EMR Tips to Help you Resume Cancer Screening

By Nancy Gunn, Senior Advisor, EMR Lab, OntarioMD; Reza Talebi, Manager, Practice Enhancement, OntarioMD; Melissa Coulson, Director, Program Design and Implementation, Cancer Screening, Ontario Health (Cancer Care Ontario); 

In follow up to the blog on Resuming Cancer Screening During COVID-19we want to make sure it’s easy for you to identify higher-priority patients for cancer screening in your electronic medical record (EMR) systems. Ontario Health (Cancer Care Ontario) and OntarioMD have worked together to give you some EMR tips to help you start to screen your patients again for cancer.  

Preventative Care Queries and Searches 

  • To review Ontario Health (Cancer Care Ontario) Screening Guidelines click here
  • Use your current Preventative Care Queries and Searches to pull up a list of active patients in need of cancer screening. Once you have your list, use the columns provided to sort the patient lists or if your EMR has the functionality, you can export your report to CSV format for sorting and filtering.   
  • For example, you could sort your breast cancer screening list by people who have never been screened.   
  • Don’t forget! Check your flagged patients (using reminders, ticklers, alerts) to see who is due for annual breast or cervical screening because these patients may not appear in your regular preventative screening searches. 

For users of OntarioMD’s i4C Dashboard 

  • Use the Prevention Screening Dashboard, and the Colorectal, Cervical and Breast Cancer Screening tiles to identify patients.  
  • Click on Overdue Pie Slices to identify lists of patients who are due for cancer screening. 

TELUS PS Suite 

  • Filter based on the new guidelines for prioritizing testing: Open Records> Patient> Search> Select your current Cancer Screening Searches> click on the appropriate column names.  
  • Or you can use the Preventative Care Summary Report to find patients: Open Records> Patient> Preventative Care Summary Report> Uncheck Include Rostered Patients Only> double click on the Preventative Care Screening you want to work with (e.g., Stool Occult Blood- Not Done).  
  • Once you have your patient list, you can click on the column names to filter based on the guidance provided for prioritizing testing.   
  • You can also export these reports to CSV and filter by multiple columns. To export, click on Reports> Utilities> save as tab delimited or save as CSV.  

QHR Accuro 

  • In QHR Accuro click on Icon at bottom left hand corner > type the word Query into the search field> click on selection Query Builder to open> select your currently used Cancer Screening Alert Definitions (queries)> click on the appropriate column names to filter based on the guidance provided for prioritizing testing.  
  • To export reports after running queries, click the Export button at the bottom of the Results window. 

OSCAR EMR 

  • Go to Report> #13 Ontario Prevention Report> select Patient Set according to cancer screening> select the Prevention Query to match> Submit Query> click on the appropriate column names to filter based on the new guidelines for prioritizing testing. NOTE: These steps will give you the report for rostered patients only. To get a report for all active patients you must create a new Patient Set.  
  • The Ontario Prevention Report is not exportable. However, you can export search results generated through Report By Template searches. 

If you want help developing preventative care tools and searches, feel free to contact your vendor or OntarioMD i4C Advisory Service at support@ontariomd.com.  

Digital Health Week

by Sarah Hutchison, Chief Executive Officer, OntarioMD

OntarioMD CEO, Sarah Hutchison with her thoughts on Digital Health Week

For many of us in the industry, Digital Health Week is the time of year when we reflect on the impact of health technology.  This year we are simply marveling at the rapid transformation of health care delivery that has been enabled by technology in response to the global pandemic.   

Like you, we could not have imagined how COVID-19 would reshape health care.  

In just eight months, it feels as though we’ve changed almost everything about the way we work, and collectively we have demonstrated a receptivity to change at a pace – and at an intensity – we could not have dreamed of at the start of 2020. 

Health care delivery persevered through the most challenging public health crisis of our time, a credit to the ingenuity and resilience of those who work across the system – including the cutting edge and adaptive technology we are creating and implementing to support care.   

Clinicians have been at the forefront of digital transformation. Their practices have embraced digital and virtual care and, as they say, there is no going back.  These clinicians are now engaging with their patients using a range of virtual tools that video consults remote monitoring, secure messaging, online bookings and prescriptions delivered electronically.  

You can find out more about how we are using virtual care tools in a clinical setting, by visiting OntarioMD’s microsite created this spring to provide tips on how to screen patients virtually, how to keep in contact with those who are symptomatic, and how to virtually help patients with other conditions including chronic disease and acute illness.  

Virtual care opens up a whole new world of opportunities for patient care, and it also raises new challenges that need our attention.  These include how patient care can be delivered so that that health information is not siloed, what encounters and circumstances are most appropriate for virtual care delivery and how we manage care across provinces.  We are also mindful to the impact of technology and change on providers and patients alike – seeking to reduce physician burnout.  Many of these timely topics were explored at OntarioMD’s first Virtual Care Day Conference in October, and for those who missed it livestreams of those sessions can be found here. 

Ontario hospitals are tapping into digital health technology to connect to family doctors as part of their role in the rapid delivery of COVID-19 test results and patient encounters related to the virus to help stop the spread of the coronavirus and ensure follow-up care for patients who contract it.  Reports from hospitals and their COVID-19 assessment centres are being transmitted instantaneously to primary care clinicians’ Electronic Medical Records (EMRs) as a result of an adaptation developed with Ontario Health – Digital Services and vendor partners to OntarioMD’s Health Report Manager (HRM®). 

This is a digital solution to a pressing need that has meant physicians and nurse practitioners are receiving instantaneous notices that COVID-19 test results involving their patients are available through the province’s Ontario Laboratories Information System (OLIS).  

