Presented by Katrina Otto

Train IT Medical Pty Ltd

www.trainitmedical.com.au

Getting the most from your

practice software

SEMPHN - 6 March, 2018

1. Develop skills in essential clinical data collection:- to meet standards- facilitate quality improvement - maximise revenue.

2. Design a planned approach to quality improvements.

3. Improve clinical documentation and minimise risk.

4. Learn advanced tips and shortcuts for MedicalDirector.

Agenda & Learning Objectives:

Improve data

Improve revenue

Improve health outcomes

Data is a hot topic for general practices

Accreditation Changes:

- linked to data

Practice Incentive Payment

(PIP) changes:

- linked to dataPIP Redesign FAQsWebinar recording

RACGP Standards – New - 5th edition

Learn more

Health Care Homes

Use data to track care and improvements

Health Care Homes P. 7 Handbook for General Practices and Aboriginal Community Controlled Health Services, 2017

Managing recalls and reminders

Health Care Homes P. 7 Handbook for General Practices and Aboriginal Community Controlled Health Services, 2017

Health Care Homes P. 7 Handbook for General Practices and Aboriginal Community Controlled Health Services, 2017

Download the ‘Data Quality’ Checklist Learn more from the ‘Standards for Digital Health’ Webinar

Past History List [coding]

Criterion C7.1 – Content of patient health record, RACGP Standards for general practices 5th edition.

Only for chronic conditions & significant events

Significant active or inactive conditions

Different from Reason for Visit (Past Visits)

Only tick ‘Add to Past History’ if you are adding a new significant diagnosis

Can choose ‘Another’ for more than one reason for visit.

Set your Options

Main Screen: Tools > Options:

Untick ‘Save in Past Medical History

? Untick Save in Past Medical History

“Practice staff must ask the patient for the information, rather than provide the identifying information and then ask the patient to

confirm the information.” RACGP Standards for general practice – 5th edition, p64

https://www.racgp.org.au/download/Documents/Standards/5th%20Edition/racgp-standards-for-general-practices-5th-edition.pdf

https://www.racgp.org.au/download/Documents/Standards/5th%20Edition/racgp-standards-for-general-practices-5th-edition.pdf

Advanced Tips

• One click Medical Certificate• Two click letters• Shortcuts for progress notes• HealthLink SmartForms• Options, options & options!

Search tools to assess your data quality

Clean up before you analyse your database:

1. Mark deceased patients as ‘deceased’.

2. Inactivate patients by searching for patients not seen for two years.

3. Delete Sample patients.

4. Delete records with no clinical data.

5. Merge duplicate patient records.

Why Improve Data Quality?

1. Improved Patient Safety

2. To enable sharing of data (Care Plans, My Health Record etc)

3. Proactive population vs episodic care

4. For analysis and to identify exceptions

5. To improve process quality & financial opportunities

Kidney Disease

Proactive Population Based Approach

Build a Register of patients with a particular condition e.g. Asthma or Diabetes etc

Why Improve Data Quality?

1. Meet standards

2. Improve patient safety

3. Streamline sharing of important patient clinical data eg

Health Record, eReferrals etc

4. Proactive population vs episodic care

5. For analysis and to identify risks and exceptions

6. To improve process quality, reduce waste and improve

financial opportunities.

What data will you focus on?

Chronic Conditions

Payments

Allergies

MBS Item #’s

EthnicityObservations

Results

Screening data

Waiting Times

& more

Income Estimator

MedicalDirector Clinical Inbuilt Searches

Data Extraction / Aggregation Tools

Polar Canning Tool

Pen CAT4Doctors Control Panel (DCP)

ElicioPractice Health Atlas

www.nevdgp.org.au

Business Process Improvements

Identify all patients with a chronic condition without a GP Management Plan

Need to manually enter screening results

Can enter from Holding File or Patient File >

Access Cervical Screening learning resources.

Download summary sheets for entering screening data in

MedicalDirector.

Analyse & set your improvement goals

Total Patients seen 1652 1749 1771 1798 1720 1735 1339 1490 1811 1866

705Long Health Assessment (45-60 mins) Non-ATSI 0 0 42 52 42 37 26 14 40 50

715ATSI Health Assessment 13 49 0 0 0 5 19 22 25 23

721Prepare GPMP 12 23 70 80 105

723Prepare TCA 12 23 9 12 40

732Review of GPGMP/TCA 0 4 5 8 2

739Organise CC 20-40 mins 0 0 3

743Organise CC > 40 mins 1 0 1

3short consult 9 21 15 21 28

23< 20 mins consult 522 1174 900 816 667

36>20 mins consult 304 497 350 339 279

44>40 mins consult 52 112 74 76 56

52Brief consult (non VR GP's)

53Standard consult (5-25 mins) (Non-VR)

54Long Consult (25-45 mins) ( Non-VR)

