EMR as an Enabler to Support Screening Processes

Transcription

1 EMR as an Enabler to Support Screening Processes

2 Objectives To identify the difference between standardized and non-standardized data, structured and unstructured data To identify how the EMR supports screening processes To identify how EMR practices support screening processes Determine where to start with our teams 2

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4 Considerations for EMR data GIGO Garbage In Garbage Out Inaccurate reporting Getting the answer vs. getting the right answer

5 Types of Data Recorded in an EMR At the clinic level, data can be classified as: Structured data May be standardized at the clinic level Searchable Unstructured data Usually unstandardized Challenging to search for, or, Non-searchable 5

6 Examples of Structured Data Radio Buttons Tick Boxes Drop Down Boxes Pick Lists 6

7 Examples of Unstructured Data Fields where notes can be written Includes drawings and sentences 7

8 Templates Templates may contain both structured and unstructured data Text Field amongst many discrete data fields 8

9 Question: What health data is most structured and encoded from physician offices across Alberta? Answer: Billing data 9

10 No matter what EMR a clinic is on. Investing time and resources in the following areas enables screening and prevention: Standardization What needs to be standardized How to standardize (optimized practices) Whole team commitment Not point in time How to generate buy in Validation of data Trust

11 Standardization Blood Pressure Example Q: Who needs the maneuver? A: Anyone ages Q: Who does not need the maneuver? A: Patients who decline; patients who have had it <1 year Q: Where is the result recorded? A: Systolic & Diastolic fields Q: What are the units of measurement? A: mm/hg Q: When was the result recorded? A: Date of data entry Q: Who enters the result? A: ***needs to be standardized for all entering***

12 How to standardize EMR KT Support Documents in development for EMR users by vendors Will outline options for standardization EMR Knowledge Resources available on TOP website

13 Whole Team Commitment Consistent message across practices that in order to achieve optimal information from EMR, the entire team must commit to defined standards. Not one person making decisions for entire team Create understanding of implications Less than full participation < full standardization

14 Validating Results Alberta practices tell us that testing the output of their standardization is an important step before using the information to initiate screening and prevention activities. Can I trust this information? Are there patients missing from the list who should be here? Are there patients on the list who don t belong? One bad response from a patient can stop the process entirely

15 Role of the Facilitator - EMR NOT the EMR EXPERT / SUPER USER / PROGRAMMER How can the facilitator help the team to optimize the information in and from their EMR?

16 EMR Capabilities Relevant to Screening Track data over time Identify panel and sort patients Identify patients who are due/overdue for screening Monitor parameters (E.g., blood pressure) Messaging between team members Generate, print and store requisitions Fax from within EMR to lab or diagnostic imaging sites Receive investigation results electronically Create reports 16

17 Blue Meadow Case Study Engaging the whole team in this discussion makes decisions and priorities transparent for all and builds shared commitment 17

18 Blue Meadow Family Clinic Relevant EMR Information Using TELUS Wolf for 5 years Current state AIM? Advanced training? EMR Leadership Who is the EMR support person for the clinic? Are there standard documentation processes? Where are templates used?

19 Current State Assessment Determine what is currently being recorded in a standardized way By individual providers/staff Amongst all providers/staff By the system 19

20 Data Relevant for ASaP How have the ASaP maneuvers been documented? 20

21 Screening Offer Documentation Handout 21

22 Consider Dr. Doe and Dr. Green s patterns of screening documentation Many offers occur during a Complete Physical examination (CPx) Mixed use of standard fields and notes which may not be searched or reported Investigation requisitions are created in the EMR and results received electronically (not scans) Influenza is offered seasonally 22

23 Moving Forward: Gain Agreement on Standardization 1) What does Blue Meadow want to get out of the EMR? Agree on desired outputs 2) What needs to go in to make this happen? Determine which fields in EMR need to be filled to generate the desired reports Agree on data entry Identify skill gaps and train Monitor regularly and reinforce 23

24 Getting Help EMR Help Files Vendor POSP funded VCUR 08 clinics Share with another clinic using the same system TOP resources Handout 24

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26 Sample Med Access Video 26

27 Key Concepts Foundationally, EMRs can: Identify panel and target populations for screening Remind that the screening is due Record that screening has been offered Fax requisitions Understand where you are in order to conduct chart review and prepare for screening process redesign Screening is not a one-time event but a process 27

28 Summary EMR is an enabler Standardization Trust in the information Facilitator Not expected to be an EMR expert Guide clinic participants to resources Use QI tools Assist the team in maintaining focus (facilitation skills) The Chart Review will help to understand the current state and inform screening process redesign