Ambulatory/EMR update

Bryan Hinch MDAssociate Director IM Residency

Ambulatory MIO

Ambulatory

• 1/3 rule– 1/3 of residents time is outpatient• We are over 35%

– what counts• Outpatient subspecialty• GIM Longitudinal Clinic• Ambulatory• VA

Ambulatory

• Ambulatory Month– Residents spends time in subspecialty clinics outside

of Dept of IM• Ortho• Gyn• Adolescent• Ophth

– Includes time in hem/onc and other IM specialties– Includes time at VA– Includes extra time in GIM Longitudinal Clinic

VA

• VA is a new experience added this year– Incorporated into ambulatory– Will be monthly rotation starting next year– Dr. Nancy Sturtz (Kessler) managing it• Lectures weekly

– Positive response overall

Longitudinal (Continuity) Clinic

• No longer has minimum/maximum # of patients

• Has to have 133 clinics in 3 years– Not meeting this last year (prior to new

requirements)– Now we are with • Restructuring of Ambulatory

– No vacation during ambulatory

Longitudinal (Continuity) Clinic

• Data driven feedback– RRC demands we give residents data driven

feedback on patient care• ABIM practice improvement module• Utilizing admitting residents ‘scholarly activity’ time• EMR will ease this burden

• Prelims– If expect prelim to stay as pgy-2 we need to

provide Continuity clinic.

EMR

EMR Project Team

• Project Manager: Melodie Rufener• Project Manager (vendor): Laura Todd• Physician Champion: me• Ambulatory Subcommittee to ESC– Representatives from clinical informatics– Physician representation– Nursing Representation– Pharmacy representation

Where we are at now:

• Application and Build training completed• Building the ‘system’ to commence now (after

design workshop)– A 2 month project

Upcoming Dates

• This week Tue-Thurs: Design Workshop• Oct 29: MD track• 2/9/10: STI goes live• 5/2010: med subspec. Go live

EMR

• ACGME requirement to implement EMR

EMR: what it includes

• Documentation– Visits

• Templates• Dictation• Free text

– Phone notes/messaging• CPOE• E-prescribe– Ohio board of pharmacy regs– Medicare incentive

EMR: what it includes

• Lab review• Outside documentation

management/scanning

EMR hardware

• Glendale and Ruppert has computers in most rooms– Project team knows that they need upgrading,

there is some budget for this

EMR

• Expect a hit in productivity– How much to block schedules– If we don’t have an EMR: penalties by 2015

• Incentive payments– We aren’t counting on it but…– HAC should meet any requirements the feds have

for “certified” EMR– Our implementation will meet requirements for

meaningful use

EMR

• Inpatient– 5/10: nurse documentation– Fall 2010: CPOE– MD documentation: not yet purchased, likely

2011– Floor redesign

• Other IT project– Scanning into HPF (I tried to stop this)

Governance

• Each clinical area will need to take ownership of implementation– Physician (for IM, me with others)– Office manager

• As clinics get close to going live, they will start reporting updates to ambulatory subcommittee.

Main Campus Collaborative

• COBA is evaluating workflows and helping with future state

• Research volunteers auditing STI charts for me• College of Pharmacy involvement

Implementation

• All modules at the same time• Go live preceded by:– Template building– Training super users– Training the rest of office

• Go live: 1-2 weeks of at the elbow support• Go live followed by: follow up support

Clinical Alerts

• Can customize clinical alerts to include identifying patients who may qualify for research studies

Timeline

• Excel…

• Questions?