Digital Health Shift – EMR Quality Dashboard and Quality Improvement

This Digital Health Shift vlog is the second in a video series of OntarioMD Chief Medical Officer, Dr. Darren Larsen discussing the EMR Quality Dashboard. This segment focuses on how the EMR Quality Dashboard delivers Quality Improvement to patient care.

Digital Health Shift – EMR Quality Dashboard

In this Digital Health Shift vlog, OntarioMD Chief Medical Information Officer Dr. Darren Larsen discusses the need to help physicians move beyond simply focusing on patient care for individuals, toward being able to more easily analyze their entire patient population and proactively those at risk. OntarioMD is focused on improving population-based care through the development of EMR-integrated tools such as our EMR Quality Dashboard proof of concept, which translate EMR data through user-friendly visualization. And, through the ongoing development of our Quality Support Program, we’re providing the support and education physicians need to improve EMR data quality for efficient population-based care.

EMRs and Empathetic Patient Care

Contributed by OntarioMD Peer Leader Dr. Yves Raymond

Recently, Newfoundland physician Dr. Thomas Hall contributed an opinion piece to CanadianHealthcareNetwork.ca, the online home of The Medical Post. Hall’s article – which can be read here (if you’ve registered for a Canadian Healthcare Network account) – argued that while EMRs are useful for connecting health care databases and analyzing patient data, using them during patient encounters risks the doctor being seen as distracted and lacking empathy.

I commented on the website that I find it interesting that we’re quick to blame technology when, in fact, it is how the user chooses to use the technology that is the real issue. In my comment, I also took the liberty to rewrite Dr. Hall’s article substituting paper charts for EMRs as evidence that his arguments could still be made if the medium were paper rather than EMRs. My version is below. Leave a comment below this post to let us know your take on this important issue.

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Paper charting no doubt helps remember what you did, but what do they do to the more subjective nonverbal parts of our patient encounters in office?

Over the last number of months, I have been talking with both psychiatry colleagues in Newfoundland and with staff at the British Columbia Psychiatry Association about their thoughts on paper charting in a family physician’s office. Generally, they felt, and I agree, that paper charts in a physician’s private office as a place to write notes after an undistracted face-to-face patient encounter is potentially helpful. However, in my informal conversations with these physicians, they all expressed serious concerns about the possibility of being distracted and the perceived lack of empathy that may arise from their use of paper charts in the office while examining a patient. This is a serious problem, as most family physicians use paper charts in their exam rooms while seeing patients.

Also problematic is that a family physician’s day is approximately one-third to one-half filled with some components of psychiatric care. I often ask physician colleagues the question: “What do you think of a patient who checks their agenda during their appointment?” Almost exclusively physicians answer with words such as annoying, wasting my time, rude, or with even more intense expletives. This is just a normal human reaction when we think our time is being wasted or we’re not being taken seriously. We physicians have to be aware that the reverse is also true for patients who perceive similarly in encounters where the physician is constantly looking at and writing notes into a paper chart.

Apart from the obvious perceived lack of caring and empathy that paper charts in patient rooms may exacerbate, there also should be serious concerns about what a physician might miss by being distracted by writing notes into a paper chart. A small enlargement of one side of a patient’s neck, clubbed nails, thinning hair, a small facial droop, a facial expression crying out for help from a patient’s partner sitting across the room, etc. These subtle things will undoubtedly be increasingly missed as physicians are pressured to enter more notes that often serves no purpose other than liability coverage and administrative information.

Paper charts will eventually be in every physician office in the country but the “leaders” in our profession, who are often too removed from complicated day-to-day front-line patient care, need to be more proactive about policies that will minimize these pitfalls. As an example, here is some advice from Nobel Prize winner Dr. Lown, author of The Lost Art of Healing:

“Healing is replaced with treating, caring is supplanted by managing, and the art of listening is taken over by technological procedures … Doctors of conscience have to resist the industrialization of their profession.”

Could rules be established by medical associations to suggest paper charting use be reserved to outside patient rooms? This would also require a potential increase in physician remuneration to manage the increased work that would result from extra notes entry at the end of the day.

Small Changes Can Have a Big Impact With EPEP

 

Contributed by Marsha Foster, OntarioMD Practice Enhancement Consultant

Does this sound familiar?  Your clinic has had an electronic medical record (EMR) for some time now. Things seem to be running OK… but maybe you expected everything to be a little easier by now.  Some questions linger in the back of your mind: Is my data truly sound? Could I use my EMR to better understand my diabetic population? Is there an easier way to keep tabs on my preventive care?

OntarioMD’s EMR Practice Enhancement Program (EPEP) is aimed at helping physicians answer these types of questions to optimize their EMR data and functionality. EPEP is a service available to all Ontario primary care providers and community specialists using a certified EMR. A typical EPEP engagement will start with a meeting between you and your Practice Enhancement Consultant (PEC), held at your office at a time that’s convenient for you. Together, you’ll discuss your areas of interest and practice priorities. Your PEC may also ask you to demonstrate some of your favourite ways to document information in your EMR. Your PEC will then perform an in-depth analysis of your EMR data.

After all this initial work is done, your PEC will present their findings and recommend steps you can take to streamline your workflow and use your EMR to achieve your practice objectives. The choice is always yours as to how closely you follow your PEC’s recommendations.

An EPEP success story

The services of a PEC were requested by a family health organization in the Greater Toronto Area that was concerned about the inaccurate data they saw in their EMR around preventive care and cancer screening. They knew their team of five physicians was providing good care, but this was not being reflected in their ministry reports. Instead of documenting their work in an easily trackable manner, they relied on detailed documents sent from the ministry, and spent many hours manually updating patient charts.

The PEC’s data analysis uncovered an issue with the clinic’s roster status process. This process gap was the cause of the poor preventive care reports being produced.

The PEC demonstrated a best practice that could be used to correct the roster status within the EMR. The clinicians and staff agreed to implement the changes suggested by the PEC, and the data gap was closed within a short amount of time. The roster clean-up dramatically improved the clinic’s preventive care reports, and eliminated the hours needed for manual updates. That was time the clinic could start dedicating to other activities and services.

This is just one story of how small changes can have big impact! To meet with a PEC and see how EPEP can improve your practice efficiency, please contact epep@ontariomd.com.