Tapering opioids for chronic non-cancer pain patients using an EMR tool and academic detailing

Submitted by Dr. Kevin Samson

The 2017 Canadian Guidelines for Opioids for Chronic Non-Cancer Pain emphasized the importance of safely minimizing the dose of opioids that patients are being prescribed. The guidelines made it important for me as a primary care provider to reassess my population of patients on opioids and ensure that I was doing my best to implement the new recommendations accordingly. This presented a formidable challenge and led to the realization that it would be very useful to have an EMR tool to support this process.

In response, the East Wellington Family Health Team (FHT), the Guelph FHT, the eHealth Centre of Excellence (eCE), and TELUS Health partnered to create an Opioid EMR Toolbar (Figure 1) using content informed by the Guidelines and work done by the Centre for Effective Practice (CEP).

Figure 1. Opiod EMR Toolbar

The toolbar provided a practical and effective way to implement the new guidelines into my practice through the following capabilities:

The figure below illustrates the steps I took in using the toolbar to implement the new guidelines.

Figure 2. Steps used to systematically manage my population of patients on opioids.

During this process, I also found it very helpful to participate in Academic Detailing sessions provided by the CEP. These are one on one sessions in which an expert from the CEP met me at my office and reviewed key topics including:

  • Non-pharmacological and non-opioid options for the management of patients living with chronic non-cancer pain
  • Managing opioid therapy for patients living with chronic non-cancer pain
  • Managing care for patients living with opioid use disorder

Results

The toolbar gave me the information that I needed, when I needed it, provided individualized patient decision support, and saved me a lot of time on documentation. I was able to spend more time with my patients. They felt engaged and well informed.

Within nine months of the adoption of the toolbar I was able to safely taper the dose of opioids for a significant number of my patients and there was a statistically significant reduction in the overall MEQs I prescribed over this time period (p<0.05).

I really hope that others will find similar success in helping their patients manage their pain safely and effectively. The Guidelines have paved the way for us, and the Opioid Toolbar has proven to be an effective vehicle to help get us there.

Resources available

  • The Opioid Toolbar is now available to all users of Telus Practice Solutions EMR. The simplified version of the toolbar used for this quality improvement initiative is available through theeHealthCentre of Excellence for PS EMR (Oscar under development). eHealth coaching sessions are also available through the eCE (with Mainpro+ credits) for primary care providers across the Waterloo-Wellington Local Health Integration Network.
  • The Academic Detailing sessions are free-of-charge and free of commercial interest. Physicians can earn Mainpro+ credits for each AD session. More information and the process of signing up for a session is available on the Centre of Effective Practice website.

References:

Busse, J.W. (2017). The 2017 Canadian guideline for opioids for chronic non-cancer pain. Hamilton, ON: McMaster University.

Need help supporting your patients in managing their pain? Visit the Ontario Pain Management Resources for a coordinated program of tools from partner organizations across the province. 

Single EMR for Canada: A Second Opinion

A national electronic health record for primary care – – http://www.cmaj.ca/content/191/2/E28 

The above editorial describes the author’s desire and need for a single national Electronic Medical Record (EMR) in primary care.  He speculates that many of our problems in primary care could be solved by such an instance, from the sharing of records between clinics to research, to specialist access to notes.  He cites single health systems in the US and Singapore as examples of how and why this could work.  This is an interesting perspective, but one which may be overly simplistic and not shine the light on the whole picture.  There has been significant progress and development made in the digital health space in Ontario over the past ten years and this should be recognized and celebrated. This, coupled with a relentless focus on systems integration across the continuum of care, is where we should put our energy.

Although we have much in common as family doctors across the country, we all ask very different things from our EMRs.  Practice environments are not the same in inner city urban centres, suburban practices, rurally, in university health clinics or aboriginal care centres.  This delivery complexity needs to be appreciated.  Nationally over 80% of family doctors already have purchased an EMR that works for them and are using it fulsomely.  In Ontario, this is over 85%.  Physicians own their systems.  They have made significant investments in these … financially, in time spent recording information about their patients, and in blood sweat and tears producing clinically useful data.  We should appreciate this effort and use the systems to their maximum.  Much has been accomplished and advancing from where we are is a very tenable option.

