Tips, Tricks & Best Practices to GetMaximum Benefit from Your EMRDr. Alan Brookstone
1. Adoption ≠ Effective Use of EMR• 16.1% of physicians report using Electronic Medical  Records instead of paper charts. ...
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 ‘Meaning...
Observations•   Goals•   Expectations•   Leadership•   Foundational computer skills•   Practice, Practice, Practice•   Col...
EMR Adoption Journey – Level of Effort                    Implementation      Readiness                      Optimization ...
EMR Implementation• Schedule reduced patient load for at least a month• Get Staff buy in• Set up training schedule• Paper ...
Implementation Types• Big Bang: turn on everything at once   – Theoretically a shorter implementation• Staged: start using...
Principles of Data Discipline• Data Standardization   – Coding   – Diagnoses, Medications, Labs, History• Data Cleaning   ...
Change• Change is disruptive• No disruption = Not sustainable• How to manage the change   –   Set clear direction, goals a...
Workflow• Workflow describes how a process takes place. The  process is evaluated and improved to ‘flow’ more  smoothly• O...
Workflow – Vitals Collection   Chart is placed                  Paper   at vitals station                                 ...
Pearls• Expect and manage disruption• EMR implementation is just the beginning, not the  destination• Change is never comp...
Training• Training not just for implementation and upgrades• Two stages 1) go live 2) follow up after baseline  implementa...
Study – October 2011• Correlation of  Training Duration  with EHR Usability  and Satisfaction:  Implications for  Meaningf...
Methodology• Based upon surveys conducted with five different  professional societies between April 2010 and July  2011.• ...
Key Finding # 1 - Overall satisfaction with an EHR was highlycorrelated with whether the respondent was involved in the EH...
Key Finding #2 - At least 3–5 days of EHR training was necessaryto achieve the highest level of overall satisfaction.
Key Finding #3 - Nearly half (49.3%) of respondents indicatedthat 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...
Integrated Medical Devices• Can you integrate data directly from diagnostic  devices?• Benefits   – Accurate information –...
Establish a User Group• Identify individuals within your community who are  using the same EMR• May be practice level if i...
Tips & Tricks•   Set goals, personally, at the practice level•   Get complete buy-in from physicians and staff•   First, o...
Tips & Tricks cont.• Avoid short cuts in documentation. It may be tempting  to enter certain data in narrative format – ti...
How to Become a Super User• A ‘Super User’ is someone who knows more than  the average User about the functional and techn...
Measure Your Results• “If you cannot measure it,  you cannot improve it.”   Lord Kelvin• “X-rays will prove to be a  hoax”...
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Tips, Tricks and Best Practices to Get Maximum Benefit from your EMR

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Implementation of electronic medical records does not necessarily mean that the systems are being used effectively. Using EMRs optimally requires extensive optimization. This presentation provides a number of useful tips trick and best practices to assist practices with the optimal use of their EMR systems.

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Tips, Tricks and Best Practices to Get Maximum Benefit from your EMR

  1. 1. Tips, Tricks & Best Practices to GetMaximum Benefit from Your EMRDr. Alan Brookstone
  2. 2. 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
  3. 3. US – Regional Extension Center Program
  4. 4. US – Regional Extension Center Program
  5. 5. National US Meaningful Use Data
  6. 6. Focus of Today’s Presentation• Adoption & Implementation• Data Quality• Change and Workflow• Training and ‘Meaningful Use’• Tips and Tricks
  7. 7. Observations• Goals• Expectations• Leadership• Foundational computer skills• Practice, Practice, Practice• Collaboration• There are some things you cannot change, right now…
  8. 8. EMR Adoption Journey – Level of Effort Implementation Readiness Optimization + Ongoing Use PreparationPre-EMR TIME
  9. 9. 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
  10. 10. 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.
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. Workflow – Vitals Collection Chart is placed Paper at vitals station trigger How many vitals stations? Patient is called How often do we to vitals station see patient in room without Ht, Wt, BP vitals? Taken & recorded Templat Are cuffs and e needed scales available in Patient is taken all rooms? to exam room How many BP’s do Paper we miss? Chart is placed in sleeve on exam door trigger Ann Lefebvre MSW, CPHQ, Executive Director, NC Regional Extension Center
  15. 15. Pearls• Expect and manage disruption• EMR implementation is just the beginning, not the destination• Change is never complete – processes can always be improved
  16. 16. 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
  17. 17. Study – October 2011• Correlation of Training Duration with EHR Usability and Satisfaction: Implications for Meaningful Use
  18. 18. 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.
  19. 19. Key Finding # 1 - Overall satisfaction with an EHR was highlycorrelated with whether the respondent was involved in the EHRselection process.
  20. 20. Key Finding #2 - At least 3–5 days of EHR training was necessaryto achieve the highest level of overall satisfaction.
  21. 21. Key Finding #3 - Nearly half (49.3%) of respondents indicatedthat they received 3 or fewer days of training
  22. 22. Patient Portal• Review availability with your EMR vendor• Leverage patient to take more responsibility for their care• Good example – Waiting Room Solutions
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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?
  27. 27. 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
  28. 28. 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
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