Alan Brookstone Presentation Fms 2010 Oct2010 Canadianemr 101017113628 Phpapp01

7/29/2019 Alan Brookstone Presentation Fms 2010 Oct2010 Canadianemr 101017113628 Phpapp01

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What you need to know in order tosuccessfully implement and use your EMR

Dr. Alan Brookstone FMF 2010October 15 - 3:10pm


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Learning Objectives

By the end of this session, participantswill understand how to:

Successfully choose an ElectronicMedical Record system

Plan an EMR implementation

Plan for successful use of an EMR


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Doctors use of EHRWhere is Canada Internationally?

* 2006: Do you currently use electronic patient medical records in your practice?

* 2009: Do you use electronic patient medical records in your practice (not including billing systems)?

Source: 2006 and 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.


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Medical, Medication, and Lab ErrorsAmong Sicker Adults

Percent reporting medical mistake, medication error, or lab

error in past two years

Data: Analysis of 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults; Schoen et al. 2005


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Percent of physicians

Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians

Doctors Reporting Routinely Receiving Alerts aboutPotential Problem with Drug Dose/Interaction


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Medications Reviewed When Discharged fromHospital Among Sicker Adults in Six Countries, 2005

Percent of hospitalized patients with new prescription who

reported prior medications were reviewed at discharge

Data: 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults (Schoen et al. 2005).


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1 - Selecting an EMR

Assess your practices readiness for an EMR

Talk to physicians in your community

Identify products that are appropriate foryour practice

www.canadianemr.ca is a resource you can useto identify and compare systems

Provincially certified or non certifiedsystems?

Vendor demonstrations

Site visits


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Develop a Practice Vision

There had to be a fullcommitment tocomputerization by all

One of the strongest driversbehind our vision was that wewanted to remove theunderserviced status that ourcommunity had. That definedwhat we had to do!

Dr. Steve Pelletier family physician in ClarenceRockland, Ontario (11 doctors & 25 support staff)


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Assess your Readiness

Establish goals

Evaluate computer skills for physicians andstaff

Set expectations

What do you want to change?

What do you want to keep the same?

Capacity for change Leadership

Financial considerations


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EMR Selection Process

Narrow to 3 vendor demonstrations

Ask lots of questions

Use a typical patient in your practice

Include office staff. They should review theirworkflow with a typical patient

References

Vendor recommended

Through a colleague

Site visits to top 2-3 systems


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EMR Functionality Evaluation

Does the EMR do what you need it to do?

Can the EMR perform your most commonand important daily activities well?

Dont be swayed by exotic features


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Considerations - Selection

Choose an EMR that matches as closely aspossible to your practice workflow

Greater customization = greater cost and

increased complexity of implementation

Dont delegate selection to a staff memberunless they are most capable of leading

Meet regularly

Due diligence!


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2 - Implementing an EMR

Where to begin

Data strategy

Personnel

Physicians

Staff

Training requirements

Workflow


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Where to Begin

Develop a 6 month timeline until Go-Liveand stick to it

Take it slow initially

Meetings, Meetings, and more Meetings

Communication is the key to success

Data transfer

Paper to EMR EMR to EMR (Data preparation & migration)


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Implementation Types

Big Bang: start with everything at once

Theoretically a shorter implementation

Staged: start using new features gradually,e.g. Clinical documentation, medicationmanagement and prescribing

Theoretically longer implementation Ensure that billing works smoothly you

still have to pay the monthly expenses!


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Personnel

Physician buy in CRITICAL- all or none!

Staff buy in Change of workflow and jobfunctions/descriptions

Significant variation in computer skills ofstaff and physicians

Technical support within practice & local

community


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Training Requirements

Vendors have specific training schedules

Difference between initial training vs.advanced training

Objectives for initial training

Get comfortable with core tasks for each role

Super-users need more training (off-site)

Practice Practice Practice Set up custom lists for meds, referrals,

templates, diagnostic codes

Understand how to setup workflows


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Common Workflows

Front office Registration & check-in

Patient recall

Patient ready, encounter finished

Scanning Document management

Exam rooms

Hardware (Laptop, Tablet, Desktop)

Printers Location of computer to patient


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Workflow Challenges

Practice transformation

Writing to typing, pick-lists, tablets, speechrecognition

Data retrieval in EMR vs. paper (patient recall,results screening)

Prescription writing to EMR-based prescribinga(ePrescriptions in the future)

In office messaging vs. verbal communicationssticky notes

Completion of charts at time of visit


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Considerations - Implementation

Dont go live on a Monday

Customization is time consuming & costly

Plan implementation around a slow time of year

Join or create user groups in your community Identify Super Users and start their training well

in advance of go-live date

Initial workload: Reduce physician schedules by

50% for first 2 weeks and then by +/- 25% fornext 4-8 weeks


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3 Successfully Using an EMR

Data quality is key

EHR is a long-term investment

Build in continuous improvement

Become self sufficient


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Principles of Data Discipline

Data Standardization

Coding

Diagnoses, Medications, Labs, History

Data Cleaning

Coverageall patients are in the system Consistencyall data tells the same story

Completenessall data is in the system

Correctnessright patients in, wrong patients out

Codedall relevant data is coded or in a single format

Data Discipline Systems thinking

Templates, reminders and searches work together

Dr. Karim Keshavjee, Family Physician, Consultant - www.infoclin.ca


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EMR is a Long-Term Investment

Many physicians see the EMR as just anotherexpense

You are now a technology dependent SME (Small

Medium Enterprise) Systems will require maintenance, support,

upgrades, refreshing of hardware and peripherals

Build $$ into your practice budget for future needs

Your EMR allows you provide care in ways youcould never do before


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Build in Continuous Improvement

Many clinicians achieve a basic level ofEMR use and never progress further

Set goals and determine how to integratecontinuous improvement principles intopractice

Team or small group based learning

Attend annual EMR vendor and user groupconferences


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Become Self Sufficient

Develop in-house Super Users (clinical andadministrative)

Meet regularly as a practice team toproblem-solve, discuss needs and set newpriorities


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Measure your Success

Would you ever go back to paper?

How are you using triggers, flags & patientrecall?

Did you have any staff turnover duringimplementation?

Implement quality indicators (part of CDM

program) e.g. % diabetic patients withHBA1c in last 3 months, % patients whohave received specific immunizations

Alan Brookstone Presentation Fms 2010 Oct2010 Canadianemr 101017113628 Phpapp01

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