EMR: Every Step Conference

October 1, 2015
International Plaza Hotel and Conference Centre, Toronto, Ontario
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Conference Agenda - Concurrent Sessions

Note: These events are not open to the public. Only Ontario-based physicians, nurses, nurse practitioners and staff are invited to attend.

7:30am - 8:30am
8:30am - 9:15am
9:30am - 10:15am
Speakers

Dr. Harry O'Halloran, Lead Physician, Georgian Bay FHO
Dr. James Lane, Physician IT Lead, Georgian Bay FHO/FHT

Learning Objectives
  1. Leveraging Existing EMR tools (e.g. HRM)
  2. The Benefits of Merged Databases
  3. Some lessons around ePrescribing
Presentation Overview

The Georgian Bay FHO and FHT have managed to use several innovative approaches to communicate within the community. By merging all EMR databases in the area onto a single server we have been able to participate in several IT Pilot projects including ePrescribing and Hospital Report Manager. With the ePrescribe portal available in local pharmacies for viewing our practice based EMR medication list, and for direct pharmacist to physician messaging within the EMR, an expectation for good communication has arisen. When HRM was implemented, we recognized that this was an opportunity to complete the communication in the circle of care. Currently, at physicians' request, discharged patients have a medication list provided and dictated into the hospital's EMR. This note encompasses a list of medications at the time of admission, changes made during their stay, and the discharge meds. This document is sent to the Primary Care Physician via HRM. As this note has been made a priority for transcription, the medication list generally arrives in the EMR on the day of discharge. Initially this has being targeted for patients being discharged by Hospitalists. The technology works ideally with hospital pharmacists able to access local EMR(s), but could be adapted to local needs in any situation where HRM is in use.

Speakers

Dr. Mohamed Alarakhia, Executive Lead, Family Physician
Mrs. Kathryn Flanigan, Nurse Practitioner, Research Associate

Learning Objectives:
  1. Attendees will learn how to use EMR templates with simple clinical decision support tools to facilitate care of patients
  2. Attendees will increase awareness of enhanced use of EMR to identify patients with chronic conditions
  3. With the use of structured data in EMR, attendees will be introduced to a model that can help predict at-risk patients in need of additional support
Presentation Overview:

Evidence/Results:

  1. In Stream 1 of QBIC, 91 primary care clinicians from 6 primary care organizations implemented tools to support Quality Based Procedures in COPD and CHF. IT Support was also provided which resulted in the better identification of patients in the EMR, improved efficiency, the elimination of unnecessary notifications, and more effective use of the EMR.
  2. In Stream 2 of QBIC, reminders were created to improve immunization rates for patients with CHF. Diabetics who had not had a yearly creatinine were identified through an EMR reminder and a workflow was established using inter-disciplinary team approach.
  3. A model was created looking at cost expenditure and number of chronic diseases to identify patients at risk of hospitalization.

Quality Based Improvement in Care (QBIC) is based on the understanding that optimizing primary care's use of electronic medical records (EMRs) is essential to supporting improvements in our health care system and achieving positive health outcomes at the patient, practice and population levels. With support from an eHealth coach and Information Technology expert, 91 primary care clinicians in 6 primary care organizations were able to enhance quality improvement, chronic disease management best practices and information management. Furthermore, after clinicians were encouraged to document chronic diseases in a structured way, reminders were created in 2 pilot Family Health Teams. After six months, data was evaluated linking workflow to patient outcomes using these reminders. Furthermore, a model was created using structured EMR data to identify at-risk patients who require further support. As primary care organizations become involved in system-level strategies to achieve higher quality care while reducing system costs (e.g. Health Links patient groups), developing best practice for using EMR use to enable better care processes will become increasingly important.

