What you need to know in order to successfully implement and use your EMR

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What you need to know in order to successfully
implement and use your EMR

• Dr. Alan Brookstone FMF 2010
• October 15 - 310pm

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Dr. Alan Brookstone

• Family physician
• Founded CanadianEMR.ca in 2004
• Partner The ClearView Group 2008
• Physician and Senior eHealth Consultant with
  national, provincial, and regional experience
• Author of numerous articles and whitepapers
  surrounding healthcare technology in Canada and
  abroad

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Learning Objectives

• By the end of this session, participants will
  understand how to
• Successfully choose an Electronic Medical 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 Errors Among 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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Doctors Reporting Routinely Receiving Alerts
about Potential Problem with Drug Dose/Interaction
Percent of physicians
Source 2006 Commonwealth Fund International
Health Policy Survey of Primary Care Physicians
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Medications Reviewed When Discharged from
Hospital 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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International Primary Care EMR/EHR Experience
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Selecting an EMR

• Assess your practices readiness for an EMR
• Talk to physicians in your community
• Identify products that are appropriate for your
  practice
• www.canadianemr.ca is a resource you can use to
  identify and compare systems
• Provincially certified or non certified systems?
• Vendor demonstrations
• Site visits

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Develop a Practice Vision

• There had to be a full commitment to
  computerization by all
• One of the strongest drivers behind our vision
  was that we wanted to remove the underserviced
  status that our community had. That defined what
  we had to do!
• Dr. Steve Pelletier family physician in
  Clarence Rockland, Ontario (11 doctors 25
  support staff)

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Assess your Readiness

• Establish goals
• Evaluate computer skills for physicians and staff
• 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 their
  workflow 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 common and
  important daily activities well?
• Dont be swayed by exotic features

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Considerations - Selection

• Choose an EMR that matches as closely as possible
  to your practice workflow
• Greater customization greater cost and
  increased complexity of implementation
• Dont delegate selection to a staff member unless
  they are most capable of leading
• Meet regularly
• Due diligence!

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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-Live and
  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 turn on everything at once
• Theoretically a shorter implementation
• Staged start using new features gradually, e.g.
  e-presribing, PMS, Medications
• Theoretically longer implementation
• Recommendation to set implement make it or break
  it systems first (PM/Billing systems) to insure
  life of practice.

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Personnel

• Physician buy in CRITICAL- All or none!
• Staff buy in Change of workflow and job
  functions
• Significant variation in computer skills of staff
  and physicians
• Technical support within practice local
  community

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Training Requirements

• Vendors specific training schedules
• 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
• Halls 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 (data input)
• Prescription writing to (ePrescribing)
• Data retrieval in EMR vs. paper (patient recall,
  results screening)
• In office communication and messaging vs. sticky
  notes
• Completing charts at time of visit

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Considerations - Implementation

• User groups in your community
• Standardized forms and templates customization is
  time consuming costly
• Plan implementation around a slow time of year
• Dont go live on a Monday
• Appoint Super Users and start their training
  well in advance of go-live date
• Guide Reduce physician schedules by 50 for
  first 2 weeks and then by /- 25 for next 4-8
  weeks

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Achieving Success with EMR

• Data quality is key
• EHR is a long-term investment
• Build in continuous improvement
• Become self sufficient

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Data Quality
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Data Discipline
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Principles of Data Discipline

• Data Standardization
• Coding
• Diagnoses, Medications, Labs, History
• Data Cleaning
• Coverage all patients are in the system
• Consistency all data tells the same story
• Completeness all data is in the system
• Correctness right patients in, wrong patients
  out
• Coded all relevant data is coded or in a single
  format
• Data Discipline
• Systems thinking
• Templates, reminders and searches work together

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EMR is a Long-Term Investment

• Many physicians see the EMR as just another
  expense
• 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 you
  could never do before

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Build in Continuous Improvement

• Many clinicians achieve a basic level of EMR use
  and never progress further
• Set goals and determine how to integrate
  continuous improvement principles into practice
• Team or small group based learning
• Attend annual user group conferences

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Become Self Sufficient

• Develop in-house Super Users (clinical and
  administrative)
• Meet regularly as a practice team to
  problem-solve, discuss needs and set new
  priorities

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Measure your Success

• Would you ever go back to paper?
• Did you have any staff turnover during
  implementation?
• Implementation of quality indicators (part of CDM
  program) e.g. diabetic patients with HBA1c in
  last 3 months, patients who have received
  specific immunizations
• Use of triggers, flags patient recall

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Questions