Post on 07-Aug-2020
Webinar – Using EMRs for Chronic Disease Management
March 3, 2011
Funding to support this Webinar has been provided by Hewle7-‐Packard
Dr. Michelle Greiver
• Practice description: – Community-based family practice in Toronto – 1,300 patients
– Part of interdisciplinary team (North York Family Health Team)
– 3 physicians, 1 nurse practitioner in the office
– 60 physicians are members of the NYFHT
• EMR used: – Nightingale EMR, since 2006
Practice Profile
• Practice description (1092 adult patients) – 77% female – Taking part in a Quality collaborative since 2009 – Part of national primary care EMR chronic disease
surveillance system (CPCSSN)
• Chronic Disease prevalence (adults) – 80 patients with diabetes (7%) – 89 COPD (8%) – 207 hypertension (19%) – 16 CHF (1%) – 27 confirmed asthma (2%)
Benefits of EMR for CDM
You cannot improve what you cannot measure • We decided to code important chronic conditions
so that we could build disease registries • We enter data consistently in the EMR so it can be
measured • We invested time and resources in measurement
and audits • All team members use the EMR • We have CDM flowsheets and templates, with
associated alerts and reminders • We use the EMR to audit and mail reminders to
patients who are overdue (diabetic, no eye exam for 2 years)
Screenshot
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Screenshot
CDM reminders for any chronic conditions this patient has: “HM button”
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Screenshot
Take Home Points
• Decide and agree: which chronic conditions you would like to focus on?
• Involve everyone in your practice • Enter your data carefully and consistently • Use the features that your EMR offers • Try small steps to improve care • Measure what you did and see if it worked,
then keep going • Use what you learned in one chronic
condition to improve other conditions
Dr. Nora Curran-Blaney
• 3 Physician Family Practice – Oakville, ON – 2 physicians work concurrently – flexible schedule
• 30 years practice experience
• EMR used: Healthscreen
• Remote access version • Experience using tablet computers
Practice Profile
• 1348 rostered patients
• 519 over 50 yrs • Chronic Disease prevalence
– Hypertension – (400 pts.)
– Obesity – BMI over 33 (100 pts.) – Diabetes Mellitus – (30-40 pts.)
– Heart failure – (10 pts.)
Benefits of EMR for CDM
• Ability to develop clinical queries
• Active use of a patient profile – Hand printed copy of profile to patient
• Used of coded data display – Requires discipline of data entry for future use
• Colour coding
• eFax directly from EMR
• Simplification of referrals • Cancer surveillance
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Take Home Points
• EMR usability is critical
• Encourage patient self management – Not yet using a patient portal
• Record information during the encounter
• Patient feedback – Most feel management is improved with EMR
– Less chance for error or that information has been forgotten
– Worry about privacy and power outages
Michael Brand, Clinic Manager Associate Medical Centre, Taber, Ab.
• 12 Physician Family Medicine Clinic • Member of Chinook Primary Care Network
• Using Wolf EMR since 2007
Practice Profile
• Approx. 18,000 patients in catchment area
• Team based Care • Physician is team lead with mix of NP, RNs,
LPNs, Psychiatric RN, Psychologist, Dietician, Health Coach & MOAs
• Large Senior & “ESL” Populations
• 19 bed Acute Care Hospital • 100 bed LTC Facility
Benefits of EMR for CDM
• All CDM Monitoring is managed through use of “Rules” within EMR
• Rules define a population and provide alert at Point of Care
• All Clinic Staff are tasked with dealing with relevant rules when in contact with a patient
• CDM Run charts are used to track performance over time
• Results are posted for all to see
Take Home Points
• Rules are constantly changing and evolving based on population and updates to CDM guidelines
• Patients appreciate the comprehensive level of care & develop trust in the team.
• Staff feel strong sense of accomplishment when they see positive results.
• Overall system costs decrease (ER Visits & Admissions) through comprehensive clinic based Chronic Disease Management
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Questions & Discussion
Webinar – Using EMRs for Chronic Disease Management
March 3, 2011
Funding to support this Webinar has been provided by Hewle7-‐Packard