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

1. What you need to know in order to successfully implement and use your EMR Dr. Alan Brookstone FMF 2010 October 15 - 3:10pm

2. 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

3. 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

4. Doctor’s 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.

5. 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

6. 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

7. 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).

8. International Primary Care EMR/EHR Experience

9. Selecting an EMR • Assess your practice’s 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

10. 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)

11. 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

12. 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

13. 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? • Don’t be swayed by ‘exotic’ features

14. Considerations - Selection • Choose an EMR that matches as closely as possible to your practice workflow • Greater customization = greater cost and increased complexity of implementation • Don’t delegate selection to a staff member unless they are most capable of leading • Meet regularly • Due diligence!

15. Implementing an EMR • Where to begin • Data strategy • Personnel • Physicians • Staff • Training requirements • Workflow

16. 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)

17. 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.

18. 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

19. 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

20. 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

21. 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

22. Considerations - Implementation • User groups in your community • Standardized forms and templates customization is time consuming & costly • Plan implementation around a slow time of year • Don’t 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

23. Achieving Success with EMR • Data quality is key • EHR is a long-term investment • Build in continuous improvement • Become self sufficient

24. Data Quality

25. Data Discipline

26. 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

27. 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

28. 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

29. 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

30. 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

31. Questions