Using an EMR for Panel & Preventative Care Foundational Concepts and Tools

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1 Using an EMR for Panel & Preventative Care Foundational Concepts and Tools Electronic Medical Records for Panel in Alberta An EMR is an enabler for panel identification, panel management and proactive patient care. The most common 7 EMRs used in the community in Alberta all support effective panel identification and panel management. Foundation for success: Commitment to standardization in the EMR It is strongly recommended to maximize use of standardized data fields and templates to record patient information in the EMR. It is helpful before improvement to determine how to record patient information in a standardized way in order to obtain the desired reports or queries. Example 1: All front staff record patient attachment in the same primary provider field and click save or update at each patient visit. Example 2: All providers in a clinic record tobacco assessment in one location in the patient chart from a pick-list of terms; as a result a search can be conducted to produce a list of patients where an assessment was offered. Part I: Panel Preventative patient care is applied to the active, paneled patients for each provider. It is important in the EMR to: Assign each active patient to a primary care provider Manage patient status or chart type (depending on the EMR) o Active patients need to be distinguished from inactive patients; this includes those patients who have left practice, are transient/temporary, lapsed or are deceased. May Visit our website Contact us or

2 o Some clinics create a unique status or chart type for populations of patients such as long term care or specialty service patients that are not part of the physician s panel, such as vasectomy or flu clinic patients. o Patients who are not members of the family physician s panel can be managed by their status or potentially by assigning to a fictional physician such as Dr. Walk-in or Clinic Patient. Manage demographic/registration information for each patient and validate regularly. o Most EMRs have a validated or verified field to mark when patient information has been validated; this includes validating which physician is responsible for the patient s care. The chart is date stamped when updated or verified. The business as usual practice of updating demographics as well as managing physician attachment and patient status ensures that when the clinic receives a critical result, the patient may be contacted in a timely manner. This process also ensures that the clinic team knows which physician is the primary provider responsible for that patient. Panel identification is not a project but a daily activity in the clinic. Panel Report/ Practice Management Report Use of the search or query functionality in the EMR enables the clinic team to produce a list of active, paneled patients by provider. Some EMRs will produce this list and show the last date the information was validated or verified. Searches that will be useful when defining panels will be to: Find out your starting point. Produce a list of active patients for each provider in the practice. This is your baseline. If possible, produce this list showing the last visit date for the patient. o Are there patients on the lists: Who are deceased? Have not had a clinic visit in many years? That the provider does not consider their patient? Who were only seen in the clinic for specific care (e.g., aesthetics, or vasectomy) not family practice? o Are there patients missing from their lists? o Are there patients attached to providers no longer practicing at the clinic? o Are some provider lists too long and others too short? Identify a list of patients that have had no appointments within a given period (E.g., 3 years) and have no future appointments booked. Once this list is validated, it may be useful to reassign the status, chart type or physician attachment of these patients. Some clinics change the status of these patients to lapsed or inactive. Identify patients that still may be attached to a provider that is no longer at the practice. These patients will need to be reassigned. Long-term care patients may be searchable by their address or billing code (E.g., O3.O3E). Some providers prefer to assign a unique status or chart type to these patients. 2

