EMR Every Step Conference Session Profiles

OntarioMD’s EMR: Every Step Conference in Toronto on September 28, 2017 will feature 25 seminars designed to inspire and educate clinicians on how to get more benefits from their EMR. These sessions have been certified by the College of Family Physicians of Canada’s Ontario Chapter for up to 7.5 Mainpro+ credits.


Evaluating a Point-of-Care Electronic Asthma Management System

This post was contributed by Dr. Samir Gupta and Courtney Price.

In The Electronic Asthma Management System (eAMS): Effects of a New EMR Tool for Asthma Care, Dr. Samir Gupta will look at the impact of eAMS, an EMR-integrated decision support tool, on asthma management.

Asthma is one of the most common chronic diseases in Canada, affecting more than 2 million Canadians. The primary goal of asthma management is to obtain good control of the disease. With the right disease management, we know that most patients can live symptom-free. However, research shows that over half of patients with asthma actually have poor control. The question is, why? Dr. Gupta, clinician-scientist and respirologist at St. Michael’s Hospital, aims to answer this question. by focusing on innovative ways to bring evidence into practice through knowledge translation tools.

In the area of asthma management, three key care practices are recommended: assess a patient’s asthma control at every visit; adjust medications according to this level of control; and provide patients with a written asthma action plan (AAP), which is a self-management tool that empowers patients to transiently intensify therapy for asthma worsening, and explains when to seek help. AAPs are known to reduce hospitalizations, ER visits, absenteeism and symptoms, and to improve quality of life.

To support the implementation of these guidelines into primary care settings – where the majority of asthma patients are seen – the research team developed an electronic tool called eAMS, which leverages information entered by patients on a pre-visit electronic questionnaire to provide physicians with their patients’ asthma control level, evidence-based guidance regarding how to adjust medications, and a pre-filled AAP. All of these functions are seamlessly integrated to the existing EMR system at the point of care.

Dr. Gupta’s presentation will highlight the results of a one-year pilot study of the tool, during which asthma control assessment increased from 2% to 30%, and the proportion of patients who received AAPs increased from 0% to 25%. Dr. Gupta will share design, functionality and evaluation of the eAMS tool with conference attendees, and looks forward to discussion with other health care providers and digital health stakeholders around how to further improve the tool.


Putting the Brakes on Breaks Bone Health Workbook

This post was contributed by Dr. Therese Hodgson and Pascal Hodgson

In their session, Putting the Brakes on Breaks Bone Health Workbook, OntarioMD Peer Leader Dr. Therese Hodgson and data coordinator Pascal Hodgson will review how EMR tools and resources can help achieve best practices in bone health. These best practices are grouped into three pillars: Falls Prevention, Osteoporosis Identification, and Management and Post Fracture Care. The session will feature YouTube videos and links to evidence-based resources, and cover key topics including:  Best Practices, Needs Assessment, Logic Program Module, EMR Tools and Resources, and Examples. The Logic module allows users to gain an understanding of how to develop a program and offers templates for each step. The Bone Health EMR modules can be incorporated into the EMR as tools without a formal program allowing group or single practices to implement bone health activities. One example is the Reminder module that populates the reminder box based on age, sex, date of last Bone Mineral Density (BMD), BMD risk score, history of family hip fracture and presence of fragility fracture.


 

Change Day Ontario

OntarioMD is excited to announce the launch of Digital Health Shift, a series of video blogs covering diverse topics affecting the health care sector today. In our first video blog, OntarioMD CMIO Dr. Darren Larsen, invites you to participate in Change Day Ontario. Please view the video, make a Change Day pledge or leave your comments below.

EMR: Every Step Session Profile Minding Your MEQs: Optimizing your EMR for Safer Opioid Management

This post was contributed by Dr. Kevin Samson. 

OntarioMD’s EMR: Every Step Conference in Toronto on September 28, 2017 will feature 25 seminars designed to inspire and educate clinicians on how to get more benefits from their EMR.

