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.
OntarioMD’s EMR Practice Enhancement Program (EPEP) helps you realize even more value for your patients and your practice by tapping into more of the benefits of your EMR. EPEP staff will work with you and your staff to achieve your unique practice goals, at a time that’s convenient for you. We will analyze your EMR workflow and data quality, and identify quick wins that achieve tangible results or save your valuable time. EPEP emphasizes hands-on support as you move beyond basic data capture to use your EMR for enhanced patient care and improved practice efficiency.
Watch the latest EPEP Success Story to find out how EPEP helped one practice focus on population health through better prevention and screening management. For more information on EPEP, visit https://www.ontariomd.ca/products-and-services/emr-practice-enhancement-program
By Peter Hamer, Executive Director, Ottawa Valley Family Health Team and OntarioMD Clinic Manager Peer Leader
There are less than two weeks left until Canada’s largest EMR conference series comes back to Toronto. If you’re a clinician who is using EMRs and digital health solutions, or you’re interested in learning more about the value of the technology for your practice, you need to register now to attend OntarioMD’s EMR: Every Step Conference on Thursday, September 27.
I’ve attended and presented at the EMR: Every Step Conference since the first one back in 2012, and I’ve connected with thousands of clinicians and other health care professionals and digital health stakeholders who have agreed that there are many good reasons to make time in their schedule for this annual event. The conference offers a full day of CME-accredited content across 20 educational sessions, EMR workshops, a vendor showcase and two keynote addresses. The ability to access this much practical knowledge and CME credits for a registration fee of just $160 ($100 for students) is virtually unmatched anywhere else.
EMR: Every Step Conference content is provided by clinicians, for clinicians. The conference abstract process for this event began in the spring, when a clinician review committee analyzed and evaluated dozens of submitted abstracts to select the ones they knew would offer the best clinical value to their colleagues.
The Conference Agenda
You can view the full agenda for our Toronto EMR: Every Step Conference agenda here, including session summaries and speaker details. The content falls into four streams:
- Clinical Enhancements (Opioid Management, Optimizing EMR for cancer screenings, etc.)
- Digital Health (ebooking, eConsult, etc.)
- EMR Management (Clinic Manager Perspective on EMR, Practical Quality Improvements, etc.)
- OntarioMD Products and Services (EMR Dashboard, Privacy and Security, etc.)
In addition to the great knowledge-building educational sessions, we’re proud to offer clinicians and their staff a variety of training opportunities to learn more about how their EMR can work for their unique practice needs:
- Learn tips and tricks from your EMR vendor in the EMR Workshops
- Get EMR-focused mentorship from Physician, Clinic Manager and Nurse Peer Leaders by signing up for one-on-one Peer Leader Engagements
- Take the opportunity to complete an EMR Progress Assessment to see what level of EMR use you’re currently at
- Learn about OntarioMD’s Privacy and Security Training Module, and why successful completion of this online training module is one of the necessary requirements for access to some of Ontario’s digital health assets, including the electronic health record systems.
For the first time ever, the upcoming OntarioMD EMR: Every Step Conference will feature two keynote addresses.
Our morning keynote will feature Julie Drury, Chair of the Minister’s Patient and Family Advisory Council, She will deliver an address on the importance of including the patient perspective in digital health.
Our closing keynote will be delivered by Dr. Julielynn Wong, internationally recognized as a 3D printing, drone, robotics, telemedicine and digital health pioneer who uses cutting-edge technology to deliver healthcare solutions across diverse environments. Her presentation is titled “From Fax Machine to 3D Printers: Digital Health at Warp Speed.”
Whether you’re a new EMR user, or your practice has been connected for many years, the Toronto EMR: Every Step Conference will help you understand the latest trends and innovations in digital health and determine how this game-changing technology and support from OntarioMD can help you meet your unique practice needs.
Limited conference registration spots remain. Register Today!
Contributed by Surya Qarin, OntarioMD Practice Management Assistant
Anyone that has known me long enough knows I have spent much of my life in and out of hospitals – and that’s not because the doctors are cute. As a matter of fact, Etobicoke General’s nurses and I are on a first name basis now, and they know exactly which vein works best when drawing blood, and which ones “hide.”
As a child, I was hospitalized every other week for severe asthma. It seemed to subside after I turned 12… at least I thought it did. I didn’t even think asthma was a real issue for adults. I’d always been told people outgrow it. But this is not the case: According to the Centers for Disease Control and Prevention, 9.7% of women aged 18 or older have asthma and are more likely to die of asthma than men. Adults are also four times more likely to die of asthma than children. Asthma Canada stats show that up to 250,000 Canadians are living with severe asthma.