Switching to one EMR solution that attempts to meet the needs of 43,500 family doctors nationally is an impossible task.  And the disruption in care created by “ripping and replacing” would take decades to recover from. Canadian provinces have collectively invested billions of dollars in EMR development, deployment and mature use. We cannot afford as a society or at any level of government to start over again. That said, fundamental health system reform, advances in integrated care models and associated compensation reform should be the driver that defines how integrated digital health platforms can and should be presented at the local, regional, provincial and national level.

Satisfaction ratings with individual EMRs is actually quite high in provincial surveys.  Even with multiple EMRs on the market, connectivity is improving year over year (witness Netcare in Alberta, Connecting Ontario and Clinical Connect in ON and Saskatchewan’s eHealth portal).  In Ontario, information from virtually every hospital is pushed directly into EMRs within minutes of it being generated via Health Report Manager.  Lab results from everywhere can be queried and downloaded through OLIS.  Integration with drug and immunization repositories is occurring now.  eReferral and eConsult systems are up and running and are becoming more and more integrated into the point of care.

As we evolve into an increasingly cloud-based environment the perceived advantages of a single EMR product or database are no longer compelling.    What is most helpful is gaining access to data for clinical, research and system planning purposes.  This is less a technical issue than a policy one.  Integration and interconnectivity are the key.  We are getting closer and closer to this daily, with the advent of single sign on, contextual launching of external digital tools from the EMR, data standards and data movement.  The most unpredictable factor is a human one: even when standards exist, having people use them consistently is a challenge.  A single EMR does not fix this.  Endless dropdown lists and tick boxes do not either.  In primary care nothing is more important than the patient narrative.  We can never lose this.

Choosing a single EMR vendor has other dangers in creating a monopolistic environment.    This makes us vulnerable as a health system and as a profession.  Currently, Ontario has certified 11 EMR vendors and 12 EMR products to a set of core requirements that improve constantly over time.  This allows progress to occur incrementally on interconnectivity, data portability and system functionality.  Having a single vendor control the entire market means that we are at the whim of one company whose business interests may not be aligned with those of clinicians or patients.  We lose our collective influence.

Open source software is not the solution to this problem either.  Although it has the advantage of being inexpensive and in some cases free, it has the disadvantage of needing as much if not more support as proprietary EMRs do.  Most physicians lack the knowledge, skill and desire to program and produce changes in their EMRs themselves. They just want to get down to the work of looking after patients. Multiple different customized instances of an open source EMR do not improve the situation overcurrent state in any way.

It may seem on the surface that having a selection of EMRs nationally is folly. But experience has shown that competition drives change and innovation.  We do not disagree that there are aggravations in navigating from an EMR to a viewer or external portals, but this is a solvable problem.  The key is to build bridges allowing access to data that is required for a clinician at the point of care.  We maintain privacy, confidentiality and security more effectively this way.  Data for secondary use can be liberated easily through these structures if we create the right policy and business drivers.  All of this comes at far less risk and with a far better user experience for the average doctor.  Banks have done it.  Retailers have done it.  We are doing it.

At OntarioMD we believe in more choice not less.  We want to encourage new software products to enter the market to speed up the pace of innovation.  Some of these are EMRs, some are apps that make an EMR fly.  We want to let doctors be doctors, not computer engineers or data scientists.  And ultimately, we think that patients should be the first and last point of approval regarding the secondary use of their personal health data.  These are our principles.   We strongly believe that the best way to accomplish them is via our current approach to EMR selection, certification and improvement.  One EMR system for all is simply not a realistic option.

OntarioMD

Darren Larsen, CMO

Sarah Hutchison, CEO

 

How OntarioMD Measures Our Success

Since 2004, OntarioMD has supported more than 16,000 Ontario primary care clinicians with the adoption and efficient use of electronic medical records (EMRs) and other digital health technology. From having the lowest rate of adoption among Canadian provinces just eight years ago, the EMR usage rate for Ontario physicians is now one of the highest among all provinces. OntarioMD’s strong industry knowledge, relationships and understanding of the health care goals of both clinician practices and the province are keys to our success.

We assist clinicians directly with their digital health needs by certifying EMRs, connecting clinician practices to provincial digital health services, developing solutions to connect these services to EMRs, and help practices adapt their workflows through hands-on change management support from OntarioMD Peer Leaders and our EMR Practice Enhancement Program, as well as at various OntarioMD events.