Speakers

Ms. Zabin Dhanji, Project Manager
Ms. Nicki Cunningham, Group Manager

Learning Objectives
  1. Learn about online self-directed EMR Optimization training tools that will teach practice EMR users how to utilize their EMRs to support cancer screening activities while improving quality of the data in their EMRs.
  2. Learn how a pilot helped 12 primary care teams improve their knowledge of EMR functionality and increase their cervical cancer screening rates.
  3. Learn how a pilot helped a Nurse Practitioner Led Clinic improve EMR data quality, and overcome the challenges of migrating to a new EMR system.
Presentation Overview

Early detection of cancer leads to better outcomes and more options for treatment, thereby reducing mortality. Primary Care Providers (PCPs) play a key role in cancer screening. While EMRs have been widely adopted across Canada (Ontario: 80%, Alberta 75%, B.C. 80%), primary care practices are at various stages of maturity in their use. CCO has developed a comprehensive suite of tools and training to help PCPs utilize the current functionality within their EMRs for cancer screening. A demonstration of the tools and training will be provided during the presentation.

In order to evaluate the usability and effectiveness of these tools, CCO has engaged in pilots with various primary care practices. Two pilots will be highlighted in the presentation.

The first is the Cervical Screening Reminder Calls (CSRC) Pilot. This pilot married two CCO interventions to support PCPs in increasing their cervical cancer screening rates. The first component was to support PCPs in learning how to utilize their electronic medical records (EMRs) to identify patients within their practices who were eligible for cervical screening. In the second part of the pilot, the practice staff used call scripts and a call log to telephone eligible patients and invited them to schedule Pap test appointments. This aspect of the initiative was based on several systematic reviews and research conducted by the Ministry of Health and Long Term Care (MOHLTC) that found that patient reminders increased cancer screening participation, especially when encouraged by their healthcare provider. The literature also demonstrated a positive effect of telephone reminders compared to letters.

The CSRC pilot was implemented at 12 practices across Ontario. Initial findings indicate that practices found the EMR Optimization tools and call script to be useful in identifying patients for screening. Practices reported more favourable results in inviting patients for Pap tests through phone calls versus other methods of contact (e.g. letter campaign). A case study, including implementation highlights and outcomes, will be presented on the Aurora Newmarket Family Health Team's (ANFHTs) pilot implementation.

The Second pilot that will be highlighted during the presentation is the EMR Optimization Implementation Pilot conducted with the Glengarry Nurse Practitioner Led Clinic (GNPLC). The practice recently migrated to a new EMR system and is facing issues with data quality and how to use the functionality to report on their Ministry-mandated Quality Improvement Plan (QIP) indicators. The pilot will focus on helping the practice staff learn how to utilize their new EMR system to support their cancer screening activities, including how to improve their data quality so that they can fulfill their reporting requirements. We will showcase the new supporting tools that were developed for this initiative and share preliminary results.

9:30am - 12:00pm

For current Nightingale on Demand EMR users. Get hands on training from your EMR vendor in this workshop.

For current OSCAR EMR users. Get hands on training from your EMR vendor in this workshop.

F.or current Clinic Information System (CIS) users ⬠Get hands on training from your EMR vendor in this workshop

10:15am - 10:45am
Speakers

Dr. Therese Hodgson, Peer Leader

Learning Objectives
  1. Review the use of coding in diabetes management
  2. Understand the capability of the EMR for individualized targets for DM care
  3. Obtain a better understanding of population based medicine with the use of dashboard in DM management
Presentation Overview

It is estimated that more than 5.7 million Canadians have prediabetes and more than 10 million with prediabetes or confirmed diabetes. Diabetes related complications include strokes, myocardium infarctions, nephropathy leading to renal failure, retinopathy leading to vision loss, vasculopathy leading to amputations, neuropathy leading to gangrenous extremities, and more.

Optimizing the management of our diabetic patients can lead to improved outcomes and reduced complication rates and hospitalizations. Leveraging the power of the EMR can improve the overall percentage of diabetic patients at target for diabetic care such as A1C, LDL, and BP while also providing for early detection of retinopathy and nephropathy in order to prevent subsequent progression to visual loss and diabetic foot complications. The use of a dashboard can enhance population based medicine and focus team based care on the most vulnerable and at risk population.

