Alberta Health Services and Advancing Uptake of HTA & Innovation

Don Juzwishin, Candis Bilyk, Rosmin Esmail, Paule Poulin, Dr. Trevor Schuler

April 5, 2011Vancouver, British Columbia

2

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

3

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)

4

Program Elements

HTAI PROGRAM

AHS SERVICE

Asse

ssm

ent &

Appr

aisa

l

Rea

sses

smen

t

Acce

ss w

ith E

vide

nce

Dev

elop

men

t (A

ED)

Inno

vatio

n

diseaseprevention

health promotion

screening diagnosis intervention continuing care

palliativepublic health

CDMrehabilitation

Kno

wle

dge

Man

agem

ent &

Tran

slat

ion

Health Technology Assessment & Innovation Departmen t at Alberta Health Services

HTAI PROGRAM

AHS SERVICE

Asse

ssm

ent &

Appr

aisa

l

Asse

ssm

ent &

Appr

aisa

l

Rea

sses

smen

t

Acce

ss w

ith E

vide

nce

Dev

elop

men

t (A

ED)

Acce

ss w

ith E

vide

nce

Dev

elop

men

t (A

ED)

Inno

vatio

n

Inno

vatio

n

diseaseprevention

health promotion

screening diagnosis intervention continuing care

palliativepublic health

CDMrehabilitation

diseaseprevention

health promotion

screening diagnosis intervention continuing care

palliativepublic health

CDMrehabilitation

Kno

wle

dge

Man

agem

ent &

Tran

slat

ion

Health Technology Assessment & Innovation Departmen t at Alberta Health Services

CPSM

Candis BilykLead Clinical Engagement

Contracting, Procurement & Supply ManagementAlberta Health Services

6

Contracting, Procurement & Supply Management

Candis Bilyk, RN, BScN, MNClinical Engagement Lead |Clinical Stakeholder Engag ement

& Standardization InitiativesContracting, Procurement & Supply Management

Alberta Health Services

7

Presentation Outline

• Overview of CPSM

• Foundational Elements of Clinical Engagement and Standardization

Initiatives portfolio

8

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.

9

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

10

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

11

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

12

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

13

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

14

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

15

Next Steps

• Utilize HTAI assessment findings to create funding models

16

Questions?

Role of Knowledge Management and Translation in HTAI

Rosmin Esmail MScDirector, Clinical Epidemiology

Health Technology Assessment & InnovationCADTH Symposium, April 3-5, 2011, Vancouver, BC

Putting Health Technologies into Practice

18

Key Message

To describe the knowledge management and translation planfor HTAI.

What is Knowledge?

20

Definition: Knowledge Management

A set of principles, tools and practices that enable people to createknowledge, and to share, translateand apply what they know to create value and improve effectiveness.

World Health Organization, 2009

21

Definition: Knowledge TranslationKnowledge 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

22

Program Elements

HTAI PROGRAM

AHS SERVICE

Asse

ssm

ent &

Appr

aisa

l

Rea

sses

smen

t

Acce

ss w

ith E

vide

nce

Dev

elop

men

t (A

ED)

Inno

vatio

n

diseaseprevention

health promotion

screening diagnosis intervention continuing care

palliativepublic health

CDMrehabilitation

Kno

wle

dge

Man

agem

ent &

Tran

slat

ion

Health Technology Assessment & Innovation Departmen t at Alberta Health Services

HTAI PROGRAM

AHS SERVICE

Asse

ssm

ent &

Appr

aisa

l

Asse

ssm

ent &

Appr

aisa

l

Rea

sses

smen

t

Acce

ss w

ith E

vide

nce

Dev

elop

men

t (A

ED)

Acce

ss w

ith E

vide

nce

Dev

elop

men

t (A

ED)

Inno

vatio

n

Inno

vatio

n

diseaseprevention

health promotion

screening diagnosis intervention continuing care

palliativepublic health

CDMrehabilitation

diseaseprevention

health promotion

screening diagnosis intervention continuing care

palliativepublic health

CDMrehabilitation

Kno

wle

dge

Man

agem

ent &

Tran

slat

ion

Health Technology Assessment & Innovation Departmen t at Alberta Health Services

DRAFTPLAN

23

Strategy #1

Connect people to evidence-informed decision making through dissemination

�Technology briefing notes

�Operational financial impact analysis

�Reviews

24

Strategy #2

Provide skills to use evidence through the application of the knowledge cycle

Education through Knowledge CycleEducation 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.

26

Strategy #3

Support sharing of HTA knowledge by engaging stakeholders through knowledge transfer activities

27

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

28

http://www.albertahealthservices.ca/4122.asp

29

Strategy #4

Facilitate, review and implement best and innovative practices in HTA

30

Challenges Ahead…

�Building a knowledge sharing culture

�Getting buy in

�Resistance to change

�Resources

“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, PhDHealth 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 SurgeryDivision of Urology

University of Alberta

34

Disclosure

• CPD presenter for GSK

35

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

36

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

37

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

38

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

39

Initiating the Process

• Establishing the framework– Development of an HTA handbook– Educational workshop for committee members

• Education– Executives– Managers– Clinicians

40

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

41

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

42

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

43

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

44

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