57Prolonged consult (>45 mins) ( Non-VR)

10962 (Podiatry)

10988Immunisation 1 7 41 42

10989Wound care 0 2 43 26

10990Under 16 YO OR Concession Card Holder Add on Fee 619 1316 1088 1036

2700GP Mental Health Care Plan (not trained) > 20 mins 4

2701GP MH Plan > 40 mins

2712GP MH Plan review 7

2713MH Surgery Consult > 20 mins 10

2715Prep GP MH Plan > 20 mins 5 9

2717Prep GP MH Plan > 40 mins 8 8

2504 (PAP > 4 years) PAP > 4 years since last, Level C 0 1

2521Annual C of C Level C

2525Annual C of C Level D

30026(sutures)

30061 (removal foreign body)

11506 (Spirometry) 6

11700 (ECG)

Your KPIs – track performance

Tips: Encourage a team effort to achieve the goals by setting a target on the graph & place graph in the staff room/noticeboard to encourage a proactive approach.

My Health Record Expansion Program

www.myhealthrecord.gov.au

2018

www.digitalhealth.gov.au www.myhealthrecord.gov.au

My Health Record Statistics – 25/2/18

Learn More

Approx 98% of your patients will be ‘green’

(indicating they have a My Health Record)

following My Health Record Expansion Program.

Approx 98% of your patients will have a My Health Record

Navigation panel

Provides access to each section within the view and also to the most recent Shared Health Summary and Discharge Summary (if available).

The blue underlined hyperlinks can be used to navigate between the sections

My Health Record – Medicines Preview

Pathology & Diagnostic Imaging in My Health Record

Prepare for patients seeing their own results

RACGP - http://www.racgp.org.au/standards/153

Now might be a good time to start to explain to your patients:

- doctors will still receive results first. Detail your practice process for follow-up.

- just because a result is marked red/‘abnormal’/outside the value range doesn’tmean the result is not normal for them.

- just because a result is marked ‘normal’ doesn’t mean further discussion orinvestigations are not necessary.

- patients can let the doctor know if they do not want a specific result uploadedto their My Health Record.

Factsheet: Pathology Reports for Clinicians

Manage well for positive change

Create a sample dialogue to fit your own practice system.

Example of GP dialogue (relevant to one specific practice system):

“I receive your results directly. You may also see those results. If I am worried I will contact you. If you are worried please

make an appointment and I will be happy to discuss them in detail with you”.

http://www.labtestsonline.org.au

Quality patient information

http://www.imagingpathways.health.wa.gov.au/index.php/consumer-info

1. Complete the (free) eLearning modules on the My Health Record system

2. Download the step-by-step ‘guides’ for your software.

3. Watch the software demonstration for your software

4. Practise in the ‘On-Demand’ Training Environment

5. Register your patients

6. Improve data quality

7. View and upload health summaries.

My Health Record – what you can do right now!

Read more about Practice Incentives Program (PIP) eHealth Incentive

Change Champions - GPs

Dr Steve Hambleton writes on his patient letters:“This patient has an active ‘My Health Record’. You may be able to access this through your clinical information system or the provider portal”.

When doctors ring asking for his patients’ health summaries he tells them to look on the patient’s My Health Record.

“I no longer fax our patient’s health summaries, when the hospital calls I just tell

them it will be on the patient’s My Health Record and to have a look”.

Cara Young (RN) Practice Manager, Surf Beach Surgery, Batemans Bay

Success stories

How effective is your ‘Recalls & Reminder’ system?

P. 7 Health Care Homes: Handbook for General Practices and Aboriginal Community Controlled Health Services, 2017

This is what can happen without a ‘system’:

General Practice Standards

“Some information may also be transferred to national

state-based registers (eg. cervical screening etc)

Read RACGP 5th standards

RACGP 5th Standards Criterion

C4.1 - Health promotion and preventive care

Remind patients when they need to have another screening

(do not rely on patients receiving reminders from these registers).“

Actions, Recalls and Reminders

REMINDERS eg. immunisation, skin check,

routine Cervical Screening Test (CST)

RECALLS (ie clinically significant/medico-legal)eg previous melanoma, inconclusive CST

✓ Define your reminder list

✓ Label your reminders so patients don’t stress if they receive a sms or letter with the reason

✓ Keep your list tidy

Save time, money & minimize risk

With a list like this how do you identify true recalls ie. Clinically significant/probability of harm/must follow-up/medico-legal/keep the doctor informed & document every single contact attempt?

Tools > Options

Label so patients don’t stress if they receive a sms or letter with the reason.

Set up

New Recall/Reminder labels required

Time for a Clean Up?

