Digital health helped me breathe again!

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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 support@ontariomd.com.

 

 

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.

Keeping our Patients Safe: Prescribing in the Digital Era

This post was originally published in Quorum on August 17th, 2017.    

According to a recent study, poison control centres in the US receive a call about medication errors every 13 seconds, and that rate has doubled in the past 12 years (1). Doctors, nurses and nurse-practitioners prescribe medications (and more recently focus on de-prescribing many drugs) on a daily basis, largely without a second thought. These medicines change the lives of our patients every day – often for the better, but unfortunately sometimes for the worse. Given the power of drugs and the authority we wield every time we sign our name to a prescription, it’s important that we do everything we can to focus on safety and effectiveness.

Most prescribers become familiar enough with a handful of different medicines to confidently prescribe them without risk. But sometimes we introduce a distinct cognitive bias by extending our comfort level with one set of drugs to others, including rare, unfamiliar and dangerous ones. It is impossible for any human being to remember all the details of side effects and interactions for the thousands of medications we are thought to be experts on when we prescribe. Add in the notion that individual genetics dictate the way or bodies consume and dispose of medications, and it’s easy to see how this overconfidence and generalization can have dramatic consequences for patients.

Fortunately, there are systems and processes in place that lower our risk of error dramatically. Computerized provider order entry applications like e-prescribing involve electronic entry and transmission of medical orders, and have been found to reduce medication error rates by over 50%.(2)The EMRs used by most community-based physicians in Canada have built-in interaction checkers that compare not only drug-to-drug interactions, but also drug-to-disease-state interactions. And they will alert us when a potential problem arises – assuming we are using the most current version of our EMR and drug database, and have not turned off alert capabilities due to information overload.

While we certainly don’t want our prescription modules to alert us incessantly, we do need to understand the likelihood of severe interactions every time we prescribe. Reminder alerts can also be set up in the EMR for therapeutic monitoring, which is frequently forgotten when prescribing titrated drugs like lithium or anti-seizure meds. It may also be worthwhile to incorporate alerts regarding Beers List drugs that should never be prescribed to elderly patients.

Of course, these types of alerts are only as reliable as the accuracy of the patient information and medication lists in our EMR. So, it’s important for every provider to take the time needed to update medication lists at every patient visit, whether or not it’s considered our direct responsibility to do so.

Tools like EMR, CPOE and automated alerts represent the tipping point in our ability to avoid medication errors using digital health. But there’s more on the horizon. Integration of province-wide databases such as the Digital Health Drug Repository, Digital Health Immunization Repository and Narcotics Monitoring System through the ConnectingOntario and Clinical Connect viewers will be a huge leap forward, giving us the ability to review medications prescribed and dispensed from all practitioners involved in a patient’s care. Integrating this information into EMR prescribing modules will have an even greater impact.

The ability to quickly view and analyze data across our entire patient roster will soon be possible for all using the OntarioMD EMR dashboard.. Work being done on the EMR dashboard – in partnership with Health Quality Ontario, the Ontario College of Family Physicians, the Association of Family Health Teams of Ontario, Association of Ontario Health Centres and the College of Physicians and Surgeons of Ontario – will make it easier to track drugs of interest among our own patients, and will provide a practice-wide population health perspective. This becomes imperative when considering high risk prescribing scenarios like narcotics doses above 50 morphine mg equivalents per day, in immunocompromised patients, and for those on multiple medications with more than one complex chronic disease.

Important digital tools, combined with appropriate policy, education and advice on how to cautiously prescribe and monitor risky drugs, have the potential to help us stave off adverse reactions, overdoses and even deaths. But we must also focus on ensuring that we understand new prescribing guidelines, screen for misuse, employ narcotics contracts and periodically review long-term medication use with patients as diligently as we analyze new drug starts.

With the privilege of prescribing comes great responsibility. Thinking about prescribing safely at the point of care and asking ourselves if we’ve taken advantage of every tool available to make this work easier will give us the best chance we have in doing the right thing for our patients, our practices and ourselves.

  1. Nichole L. Hodges, Henry A. Spiller, Marcel J. Casavant, Thiphalak Chounthirath, Gary A. Smith. Non-health care facility medication errors resulting in serious medical outcomes. Clinical Toxicology, 2017; 1 DOI: 10.1080/15563650.2017.1337908
  2. Nuckols TK, Smith-Spangler C, Morton SC, et al. The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis. Systematic Reviews. 2014;3:56. DOI: 10.1186/2046-4053-3-56.