We believe digital innovation can power a healthier Canada.  That’s why we’re driving and enabling innovation in health care, developing an ever-expanding portfolio of digital health tools and services that allow clinicians to practice efficiently and connect to systems across health care in real time. Our products help clinicians improve the patient experience while providing significant cost savings to health care delivery. 

Today, more than 20,000 Ontario clinicians have adopted EMRs and additional award-winning digital products connected to them developed by OntarioMD.  

For example, through Health Report Manager, clinicians using an OntarioMD-certified EMR can securely receive electronic patient reports from hospitals and speciality clinics directly into patients’ charts, eliminating paper, saving time, and most importantly, enabling faster follow up with patients to reduce complications and hospital readmissions.  

And the Insights4Care Dashboard is an EMR-integrated population health management tool that provides insights about patients at a glance to help turn data into better outcomes through preventative care and better management of chronic illnesses. 

Through EMR-integrated eConsult, clinicians can get timely access to the advice of specialists within their EMR, which may result in a timely referral or prevent an unnecessary one.  

With digital tools, of course, come privacy and security issues. OntarioMD offers training, tools and resources to ensure physicians understand their role as health information custodians and can put in the safeguards to treat patient data securely and help prevent breaches.  

Our services are in demand as more and more clinicians look for digital solutions, products and services that enhance patient care, and we are in discussions to expand some of our services to other jurisdictions as a result. 

Only a decade ago, physicians had to rely on fax machines and the postal service to learn that their patient had been discharged from hospital. 

Today, patient information from more than 500 hospital and specialty clinic sites are delivered to the EMRs of more than 11,000 clinicians across Ontario. Through HRM, more than 70 million reports have been delivered digitally – that’s more than two million reports every month.  

Technology has moved the dial in health care delivery, this year, and it will continue to drive transformation over time. I can hardly wait to see what next year brings. 

To find out more about OntarioMD’s suite of digital health tools, visit OntarioMD’s website at www.ontariomd.ca, or contact us at support@ontariomd.com

#thinkdigitalhealth

Resuming Cancer Screening During COVID-19

By Aisha K. Lofters MD PhD CCFP Family Physician, Women’s College Hospital Family Practice Health Centre; Associate Professor and Clinician Scientist, Department of Family and Community Medicine, University of Toronto; Chair in Implementation Science, Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital 

Ontario’s health care system has been significantly impacted by COVID-19 and these impacts will be felt for a while. At Ontario Health (Cancer Care Ontario), we paused cancer screening back in March as a result of the pandemic, but we recently provided guidance on gradually starting up breast, colorectal and cervical screening. Because COVID-19 is affecting health system capacity differently across Ontario, here are some tips based on this guidance to help you make decisions about when to screen your patients in the coming months.  

Breast Screening  

Screening at Ontario Breast Screening Program (OBSP) sites is gradually beginning again. Each site is resuming based on local factors, such as availability of personal protective equipment, staffing, physical space and local COVID-19 infection trends.   

If capacity is limited in your area, here are some tips on who to send for breast screening: 

  • High Risk OBSP participants 
  • Average risk initial screens 
  • Average risk one year rescreens  

Our website has more information on the current breast cancer screening guidelines.  

Cervical Screening 

If someone comes to your office and they are due for cervical screening, we suggest screening them. Annual screening for people at elevated risk for cervical cancer should also start up again as you begin to have in-person appointments. Examples of people at elevated risk include anyone who is:  

  • Discharged from colposcopy with persistent low-grade cytology 
  • Discharged from colposcopy with an HPV-positive test and a normal or low-grade cytology 
  • Immunocompromised 

In addition, colposcopy services are gradually resuming. To make sure people at the highest risk for cervical cancer are able to get a colposcopy appointment during COVID-19, we recommend only sending patients with a single high grade cytologic abnormality (e.g., HSIL+, AIS) or two consecutive low grade cytologic abnormalities (e.g., LSIL, ASCUS). Patients with a single low grade cytologic abnormality should be re-screened in primary care in approximately 12 months with cytology.  

As a reminder, any patient who is positive for human papillomavirus (HPV) strains 16 or 18 should be referred to colposcopy regardless of cytology result. 

Visit our website to find out more about the current cervical screening recommendations.  

Colorectal Cancer Screening  

As of October 20, 2020, screening with the fecal immunochemical test (FIT) has been expanded to all eligible people at average risk for colorectal cancer. Since ongoing fluctuations in COVID-19 cases and local variation in COVID-19 trends are expected, consider local trends in COVID-19 transmission and local capacity for diagnostic services (e.g., colonoscopy) prior to initiating colorectal cancer screening. If you have limited capacity for screening, we recommend focusing your screening efforts on people over the age of 60. 

Because of COVID-19 safety precautions and potential delays with the mail, there may be delays in getting a FIT kit. 

Here are some tips for sending in requisitions to prevent further delays: 

  • Please do not batch fax requisitions as this can lead to errors and subsequent delays 
  • Include a valid OHIP number with updated version code 
  • Ensure that your patient’s mailing address information is correct  
  • Do not send repeat orders until at least 4 to 6 weeks have passed to allow for processing and mailing time 

You should also resume referrals to colonoscopy, especially for patients with an abnormal FIT result, patients who are at increased risk for colorectal cancer, or patients who are eligible for post-polypectomy surveillance with colonoscopy. You can find out more about the current colorectal cancer screening recommendations on our website

This guidance is based on the best available evidence and we hope you find it helpful. Please contact us if you have any questions at cancerinfo@ontariohealth.ca.