Implementation of electronic medical records does not necessarily mean that the systems are being used effectively. Using EMRs optimally requires extensive optimization. This presentation provides a number of useful tips trick and best practices to assist practices with the optimal use of their EMR systems.
Tips, Tricks and Best Practices to Get Maximum Benefit from your EMR
1. Tips, Tricks & Best Practices to Get
Maximum Benefit from Your EMR
Dr. Alan Brookstone
2. 1. Adoption ≠ Effective Use of EMR
• 16.1% of physicians report using Electronic Medical
Records instead of paper charts. This compares to
9.8% in 2007
• 34.1% of physicians used combination of paper
charts and EMR in 2010 vs. 26.1% in 2007.
2010 National Physician Survey - http://www.nationalphysiciansurvey.ca/nps/home-e.asp
6. Focus of Today’s Presentation
• Adoption & Implementation
• Data Quality
• Change and Workflow
• Training and ‘Meaningful Use’
• Tips and Tricks
7. Observations
• Goals
• Expectations
• Leadership
• Foundational computer skills
• Practice, Practice, Practice
• Collaboration
• There are some things you cannot change, right
now…
8. EMR Adoption Journey – Level of Effort
Implementation
Readiness Optimization + Ongoing Use
Preparation
Pre-EMR
TIME
9. EMR Implementation
• Schedule reduced patient load for at least a month
• Get Staff buy in
• Set up training schedule
• Paper chart conversion
• IT support staff (Consultants/Vendor)
• Workflow analysis
10. Implementation Types
• Big Bang: turn on everything at once
– Theoretically a shorter implementation
• Staged: start using new features gradually, e.g. e-
presribing, PMS, Medications
– Theoretically longer implementation
• Recommendation to set implement make it or break
it systems first (PM/Billing systems) to ensure
sustainability of practice.
11. Principles of Data Discipline
• Data Standardization
– Coding
– Diagnoses, Medications, Labs, History
• Data Cleaning
– Coverage –all patients are in the system
– Completeness –all data is in the system
– Consistency –all data tells the same story
– Correctness –right patients in, wrong patients out
– Coded –all relevant data is coded or in a single format
• Data Discipline
– Systems thinking
• Templates, reminders and searches work together
– System supports humans
• Provides clues that data is incomplete or inconsistent or not coded
Dr. Karim Keshavjee, McMaster University
12. Change
• Change is disruptive
• No disruption = Not sustainable
• How to manage the change
– Set clear direction, goals and objectives
– Communicate regularly
– Invite and acknowledge contributions and concerns
– Address resistance by asking for input
– Reward initiative
– Build commitment
13. Workflow
• Workflow describes how a process takes place. The
process is evaluated and improved to ‘flow’ more
smoothly
• Optimizing workflow
– Improve efficiency
– Reduce redundancy (waste/duplication)
– Identify gaps or areas of instability
• Plan on paper first
– Office Visits
– Chart Conversions
– Allergy/Therapeutic injections
14. Workflow – Vitals Collection
Chart is placed Paper
at vitals station
trigger How many vitals
stations?
Patient is called
How often do we
to vitals station
see patient in
room without
Ht, Wt, BP vitals?
Taken & recorded Templat
Are cuffs and
e needed scales available in
Patient is taken all rooms?
to exam room
How many BP’s do
Paper we miss?
Chart is placed in
sleeve on exam door
trigger
Ann Lefebvre MSW, CPHQ, Executive Director, NC Regional Extension Center
15. Pearls
• Expect and manage disruption
• EMR implementation is just the beginning, not the
destination
• Change is never complete – processes can always be
improved
16. Training
• Training not just for implementation and upgrades
• Two stages 1) go live 2) follow up after baseline
implementation
• Should be ongoing and comprehensive - includes
new learning and advanced functions
• As users get comfortable with a system, they learn
new and faster ways to work using the EMR
• More complex features require more training
• Super User Training
17. Study – October 2011
• Correlation of
Training Duration
with EHR Usability
and Satisfaction:
Implications for
Meaningful Use
18. Methodology
• Based upon surveys conducted with five different
professional societies between April 2010 and July
2011.
• 4,280 responses. The average response rate was
8.5%, though rates differed across professional
societies.
• Of those who responded to the survey, 2,384 (54%)
had an EHR system and completed the entire survey.
• 69% of the surveys were received from physicians in
practices of <10 clinicians.
19. Key Finding # 1 - Overall satisfaction with an EHR was highly
correlated with whether the respondent was involved in the EHR
selection process.
20. Key Finding #2 - At least 3–5 days of EHR training was necessary
to achieve the highest level of overall satisfaction.
21. Key Finding #3 - Nearly half (49.3%) of respondents indicated
that they received 3 or fewer days of training
22. Patient Portal
• Review availability
with your EMR
vendor
• Leverage patient to
take more
responsibility for
their care
• Good example –
Waiting Room
Solutions
23. Integrated Medical Devices
• Can you integrate data directly from diagnostic
devices?
• Benefits
– Accurate information – no transcription
– Fast (wired or wireless connectivity)
– Linkage directly into the patient’s record
• Examples include: Welch Allyn
24. Establish a User Group
• Identify individuals within your community who are
using the same EMR
• May be practice level if in larger group
• Combine clinical with technology sessions e.g.
journal clubs
• Present use of a clinical feature (10mins) plus Q&A,
e.g. search methodology, reporting function
• Ideal – monthly
• Building into standard operations
25. Tips & Tricks
• Set goals, personally, at the practice level
• Get complete buy-in from physicians and staff
• First, optimize your internal practice environment
• Hold regular practice meetings
• Make your data comparable and reproducible.
Standardize on lists, codes, medications, order sets
and templates
26. Tips & Tricks cont.
• Avoid short cuts in documentation. It may be tempting
to enter certain data in narrative format – time
pressured. To make data reproducible, it needs to be in a
standard format
• Trust your gut. The EMR is a tool. Use clinical judgment
when making decisions. Your EMR vendor is not infallible
and needs your support and feedback
• Keep an open mind. What can your EMR do for you that
you were never able to do before?
• Optimize for Chronic Disease Management
• Are you taking advantage of all of the incentive
payments available?
27. How to Become a Super User
• A ‘Super User’ is someone who knows more than
the average User about the functional and technical
aspects of an EMR
• Can be anyone in your practice – MOA, Nurse, Nurse
Practitioner, Physician
• Aptitude and desire to learn
• On-site expert for trouble shooting & customizations
e.g. template creation
• Need time and support to receive education sessions
and training well in advance of go-live date
28. Measure Your Results
• “If you cannot measure it,
you cannot improve it.”
Lord Kelvin
• “X-rays will prove to be a
hoax”
• “Radio has no future”
• More simply put, you
cannot manage what you
don’t measure