Alan Brookstone Presentation Fms 2010 Oct2010 Canadianemr 101017113628 Phpapp01
Transcript of 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