The digital health space is evolving rapidly as health care needs change, and potential solutions are regularly introduced. However, not all digital health services are effective solutions for clinician needs or for health care system challenges. With this in mind, we constantly test and measure the success of our innovations and support programs with end users. We also collaborate with system partners on assessment and evaluation activities, with the end goal of continuing to build an integrated, effective, patient-centred system aided by technology. The following are just a few examples of how we measure success.

Health Report Manager (HRM)

Health Report Manager (HRM) enables clinicians using an OntarioMD-certified EMR to securely receive patient reports electronically from participating sending facilities including hospitals and specialty clinics. Clinicians connected to HRM automatically get text-based medical reports such as discharge summaries and transcribed diagnostic imaging reports sent to patients’ charts within the EMR. More than 9,000 physicians receive reports through HRM from over 160 hospital sites and more than 200 specialty clinics locations – and the numbers of connected clinicians and sending facilities goes up each month.

In 2017, we asked Deloitte to conduct a survey-based benefits evaluation of HRM that was supplemented by an OntarioMD-led study where practice advisors studied workflow variations and conducted timing assessments. Findings from Deloitte and OntarioMD found that HRM saves an average of 33 minutes per clinician per day by not having to manually handle paper reports. HRM also reduces hospital expenses on printing and postage, as well as labour related to reports that would otherwise need to be faxed to clinicians. The Deloitte report estimated that HRM avoids an average of $15 million a year in costs to the Ontario health care system.

EMR Practice Enhancement Program (EPEP)

EPEP was launched in 2016 to help clinicians and their staff unlock the full potential of their EMR and realize benefits for their practice and patients. Using a hands-on, evidence-based approach, the EPEP team has helped over 500 clinicians and their staff improve EMR data quality and practice workflows and tap into their EMR to proactively monitor and treat patients.

EPEP works with evidence-based tools developed by OntarioMD: the EMR Maturity Model (EMM) and EMR Progress Assessment tool (EPA). These tools assess maturity on a six-point scale (0-5) across three functional areas: Practice Management, Information Management, and Diagnosis and Treatment Support. During EPEP engagements, advisors conduct baseline assessments of a clinician’s EMR maturity and EMR data quality in several priority measures, such as smoking status, cancer screening adherence, and immunizations. They then reassess at regular intervals during and after an EPEP engagement. Our results of these assessments have revealed that data quality measures show improvement after six months. More importantly, most improvements are sustained or even further improved upon at 12 months.

EMR Quality Dashboard

OntarioMD has recognized the need for busy clinicians to quickly and easily visualize their entire patient roster based on their EMR-based patient data. Working with TELUS Health, OSCAR EMR and various industry partners, we developed an EMR Quality Dashboard. The proof of concept initiative is currently in phase 2 with approximately 500 participating clinicians. The Dashboard:

  • provides clinicians with real-time access to EMR data in a user-friendly visual manner, using widely-recognized primary care indicators from Health Quality Ontario, the Canadian Institute for Health Information and the Association of Family Health Teams of Ontario;
  • provides the ability to drill down to patient-level data for each indicator, enabling clinicians to take immediate proactive steps to improve patient care;
  • helps clinicians standardize their data entry to improve the quality of patient data in their EMR;
  • allows clinicians to trend and compare their indicator metrics with other physicians using the Dashboard;
  • would scale provincially to all Ontario physicians using an OntarioMD-certified EMR, and
  • is easily expanded as practice needs and clinical indicators evolve.

Phase 1 of the proof of concept involved approximately 100 physicians. We conducted a benefits evaluation at the end of that phase, which found that over 75% of participating physicians recognized the Dashboard’s value in identifying target patients and generating actionable patient lists. In addition, 80% said the change management support they received from OntarioMD while using the Dashboard was effective in addressing their questions and concerns and optimizing their use of the technology. Following the end of phase 2 in December 2018, we will conduct a more in-depth analysis of participating clinicians to further demonstrate the clinical impact of Dashboard on participating practices.

In each of these cases, our focus on measuring the success of our initiatives has helped us refine and expand our offerings, and integrate them with OntarioMD’s robust change management and support services. Find out more about HRM, EPEP, Dashboard and our other programs and services at www.ontariomd.ca or by contacting us at support@ontariomd.com.