In the coming weeks, we’ll highlight some of the sessions, which have been certified by the College of Family Physicians of Canada’s Ontario Chapter for up to 7.5 Mainpro+ credits. To register for the EMR: Every Step Conference and attend sessions, please register at https://www.ontariomd.ca/about-us/events/every-step-conference-toronto.

In Minding Your MEQs: Optimizing your EMR for Safer Opioid Management, Dr. Kevin Samson will look at how new and innovative EMR tools can help promote the safer and effective prescribing of opioids to patients with chronic non-cancer pain.

Each year more than 650,000 Ontario Drug Benefit (ODB) eligible Ontarians are prescribed opioids. Today, prescription opioids are more likely to be found on the street than heroin, and opioids have become the drug of choice for teens. Opioids are responsible for more than 3,000 ER visits and more than 600 deaths each year.

Finding the time and expertise required to meet recommended prescribing requirements and provide optimal, individualized opioid treatment for patients with chronic non-cancer pain is a real challenge for physicians. But clinicians can tap into new tools to use their EMRs to optimize their opioid prescribing, and improve clinical outcomes for these patients.

These tools are presented in a toolbar which appears in the EMR, within the charts of patients who require opioid therapy. One important feature of the toolbar is that it displays the calculated morphine equivalents (MEQs) that the patient is on, and the display turns color to attract attention when the levels are above certain ranges. The toolbar also includes buttons representing each of the recommended requirements (pain condition diagnosis, risk screening, goal setting, informed consent, appropriateness of opioid(s) selected and dose, opioid effectiveness, and drug testing). If any of the requirements are missing or out of date for a particular patient, the corresponding buttons will change colour to provide clinicians with a user-friendly ‘at a glance’ view of the patient’s opioid management status. Clicking the buttons brings up standardized, evidence based tools used to manage the patient’s care. Additional buttons in the toolbar provide links to other related tools, references, handouts and patient report cards.

In this EMR: Every Step Conference session, Dr. Samson will share data and feedback from patients and physicians in the practices that have deployed the toolbar, he will explore the toolbar’s impact on the quality and completeness of opioid-related data in the users’ EMRs, and its impact on prescribing patterns.

EMR is the Solution, Not the Problem

This post was contributed by Dr. Adam Stewart. The original entry can be found on his blog at https://www.stewartmedicine.com/blog/emr-is-not-the-problem

 

These days, it seems there is an anti-EMR proclamation to match every anti-vaccination decree. As the old adage goes, “You can lead a horse to water, but you cannot make it drink.” For the skeptics, by the end of this article, hopefully the water will reveal itself to be a little more palatable.

Paper vs Basic EMR vs Advanced EMR:

In its most basic form, EMR is used simply as an electronic typewriter and appointment scheduler. As a next step in advancement, the EMR user takes advantage of features like prescription writers, some basic note templates for common types of visits, and perhaps using a few simple “reminders” to aid in patient care. This would be classified as “Basic” EMR use. “Advanced” use of EMR includes taking advantage of features such as searches, complex reminders, and many of the other innovative features that EMR systems have to offer.

Even in its most basic form, EMR transcends paper charts in arguably every way imaginable.

EMR has become a Scapegoat:

Critics of EMR often claim that much of their day is spent entering data into a computer, rather than face to face patient care. They are frustrated and feel this type of administrative work is a waste of valuable physician time and expertise. This is all totally understandable and merits improvement. However, EMR is not to blame here. EMR is simply the tangible instrument for the deeper issues and causes here.

It is not the EMR that is causing nor necessitating the diversion of physician time. Rather, it is the increasingly burdensome administrative requirements of today’s clinical practice. It is the CPSO and MOHLTC requirements that mandate thorough documentation. It is the mounting complexity of each and every patient, compounded by a growing number of clinical practice guidelines for each of their chronic conditions. It is the incentives and corresponding metrics that amplify administrative burden. It is government and hospital policies that mandate documentation requirements.