Methodology/Approach:

By combining the capabilities of the EMR software, applying the most recent guidelines and best practices templates, one can achieve improvement in chronic diseases management, follow-up, review of adherence to therapy and laboratory monitoring while obtaining metrics to measure success.

We are all aware of the multiple ways one may label a patient as diabetic in the CPP. Data consistency may be more easily applied to an individual physician but as a group such consistency can be a challenge. The use of coding systems can create cohorts and simplify the process required for measurement of success. These measurements can be obtained for individual physicians or as a group of patients following a Family Health Team program.

Best practices follow evidence based recommendations and guidelines. The CDA guidelines on diabetes recommends 2 groups of A1C targets, based on patient profile.

An EMR tool stratifies the patient based on its individual A1C target and reflects this information in the dashboard.

The dashboard allows for regular review and call back of patients requiring modification of management to obtain recommended targets.

Findings/Results:

The presentation will review several tools that were developed and steps involved in best practice focus of population based medicine in diabetic care.

  1. Coding
  2. Developing a cohort
  3. Encounter assistant that provides the following:
    • Individualized A1C target
    • Quick assessment of target and date of last evaluation
    • Best billing practices
  4. Use of a comprehensive dashboard (long version). This dashboard includes the details of the result of the last test, the date of last test and the conclusion of target level for all diabetes parameters (A1C, LDL, BP, WC, feet exam, eye exam)
  5. Use of a concise dashboard. This dashboard includes the details of the targets and last date obtained for the diabetes parameters
Conclusions/Implications/Recommendations:

The use of EMR dashboards enables population based medicine to allow focused care of the most needed patient in an efficient manner.

Speakers

Ms. Mary Byrnes, Manager, Primary Health Care Information
Mr. Rodney Burns, Chief Information Officer, Association of Ontario Health Centres

Learning Objectives
  1. Discuss how CIHI's EMR content standard and clinician-friendly pick-lists are being piloted in an OntarioMD-certified EMR
  2. Discuss how the pilot project is building on existing EMR mechanisms to collect structured data and taking on small tests of change to add new EMR content standard mechanisms
  3. Discuss the benefits of structured and comparable EMR data and possible uses of the data for the calculation of performance indicators
Presentation Overview

A Primary Health Care EMR Content Standard is being piloted by primary health care organizations in conjunction with the Canadian Institute for Health Information (CIHI), to enable the collection of structured, comparable Electronic Medical Record (EMR) data. CIHI's 45 EMR data elements and validated clinician-friendly pick-lists (CFPL) can support clinicians in entering structured data into EMRs using common terms for high priority data fields, such as health concern and social behavior. The CFPL terms are mapped to code systems behind the scenes.

Results from this demonstration project will showcase the benefits of generating structured and comparable EMR data and the possible uses of the data for the calculation of performance measures. Potential outcomes include improvements in data quality for indicator calculations to support practice management and quality improvement.

10:15am - 11:15am
Speakers

James Swan M.D. F.R.C.P.(C) Heart Health Institute Toronto
Richard Davies M.D. F.R.C.P.(C) Ottawa Heart Institute
Robert Wald M.D. F.R.C.P.(C) Mount Sinai Hospital Toronto

Presentation Overview

Our presentation will clearly outline the necessary steps involved for the successful integration into a university and community cardiology clinic environment of an Ontario M.D. level 4 EMR , initially developed for family doctors , using vendor staff ,vendor resources, in-house IT structure and staff and the cardiology office staff support personnel . The co-operation of all is critical to ensure that the clinical cardiologist's needs and expectations will be met in the end. We will share our experience with 2 different level 4 EMR's and outline the steps that can be taken with any Ontario M.D. Level 4 EMR vendor so one can avoid major problems and disappointments before, during and after implementation. We will also share our vision how the current level IV EMR can be improved to further enhance patient care in a cost-effective manner, harvest data , attract other specialist physicians to use the 2015 level 4 EMR and prevent attrition from current level IV EMR adopters