Maintaining the healthcare system is hard work: My decision to the deep dive into Canada’s most complicated system

Contributed by Janet Song

OntarioMD is excited to partner with the Quality Improvement Practical Experience Program (QIPEP) at Queen’s University. Our two organizations share a passion for quality improvement in health care and a commitment to developing future health care leaders.

QIPEP aligns with OntarioMD’s EMR Practice Enhancement Program (EPEP) in seeking to enhance the quality improvement competencies of EMR users and students who will shape the future of health care increasingly enabled by digital health services.

In this blog post, Janet Song shares her perspective on how quality improvement will help practices, the impact of digital health, and more.


Why did you decide to join QIPEP?

My interest in Ontario’s healthcare system began with my frustration as a patient. It was a month of being ill in my second year of university where I was travelling from clinic to clinic, in a desperate search for a diagnosis. It was through hours in different waiting rooms, multiple retellings of the same medical history, and dealing with the inability to eat solid food, when a doctor finally decided to do a specific blood test for H.Pylori, when I finally discovered my illness.

Throughout this month-long journey, I became tired of complaining about everything wrong about my experience, and instead, I found the motivation find a way to improve the quality of our health care system.

It was through following the Queen’s Institute for Healthcare Improvement’s Facebook page where I found the opportunity to receive hands-on experience to do research in healthcare quality and improvement at a healthcare institution.

As a fourth-year commerce student who is interested in experience in healthcare management, I am extremely excited that experience will enable me to do work that can directly support the improvement of hospital operations to better improve the lives of patients. My project is in the cardiology unit at KHSC which involves working with hospital workers in assessing sources of delay for cardiac order entries for doctors to order care actions for nurses on their patients.

Why do you think Quality Improvement is important to your future practice?

Quality Improvement (QI) is important for my future practice because of my interest in utilizing my management degree to socially impacting the lives of those, and healthcare management is definitely a place where I can positively make a difference in someone else’s life.

I want to learn how to manage certain components of this complicated system, and it begins with starting in a small component of the healthcare sector and learning how to improve the quality of it. It is through the process of the Planning, Doing, Studying, and Acting (PDSA) model in my work. This process will sharpen my research, planning and implementation capacities to not only practice healthcare management in the future but also better manage a complicated system to positively impact the lives of others in other fields as well.

Additionally, as an Ontarian, I deeply care about the future of this fragile system, and I want to be part of improving the system.

In 2017, Ontario was recorded as having the shortest waiting times on average in the country at 15.4 weeks, which is under Canada’s average of 21.5 weeks.

However, digging deeper into this information, the Government of Ontario continues to balance $312 billion ($122,919 per Ontarian) where the cost of healthcare is almost 40%, pushing out resources for other social services to maintain this expense and also paying for interest— which half of the education expenses.

The major question lies, how sustainable is our healthcare system? How much longer can an insurmountable amount of debt be maintained in Ontario?

What do you think of digital health? Where do you think it’s going?

The greatest demand comes from the area of the greatest need; the increasing senior population.

Ontario has a senior population that is aged 65 and over is projected to almost double from 2.4 million, or 16.7 percent of the population, in 2017 to 4.6 million, or 24.8 percent, by 2041. This population is living longer lives, the model of the emphasis of healthcare services in hospitals, the highest healthcare expense, transformed into a home care model.

How can Canada prepare for this great demand?

It begins with redefining care to support these seniors through homecare and digitizing the experience to efficiently distribute resources, minimize costs, and still deliver quality care. Consumer digital health tools increasingly will focus on chronic disease management.

Incredible organizations are taking great steps towards improving this complicated system such as SE Futures, the innovation arm of the home care provider Saint Elizabeth. They focus on priorities such as new senior living communities, patient experiences in-home (home self-screening), homecare experience, caregiver experience (chatbot support), and more.

 

One Visit. Multiple Services. Efficient Use of Clinicians’ Time.

