Transcript Physician Use of IT: Lessons Learned

Michael Martineau,
Dr. Alan Brookstone,
Presenters
Dr. Alan Brookstone – CanadianEMR founder
Michael Martineau – eHealth consultant and commentator
Lessons Learned
EMR Selection & Implementation
Office & Ancillary Equipment
Handling Paper
• 1st podcast – 3 Sept ‘08
• 47 podcasts
Issues
• 4 Roundtables
Interoperability
Data Quality
31 May 2010
CanadianEMR Podcasts
• 13:24 average duration
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Evaluate with own use cases
Look at system in operation in similar setting
Consider vendor support as a critical selection
criteria
Involve staff in the selection process
Be patient, process takes time
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Majority of functionality same as GPs
Major considerations for specialists:
Typically work in two environments
Often have teaching commitments
Need to send letters to referring physicians
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Clearly define requirements
Communicate, communicate, communicate
Engage / involve staff
Work closely with EMR vendor
Practice, Practice, Practice
Plan for go-live period
Maintain a +ve attitude and sense of humour
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Source: Dr. Kevin Leonard
6 to 12 months
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Non-functional requirement
Quality attribute to assess user interface
Cannot be directly measured
Three levels to consider:
Biomechanical
Cognitive
Social
Consider carefully during system selection
Can improve usability of existing EMR
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Take “preventive care” approach
Engage multiple times:
At least several times during 1st 12 to 18 months
Ideally every 3 months during 1st year
Support continued learning
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Don’t need to scan every piece of paper
Prepare electronic charts prior to “go-live” date
Ensure that paper charts are current
Start with charts for upcoming appointments
Populate lists – allergies, medications, and allergies
Clean up and scan chart summaries
Active medications / dosages
Check allergies
Ensure anaphylactic reactions noted
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Avoid hybrid patient record
Paper arrives by various means (mail, courier, etc)
Scan into EMR
Use commercial grade scanning equipment
Designed to handle large volumes
Particularly important in multi-doctor office
Create project to design / implement workflow
Understand current workflow for incoming paper
Design new workflow based on scanning
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If computer not in the right spot it won’t be
used
Consider exam room layout
Patient care area
Patient consulting area
Consider lighting
EMR impacts on office design:
Save 20% to 25% on floor space
Reduce foot traffic -> time savings
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Different criteria from selecting home system
Consider an integrated package of hardware
and software
Five year evergreen horizon
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Consider multiple printers in each exam room
Buy multiple copies of inexpensive printer
Selection criteria:
Time to print 1st page
Noise level
Try at home
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Consider as an alternative to typing
Minimum hardware requirements
Dual core CPU @ 2GHz or better
2 Gbytes of RAM
Invest time to become proficient
At least one hour per day
Couple of weeks to couple of months needed
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Significant challenge
Hindered by privacy concerns / policies / legislation
Raised frequently by specialists
Information exchange key to working in teams
Single system, multiple data sources preferred
Limited value in “viewer”-based approaches
Don’t want to switch mindsets when viewing data
Don’t want to have to transcribe to import
information
Enables advanced EMR functions
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All GPs have an EMR
22 different products
MEDCOM supports exchange of information
Created in 1990’s
Defines standards and approves software
Scalable architecture - 5M+ messages per month
Single standard for:
Lab results
Discharge summaries
ePrescriptions
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All GPs and majority of specialists have an EMR
Healthcare reform in 90’s was major driver
Focus on primary care
Need to submit information for claims and payments
Private sector driven
Highly competitive and dynamic IT market
Innovative products and services
Private sector HIE – HealthLink
Support exchange of 40 different message types
Receives reports from 60 different sources
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Interoperability drives need for data quality
EMRs not designed for population based care
Use EMR as information management tool:
Be more consistent in coding
Code at a high level; don’t be too granular
Code diagnosis and medications
Clean existing data
Make all labels consistent using ICD codes
Make sure patients labeled appropriately with
respect to disease
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"I hate paper
records. I think
that they are
terrible, inefficient,
and bad for patient
care"
“A good doctor is
good doctor no
matter what tool
they use”
“Requires an up
front investment
that some
physicians don't
want to make”
“Give physicians
more tools to
provide improved
care and patient
safety”
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“If you keep
thinking and
working as you did
with paper records
then the quality of
care won't change”
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Michael Martineau
[email protected]
Blog: eHealthMusings.ca
Dr. Alan Brookstone
[email protected]
Web: CanadianEMR.ca
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Power outage is an eventuality
Consider minimum equipment required
One computer at front desk
Computer for each physician
External connection (ASP) or Server (Local)
Install UPS for each req’d piece of equipment
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