Creative Professional Activity Statement
While Assistant Professor, I have obtained Excellence in Creative Professional Activity with impact at the national and international levels. In my academic and regional leadership roles, I have employed an academic lens and focused on quality improvement, facilitating physician knowledge transfer through point-of-care EMR tools, and developing and measuring the impact of eHealth solutions on health and patient care.
My Excellence in Creative Professional Activity has been most evident in two spheres of academic pursuits:
1. A series of novel initiatives to facilitate electronic medical records (EMR) adoption and create and disseminate inter-professional EMR quality improvement tools; and
2. The implementation of a research program in a community-affiliated hospital.
The following is an outline of creative professional activities that support my promotion, as well as evidence of their impact and innovation.
Sphere 1: Professional Innovation and Creative Excellence
A series of novel initiatives to facilitate electronic medical records (EMR) adoption and create and disseminate inter-professional EMR quality improvement tools.
Michelle Greiver, Jan Barnsley, Babak Aliarzadeh, Paul Krueger, Rahim Moineddin, Debra A Butt, Edita Dolabchian, Liisa Jaakkimainen, Karim Keshavjee, David White, David Kaplan. Using a data entry clerk to improve data quality in primary care electronic medical records: a pilot study. Informatics in primary care 01/2011; 19(4):241-50.
This method of using non-physicians to improve data quality in electronic medical records has proven to be the key to linking quality improvement in clinical work to practice-based research.
International Impact: Subsequent to this publication and based on my leadership in this area (linking clinical practice to practice-based research), I have been asked to be the sole Canadian family physician on the NAPCRG Community Clinician Advisory Group (8 members total). NAPCRG, the North American Primary Care Research Group, is a multidisciplinary organization for primary care researchers. The role of the Community Clinician Advisory Group is to assist in formulating the future North American primary care research agenda.
National Impact: Currently, we are building the first Canadian shared acute care/primary care clinical and research database funded by the NYGH Exploration Fund. “Building a health data warehouse to monitor outcomes for Health Links in North York: a feasibility and design project.” This is being presented in the Fall of 2013 at the Association of Family Health Teams of Ontario provincial conference.
B. 18-Month Well-Baby Care Toolkit (Scholarly work #5 – second binder)
In 2007/2008, funded by a HealthForceOntario Inter-Professional Care / Education Fund (ICEF) grant (Inter-Professional Program Development for a Network of Family Health Teams), I chaired the DFCM Academic Family Health Team Forum Collaborative on 18-Month Well-Baby Care. My cross-disciplinary development team engaged team-based practices to implement inter-professional practice guidelines, tools and information resources to support teams and establish capacity to deliver optimal patient care to 18-month-old babies in Ontario, and beyond.
International Impact: Co-presented the work of the project (Inter-Professional Program Development for a Network of Family Health Teams) at CME Congress (2008), the international leading event for continuing health education professionals.
Regional Impact: Co-presented same at the Association of Family Health Teams of Ontario Annual Retreat (2012).
National Impact: Invited to deliver the 18-Month Well-Baby update at Primary Care Today 2011 (Canada’s largest education conference and medical exposition) hosted by the University of Toronto and attended by over 1000 clinicians. http://www.academia.edu/741405/Thats_it_baby_A_practical_approach_to_implementing_an_18_month_well_baby_visit
- Developed website to complement the presentation and provide tools to the session at http://18wbv.com
- Co-Investigator. Improving Data In Primary Care EMRs: A Pilot Study. Ministry of Health and Long-term Care. Primary Health Care Program. Collaborator(s): Michelle Greiver; Jan Barnsley; Babak Aliarzadeh; Paul Krueger; Rahim Moineddin; Debra A. Butt; Edita Dolabchian; Liisa Jaakkimainen; Karim Keshavjee; David White. 10,000. [Grants]
Work was cited and included in the Quality Book of Tools, a comprehensive set of primary care indicators for family practices, by Cheryl Levitt, family physician and Professor, Department of Family Medicine, McMaster University and Linda Hilts, family practice nurse and Assistant Professor, Department of Family Medicine, McMaster University.
National Impact: Dissemination of EMR-based tools via Practice Solutions and Nightingale-on-Demand EMR (45% of Ontario Primary Care market-share, including all Community Health Centres).
C. Developed asynchronous EMR charting methods that allowed for quality improvement work in diabetes and EMR utilization (funded by the Ontario Government’s Aging at Home initiative for $98,770)
Allowed for improved diabetes care through either a co-located professional team or a virtual team.
Hosted visit and briefing to the Minister of Health and Long-Term Care. We highlighted to the Minister the potential of EMRs to be much more than sets of patient records. The Minister saw the innovative work that family health teams are engaged in, including chronic disease management, making patient visits more complete and productive, and the measurements we have been able to use to continuously raise the quality of care that we provide.
National Impact: Invited to national panel discussion at Canadian Institute for Health Research Primary Care Research Day in 2010
National Impact: For my work in facilitating EMR adoption and EMR-based quality improvement, I was nominated for Canada’s Top 40 Under 40 in 2008.
National Impact: Successful application to the Federal Economic Development Agency for Southern Ontario, Government of Canada (sub-grant of $350,000 of a total $15,549,290 grant) Co-Investigator. The Connected Health and Wellness Project., Technology Development Program. Collaborative project led by a partnership of York University, NexJ Systems and McMaster University. The Connected Health and Wellness Project is a technology platform containing an integrated suite of compatible technologies and apps designed to improve the health of Canadians. This project will allow patients to access and share their health records with their family, friends and care teams, including a health coach, to collaboratively manage their health and wellness. This technology will also allow hospitals, physicians and other healthcare professionals to access and update this information on an ongoing basis. For example, patients with diabetes will be able to track their biometric measurements, such as meals and exercise, using smartphones and share this information easily with their medical teams.
