February 28, 2014, President's Letter

February 28, 2014

Dr. Allan S. Garbutt, AMA President

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Dear Member:

In this letter:

  • There is a long-term vision for electronic medical records (EMRs) in Alberta, but we need a path to get there. Short-term things can be done to move in the right direction:
    • Non-financial support.
    • Costs and incentives.
    • Making the most of what we have.
  • The Alberta Medical Association (AMA) will be implementing a stop-gap limited EMR support service.
  • Communication begins from the Physician Compensation Committee now that its first decisions have been made:
    • Allocation 2014.
    • Rates for alternative relationship plan (ARP) and the clinical portion of academic ARPs.
    • Rates for Business Costs Program and Rural Remote Northern Program.
    • Provincial rate for physicians in family care clinics (FCCs).

POSP and the EMR

Under the Provincial Electronic Medical Records (EMR) Strategy Consultation Agreement, Alberta Health (AH) and the AMA have been working toward a strategy document for a deadline of mid-February.

At the same time, as members know, Physician Office System Program (POSP) will wind down officially on March 31 (as provided for under the AMA Agreement). While some eligible physicians continue to receive funding support after that (some up to 2019), for many others funding will cease. Additionally, the non-financial support for physicians that POSP has been providing will end.

There has been much talk of a long-term vision and direction for health information: greater ability to share information; clinical decision support; and analytics to help us better understand the needs of Albertans. These things are important and the previously described strategy document developed does a good job of laying out these perspectives.

At the same time, we also need to know what we are going to do on April 1 and for the next few years to get us to that long-term goal. What kind of bridge will be available to support physicians? The best strategies can fail if the beginning steps are missed – in this case, listening to and understanding patients and providers in terms of their capabilities and needs.

In particular, any successful strategy will need to address the following:

1. Non-financial support: POSP has provided incredible support, including a help desk, advisory services for EMR selection and implementation (privacy, security, vendor relations and issues management, etc.). Physicians need this kind of support.

There are now about 4,000 physicians using EMRs, providing care to approximately 85% of four million Albertans. There are millions of records involved, all requiring support for associated issues of security, safety and appropriate sharing. It is not just about rules and regulations; it is about appropriate and timely support from a trusted source.

2. Costs and incentives: The fact that EMR funding goes away does not mean the costs of operating an EMR go away. So how do we recognize these costs and what incentives towards EMR usage should be put in place? More specifically:

a) What is the appropriate method/mechanism to measure the costs? This could be accomplished, for example, through an expanded Business Cost Study as being discussed at the Physician Compensation Committee.

b) How can we direct the money to where the costs arise, i.e., toward those physicians using an EMR?

c) What are the incentives? Should there be e-visits for patients? Should concepts such as “meaningful use” be introduced, which incent physicians not only to have an EMR, but also to use the EMR in certain ways?

3. Making the most of what we have: We have a provincial investment now in EMR technology. We have accumulated a massive amount of health information, developed skills within physician offices and built patient acceptance.

To make the best use of this investment there are several steps that can be taken.

For example, we could build on existing infrastructure in the form of the Provincial Health Information Exchange and our EMRs to allow all these systems to “talk” to one another. In this way, we leverage the technology we’ve already invested in to move the information that patients want us to share when we are caring for them – across the continuum of care and at many different locations.

While the long-term strategy document has been sent to the minister, these short-term issues continue to be discussed. Government has indicated that they have heard these concerns. I will keep you apprised of what develops.

Today, however, you may simply be asking: What happens April 1 when there is no more POSP?

As previously communicated, physicians who have not received their full allotment of POSP funding will continue to receive funding to the maximum they are eligible to receive. For some, funding may continue until 2019.

As for the extensive support services that POSP has provided, the AMA will offer a stop-gap EMR support service beginning March 1. The details will be communicated very shortly but will include limited help desk (operation support), privacy, data management and EMR implementation support.

We hope that some longer term arrangements for support can be identified in a reasonable period of time. Stay tuned.

Physician Compensation Committee

The PCC has continued to meet every two weeks since my last President’s Letter, developing its processes and making decisions that can now be communicated.

Although the parties expect to communicate separately on various issues, a joint newsletter, PCC Update, has been developed. By the time you read this letter, you should have received issue one. If you missed it, here is a link.

The update identifies the topics that have occupied the committee since December, including:

  • Completing the April 1, 2014 allocation (details will be sent to all physicians in March), which includes new wording for a general rule related to time-based codes.
  • New alternative relationship plan (ARP) rates and rates for clinical portions of academic ARPs matching the sectional increases under the main April 1 allocation.
  • Approving increases matching the main April 1 allocation for the Business Costs Program and Rural Remote Northern Program.
  • Approving a provincial rate for physicians in family care clinics (FCCs).

The PCC process is unique – and accordingly it has been built “from scratch.” There is a learning curve for everyone, but the committee is working according to the requirements of the AMA Agreement.

It has made a good beginning on urgent issues for physicians and is preparing to work ahead on addressing, e.g., primary care compensation, business costs and overhead and relative value, including an individual fee review.

For the AMA, the focus continues to be fair, transparent processes, decisions made on the best information available and appropriate input from those groups affected.

All these things can contribute to the goal spelled out in the AMA Business Plan for a comprehensive provincial Physician Compensation Strategy that aligns how physicians are paid with the health care system we practice in today and in the future.

Input from the sections has been extremely important. It will be equally important in the months ahead.

I look forward to hearing from delegates at the Representative Forum March 14-15 in Edmonton during the PCC session. The RF will receive an update on the latest PCC decisions, priorities and work plan and have the opportunity for feedback and advice.

Once again, I welcome your comments. Email president@albertadoctors.org or comment below.


Allan S. Garbutt, PhD, MD, CCFP

P.S. With the RF approaching, be sure to also let your delegate(s) know what’s on your mind so your voice can be heard at the meeting. If you’re not sure who your delegate is by section or zone as appropriate, visit the website RF delegate page.

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