Asthma returned to my life a few years ago, as a moderate condition. I had become more active, believing it would help with my other health issues (which it did). As long as I took my puffers before and after working out, I would not have any issues with breathing.
Then flu season hit, and I got sick a few times between December 2016 and February 2017. Those who know me understand my strong belief that I am super woman and do not like to complain about being sick or having “a little cold.” Unfortunately, this was not just a small cold: it had turned from a cold, to bronchitis, to full blown pneumonia by April 2017. Even then, I still refused to see a doctor. One day, on my drive home from work, I felt a sharp chest pain, and something didn’t seem right. I was not just having a little difficulty while breathing as I had been the last few months. I actually could not breathe.
Gasping for air, I pulled over, sent a quick text to my sister and drove to Humber River Hospital. There, I realized how difficult it would be for me to get my medical records: My family doctor was not affiliated with the hospital, nor was Etobicoke General. They were, however, able to pull my past drug history from my pharmacy and go based off that information. I was stabilized and discharged.
A few days later, my breathing difficulties returned. I went into Etobicoke General, and they were able to pull my history right away and admit me to hospital within the hour. Turns out my lungs had started shutting down due to the pneumonia and asthma, and as it was high-humidity and high-allergy season, being outside did not help me. During my stay in the hospital, my family doctor received hospital reports via Health Report Manager (HRM) and he was kept updated on my condition, as were my respirologist and cardiologist.
After a few weeks of recovery, I thought all was well. However, I caught a “cold” again in October, and this time things deteriorated fast! I ended up in hospital yet again. My respirologist was made aware of my condition in real time via the hospital’s EMR and was able to work with the other respirologist on duty and doctors working on my case to provide the best course of treatment given my history. My current spirometry test results were easily available for the clinicians, and the instant connectivity between those on my medical team helped improve my care and recovery process.
Once again, my family doctor’s ability to receive hospital reports to his EMR through HRM enabled him to follow-up accordingly, ensure I had the contacts I needed for my health, schedule regular testing, and most importantly, help ensure that I didn’t end up in the hospital again. I’m happy to say that I have not been hospitalized overnight since November of 2017.
As a member of the team at OntarioMD, I help clinicians across the province understand the value that EMRs and digital health tools such as HRM can bring to their practice and the quality of patient care they’re able to provide. But being a patient in the health care system has really demonstrated the importance of these tools to me first-hand. If you’re a clinician who has questions about optimizing your EMR use, or you want to connect to HRM or the wide range of other digital health tools in Ontario, contact OntarioMD at email@example.com.
Submitted by Dr. John Crosby
I am a family physician in Cambridge with 1,400 patients serving 2 nursing homes in an 18-physician family health team with 30,000 patients in total. I have spent 26 years as a physician, with 20 years’ experience as an emergency physician.
A recent survey in the Medical Post listed paperwork as the biggest stressor for physicians. Luckily for me, paperwork is a thing of the past as we have eliminated paper coming from hospitals and specialty clinics and gone digital using Health Report Manager (HRM). It was easy to implement, and both my office manager and I have found that it saves us time to focus on delivering better patient care.
HRM is simple to implement as OntarioMD does all the work in helping to get your practice set up. OntarioMD came into my practice to sign subscription and user agreements and TELUS helped with the set-up of the system. Report types such as imaging, emergency, specialist and other hospital reports automatically downloaded into our EMR system. This eliminated the need to store paper reports. If I were to get an MRI report showing a brain tumour, I can quickly call the patient in and refer them to a specialist.
I can also access lab results through my EMR via the Ontario Laboratories Information System (OLIS). I simply login into my computer and click on lab reports to view any abnormal patient results. If a patient’s potassium level comes back low, I can simply tell my office manager to tell they will need to change their diet or take certain medications.
One of the newer digital health tools I’ve connected to is eConsult. I can send a message and documentation to a specialist anywhere in Ontario without having to send my patient for an in-person visit. This means faster advice, usually within a couple of days, I can use for my patient who doesn’t have to wait months to benefit from a specialist’s advice.
These tasks are all done without paper. Prior to using an EMR, HRM, OLIS and eConsult, receiving, sending and viewing patient health information was tedious and time consuming. In the past, all my reports were mailed or faxed. We would have to physically travel to the hospital and pick up the paper reports daily. Then the paper report was scanned, the patient’s file had to be opened and the report dragged there. Then my office manager would mark it as seen by me.
With HRM, I see a patient’s report as soon as it downloads. With a couple of clicks, the information is posted into the patient’s chart. I no longer need to go to the hospital and wait for mail and faxes. Now I can receive specialist reports the same day of the patient’s visit all thanks to HRM. HRM also sends me eNotifications so I know when my patients were in the hospital and know that I can expect hospital reports to follow.
