Tips, Tricks & Best Practices to Get Maximum Benefit from Your EMR

Dr. Alan Brookstone

1. Adoption ≠ Effective Use of EMR

• 16.1% of physicians report using Electronic Medical Records instead of paper charts. This compares to 9.8% in 2007

• 34.1% of physicians used combination of paper charts and EMR in 2010 vs. 26.1% in 2007.

2010 National Physician Survey - http://www.nationalphysiciansurvey.ca/nps/home-e.asp

US – Regional Extension Center Program

US – Regional Extension Center Program

National US Meaningful Use Data

Focus of Today’s Presentation

• Adoption & Implementation• Data Quality• Change and Workflow• Training and ‘Meaningful Use’• Tips and Tricks

Observations

• Goals• Expectations• Leadership• Foundational computer skills• Practice, Practice, Practice• Collaboration• There are some things you cannot change, right

now…

EMR Adoption Journey – Level of Effort

TIME

Readiness Preparation

Implementation

Optimization + Ongoing Use

Pre-EMR

EMR Implementation

• Schedule reduced patient load for at least a month

• Get Staff buy in

• Set up training schedule

• Paper chart conversion

• IT support staff (Consultants/Vendor)

• Workflow analysis

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 ensure sustainability of practice.

Principles of Data Discipline

• Data Standardization– Coding– Diagnoses, Medications, Labs, History

• Data Cleaning– Coverage –all patients are in the system– Completeness –all data is in the system– Consistency –all data tells the same story– 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– System supports humans

• Provides clues that data is incomplete or inconsistent or not coded

Dr. Karim Keshavjee, McMaster University

Change

• Change is disruptive• No disruption = Not sustainable• How to manage the change

– Set clear direction, goals and objectives– Communicate regularly– Invite and acknowledge contributions and concerns– Address resistance by asking for input– Reward initiative– Build commitment

Workflow

• Workflow describes how a process takes place. The process is evaluated and improved to ‘flow’ more smoothly

• Optimizing workflow– Improve efficiency– Reduce redundancy (waste/duplication)– Identify gaps or areas of instability

• Plan on paper first– Office Visits– Chart Conversions– Allergy/Therapeutic injections

Chart is placed at vitals station

Ht, Wt, BP Taken & recorded

Patient is called to vitals station

Patient is taken to exam room

Chart is placed in sleeve on exam door

Paper trigger

Paper trigger

Template needed

How many vitals stations?

How often do we see patient in room without vitals?

Are cuffs and scales available in all rooms?

How many BP’s do we miss?

Ann Lefebvre MSW, CPHQ, Executive Director, NC Regional Extension Center

Workflow – Vitals Collection

Pearls

• Expect and manage disruption• EMR implementation is just the beginning, not the

destination• Change is never complete – processes can always be

improved

Training

• Training not just for implementation and upgrades• Two stages 1) go live 2) follow up after baseline

implementation• Should be ongoing and comprehensive - includes

new learning and advanced functions • As users get comfortable with a system, they learn

new and faster ways to work using the EMR• More complex features require more training• Super User Training

Study – October 2011

• Correlation of Training Duration with EHR Usability and Satisfaction: Implications for Meaningful Use

Methodology

• Based upon surveys conducted with five different professional societies between April 2010 and July 2011.

• 4,280 responses. The average response rate was 8.5%, though rates differed across professional societies.

• Of those who responded to the survey, 2,384 (54%) had an EHR system and completed the entire survey.

• 69% of the surveys were received from physicians in practices of <10 clinicians.

Key Finding # 1 - Overall satisfaction with an EHR was highly correlated with whether the respondent was involved in the EHR selection process.

Key Finding #2 - At least 3–5 days of EHR training was necessary to achieve the highest level of overall satisfaction.

Key Finding #3 - Nearly half (49.3%) of respondents indicated that they received 3 or fewer days of training

Patient Portal

• Review availability with your EMR vendor

• Leverage patient to take more responsibility for their care

• Good example – Waiting Room Solutions

Integrated Medical Devices

• Can you integrate data directly from diagnostic devices?

• Benefits– Accurate information – no transcription– Fast (wired or wireless connectivity)– Linkage directly into the patient’s record

• Examples include: Welch Allyn

Establish a User Group

• Identify individuals within your community who are using the same EMR

• May be practice level if in larger group• Combine clinical with technology sessions e.g.

journal clubs• Present use of a clinical feature (10mins) plus Q&A,

e.g. search methodology, reporting function• Ideal – monthly• Building into standard operations

Tips & Tricks

• Set goals, personally, at the practice level• Get complete buy-in from physicians and staff• First, optimize your internal practice environment• Hold regular practice meetings• Make your data comparable and reproducible.

Standardize on lists, codes, medications, order sets and templates

Tips & Tricks cont.

• Avoid short cuts in documentation. It may be tempting to enter certain data in narrative format – time pressured. To make data reproducible, it needs to be in a standard format

• Trust your gut. The EMR is a tool. Use clinical judgment when making decisions. Your EMR vendor is not infallible and needs your support and feedback

• Keep an open mind. What can your EMR do for you that you were never able to do before?

• Optimize for Chronic Disease Management• Are you taking advantage of all of the incentive payments

available?

How to Become a Super User

• A ‘Super User’ is someone who knows more than the average User about the functional and technical aspects of an EMR

• Can be anyone in your practice – MOA, Nurse, Nurse Practitioner, Physician

• Aptitude and desire to learn• On-site expert for trouble shooting & customizations

e.g. template creation• Need time and support to receive education sessions

and training well in advance of go-live date

Measure Your Results

• “If you cannot measure it, you cannot improve it.”Lord Kelvin

• “X-rays will prove to be a hoax”

• “Radio has no future”

• More simply put, you cannot manage what you don’t measure