Whether or not each of these factors is misguided is beyond the scope and purpose of this article. The fact remains, though, that the digression in clinician time is due to factors like these, and not because the EMR is somehow demanding the clinician’s time.

EMR is not the problem here. It is the solution. The administrative burden caused by all of the above factors would undoubtedly be even more time consuming and inefficient if not for EMRs.

 

One Click is Faster than Fifty Keystrokes:

Even in its most basic form, EMR as a word processor with elementary templates for notes is exponentially more efficient than hand-written paper charts – not to mention the legibility factor.

Imagine a patient who presents with a respiratory infection. Assessment reveals clinical suspicion of pneumonia. A chest x-ray is ordered and the patient is prescribed amoxicillin. Ultimately, the physician will need to document a chart note, complete an x-ray requisition, and write a prescription.

The chart note may look something like this, and took 2:26 minutes to write:

 

The hand-written chest x-ray requisition may look something like this, and took 1:11 minutes to write (not including the time it would have taken to manually retrieve the paper requisition):

The hand-written prescription may look something like this, which took 43 seconds to write:

 

This paper-based encounter took a total of 4:20 minutes in paper-work.

In comparison, using an EMR with just basic features, the same encounter required a total of only 1:37 minutes to write the chart note (1:05 minutes), prepare the x-ray requisition (29 seconds), and write the prescription (13 seconds).

 

Here, basic EMR use saved 2:43 minutes in administrative and charting time in this simple visit example. This is not to mention all of the time saved in chart retrieval and filing, the administrative time saved by electronically faxing the prescription and requisition, and the added efficiency of tracking a pending test result.

If one assumes an average time savings of even 3 minutes per visit, multiplied by 100 patient visits per week, that amounts to 5 hours of physician time saved each week, in just this simple example.

In actual practice, the efficiency savings are even greater when one considers the difference in time saved with more complex visits such as chronic disease management, like diabetes flowsheets, and so on. For instance, EMRs allow easy graphing of measurements such as blood pressures, weights, and A1C levels, so as to have this type of data readily available within a couple of key strokes, thereby improving the ease and quality of clinical decision making.

 

 

Metrics and Population Health Management:

There are deserved merits and criticisms for most of the popular metrics that physicians are asked to track, and the incentives that are sometimes tied to them. These types of discussions are beyond the purpose and scope of this article.

That aside, the benefits of screening for cervical cancer in women are relatively non- controversial. Imagine, for example, a family practice that has 600 applicable women who are to be screened every three years with a PAP smear. Using an EMR, a simple search takes just a minute or two to generate a recall list. With advanced features such as bulk emailing, hundreds of women can be notified and recalled using less than ten minutes of a staff time. Whereas with paper charts, the amount of administrative burden required to find and recall every single woman who is overdue for her PAP smear is enormous, not to mention subject to a tremendous amount of human error and inaccuracy.

Magnify this example by the similar administrative burden (or savings with EMR) of recalling patients for the multitude of other tests they require (Colon Cancer screening, Mammograms, Immunizations, Blood Pressures, certain blood tests, Bone Density Tests, etc). There is simply no logical justification for the use of paper charts over EMR, neither in terms of efficiency nor quality of patient care.

Other EMR Advantages:

EMRs carry other sorts of advantages that paper charts cannot offer, including but not limited to:

– Legibility
– Accessibility (i.e. remotely from outside of clinic)
– Safety checks such as drug interaction warnings
– Intra-office messaging features
– Efficiency of sending referrals (that are high quality and comprehensive)
– Ease of ability to track pending tests and referrals
– Ease and potential for data retrieval and analytics

Even its most basic form, the immediate and tangible advantages that EMR offers over paper charts are clear. This is not to mention the spectrum of advanced capabilities not explored within this article. EMR should not be a scapegoat. Frustrations with current administrative burden should be more appropriately directed at its more insidious root causes. If anything, EMR and technology will continue to assist as solutions, rather than be obstructions.

– Dr. Adam Stewart

May 14, 2017