Primary Care as an Example of Complex Adaptive Systems – Presentation by Dr. Clare Liddy

Earlier this month I wrote a blog post promoting a presentation by Dr. Clare Liddy at the monthly OCRI IT in Healthcare lunch event series.  As I was unable to attend the session, Mary Van Buren, a colleague and member of the OCRI IT in Healthcare event series organizing committee, graciously agreed to prepare a synopsis of Dr. Liddy’s presentation.  Thanks, Mary.

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Primary Care = Complex Adaptive System

Dr. Clare Liddy introduced this concept as an explanation for some of the challenges facing vendors in working with physicians and within the primary care environment.  She was invited to speak as part of OCRI’s Health IT luncheon series, designed to highlight the many local health-IT initiatives and successes taking place here in Ottawa.  A family physician, Dr. Liddy also has a Masters in Epidemiology from the University of London; is the lead on the IDOCC project, a  heart disease initiative; and is the primary care lead in the Champlain region for Diabetes.  You may also take some comfort, as I did, that even a highly-regarded and qualified physician such as Dr. Liddy, working from within the system, encountered some difficulties in getting adoption of a new tool she and a team developed.  See if these characteristics of a complex adaptive system that she described sound familiar to you:

• Non-linear and dynamic
• Independent agents
• Intelligent agents who adapt/learn leading to self organization
• No single point of control

And now layer in the various practice cultures that drive everything from decision-making to patient care:

• Quality centric: favour patient satisfaction surveys
• Business oriented: favour benchmarking
• Collegiate: informal peer review
• Autonomous:  self-reflection
• Information:  favour electronic data systems and evidence-based data

While Clinical information systems is a key pillar in the chronic care model and provinces have created incentives for physician adoption of e-solutions, IT in healthcare remains woefully behind other countries.  According to one of the data points Dr. LIddy shared from the 2009 Commonwealth and International Survey of primary care physicians, 37% of Canadian physicians are using electronic medical records, putting us in last place.  Netherlands has 99% and is in first place, while the US is in second last place, but still well ahead of Canada at 46%.

That is why it is so encouraging to hear from physicians like Clare Liddy who are championing the adoption of new solutions to improve the health of their patients.   It is no secret that the aging demographics combined with high consumer expectations of good quality of life will place a high toll on health care both in terms of human and financial resources.

One of the issues she raised is the lack of connectivity between primary care and hospitals, and among physicians.  It still surprises me that faxes are a preferred method of communication by physicians.  I can’t tell you the last time I received or sent a fax!

Another challenge is that of the 83 practices involved in her project, about half had an EMR and half had paper records.  And among those with EMRs, there were 10 different versions being used.  This prevented the ability to pull data seamlessly.  Instead a researcher was required to go to each practice, look through paper records or view the records online and compile the data manually.  Not exactly the fast lane!

The good news is that there is wide-spread recognition of this lack of inter-connectivity and Ontario is making some progress.  As reported recently in Canadian HealthCare Technology, Ontario   has launched its Clinical Document Specification (CDS) initiative  “We are currently developing the standards-based CDS to allow clinical documents to be shared electronically between hospitals, physicians, Community Care Access Centres (CCACs) and other health care providers,” says Grant Gillis, Director, eHealth Standards.

Bringing new solutions to the primary care community can be challenging.  The opportunity is to allow for  “mass customization” as each physician, practice or institution appears to want tailored e-health solutions, yet on an affordable basis.  This is indeed the promise of the new collaborative tools- from the internet, to wikis, to social networks – solutions can be brought not just to the masses, but can extend out to the long tail.

I’d love to hear about  your successes!

Mary Van Buren

http://www.excelerateconsulting.blogspot.com
http://www.cepsm.ca/team/associates/