3 Managing the records of deceased patients is essential. Identifying deceased patients and marking the record as deceased is crucial if the practice is contemplating any type of patient outreach. Once a list of patients is produced by a search and the clinic wishes to make a bulk change to the list of patients consider that the change does not necessarily need to be made patient by patient. Many EMRs are capable of a bulk change. View the EMR tips sheet or contact your vendor for assistance. Identify the fields that all front staff are expected to use in a consistent manner. Some EMRs have multiple fields for providers such as Patient s MD and Primary Provider, for example. Staff should know which field is used in the clinic for physician assignment. Assistance with Panel The TOP web site has EMR resources such as tip sheets and videos to support panel for the following EMRs: TELUS Wolf TELUS Med Access TELUS PS Suite Microquest Healthquest Telin Mediplan QHR Accuro Jonoke For a full list of resources see page 5 or visit: Part II: Preventative Screening Recording of Screening Offers Consistent charting of the screening maneuvers in standardized fields, where possible, will allow monitoring over time. It is encouraged to use a visit template to record screening offers and refusals. A flowsheet is a tool that can display patient observations over time. Capture information consistently. For example, any members of the clinic team assessing tobacco would record it the same way such as: no tobacco use, tobacco user, ex-tobacco user. Use of Population Prompts for Opportunistic Care EMRs are capable of displaying when a patient is due or overdue for a screening or care maneuver. While functionality varies by EMR solution, reminders or prompts can be set for an individual or by patients meeting certain criteria. During an unrelated patient visit or periodic health exam, the reminder will alert the clinic team member that the patient is due for the screening or care maneuver. 3

4 User Tip: Turn on population reminders or prompts incrementally in the clinic. Enabling many at one time may be too big of a change for the clinic team. E.g., set the reminder to identify adult males over 50 who have not had a BP taken in the last year. Once that change has been successful, expand to include females, and then expand to the full age group. Assigning Tasks/Recall or other Actions Depending on the process and workflow that is developed for screening, use of functionality such as tasks or recall should be explored for your system. Searches Practice search or query functionality can be used to identify patients that are overdue for screening or care maneuvers. Lists can be produced and through outreach processes, these patients may be contacted and offered care. Reports generated in the EMR can be used to measure progress and rates of screening offers throughout the improvement period. Developing team capabilities in your EMR search/query/reporting capabilities is a long-term asset of the clinic. It is recommended to develop this capability for a number of team members, not just one individual. Assistance EMR vendors have additional resources beyond calling the help desk; users should be familiar with the help files and video tutorials that may be accessed through their EMR help link. Clinic training may also be arranged. Ask your vendor about user meetings or webinars. TOP has developed EMR specific tip sheets for panel identification and preventative care that are available in the EMR Knowledge Resources area of the TOP web site at: EMR Knowledge Resources available through TOP Microquest Healthquest Tip Sheet Using Healthquest for Panel Identification and Proactive Screening Care Jonoke Tip Sheet for Jonoke Users Telus Health Med Access Tip Sheet Using Med Access for Panel Identification and Proactive Screening Care 4

5 Med Access Video 1 - Assigning Patients to a Provider & Managing Patient Status Med Access Video 2 - Producing a List of Patients by Provider for the Chart Review Med Access Video 3 - Importing & Using the Profile Template to Record Screening Med Access Video 4 - Using Clinical Decision Support Triggers in Med Access: Creating, Workflows and Setting Criteria Med Access Video 5 - Med Access Practice Management Reporting and Tasking Telus Health PS Suite Tip Sheet for PS Users QHR Accuro Tip Sheet for QHR Accuro Users Video 1 Using Accuro EMR for Panel Identification, Screening and Preventative Care Telin Mediplan Tip Sheet for Telin Mediplan Users Panel Management and Reporting in Telin Webinar: Using Telin Mediplan for Alberta Screening and Prevention Telin Video 1: Using Telin Mediplan for Alberta Screening and Prevention Telin Video 2: Using Telin for Panel Identification and Screening Telus Health Wolf Wolf Panel & Screening Tip Sheet How to Customize Exam Template and Flowsheet Wolf Webinar Presentation (April 2014) Wolf Video 1 - Assigning a patient to a primary care provider Wolf Video 2 - Patients who are not members of a physician's panel Wolf Video 3 - Managing patient status Wolf Video 4 - Creating a non-billing placeholder (physician) Wolf Video 5 - Practice search and customizing view of practice search Wolf Video 6 - Recording screening offers using manual lab results function Wolf Video 7 - Recording tobacco status Wolf Video 8 - Tips in Using Wolf for Panel Identification, Screening and Preventative Care Wolf Video 9 - Proactive preventative screening care using rules and messages 5

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