My practice is more efficient all thanks to my EMR and other digital health tools like HRM. They have benefitted my practice by:
- Enabling me to find patient information quickly
- Allowing me to spot trends and abnormalities
- Providing faster patient follow-ups
- Accessing specialist advice and getting responses sooner
- Enabling more time spent on patient care
- Creating workflow efficiencies
- Less time spent on administrative and operational tasks
Physicians and other clinicians need digital health tools to practice medicine today. They really need the services of OntarioMD to advise them on how to go digital. You can start with one digital service and OntarioMD will help you integrate it into your workflow. Or, you can start with multiple digital health tools. OntarioMD can connect you to all of them and help you understand how to use them effectively to care for patients and to manage your practice. If you hate paperwork like I do, contact OntarioMD to get HRM, eNotifications, OLIS, eConsult or any other available provincial digital health tools (e.g., ONE® ID, ONE Mail, ConnectingOntario Clinical Viewer and more). Call 1-866-744-8668 or e-mail firstname.lastname@example.org.
Today’s Digital Health Shift vlog is the third in a video series of OntarioMD CMO, Dr. Darren Larsen, speaking about the EMR Quality Dashboard. In this segment, Dr. Larsen discusses how leadership and collaboration amongst health care organizations are driving change to benefit patient care.
Submitted by Amanda Story, OntarioMD Practice Advisor
On April 11, 2017, at the Muskoka Algonquin Health Centre in Huntsville, my third child was born. Clark was a perfect 19 inches long and 7.7 pounds, with a full head of hair. But things quickly got scary, when his blood sugar and body temperature began dropping and his breathing became irregular. He was stabilized, and we were transferred to Toronto’s Sick Kids Hospital.
Little did we know our journey with Kabuki Syndrome was about to begin. Kabuki syndrome is a rare, multisystem disorder characterized by multiple abnormalities including facial features, growth delays, varying degrees of intellectual disability, skeletal abnormalities, and short stature. There’s also the potential for a wide variety of additional symptoms affecting different organ systems. Kabuki syndrome affects males and females in equal numbers, and specific symptoms can vary greatly from one person to another. The incidence of Kabuki syndrome has been estimated to be somewhere between 1 in 32,000 to 1 in 86,000 individuals in the general population.
Sick Kids Hospital was up and running on a computerized charting system, and was able to get all the test results from our local hospital quickly. It was amazing how hospital information flowed – physicians of all specialties sharing one chart, no test duplication, everyone knowing and seeing what had been ordered, what was pending and what the plan was. I was a stressed out, tired and scared mom, and I appreciated not having to repeat Clark’s history over and over again. When Clark would decide to throw a wrench in the plan, it was easy for the nurse and I to note it and a message was sent to the physician to get new orders and/or a new plan. The digital health system made it easy for the changes to be communicated to his entire team of cardiologists, respirologists, and endocrinologists.
Eventually Clark rallied, and we were transferred closer to home, to The North Bay Regional Health Centre. It was a big adjustment. We were surprised that communication between Sick Kids and North Bay Regional Health Centre was by paper and mail. When Clark regressed a bit, it was hard to compare results, causing duplicate tests and delayed treatment while phone calls were made to discuss results. We had experienced the power of digital health at Sick Kids, and appreciated how all the health care providers were connected. At the time, North Bay didn’t offer this – though it has since implemented a computerized system. It did offer video conference calls through the Ontario Telemedicine Network’s system, which allowed Clark’s entire team to connect and get his treatment back on track.
We finally made it home after a couple more weeks. Unfortunately, our stay at home was short. Within a couple of months, Clark caught a cold and a bad cough. We quickly took him back to North Bay Regional Health Centre, where he was admitted and put under observation. After the first 24 hours, Clark got worse. The following day, he went from needing a little bit of oxygen support to needing to be intubated and rushed to The Children’s Hospital of Eastern Ontario (CHEO), which had been consulted during his rapid decline. During transportation, his heart got tired and arrested from working so hard to make up for the decreased lung function. The amazing transfer team from Ornge was able to revive him quickly en route to CHEO. The Pediatric Intensive Care unit was ready and had pulled together a team to assess him and move him to extracorporeal membrane oxygenation (ECMO), which is a heart and lung bypass to allow him to heal.
CHEO had just implemented a computerized charting system called EPIC. It allowed the hospital to flow information around his care, similar to what we’d seen at Sick Kids. Everyone could see and use the same information in real time to assist with coordinating Clark’s care. His entire team at CHEO – Pediatric Intensive Care Unit (PICU), cardiology, vascular surgery, perfusionists, respirology, genetics immunology, infection control, physiotherapy and pain and symptom management, along with imaging and pharmacy, were all working in one chart around a single patient. This was digital health at its best – facilitating communications and transitions in care.
