Data Collection in Private Practice and Implementation with Electronic Medical Records

1. Data Collection in Private Practice and Implementation with Electronic Medical Records Martin J Bergman, MD Chief—Rheumatology Taylor Hospital Ridley Park, PA

2. 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

3. % of Office-based Physicians using EMR CDC-National Center for Health Statistics--2006

4. % of Office-based Physicians using EMR CDC-National Center for Health Statistics--2006

5. Use of Billing Software vs EMR CDC-National Center for Health Statistics--2006

6. Obstacles to EMR • Cost • Ranges from $5000 to >$30000 • Loss of Productivity • “Steep learning curve” • Integration into Group Setting • Networking • Competing practice styles • Technophobia

7. 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

8. Data Collected • Demographics • Age • Sex • Employment status • Diagnoses • Active and Co-morbid • Medications • Active and Past

9. Data Collected • Labs • Patient reported measures • Pain • Patient Global • Function (MDHAQ) • RAPID • Fatigue • MD Global • Tender and Swollen Joint Counts • DAS28

10. Data collection is facilitated through the use of questionnaires

11. Patient completes questionnaire while waiting for visit Patient “checks in” and is given questionnaire by the receptionist Physician “eyeballs” questionnaire and “scores” Results of questionnaire are entered into computer “Standard” office visit begins

12. 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

13. Entering data into a computer does not decrease productivity Computer Paper Paper T Pincus, M Bergman, Y Yazici, J Roth, C Swearingen Abstract 1764 ACR 2006 Washington DC

14. 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

15. Graphing of Patient Response MTX ADA

16. Practice Statistics

17. Duration of Treatment vs. RAPID

18. DAS28 vs RAPID

19. 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)

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