how to successfully select, implement and use an emr in your medical practice
DESCRIPTION
What you Need to Know in order to Successfully, Select, Implement and Use an EMR in your Medical Practice.TRANSCRIPT
What you need to know in order to successfully implement and use your
EMR
Dr. Alan Brookstone FMF 2010October 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
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.
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
Percent of physicians
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
Doctors Reporting Routinely Receiving Alerts about Potential Problem with Drug Dose/Interaction
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 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
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?
Don’t 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
Don’t 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
Don’t 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