Physician practices can choose multiple digital health services to help them care for their patients effectively and efficiently. They’ve seen the ads, they’ve talked to colleagues who already use them, but simply don’t know who to contact or what’s involved to get the process started. OntarioMD has a solution that respects clinicians’ valuable time. In one visit, OntarioMD can describe the benefits of each digital health service, get the onboarding process started and help get you trained on using each service. We call this approach the Digital Health Services Bundle. Much like bundling your cable, Internet and phone services, there’s a current bundle of digital health services available to clinicians that give you access to provincial digital health services that contain information about your patients. This streamlined approach is convenient for clinicians and saves time. Instead of multiple organizations knocking on your door, OntarioMD, because of our experience over the last decade in working with physician practices, is their chosen partner to roll out their digital health services across Ontario. OntarioMD is currently rolling out a bundle of services to clinicians on behalf of eHealth Ontario, Toronto Central LHN, the Northern and Eastern LHINs, University Health Network and the Ontario Telemedicine Network.   

The current bundled services include:  

In order to access provincial digital health services, clinicians require a ONE ID provided by eHealth Ontario. Think of it as your proof of identity, like a passport, to log into digital health services. With ONE ID, clinicians do not need to remember multiple user IDs and passwords. It provides one secure single sign-on to access multiple services like the ConnectingOntario ClinicalViewer.  

ONE Mail, also from eHealth Ontario, is a secure e-mail service specifically created for health care organizations and professionals. You can send encrypted patient information to 390,000 users in Ontario across 800 organizations. Set-up is easy and there’s 24/7 dedicated support and no need for an on-site mail server.  

The ConnectingOntario ClinicalViewer allows you to access and view a patient’s real-time information through secure, web-based portal. You can view your patients’ digital health records that include hospital visits, laboratory results, dispensed medicationss, diagnostic imaging reports and more.  

eConsult, managed by the Ontario eConsult Program, is a tool that provides timely access to specialist advice and often eliminates the need to send patients for an in-person specialist visit. Through a private and secure web portal, you can send a specialist a clinical question about your patient and receive advice quickly and securely. This saves you and your patient time and provides quicker access to care and treatment for your patients.  

To use any digital health services, you need privacy and security training to fulfill your legal obligations and protect your patient data from privacy breaches. OntarioMD has made it easy, and free, for you to get this kind of training. We offer the OntarioMD Privacy and Security Training Module at OntarioMD.ca. You can do the training whenever you have time, from wherever you can access the Internet. Family physicians also earn two Mainpro+ credits for their time. If you’d like some help to complete it, just ask our staff during the Digital Health Services Bundle visit and they can help you. Once you’ve completed the online training module, you can print a certificate of attestation to prove that you are familiar with the best practices to protect personal health information.  

With so many digital health services now available to Ontario clinicians, you may be confused about what’s out there and how the services can help your practice. One email or phone call to OntarioMD will help you make sense of it all and connect you to the tools that are best for your patients and your practice.  

Dr. Therese Hodgson, a family physician in the Ottawa area, has found the bundled approach to digital health services valuable and says of some of the services, “The ConnectingOntario Clinical Viewer provides me access to critical information for my patient in an easy and reliable way. This prevents delays in obtaining the information I need to best care for my patients. The OntarioMD Privacy and Security Training Module is a great resource and has helped me educate my staff in our duties as Health Information Custodians to protect personal health information”. 

Get connected to digital health services efficiently, in one visit. Contact OntarioMD at support@ontariomd.com to talk to one of our staff in your area.

Support + Training = EMR Knowledge for Busy Ontario Clinicians

More than 16,000 clinicians use OntarioMD products and services, and over the years our staff both in the field and at our head office have built strong relationships and had thousands of conversations with primary care providers. So, we’re intimately aware of how busy most primary health care practices are. And we know that most of you want to maximize the benefits of the EMR to enhance patient care and make your practice more efficient. If only you had the time and money to devote to learning how to make the technology work for your practice! 

You’re likely already using several digital health services like our award-winning Health Report Manager (HRM), or want to start using them. Did you know that OntarioMD also has staff all over the province available to help you better understand and use digital health services? Our staff and Peer Leaders are clinicians, practice managers and EMR experts who understand how you work, understand your challenges, and understand the demands on your time. They can help you achieve your unique practice goals. They will come to your practice, or Skype with you, to work with you one-on-one, give you training tips, show you useful features and tools, analyze your EMR data, all to help you better use your EMR to manage your patients’ health. They can help you learn in as little as one visit or work with you over several sessions, depending on your practice objectives.  