Speakers

Dr. Doug Kavanagh, Family Physician, Lawrence Park Medical and Co-Founder, CognisantMD
Dr. Rjesh Girdhari, Family Physician, St. Michael's Hospital Academic Family Health Team
Dr. Igor Wilderman, Medical Director, Wilderman Medical Clinic

Presentation Overview

In this presentation, you will learn how EMR-integrated tablets is helping primary care teams in Ontario to get more from their existing EMR, while enhancing patient communication and saving time.

This presentation will discuss how primary care clinics are using mobile tablets and online forms to replace paper-based data collection, allowing patients to digitally share information with their patient record.

See how providing patients with a tablet at check-in can allow clinics to easily automate time-consuming administrative tasks like email consent and demographic updates. This consistently results in greater patient satisfaction while reducing the burden on front-desk staff.

This session will demonstrate how data entered by the patient can be automatically used to calculate scores, recommend treatment based on clinical guidelines, add a clinical note to the EMR, and even generate customized patient educational materials and handouts.

By replacing scanned paper forms with intelligent digital data entry on tablets and secure online forms, learn how your clinic can make EMR patient records more structured, accurate, and minable, while improving the patient experience and saving time.

11:15am - 11:45am
Speakers

Ms. Elaine Gibson, Professor, Dalhousie Law School

Learning Objectives
  1. Understand the legal environment
  2. Appreciate the need for destruction
  3. Identify ethical issues surrounding destruction
Presentation Overview

Physicians are entrusted with patients' personal health information and vested with the legal and ethical obligation to maintain confidentiality. One aspect of this obligation is the requirement that information be destroyed once it is no longer needed for the purpose or purposes for which it was collected. The recent and ongoing shift from paper to electronic medical records (EMRs) presents particular challenges to the requirement for destruction. Legislation and policies need alteration and clarification, and physicians need guidance as to how to meet their obligation. Issues surrounding retention and destruction of the OntarioMD-certified EMR will be discussed in this presentation.

Retention is positive for individuals and for society in a number of ways. Physicians have an ethical obligation toward their patients to hold their information in trust for an extended period of time. This obligation attempts to ensure that a historical record of one's health status, tests ordered, and treatments received is available for the subsequent provision of care and in case it is needed for litigation purposes. It also enables review for purposes of quality assurance, billing, and regulation. As well, records have become highly valuable to enable the conduct of population-based research and epidemiology. These factors lean toward retention of information for as long as possible if not in perpetuity.

However, the possibility or likelihood of inappropriate access and dissemination increases the longer information is retained. This gives rise to acute privacy concerns. Destruction is the sole guaranteed method of preventing a breach of confidentiality. Proper policies and procedures on destruction of personal health information are essential to respecting patient confidentiality and maintaining public trust. Herein is rooted the general obligation in Canadian information laws that information be destroyed once it is no longer required to fulfil the initial purposes for which it was collected.

The very nature of health information is shifting and expanding. Historically, information was collected and stored in the context of healthcare delivery in order to ensure quality patient care and for billing purposes. The electronic era has veritably exploded the possibilities for other uses of personal health information, ushering in a new value in information itself. The collection of information in databases, combined with the ability to merge various databases, results in a range of possibilities for exploitation of electronic information for secondary purposes. There is a newfound currency in health information.

The federal government first enacted legislation with the aim of ensuring the protection of information held by public institutions, and the provinces followed suit. Legislation has since been enacted regulating either personal health information, or personal information more broadly, in the private sector (all provinces other than PEI now have legislation for the protection of health information in the private sector). However, there has been insufficient focus in this legislation on the companion topics of the retention and destruction of health records. Differing conceptions of privacy and their implications for the need for destruction of the OntarioMD-certified EMR will be examined in this presentation.

