access and areas for improvement.
Mental Health In February 2012, practicing members of the Division alongwithpatients,VCH&St.Paul’sHospitalphysiciansand front line staff from the emergency department, and inpatient/outpatient Psychiatry Departments met for a half-day client journey mapping session.
During this session current state maps of two patient journeys were completed: 1) patients referred to the Emergency Department for acute psychiatric a ssessment, and 2) patients referred to the outpatient departments for psychiatric assessment. As a result of the mapping session, areas of opportunity were i dentified for improving each of the two streams.
InJune2012,anotherjointsessionofDivisionmembers,patients, and members of VCH met to map the patient journey, from recognizing that they had a mental health issue, to resolving the concern. The group began with public and web based assessment and support, and went through primary care to referral, treatment and support and post-discharge support for patients. The session developed 17 promises, including improving the referral process and shared care. The Mental Health Working Group will continue to actively pursue these topics in the coming year.
• ScottHarrison
• LornaHowes
• YasminJetha
• Dr.AndrewMacFarlane
• AnneMcNabb
• JenniferVornbrock
Several member events were held throughout the year, offering CME, networking and social opportunities, and opportunities for member input on Division projects. These events continue to be well-attended and highly valued by members.
January 2012 External communication campaign launch, presentation of and member engagement on membership survey results.
Member Events and EngagementMarch 2012GuestspeakerDr.DeeManginfromNewZealandpresentedontheNewZealandexperiencewitha model similar to Divisions of Family Practice.
May 2012Working Session on Specialist Communication/Relations –Membershadtheopportunitytodiscusstheresultsof the survey on specialist communication and referrals and provide input to help guide the work of the Shared Care Advisory Group.
• Dr.PattHowitt
• Dr.RosannaLima
Vancouver Division of Family Practice Annual Report 2011/2012 13
This past fiscal year we saw continued growth of our membership which directly translated into growth of our operating budget. The funding surpassed the $825,000 mark, which has put us in a strong position
to move our mandate forward.
With this increased funding has come the ability to operationalize our many initiatives. I am pleased to report that the Board has maintained focus and produced early results to that end. Initiatives in the areas of mental health care delivery, specialist referral processes, information technology and transitions of care have seen the majority of activity.
Additionally, we have placed significant resources towards the province-wide Physicians Data Collaborative. We believe that this is a valuable, forward-looking project that will return long-term dividends to primary care physicians and our patients in years to come through sharing and analyzing pooled data.
While it is gratifying to see the increasing numbers, I believe that we need to continue to reach out to the many family physicians in Vancouver who are not yet members of the Division, so that they too can have input into the direction of our activities and so that we can represent the largest possible majority of Vancouver family doctors in our interactions with our health care partners.
Finally, I call out to the many of you who are or would be exceptional leaders. The Division is an organization of significance that represents you, and needs you to participate and help guide our activities. Please become involved as much as you can.
Sincerely,
Dr. John Ridley Treasurer
Message from the Treasurer
2011/2012 EXPENSES
2011/2012 ASSETS
Physician Costs: Events – $82,057
Marketing and Communications – $146,628
Physicians Data Collaborative – $130,000
Events – $56,790
Physician costs: Board and Committee – $175,988
Meetings – $9,685
Administrative – $40,974
Contractors – $181,242
Amortization – $6,201
Other – $1,050
Grant – $825,987
Term Deposit – $10,000
Cash – $283,882
Receivables – $28,865 Tangible Capital Assets – $9,684 Prepaid Expenses – $635
2011/2012 REVENUE