Clean up

Clean up: merge lists if duplicated

For ‘reminders’ that are only for the clinician, consider:

‘ACTIONS’ eg. Discuss screening, discuss smoking

Actions, Reminders & Recalls

RECALLS (ie clinically significant/medico-legal) eg previous melanoma, inconclusive

REMINDERS eg. immunisation, skin check,

routine Cervical Screening Test (CST)

Outstanding action prompts appear on opening the patient record and can be tracked from the main screen (Clinical > Outstanding Actions).

Actions

What’s your Correspondence Management ‘system’?

CR

EATE

YO

UR

OW

N

Download a blank flowchart here:

Evaluate your practice ‘system’?

SAM

PLE

ON

LY

Display Actions Pane (Audit Trail)

Follow Up Recalls & Reminders

• Track Contact Attempts

• Review Audit Log

• Remove recall once complete

Consent for SMS

✓ Bulk select and bulk send SMS. ✓ Opt-in consent now in PracSoft✓ Add Preferred Contact in Patient Details in MedicalDirector Clinical✓ Tickbox ‘Do not send SMS’ if patient consent has not been given.

When patient returns: delete recall

Audit trail of contact

Change Management is a process

Share success stories:

eg.

Share inspiring success stories of what other practices are doing Link to what’s new that we need to know about:Cervical screening tests good data is vital Medicines view – in My Health RecordPathology & Radiology becoming available in My Health Record

These are all attention grabbers. New Practice Incentive payment linked to improvementsePIP payments all about uploading New era where patients see their info

Choose one thing at a time to focus on (can be one small aspect eg. allergies) and celebrate success.

Celebrate your success!

Learning Resources

• RACGP – Putting Prevention into Practice (Green Book)

http://www.racgp.org.au/your-practice/guidelines/greenbook/

• AMA- Recall systems and patient consent - https://ama.com.au/position-statement/patient-

follow-recall-and-reminder-systems-2013

• Avant – The Dos and Don’ts of patient sms http://www.avant.org.au/news/20160419-dos-and-

donts-of-patient-sms-communication/

• HealthLink SmartFormsRTA Fitness to Drive formAustralian Hearing Form

• Train IT Medical – Practice Management free resources –

http://trainitmedical.com.au/practice-management-free-resources

Learning Resources - Data Quality:

RACGP

Using Data for Better Health Outcomes

Australian Digital Health Agency:

Importance of Data Quality

Data Cleansing & Clinical Coding

Data Quality Checklist

Train IT Medical

Data Aggregation using Pen Clinical Audit Tools (blog)

Cancer Screening & Prevention – Free Resources (blog)

5 Steps to Data Quality Success (blog)

Pen CAT4 summary sheet

Pen Clinical Systems

CAT4 Recipes

Learning Resources – Health Care Homes

Australian Association of Practice Managers (AAPM): AAPM Guidance for Health Care Homes

Health Care Homes WIKI

Dept of Health Recorded Webinar: Becoming a Health Care Home (11/2016)

RACGP Standards for Patient-Centred Medical Homes

‘From good to great: the potential for the Health Care Home model to improve primary health

care quality in New Zealand.’ CSIRO Publishing

FAQs - http://www.health.gov.au/internet/main/publishing.nsf/content/health-care-homes-faq

Pulse IT article ‘Health Care Homes practices given a year to use compliant software’

Australian Digital Health Agency:www.digitalhealth.gov.au

Get Started

On Demand Training (practise in the sandpit)

Training Resources

www.myhealthrecord.gov.au

Pathology

‘NSW patients first to view their pathology results in My Health Record’

Train IT Medical:Digital Health Free Resources including Pen CAT4

Developing a ‘My Health Record’ Practice Workflow (blog)

My Health Record – your questions answered (blog)

Top 30 questions doctors ask about My Health Record with Katrina’s responses (blog)

Event Summaries (blog)

Katrina Otto’s ‘My Health Record’ detailed presentation

Learning Resources: My Health Record:

Learning Resources – Cancer Screening

Train IT Medical Free Resources – Cervical Screening Program

National Cervical Screening Program - Dept of Health - FAQs

Cervical Screening Changes FAQ - Video - Dr Sally Sweeney Hunter New England Central Coast

PHN (HNECCPHN)

NPS Information & FAQs

NPS free eLearning

Cancer Council Australia Cancer Guidelines Wiki

'Cancer Council study confirms starting cervical cancer screening at age 25 is safe'

Cancer Institute NSW 'Information for Health Professionals'

Untold Stories - Cervical Cancer Screening - Audio-visual stories

(Family Planning NSW). Spoken in Arabic, Assyrian, Dari, French, Hindi, Karen, Khmer, Mandarin, Nepalese & Vietnamese.

'Changes to cervical screening will benefit Australian women' RACGP media release

NCPHN Cervical Screening Workshop Presenter Slides

.

Keep in touch! With best wishes, Katrina Otto

katrina@trainitmedical.com.au

Twitter: trainitmedical

Facebook: trainitmedical

www.trainitmedical.com.auAccess more free practice resources

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