You can also get EMR and digital health support surrounded by a small group of your peers through OntarioMD’s unique On the Road with OntarioMD regional learning seminars.  

On the Road with OntarioMD are free Continuing Medical Education (CME)-accredited interactive evening seminars near you for you and your staff to learn how to get more immediate clinical value from your EMR. Whether you’re a seasoned, active user of all your EMR’s features, or you want to learn how to use it for more than just data entry, these seminars will teach you new skills in a stress-free environment. 

On the Road with OntarioMD seminars begin with a presentation on Partnered Efforts for Safer Opioid Prescribing conducted by an OntarioMD Physician Peer Leader or our Chief Medical Officer, Dr. Darren Larsen. You’ll then meet with other Peer Leaders in small breakout groups with other clinicians who use the same EMR as you do. Peer Leaders listen to your challenges and provide their own EMR best practices that you can take back to your own practice and use immediately. The small size of On the Road with OntarioMD seminars give you the opportunity to share and compare your digital health experiences with other clinicians. 

All that, plus dinner is included! 

On the Road with OntarioMD has visited 14 Ontario cities and more seminars are scheduled.  

Register now for our upcoming seminars – or keep an eye on OntarioMD.ca for an On the Road with OntarioMD near you soon! 

Wednesday, November 28, 2018
Delta Hotels by Marriott Toronto East
2035 Kennedy Road
Scarborough, ON
M1T 3G2

Tuesday, December 4, 2018
Hampton Inn & Suites by Hilton Barrie 
74 Bryne Drive
Barrie, ON
L4N 9Y4

 

OntarioMD’s EMR Quality Dashboard and the Important Role of Data Quality

At OntarioMD, we talk frequently about how we add value to the health care system by helping physicians and stakeholder partners realize digital health’s tremendous potential to improve efficiency, reduce wait times, and improve population health management and patient outcomes. That’s a key focus of our 2017-2020 Strategic Plan, and is interwoven in everything we do.  

But what does this mean in practice, exactly? It means that each offering under OntarioMD’s products and services umbrella – whether it’s something developed in-house like Health Report Manager, or a product like eConsult that our head office staff and field teams deploy on behalf of one of our partners – needs to meet these objectives. And it means that the primary care providers that look to OntarioMD as a trusted advisor are confident we’ve done the work needed to ensure the products and services we bring to their practice will help them with patient care and practice efficiency. 

Our ongoing work on the EMR Quality Dashboard initiative is a prime example of the rigorous testing and analysis we apply to ensure our offerings aren’t simply digital health tools, but innovations that integrate and add value to the system. We launched a proof of concept in 2015 to demonstrate how user-friendly dashboard tools use real-time EMR data for improved clinical outcomes and practice efficiency. In phase 1 of the proof of concept, we worked with vendor partners TELUS Health and OSCAR EMR, physician advisory board members and other health care sector stakeholders, to develop a framework that would allow clinicians to view their patients’ data measured against a range of widely-accepted health indicators, and to take immediate action by identifying patients in need of follow up.   

We’ve since expanded both the number of health indicators incorporated into the dashboard and the number of participating clinicians. Today, more than 400 clinicians from across the province are participating in the proof of concept. Their feedback and experiences will be reflected in a benefits evaluation after phase 2 ends in December. But we already know that by using the dashboard to view their patient population data across indicators for conditions including smoking status, cancer and diabetes, participating clinicians can see and quickly respond to preventive care trends among their population.  

They can also easily see where the data in the EMR appears to not match their patient care experience. For example, if the Dashboard shows that smoking status isn’t recorded for most patients, but the clinician knows it is, they can then take action to make sure the information is stored in the right place. An EMR’s potential can only be tapped into if data is being entered effectively. 

In recognition of the importance of change management and ongoing support in the adoption of new tools, this initiative has incorporated the expertise of OntarioMD’s EMR Practice Enhancement Program (EPEP) practice advisors. They are deploying the Dashboard to all participating clinicians and supporting them in getting the most out of the tool. The EPEP process involves first analyzing a practice’s workflow and EMR data and then working one-on-one with clinicians to improve their data quality so that the patient information in their EMR can be effectively used for better patient care. When paired with a digital health innovation like Dashboard, that’s a powerful combination that can lead to better patient care for all. 

