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

Dr. Alan Brookstone FMF 2010 October 15 - 3:10pm

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

Doctors use of EHR Where 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.

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

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

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).

1 - 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

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)

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

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

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

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!

2 - Implementing an EMR
Where to begin
Data strategy

Personnel
Physicians Staff

Training requirements Workflow

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)

Implementation Types
Big Bang: start with everything at once
Theoretically a shorter implementation

Staged: start using new features gradually, e.g. Clinical documentation, medication management and prescribing
Theoretically longer implementation

Ensure that billing works smoothly you still have to pay the monthly expenses!

Personnel
Physician buy in CRITICAL- all or none! Staff buy in Change of workflow and job functions/descriptions Significant variation in computer skills of staff and physicians Technical support within practice & local community

Training Requirements
Vendors have specific training schedules Difference between 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

Common Workflows
Front office Registration & check-in Patient recall Patient ready, encounter finished Scanning Document management Exam rooms
Hardware (Laptop, Tablet, Desktop) Printers Location of computer to patient

Workflow Challenges
Practice transformation
Writing to typing, pick-lists, tablets, speech recognition Data retrieval in EMR vs. paper (patient recall, results screening) Prescription writing to EMR-based prescribing a(ePrescriptions in the future) In office messaging vs. verbal communications sticky notes Completion of charts at time of visit

Considerations - Implementation
Dont go live on a Monday Customization is time consuming & costly Plan implementation around a slow time of year Join or create user groups in your community Identify Super Users and start their training well in advance of go-live date Initial workload: Reduce physician schedules by 50% for first 2 weeks and then by +/- 25% for next 4-8 weeks

3 Successfully Using an EMR

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

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

Dr. Karim Keshavjee, Family Physician, Consultant - www.infoclin.ca

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

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 EMR vendor and user group conferences

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

Measure your Success

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