Transcript Embracing Electronic Health Records to Improve Quality and

Michele McDermott, MD, CCD, NCMP
The Austin Diagnostic Clinic
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Describe the experience of The Austin
Diagnostic Clinic with our EMR including
implementation of Meaningful Use to improve
patient care and outcomes
Discuss how clinical continuity and
coordination of care is supported and
enhanced using our EMR
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Multi-Specialty medical clinic serving Austin
and Central Texas.
120 physicians; primary care and 22
specialties
Seven clinic locations
After hours care
Imaging services
Laboratory
Outpatient Surgical Center
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1995: Austin Diagnostic Medical Center
established
◦ Clinic and Hospital in one facility
◦ Hospital inpatient records, laboratory and imaging
reports in Meditech
◦ Outpatient records in paper charts
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Need to access reports from Meditech
◦ Desktop PCs for ADC physicians to view reports
◦ Dictated office notes transcribed in to Meditech
◦ Reports from Meditech printed and placed in outpatient
charts
Quality of care:
Multiple providers needing to access medical
record at the same time, in different locations
Efficiency of care:
Reduce time for documents to be placed in paper
charts
Improve Work Flow:
Phone call from patient: write note on paper
request chart from medical records \ attach note
to chart \ put on stack of charts for physician to
respond \ return call
file note chart
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Cost containment
◦ Management of paper records
◦ Cost of dictation, placement of dictated reports in
to paper record
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Desire for a central location within ADC to
have all documents in digital form
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2 years
Advisory Board made up of MIS staff and
physicians
What features did we want?
What product would work best for our needs?
What product was affordable?
What kind of support, training would be
needed?
Site visits to view EMRs in use
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IT Preparation
◦ Training information technology staff
◦ Assessment of equipment needs
◦ Purchasing and installing computers
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Clinical Preparation
◦ What information would be pulled in to EMR from
Meditech?
◦ What order and over what time frame would clinical
reports and diagnostic test reports be imported?
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ADC “went live” with EMR in December, 2001
Step one:
◦ Began with importing existing records that were in
digital form. EMR was in viewing mode initially.
◦ Gradual process of eliminating paper copies of
reports and dictated notes
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Step two:
◦ Development of patient encounter forms
 Phone notes
 Office visit templates
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Timeline with precise goals for steps of
implementation, ie. “stop printing lab reports
3rd quarter or year two”
Testing and validation process performed
regularly by MIS team
Measurement of physician acceptance and
use of EMR tools
◦ Example: How many physicians were creating
prescriptions in the EMR
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Continuous Quality Improvement Process at
ADC
◦ Each ADC section responsible for selecting quality
measures that relate to their patient population
◦ EMR is used to gather baseline information and
change over time
◦ Recognition and awards for the sections with best
quality scores and the most improvement
◦ Quality Improvement processes published on ADC
website for patient viewing
http://www.adclinic.com/quality_reports/menopause-center-breast-cancer-screenings/
http://www.adclinic.com/quality_reports/endocrinoloy-diabetes-management/
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Care Alerts
Popup Alerts
Medication Interaction Warnings
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Flowsheet
ADC Medical Quality Initiatives
Health Coaches
Prevention Measures Group reporting ( PQRI)
Meaningful Use
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Healthcare cost savings
◦ Shared charting prevents duplicate tests
◦ Improved and more accurate reimbursement coding
with improved documentation for highly
compensated codes
◦ Reduced medical errors through better access to
patient data and error prevention alerts
◦ Improved patient health/quality of care through
better disease management and patient education
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Reduced transcription costs
Reduced chart pull, storage, and re-filing costs
Electronic prescribing reduces error and re-work,
saves time
Enhanced ability to meet important regulation
requirements such as PQRI and Meaningful Use
through alerts that notify physicians to complete key
regulatory data elements
Reduction of time and resources needed for manual
charge entry resulting in more accurate billing and
reduction in lost charges
Reduction in charge lag days and vendor/insurance
denials associated with late filing
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Limited function (view only) of EMR initially
contributed to slow adoption by physicians
Policy of optional use slowed implementation
Inadequate training of clinicians
No financial incentive, significant time
commitment
Lack of uniformity of EMR patient encounter
forms hindered quality of documentation and
coordination of care
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Ability to measure and influence quality of
care
Patient satisfaction
◦ Coordination of care among specialists
◦ E-prescribing
◦ My ADC Portal: Secure e-mail to physician’s
office, appointments, view medical record
information
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Physician and staff satisfaction
Financial reward
1. Start with the basics:
Problem list, medications, allergies
2. Select a function that will allow an early
success.
Example: phone notes
3. Design documentation forms to follow work
flow
4. Design forms to match the purpose of the
encounter and the personnel entering the
data
5. Patient encounter forms should meet
guidelines and standards for patient visits
Reason for Visit, History of Present Illness, Past
Medical History, Surgical History, Current Meds,
Allergies, Family History, Assessment, Plan
6. Adequate training
7. Share tools and tricks