We’re currently working on a business plan for the eventual province-wide availability of the Dashboard that will ensure that clinicians on all EMRs have access to both the tool and, crucially, the data quality support offered by OntarioMD’s EPEP team.  

For more information on OntarioMD’s EMR Quality Dashboard initiative, please visit https://www.ontariomd.ca/products-and-services/proof-of-concepts or email us at emrdashboard@ontariomd.com. To talk to an advisor about the quality of your EMR data or about any digital health tool, contact OntarioMD at support@ontariomd.com.  

 

What Digital Health Means to Primary Care

What do you think of when you hear the words digital health? Is it the latest medical health tracker app? Your electronic medical record? Robot doctors?  

Digital health includes all these tools, and many more. But the true essence of digital health – and the reason why it’s worth celebrating with its own Digital Health Week – is something much bigger than the technology itself.  

Digital health is a technology-led evolution aimed at empowering patients and clinicians. It allows us to better monitor, manage and improve our own health and well-being, while allowing clinicians to improve patient outcomes through more responsive technology and better use of patient data.  

In Canada and around the world, digital health is providing tremendous clinical value through improved  access to care for patients, reduced costs, cost avoidance, greater efficiencies, and better quality of care. 

The work we do at OntarioMD is guided by our aim to empower physician practices and enhance the care they and their teams provide patients using EMRs and digital health. We do this through focusing on innovation, and on forging strong relationships and collaborating with health care industry partners to offer products and services that deliver measurable value to the Ontario health care system.  By connecting clinicians with the right tools to meet their practice objectives and ensuring they understand how to effectively use those tools, we help them follow up faster with patients, ensure better coordination of care between all health care providers connected to a patient’s circle of care, reduce unnecessary hospital readmissions, lower wait times, and avoid administrative costs. 

Consider our award-winning Health Report Manager (HRM), for example.  Clinicians using an OntarioMD-certified EMR can use HRM to securely receive patient reports into their EMR from participating hospitals and specialty clinics. With HRM, primary care providers know when their patients get discharged from a hospital or specialty clinic, and all medical record and diagnostic imaging reports they need to ensure effective follow-up are transferred directly into the patient’s medical chart in their EMRs. This eliminates the need for mailed or faxed paper reports and time staff spend handling them.  Most importantly, it lets clinicians be more proactive and provide patients with the quality care they need, fast. 

We’re also helping clinicians use digital health to take action to combat Canada’s growing opioid crisis. According to Health Canada in 2017, there were 4,000 opioid related deaths, up 25% from the year before.  

Digital health offers the tools needed to better combat crises such as this. By tapping into the power of their EMR, clinicians can analyze their patient data to learning more about trends and demographics. Armed with this information, clinicians can identify those patients who are most at risk of opioid abuse, and monitor them to prevent addiction and overdoses.  

OntarioMD’s Peer Leaders and EMR Practice Enhancement Program (EPEP) staff provide clinicians with important hands-on support to help them optimize how they input and use EMR data. Our Peer Leaders and staff have helped primary care providers learn how to use their EMRs to quickly identify their patients taking opioids, the number of different drugs prescribed, and the length of time they’ve been taking the drugs. Clinicians can then create alerts within the EMR to monitor patients on high doses and create a narcotics contract between clinician and patient that can help reduce the risk of addiction and further harm by opioids.  

Whether you need help managing a high opioid risk population, or have other practice challenges and goals, OntarioMD Peer Leaders and staff are like a Geek Squad for clinicians. These clinical practice and technology experts can: 

  • Help you better understand your EMR’s functions and tools; 
  • Analyze your data entry and practice workflows, to improve the quality of patient data in your EMR;  
  • Proactively use EMR patient reminders, reports, population health informatics and more to improve your population health practices; 
  • Implement best data quality practices to access the most relevant patient information at the point of care 

Digital health has the power to improve patient outcomes and help us live longer and healthier lives. But like any technology, the impact depends on the user’s understanding of how to tap into its full potential. By working with patients, clinicians, health care stakeholders and technology vendors, OntarioMD is working to advance digital health care, for the benefit of clinicians and patients across Ontario and all of Canada.  