International Impact: asynchronous EMR charting methods have now been implemented in most EMR packages in Canada and by Nightingale-on-Demand which offers EMR in the United States.
International Impact: Presented at the Institute for Healthcare Improvement’s (IHI) 22nd Annual National Forum on Quality Improvement.
D. USB Toolkit for Diabetes Quality Improvement (Scholarly work #3)
Created and disseminated a USB-based toolkit for quality improvement in primary care of diabetes (funded by a $15,000 unrestricted educational grant from Sanofi-Aventis) as part of my innovative primary care engagement strategy as Diabetes Primary Care Lead for the Central LHIN. In addition, I created a hyperlinked, Coordinated Diabetes Care Plan for coordinated diabetes care for primary care providers in the Central LHIN. Recognizing that approximately 50% of family physicians had adopted an EMR, the toolkit also contained basic computerized quality improvement tools for physicians who had not yet implemented an EMR. Through this novel electronic dissemination method, this toolkit was distributed to approximately 1,200 family physicians in the Central LHIN.
Provincial impact: Other Primary Care Diabetes LHIN Leads in Ontario asked for copies of the toolkit so that they could adapt it (and the care plan) for use in their regions
Provincial impact: Invited to lecture to Cancer Care Ontario CIO retreat: Trends and Opportunities in Healthcare IT in Primary Care. Cancer Care Ontario Annual CIO Retreat, Toronto, Ontario, Canada.
Provincial impact: led to improved Central LHIN Primary Care performance in the Ontario Diabetes Strategy Process Measures
National Impact: Success of our CIHR Grant ($100,000) for “Development, testing and feasibility of an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes in clinical care” based on my being the Co-applicant/Principle Knowledge User
E. Primary Care Personal Health Record Pilot
One of four Ontario sites selected for a pilot project of personal health records. Led the implementation and scholarly evaluation of mypatientaccess, a web-based personal health record platform.
Patients were given access to their medical records and laboratory results, as well as on-line scheduling of appointments and messaging with their clinicians to further support chronic disease management.
Principal Investigator. Patient and Physician Perspectives of a Personal eHealth Record. eHealth Ontario. (Contracts). Total Amount: 120,000 CAD.
Impact: Scholarly assessment of this pilot is still underway (Spring 2013).
F. Centre for Complex Diabetes Care (Scholarly work #4)
I co-created a model of care and co-wrote a proposal to create a Centre for Complex Diabetes Care for the Central LHIN – a new model of inter-professional diabetes care. This centre provides a single point of access to specialized interprofessional teams who provide expert care for patients experiencing complications related to diabetes.
Provincial impact: MOHLTC funded our Centre for Complex Diabetes Care (1 of 6 in the province) based on the proposal.
Innovation: The Coordinated Diabetes Care Plan improved how diabetes was managed across the continuum of care from prevention to complex care (according to patient feedback); MOHTLC evaluation pending.
National Impact: This model of care was presented at the national Canadian Diabetes Association Meeting in November 2012. Developing a Centre for Complex Diabetes Care. Canadian Diabetes Association Annual Meeting, Vancouver, British Columbia, Canada. Presenter(s): Levin T, Guilar A, Kaplan DM, Dumsha, R, Leckman.
National Impact: I was recently awarded the 2013 National Innovation Leadership Award from the Society of Graduates of the Institute for Health Policy, Management and Evaluation. This award honours my “significant contribution to the field of health policy, health management and/or health evaluation, and celebrates my example and inspires others.”
Sphere 2: Implementation of a Research Program in a Community-Affiliated Hospital
The four activities below formed the foundation for the province’s first Practice-Based Research Network (PBRN), UTOPIAN, housed at North York General.
A. As Interim Family Physician-in-Chief and Program Medical Director at North York General Hospital, I developed a model for the first endowed Chair in Family and Community Medicine at a community hospital.
Innovation: This novel model for a research chair was approved by the Dean of Medicine at the University of Toronto.
International Impact: The hospital and the University of Toronto are currently conducting an international search for this position
B. While Deputy Chief of Family and Community Medicine, I led the development of the first conforming practice plan at the University of Toronto that did not require pooling of clinical income.
Innovation: The approval of a Practice Plan model by the Dean of Medicine allowed for the flow of AFP dollars to community-based teachers in a distributed education model, which assisted in Faculty of Medicine recruitment for residency expansion in 2006 and 2008
C. Co-chaired the Future Research Activity Strategic Working Group, NYGH, 2004-2012.
Innovation: This work formed the basis of the strategic development of the novel model of a “community-academic hospital”
D. My CPA interests, as Chair of the NYGH Research Ethics Board (2004-2013), examined the impact of Canadian privacy laws on clinical research.
International Impact: This work was presented at the United Nations Educational, Scientific and Cultural Organization (UNESCO) Conference on Ethics Committees in Hospital in 2009
National Impact: Supported the creation of the Canadian Primary Care Sentinel Surveillance Network Regional Network at NYGH – UTOPIAN / formerly the North Toronto Research Network (cross-referenced under Excellence in Administrative service)
Our REB has taken a leadership role among TASHN hospitals in protecting personal health information while expanding our research mission