Webinar – Using EMRs for Chronic Disease Management

March 3, 2011

Funding  to  support  this  Webinar  has  been  provided  by  Hewle7-­‐Packard      

Dr. Michelle Greiver

•  Practice description: –  Community-based family practice in Toronto –  1,300 patients

–  Part of interdisciplinary team (North York Family Health Team)

–  3 physicians, 1 nurse practitioner in the office

–  60 physicians are members of the NYFHT

•  EMR used: –  Nightingale EMR, since 2006

Practice Profile

•  Practice description (1092 adult patients) –  77% female –  Taking part in a Quality collaborative since 2009 –  Part of national primary care EMR chronic disease

surveillance system (CPCSSN)

•  Chronic Disease prevalence (adults) –  80 patients with diabetes (7%) –  89 COPD (8%) –  207 hypertension (19%) –  16 CHF (1%) –  27 confirmed asthma (2%)

Benefits of EMR for CDM

You cannot improve what you cannot measure •  We decided to code important chronic conditions

so that we could build disease registries •  We enter data consistently in the EMR so it can be

measured •  We invested time and resources in measurement

and audits •  All team members use the EMR •  We have CDM flowsheets and templates, with

associated alerts and reminders •  We use the EMR to audit and mail reminders to

patients who are overdue (diabetic, no eye exam for 2 years)

Screenshot

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Screenshot

CDM reminders for any chronic conditions this patient has: “HM button”

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Screenshot

Take Home Points

•  Decide and agree: which chronic conditions you would like to focus on?

•  Involve everyone in your practice •  Enter your data carefully and consistently •  Use the features that your EMR offers •  Try small steps to improve care •  Measure what you did and see if it worked,

then keep going •  Use what you learned in one chronic

condition to improve other conditions

Dr. Nora Curran-Blaney

•  3 Physician Family Practice – Oakville, ON –  2 physicians work concurrently – flexible schedule

•  30 years practice experience

•  EMR used: Healthscreen

•  Remote access version •  Experience using tablet computers

Practice Profile

•  1348 rostered patients

•  519 over 50 yrs •  Chronic Disease prevalence

–  Hypertension – (400 pts.)

–  Obesity – BMI over 33 (100 pts.) –  Diabetes Mellitus – (30-40 pts.)

–  Heart failure – (10 pts.)

Benefits of EMR for CDM

•  Ability to develop clinical queries

•  Active use of a patient profile –  Hand printed copy of profile to patient

•  Used of coded data display –  Requires discipline of data entry for future use

•  Colour coding

•  eFax directly from EMR

•  Simplification of referrals •  Cancer surveillance

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Take Home Points

•  EMR usability is critical

•  Encourage patient self management –  Not yet using a patient portal

•  Record information during the encounter

•  Patient feedback –  Most feel management is improved with EMR

–  Less chance for error or that information has been forgotten

–  Worry about privacy and power outages

Michael Brand, Clinic Manager Associate Medical Centre, Taber, Ab.

•  12 Physician Family Medicine Clinic •  Member of Chinook Primary Care Network

•  Using Wolf EMR since 2007

Practice Profile

•  Approx. 18,000 patients in catchment area

•  Team based Care •  Physician is team lead with mix of NP, RNs,

LPNs, Psychiatric RN, Psychologist, Dietician, Health Coach & MOAs

•  Large Senior & “ESL” Populations

•  19 bed Acute Care Hospital •  100 bed LTC Facility

Benefits of EMR for CDM

•  All CDM Monitoring is managed through use of “Rules” within EMR

•  Rules define a population and provide alert at Point of Care

•  All Clinic Staff are tasked with dealing with relevant rules when in contact with a patient

•  CDM Run charts are used to track performance over time

•  Results are posted for all to see

Take Home Points

•  Rules are constantly changing and evolving based on population and updates to CDM guidelines

•  Patients appreciate the comprehensive level of care & develop trust in the team.

•  Staff feel strong sense of accomplishment when they see positive results.

•  Overall system costs decrease (ER Visits & Admissions) through comprehensive clinic based Chronic Disease Management

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Questions & Discussion

Webinar – Using EMRs for Chronic Disease Management

March 3, 2011

Funding  to  support  this  Webinar  has  been  provided  by  Hewle7-­‐Packard