Data Collection in Private Practice and Implementation with

Electronic Medical Records

Martin J Bergman, MDChief—Rheumatology

Taylor HospitalRidley Park, PA

Patient Encounters

• The average Rheumatologist sees:

– 19 encounters/day-- 4 days/wk– 3574 patient visits/year

Practice Benchmarking for the Rheumatologist, ACR and the Health Care Group, August 2003

% of Office-based Physicians using EMR

15

20

25

30

2001 2002 2003 2004 2005

% ofPhysicians

CDC-National Center for Health Statistics--2006

% of Office-based Physicians using EMR

0102030405060708090

100

2001 2002 2003 2004 2005

% ofPhysicians

CDC-National Center for Health Statistics--2006

Use of Billing Software vs EMR

0%

10%

20%

30%

40%

50%

60%

70%

80%

BILLING EMR

CDC-National Center for Health Statistics--2006

Obstacles to EMR

• Cost– Ranges from $5000 to >$30000

• Loss of Productivity– “Steep learning curve”

• Integration into Group Setting– Networking– Competing practice styles

• Technophobia

Advantages of EMR

• Decrease in Practice expenses– Dictation services and Ancillary staff

• Increased productivity– Elimination of “after hours” dictation

• Improved quality of documentation– Improved patient care– Improved documentation for reimbursement

• Ability to extract data for personal use

Data Collected

• Demographics– Age– Sex– Employment status

• Diagnoses– Active and Co-morbid

• Medications– Active and Past

Data Collected

• Labs• Patient reported measures

– Pain– Patient Global– Function (MDHAQ)– RAPID– Fatigue– MD Global– Tender and Swollen Joint Counts– DAS28

Data collection is facilitated through the use of questionnaires

Patient “checks in” and is given questionnaire by the receptionist

Patient completes questionnaire while waiting for visit

Physician “eyeballs” questionnaire and “scores”

Results of questionnaire are entered into computer

“Standard” office visit begins

Methods of Entering Data

• Paper questionnaire– Manually entered or scanned

• Desktop– Increase in physical space required

• PDA– Small screen and small size is advantage and

disadvantage

• Laptop– Cost

Entering data into a computer does not decrease productivity

0

20

40

60

80

100

120

Time to Perform and Document 28 Joint Count

MD#1

MD#2

MD#3Computer

Paper

Paper

T Pincus, M Bergman, Y Yazici, J Roth, C Swearingen Abstract 1764 ACR 2006 Washington DC

Uses of Data

• “Extract” data for personal use– Monitor individual patient responses– Monitory practice outcomes

• “Extract” for collaborative use

• Share with existing databases– National Data Bank for Rheumatic Diseases– CORRONA

• May require reformatting

Graphing of Patient Response

MTX

ADA

Practice StatisticsFATIGUETENDERSWOLLENCRP-mg/LDAS28 MD GLOB

25 0 0 7 2.3 2595 8 7 8 5.2 4540 1 0 1.4 1.9 1050 0 2 1 2.3 15

0 0 0 6.2 1.6 550 1 1 6 3.2 2030 0 4 4.3 2.5 1050 1 1 2 2.9 3020 1 1 1.7 2.3 20

0 0 16 3 2.8 4560 0 0 2 1.7 1040 0 0 25 2.4 1555 1 7 6 3.7 6030 4 5 8 3.8 3590 0 0 3.3 2.6 40

0 0 4 19 2.6 1560 6 0 41 4.5 1540 0 12 2.3 2.9 4550 1 1 2 2.9 3050 1 2 7 3.7 2555 1 2 10 3.5 4515 0 2 5 2

5 1 4 2.2 2.7 510 0 2 25 2.6 2070 2 2 1.7 3.3 2040 0 4 2 2.6 2650 0 14 4.1 3.3 4535 0 0 1.1 1.7 4055 0 7 1 2.7 20

0 0 0 7 1.7 55 0 0 4.7 1.5 2

Descriptive Statistics

DAS28

Valid cases 70Mean 2.794285714

Std. error of mean 0.12697933Variance 1.128662526

Std. Deviation 1.0623853Variation Coefficient 0.380199238rel. V.coefficient(%) 4.544250068

Skew 0.846222072Kurtosis 0.375428342Minimum 1.2Maximum 5.7

Range 4.5Sum 195.6

1st percentile ----5th percentile 1.35510th percentile 1.5125th percentile 2

Median 2.675th percentile 3.390th percentile 4.3895th percentile 5.2999th percentile ----

Duration of Treatment vs. RAPID

0

50

100

150

200

250

300

350

1 2 3 4 5 6 7 8 9 10 11 12

DURATION

RA

PID

Standard deviation

Standard error

Confidence interval

DAS28 vs RAPID

0

1

2

3

4

5

6

7

8

9

10

1 to1.5

1.5 to2

2 to2.5

2.5 to3

3 to3.5

3.5 to4

4 to4.5

4.5 to5

5 to5.5

5.5 to6

DAS28

RA

PID

Standard deviation

Standard error

Confidence interval

Summary

• Private Practioners are a valuable and underutilized source of useful clinical data

• Computerized records can be a means or collecting clinical data– Low cost– Efficient– Comprehensive

• Choice of system is dependent on the needs of the practitioner(s)

Summary

• Collected data has multiple uses– Monitoring individual patient outcomes– Monitoring practice performance– Participation in large databases– Participation in small, independent research