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Using Electronic Health Using Electronic Health RecordsRecords

For education and researchFor education and research

Robyn Tamblyn, McGill University

OutlineOutline

Key Components of Electronic Health RecordsKey Components of Electronic Health Records Uses in EducationUses in Education Uses in ResearchUses in Research

Key Components of EHRKey Components of EHR

Health Problem

List

Medication List

Retrieval of lab, drug, dx test + report

information from feeder systems

Drug and Visit Profile Information Drug and Visit Profile Information from Regional/ Provincial Repositoriesfrom Regional/ Provincial Repositories

Costs of Medications

Dates of Hospitalizations & ER Visits

List of Drugs Dispensed over Past 6 Months

.

Structured order entry

Clinical NotesClinical Notes

Uses in EducationUses in Education

Reminders

Educate About Preventive Care Educate About Preventive Care and Provide Practice Remindersand Provide Practice Reminders

E-Rx PadE-Rx PadEducate + Reduce Potential Errors by Providing Educate + Reduce Potential Errors by Providing Menus for Dose Selection & Treatment IndicationMenus for Dose Selection & Treatment Indication

cou

Educate about Drug Interactions & Reduce Educate about Drug Interactions & Reduce Errors in Drug Selection by Providing Alerts Errors in Drug Selection by Providing Alerts

for Prescribing Problemsfor Prescribing Problems

Evidence-Based Asthma Decision Support Evidence-Based Asthma Decision Support Customized for Individual Patient Profiles Customized for Individual Patient Profiles

CIHR supported RCT-2004-2008CIHR supported RCT-2004-2008

Uses in ResearchUses in Research

Practice ProfilesPractice Profiles

0

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f A

ll

Pat

ien

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ER Visit Hospitalization Mortality

0

20

40

60

80

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Per

cent

age

of E

ligib

le

Pat

ient

s

Mammograms PAP Smears Prostate Screens

VulnerablePatients

Risk FactorManagement

CHFDiabetesHypertension COPDAsthmaMy Practice

Profile

0

20

40

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Perc

entag

e of

Asth

ma P

atien

ts

Excess RescueMedication

ER Visit Overall PoorControl

2004 2005 2006

Demographics: My Practice

2004 2005 2006 Number of asthmatics 45 52 64 Average age (years) 37 38 34 Female (%) 45 48 45 Receive an income subsidy (%) 4 7 6

Comorbidity:

Average number of serious health problems

0.68 0.72 0.84

Average number of medications 3 3.1 2.1

Continuity of care:

Average number of visits to my practice

4 5 1.8

Average number of visits to other physicians

1 1.2 0.9

Patients with all asthma therapy Rx by me (%)

65 68 72

My Asthma Patients

VulnerablePatients

Risk FactorManagement

CHFDiabetesHypertensionMy Practice

ProfileCOPDAsthma

Asthma Quality IndicatorsAsthma Quality Indicators

Proportion of my asthma patients with poor control

Compliance with Rx

All asthma patients should have an action plan

All asthma patients with poor control should have inhaled corticosteroids

Disease ControlDisease Control

Show me my current asthma treatment outcomes

Compare my asthma treatment outcomes to those of my peers

My Asthma Patients

0

20

40

60

80

100

Mea

n C

ompl

ianc

e

Inhaled Steroids Long Acting B-Agonist

Leukotriene

Demographics: 2006

Number of asthmatics 64 Average age (years) 34 Female (%) 45 Receive income subsidy (%) 6

Comorbidity:

Average number of serious health problems 0.84 Average number of medications 2.1

Continuity of care:

Average number of visits to my practice 1.8 Average number of visits to other physicians 0.9 Patients with all asthma therapy Rx by me (%) 72

Asthma Quality IndicatorsAsthma Quality Indicators

Proportion of my asthma patients with poor control

Compliance with Rx

All asthma patients should have an action plan

All asthma patients with poor control should have inhaled corticosteroids

Disease ControlDisease Control

Compare my asthma treatment outcomes for the past 2 years

Compare my asthma treatment outcomes to those of my peers

VulnerablePatients

Risk FactorManagement

CHFDiabetesHypertensionMy Practice

ProfileCOPDAsthma

My Asthma Patients

0

20

40

60

80

100

Per

cen

tag

e o

f P

atie

nts

w

ith

IC

S

Poor Control Good Control

Demographics: 2006

Number of asthmatics 64 Average age (years) 34 Female (%) 45 Receive income subsidy (%) 6

Comorbidity:

Average number of serious health problems 0.84 Average number of medications 2.1

Continuity of care:

Average number of visits to my practice 1.8 Average number of visits to other physicians 0.9 Patients with all asthma therapy Rx by me (%) 72

Compare my asthma treatment outcomes for the past 2 years

Compare my asthma treatment outcomes to those of my peers

Asthma Quality IndicatorsAsthma Quality Indicators

Proportion of my asthma patients with poor control

Compliance with Rx

All asthma patients should have an action plan

All asthma patients with poor control should have inhaled corticosteroids (guidelines)

Disease ControlDisease Control

VulnerablePatients

Risk FactorManagement

CHFDiabetesHypertensionMy Practice

ProfileCOPDAsthma

My Asthma Patients

Demographics: My

Practice 2006

My Peers 2006

Number of asthmatics 64 89 Average age 34 36 Female (%) 45 42 Receive an income subsidy (%) 6 7

Comorbidity:

Average number of serious health problems

0.84 0.72

Average number of medications 2.1 3.1

Continuity of care:

Average number of visits to my practice 1.8 2.2 Average number of visits to other physicians

0.9 0.6

Patients with all asthma therapy Rx by me (%)

72 64

0

20

40

60

80

100

Perc

enta

ge o

f As

thm

a Pa

tient

s

Excess RescueMedication

ER Visit Overall PoorControl

My Practice My Peers

VulnerablePatients

Risk FactorManagement

CHFDiabetesHypertensionMy Practice

ProfileCOPDAsthma

Asthma Quality IndicatorsAsthma Quality Indicators

Proportion of my asthma patients with poor control

Compliance with Rx

All asthma patients should have an action plan

All asthma patients with poor control should have inhaled corticosteroids

Disease ControlDisease Control

Show me my current asthma treatment outcomes

Compare my asthma treatment outcomes for the past 2 years

My Hypertension Patients

Demographics: 2006

Number of hypertensives 64 Average age (years) 34 Female (%) 45 Receive an income subsidy (%) 6

Comorbidity:

Average number of serious health problems 0.84 Average number of medications 2.6

Continuity of care:

Average number of visits to my practice 1.9 Average number of visits to other physicians 1.0 Patients with all anti-hypertensive therapy Rx by me (%)

72

My PracticeProfile

AsthmaVulnerable

Patients Risk FactorManagement

CHFDiabetesCOPD Hypertension

Compare my hypertension treatment outcomes for the past 2 years

Compare my hypertension treatment outcomes to those of my peers

0

20

40

60

80

100

HTN Stroke MI All CV

Hypertension Quality IndicatorsHypertension Quality Indicators

Hospitalizations for hypertension complications

Compliance with Rx

All hypertension patients should have their blood pressure monitored regularly

All patients with complicated hypertension should be prescribed an ACE Inhibitor (unless contraindicated)

Disease ControlDisease Control

The voyage begins…Thank you.

robyn.tamblyn@mcgill.ca