Keep up to date on digital health advances and our work by following OntarioMD on FacebookTwitter, and LinkedIn. Also, subscribe to our blog at www.ontariomd.blog and visit us online at www.ontariomd.ca for more info on all our products and services. If you have any questions or want to get connected to digital health products and services, please call us at 1-866-744-8668 or e-mail support@ontariomd.com.

OntarioMD: Advancing digital health in Ontario

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Front-line health care providers, quality improvement organizations, digital health delivery leaders and government recognize that digital health delivery has become an indispensable support to keep up with increasing health system demands. It is no longer imaginable that health care could be delivered without digital information technology to manage the array of information processed and recorded for patients every minute in Ontario physician practices, hospitals, home care, long-term care homes, public health units and health care provider practices across the continuum of care. All have adopted digital health tools, in varying degrees, to manage and support patient care.

There is a lot of discussion about what digital health doesn’t do yet – the promise not yet fulfilled, and definitely the glass half empty analogy. What about the glass half full? It is truly important to understand what digital health is doing every day in the health care system.

I’m going to focus on digital health in primary care because that is the area in which we spend our time as an organization. OntarioMD has been at the forefront to rollout digital tools and services across the province to support and enable efficient and effective practice and underpinning the delivery of excellent care to patients. We are known for our success in getting electronic medical records (EMRs) into the hands of community-based family physicians and specialists. From a province with one of the lowest adoption rates when our work began, to now one of the highest. How valuable are EMRs to the health care system? They’re more valuable than people may realize. More than 15,000 physicians and more than 1,100 nurse practitioners are using them to care for about 11 million Ontarians.

EMRs in primary care enable clinicians to manage your personal health information in a secure manner. EMRs require login credentials to access information, and no charts will be misplaced or lost. Protecting personal health information is critical to all of us. EMRs are the secure virtual filing cabinet to protect your information and make it accessible only to those to whom you give consent. We take privacy and security obligations very seriously and we offer a comprehensive program to enable physicians to stay up-to-date on their obligations and how to protect your information in their EMR systems.

Let’s say you were in the hospital emergency department last week and experiencing severe abdominal pain. If your physician used an EMR, they would be getting your discharge summary about your visit from the hospital directly to the EMR through OntarioMD’s Health Report Manager (HRM). They see your discharge summary in their EMR inbox, with a summary of your visit and it is increasingly likely that they may have called you for a follow-up appointment before you call the office.

Whether you are a patient with a single lab test or you require regular laboratory tests to be performed. Physicians are sent your results electronically by the laboratory, and they can also query OLIS (Ontario Laboratory Information System) to see your results. EMRs enable the physician to display results graphically, and this makes a lot easier to review trends in your results, supporting discussions about what might be working well or where attention needs to be focused.

Prescriptions generated and managed in EMRs provide extraordinary value. With an EMR, your physician can alert about drug indications or potential conflicts with current medications. Thousands of Ontarians experience adverse events due to drug interactions every year. EMRs have helped to reduce adverse drug events. It is one of the most valuable things digital health delivers for patients and the health care system.

If your physician wants to ask a specialist about something, he or she can make a request through an online portal and get an answer often in hours. This means you don’t have to wait for months and then take time away from family or work to go to a specialist for something that could have been dealt with by your family physician. OntarioMD is working with our partners in the Ontario eConsult Program to make it even easier for physicians to request an eConsult through their EMRs. This is just one of the ways we’re connecting the health care system to benefit patients.  

Back to the glass half empty – can everyone in the health care system seamlessly exchange data electronically to care for patients? No, but we’re getting there. Ontario physicians understand that the way forward is digital. They see its value and potential by using their EMRs and connecting to OntarioMD products and services and those of our partners that augment the value of digital health to realize better patient outcomes and healthier Ontarians.  

What about the physicians who use digital health and their needs? It’s great that they’re using digital health in increasing numbers to care for patients. We care about their workflows and ensuring that they get the training and ongoing support they need.  We know that it is important to create capacity in a physician’s office to support their adoption and best use of digital health tools and services, all while they are getting on with their most important work – delivering excellent care to their patients.   

Let’s keep working together to fill that glass and realize even more value for our health care system!

EMR Quality Dashboard: Data Quality and Analytics

In this fourth entry in our video series on the EMR Quality Dashboard, OntarioMD CMO Dr. Darren Larsen discusses the importance of good data quality and how analytics can help patient care through population health management.