Alberta Health Services and Advancing Uptake of HTA & Innovation Don Juzwishin, Candis Bilyk, Rosmin Esmail, Paule Poulin, Dr. Trevor Schuler April 5, 2011 Vancouver, British Columbia
Objectives Introduction to approach in Alberta Role of central procurement and supply management Role of knowledge management and translation Overview of clinical networks and the bottom up approach Opportunities and challenges of clinical leadership and engagement Discussion 2
Our Context 3.7 million people 12 former health jurisdictions 90,000 staff 7,400* Physicians Macro AACHT Mezzo AHS Micro Clinical setting *this figure is the total physician count for Alberta both employed and independent physicians) 3
Program Elements Health Technology Assessment & Innovation Department at Alberta Health Services HTAI PROGRAM AHS SERVICE 4 Assessment & Appraisal Reassessment Access with Evidence Development (AED) Innovation Knowledge Management & Translation health promotion disease prevention public health screening diagnosis intervention CDM continuing rehabilitation care palliative
CPSM Candis Bilyk Lead Clinical Engagement Contracting, Procurement & Supply Management Alberta Health Services
Contracting, Procurement & Supply Management Candis Bilyk, RN, BScN, MN Clinical Engagement Lead Clinical Stakeholder Engagement & Standardization Initiatives Contracting, Procurement & Supply Management Alberta Health Services 6
Presentation Outline Overview of CPSM Foundational Elements of Clinical Engagement and Standardization Initiatives portfolio 7
What is CPSM? CPSM is the acronym for Contracting, Procurement & Supply Management. CPSM is the AHS division responsible for contracting, purchasing and overall supply management of goods and services that include: warehousing, distribution, transportation and supply services provided at health care facilities throughout Alberta. CPSM also supports clinical stakeholder engagement initiatives, vendor relations, surplus equipment, product safety, forms management and environmental sustainability. 8
Overview: Clinical Stakeholder Engagement, Standardization & Evaluation Initiatives Portfolio Engage clinicians in sourcing strategies End to end communication during all phases of transition and ongoing participation of stakeholder groups as required Clinical support and liaison for CPSM Consultative role: acting as change agents in the evaluation and implementation of products introduced through GPO and internal contracting efforts Encouraging involvement in decision making to enhance accountability and transparency 9
Overview: Clinical Stakeholder Engagement, Standardization & Evaluation Initiatives Portfolio (Cont d) Building partnerships with key stakeholder groups Support evidence based decision making Creating the framework for a provincial standardization committee Creating and implementing a physician engagement strategy Developing and implementing a clinical engagement strategy Collaborating with Equipment Planning in developing a stakeholder engagement strategy 10
Clinician Engagement Strategy Involve key clinical AHS staff in decision-making processes as they relate to contracting, procurement and supply management initiatives Physician engagement key, particularly in high preference areas Transparent communication to facilitate understanding, learning and improvement Build sustainable relationships Responsive to needs of end users Empower clinical stakeholders 11
Clinical Engagement s Link to Health Technology Assessment & Innovation (HTAI) Reliance on HTAI to demystify conflicting sources of information and provide objective technology assessment information CPSM supports HTAI in the facilitation of evidence-based decision-making through the management of health technology New and existing contracts for medical devices: Involve clinical stakeholders in the establishment of sourcing strategy and design, understanding the market place, establishing requirements, specifications, etc. Health Technology Assessment and Innovation: Provide medical device information including procedural and product usage information, contractual terms and conditions, other vendor information as required 12
Clinical Engagement s Link to Health Technology Assessment & Innovation (HTAI) (cont d) Clinical evaluation of a new medical device: CPSM recognizes that technology evolves as a result of which contracts must have a provision for introduction of new technology A provincial medical device evaluation form and process has been established with both clinical and financial implications being reviewed Linkage with HTAI to capture all evaluation requests Evaluation requests requiring a health technology assessment are routed to HTAI Ensure appropriate stakeholders within the clinical community are evaluating products (usage reports, clinical service specialties) Facilitate evaluation process to ensure that medical device trials are meaningful and adding value to the process 13
Why Support a Partnership with HTAI? Transparency in activities allows CPSM to be prepared for change and respond in a timely manner Awareness of emerging issues, changes to service delivery models, etc. Leverage our strengths and obtain critical input in product selection including using clinical expertise in ensuring appropriate products and technology enter our system Participate in ongoing technology planning (continuous 3 year planning cycle) Facilitate innovation and evidence-based practice 14
Next Steps Utilize HTAI assessment findings to create funding models 15
Questions? 16
Role of Knowledge Management and Translation in HTAI Putting Health Technologies into Practice Rosmin Esmail MSc Director, Clinical Epidemiology Health Technology Assessment & Innovation CADTH Symposium, April 3-5, 2011, Vancouver, BC
Key Message To describe the knowledge management and translation plan for HTAI. 18
What is Knowledge?
