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

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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  • 1. Tips, Tricks & Best Practices to GetMaximum Benefit from Your EMRDr. Alan Brookstone
  • 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. US – Regional Extension Center Program
  • 4. US – Regional Extension Center Program
  • 5. National US Meaningful Use Data
  • 6. Focus of Today’s Presentation• Adoption & Implementation• Data Quality• Change and Workflow• Training and ‘Meaningful Use’• Tips and Tricks
  • 7. Observations• Goals• Expectations• Leadership• Foundational computer skills• Practice, Practice, Practice• Collaboration• There are some things you cannot change, right now…
  • 8. EMR Adoption Journey – Level of Effort Implementation Readiness Optimization + Ongoing Use PreparationPre-EMR TIME
  • 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. 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. 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. 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. 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. 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. Pearls• Expect and manage disruption• EMR implementation is just the beginning, not the destination• Change is never complete – processes can always be improved
  • 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. Study – October 2011• Correlation of Training Duration with EHR Usability and Satisfaction: Implications for Meaningful Use
  • 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. Key Finding # 1 - Overall satisfaction with an EHR was highlycorrelated with whether the respondent was involved in the EHRselection process.
  • 20. Key Finding #2 - At least 3–5 days of EHR training was necessaryto achieve the highest level of overall satisfaction.
  • 21. Key Finding #3 - Nearly half (49.3%) of respondents indicatedthat they received 3 or fewer days of training
  • 22. Patient Portal• Review availability with your EMR vendor• Leverage patient to take more responsibility for their care• Good example – Waiting Room Solutions
  • 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. 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. 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. 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. 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. 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