Our family physician was also kept informed through her office EMR, using Health Report Manager (HRM) to get Clark’s hospital reports quickly and keep up to date on his progress. I received many phone calls for support and counselling without having to give updates or go into details. It very much kept me sane during a very scary time.
When Clark was able to be transferred to recovery, the same chart, same information and same teams followed him. Even after discharge, the amazing efficiency of digital health still helps us to this day with his scheduled follow-ups. Each team can communicate and coordinate his appointments into clusters that help us save travel time, and tests and procedures can be grouped together to help minimize Clark’s discomfort.
I am very thankful for the adoption of digital health by Ontario hospitals and health care providers. I’ve seen the high level of accuracy and understanding it offered to everyone involved in Clark’s care. It made me feel comfortable and confident that the physicians had access to everything they needed all in one shareable electronic record. Clark’s medical information followed him wherever he was treated. Digital health has helped connect all the hospitals we visited with Clark, so they could share information and make the best decisions for his care. The digital health change in our health care system is also providing more information quickly and easily to family physicians everywhere in the province. Keeping physicians up to date to provide supportive care to caregivers and other family members is easier and faster. I am convinced that digital health is removing many barriers to efficient and effective health care in Ontario, and I honestly believe it helped save my baby’s life!
Clark is growing stronger daily. We have celebrated many “inchstones” such as regaining head and neck control and re-learning how to roll over, along with a few milestones such as pulling his socks off. He is a very happy baby that brings so much light into our lives.
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.
Submitted by OntarioMD Dr. Adam Stewart
This blog post was originally published on April 22, 2018, on Dr. Adam Stewart’s website at www.stewartmedicine.com.
Information and data have value in every industry. The value of data in health care is only beginning to bloom. Who owns it, though?
Patients undoubtedly have rights with respect to their medical records. It goes unrecognized by most, however, that physicians own the value of data with their electronic charts.
Patients have rights to the content of the data within their medical records. The charts contain their personal information. This is unquestionable. However, the value of data comes from its structure and the organization, which is fully dependent on the physician who generates and maintains the medical record.
The organization of a patient’s chart may vary from being a barely legible handwritten paper chart to the other end of the spectrum of being a complex Electronic Medical Record (EMR) with the advanced data structure. Across the spectrum, the exact same patient information (content), can have widely different functionality and analyzability (value). This quality differential is entirely dependent on the physician and there can be extreme differences when comparing the charts, and thus data quality, of one physician to another.
Governments covet the value of the aggregate, even anonymized, data within EMRs for planning and policy purposes. Pharmaceutical companies share a similar craving for the data for marketing and development purposes. Innumerable interest groups and organizations equally desire data that relates to their agendas. (The legalities and ethics of sharing or selling data are beyond the scope of this article. Rather, the intent of this article is to identify and raise awareness of the value of EMR data that physicians possess).
As per College of Physicians and Surgeons of Ontario (CPSO), “patients have a right of access to their personal health information that is in the custody or under the control of” a physician.1 Patients can request copies of their charts. Even if the original chart was in EMR format, though, what the patient is entitled to and receives is either a printed paper copy of the records, or an electronic PDF document saved on a CD or memory stick, for example. In these formats, the data has relatively nil to minimal value because it is not structured in a way that is easily navigated and analyzed.
Physicians, and staff hired by physicians are the ones who input the notes and structure the data within their charts. Many physicians further build and customize tools within their EMRs to aid in the documentation. Physicians are the ones who pay for the EMR software, training, and vendor support. Physicians are the ones who are responsible for funding all of the computer hardware, technical support, and the physical space in which to house the infrastructure. Accordingly, in every sense, physicians own their EMRs.
One might try to argue that part of the payment to physicians from Ontario Health Insurance Plan (OHIP) for their services includes the generation and maintenance of the medical record.2 However, OHIP simply mandates and includes payment for physicians to “keep and maintain appropriate medical records”.3 It specifies nothing with respect to a standard of quality. The CPSO has more specific requirements.1 However, even a legible and complete paper chart meets those standards of care. Anything above and beyond the minimum baseline of those requirements has value, and that value is derived from, and therefore owned by, the physician who generates and maintains that chart.
There is obvious variability with respect to the quality of data within physicians’ EMRs. The difference from one extreme to another highlights the differences in the value of EMR data. Physicians own that value.
Patients have rights to the content of their individual data. Physicians own the organization, structure, functionality, and analyzability of the data. Physicians own their EMRs. It follows that physicians own the value of the aggregate data within their EMRs. These are careful and important distinctions.
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.
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.