Definition: Knowledge Management A set of principles, tools and practices that enable people to create knowledge, and to share, translate and apply what they know to create value and improve effectiveness. World Health Organization, 2009 20
Definition: Knowledge Translation Knowledge translation is the exchange, synthesis and ethically-sound application of knowledge - within a complex system of interactions among researchers and users - to accelerate the capture of the benefits of research for Canadians through improved health, more effective services and products, and a strengthened health care system. CIHR, March 2011 Accessed at: http://www.cihr-irsc.gc.ca/e/26574.html 21
Program Elements Health Technology Assessment & Innovation Department at Alberta Health Services HTAI PROGRAM AHS SERVICE 22 Assessment & Appraisal Reassessment Access with Evidence Development (AED) Innovation Knowledge Management & Translation health promotion disease prevention public health screening diagnosis intervention CDM continuing rehabilitation care palliative DRAFT PLAN
Strategy #1 Connect people to evidenceinformed decision making through dissemination Technology briefing notes Operational financial impact analysis Reviews 23
Strategy #2 Provide skills to use evidence through the application of the knowledge cycle 24
Education through Knowledge Cycle Education Modules on Awareness and Assessment Education Module on Application Scott C et al, 2009. Integrated Health Systems and Integrated Knowledge Creating Space for Putting Knowledge into Action. Healthcare Quarterly, 13, Special Issue October 30-36.
Strategy #3 Support sharing of HTA knowledge by engaging stakeholders through knowledge transfer activities 26
Communities of Practice HTAI Groups of people who share a concern or passion for something they do and, interacting regularly, collectively learn how to do it better Wenger accessed at http://www.ewenger.com 27
http://www.albertahealthservices.ca/4122.asp 28
Strategy #4 Facilitate, review and implement best and innovative practices in HTA 29
Challenges Ahead Building a knowledge sharing culture Getting buy in Resistance to change Resources 30
A little knowledge that acts is worth infinitely more than much knowledge that is idle. Khalil Gibran
Adapting a Local HTA Program to Clinical Networks with Alberta Health Services Paule Poulin, PhD Health Technology & Innovation Department of Surgery Calgary Research Portfolio CADTH Symposium, April 3-5, 2011, Vancouver, BC
Clinician Engagement in the HTA Process Dr Trevor D. Schuler, MD FRCS(C) Assistant Professor Department of Surgery Division of Urology University of Alberta
Disclosure CPD presenter for GSK 34
Objectives To describe to role for clinicians envisioned within the Surgery Clinical Network HTA process To stimulate discussion surrounding the role of clinicians within the HTA process 35
HTA and Surgery in Alberta Institutional HTA (local HTA) has been present in Calgary for a number of years Clinician initiated Clinician lead Dr. Lea Austen General Surgeon Surgery Clinical Network Co-chaired by surgeons Members from the surgeon community, nursing, administration, CPSM and management Liaison with HTA and Innovation Within the Research and Innovation portfolio of AHS 36
Goal of the SCN Committee To provide decision support to clinicians and managers within all disciplines of surgery To apply sound HTA principles in Rural, Urban, Academic and Community hospitals To stimulate innovation and research To do so in a fair, equitable and engaging manner 37
Goals of the Committee To assess: new devices devices being used at new anatomic sites new surgical approaches technologies with significant budget impact technologies requiring new institutional considerations technologies with significant social or ethical implications 38
Initiating the Process Establishing the framework Development of an HTA handbook Educational workshop for committee members Education Executives Managers Clinicians 39
Projects currently under review Evaluation of pre-surgical skin preparation solutions and techniques Evaluation of biological mesh devices Evaluation of a new ventricular assist device 40
How to Engage Clinicians? Will require a change in medical decision making paradigm: Education Divisional Rounds Site based management committees Transparency Facile process Support for applications Universally applied Support for clinical trials 41
How not to engage Clinicians Perception of HTA as Bean Counting or Gate Keeping Perception that innovation will be suppressed Replace the notion of being the first or largest with being the best designed and most representative trial or clinical series Lengthy process Inequity in process Forceful implementation 42
How to engage clinicians We have an ability to: Harness enthusiasm for new technology with Simple, equitable and transparent process that Can stimulate the closure of the loop from implementation of new technologies to Innovation and Discovery We must continually re-evaluate our process Ensuring it meets the needs of clinicians and administrators 43
Summary Clinical Engagement Requires: Physician leadership Physician education around the roles of HTA A simple, equitable, transparent process With these foundations a move to evidence based decision making is possible 44