Speakers

Dr. Therese Hodgson, Peer Leader

Learning Objectives
  1. Understand the EMR capabilities to incorporate algorithms and guidelines
  2. Review the need to establish clear metrics to measure success
  3. Review the use of a dashboard in fracture management
Presentation Overview

Osteoporosis and its complication results in a tremendous cost to the health care system and on patients' quality of life, and yet simple steps can be taken in both prevention and management of this condition.

  • Osteoporosis fractures are more common than MI, strokes and breast cancer combined
  • 1 in 3 women and 1 in 5 men will sustain an osteoporosis related fracture in their lifetime
  • Osteoporosis and its complications cost $2.1 billion to the Canadian health care system in 2010
  • There are 20,000 to 30,000 hip fractures in Canada every year
  • The cost of a hip fracture is estimated at more than $20,000 in the first year following the fracture and at more than $40,000 if the patient is institutionalized
  • Following a fracture, less than 20 % of patients are evaluated for osteoporosis or receive appropriate treatment
  • 1/3 of patients aged 65 and over fall once a year; 1/4 of these falls will result in injuries
  • More than 90% of fractures in elderly are due to falls.

Leveraging the power of the EMR has a potential to improve management of osteoporosis, decrease the care gap in fracture patients and apply the Champlain LHIN fall prevention strategies.

Methodology/Approach:

By combining the capabilities of the EMR software and applying best practices templates, one can achieve improvement in chronic diseases management, follow-up, review of adherence to therapy and obtain metrics to measure success.

Several tools were developed for fall prevention and evaluation of risk factors for fall, screening, evaluation and management of osteoporosis and post fracture care. These include fall prevention algorithm screening tool, multifactorial assessment encounter assistant/custom form, bone mineral density (BMD) screen from age identified criteria, management of BMD result following the Osteoporosis Canada 2010 algorithm with an encounter assistant and custom form, tools incorporating review of adherence to therapy and a dashboard incorporating the Osteoporosis Foundation Best Practice standards.

Findings/Results:

The presentation will review several tools that were developed:

  1. Fall Prevention, Champlain LHIN screening algorithm and multifactorial assessment
  2. Incorporation of Osteoporosis Canada 2010 Guidelines
    • Reminders in the EMR
    • Assessment of results of BMD and fracture risk correction (CAROC, Frax) Incorporating tools the EMR
    • Osteoporosis Guidelines algorithm in the assessment of patients that may benefit from pharmacotherapy based on BMD correction or presence of fragility fracture
  3. Post fracture care management
    • reducing care gap by ensuring timely assessment of repeat fracture risk, benefit to pharmacotherapy and adherence to therapy

Conclusions/Implications/Recommendations:

The continued advancement of electronic medical records will allow for more incorporation of best practice guidelines that are evidence based and will allow the measurement of success by integrating tools that allow easy metrics measurement. This will in turn enable population based health care with the potential of decreasing the burden of chronic disease. The example of fall prevention, osteoporosis management and post fracture care is only one example of these possibilities.

Speakers

Dr. Igor Wilderman, Medical Director, Wilderman Medical Clinic
Mr. Jason Norman, General Manager, Wilderman Medical Clinic

Learning Objectives
  1. How to enhance the EMR experience
  2. How to intergrate EMR with web intakes
  3. How to easily gather information from patients
Presentation Overview

At Wilderman Medical Clinic, we believe that EMRs should not just be about using less paper; we believe that EMRs should be used to enhance the patient's experience and our overall office administration. This way, physicians, staff, and patients can spend more time on the things that matter. Since we introduced an EMR system at our clinic, we have implemented a variety of unique applications within our EMR system, including report creation, intra-office communications, and patient intakes.

We have adapted our EMR so that the patient visit begins before they even arrive at our clinic. Using a web interface, patients can enter all their pertinent information from their home, office, on the go, or any place they can find an internet connection. We contracted an IT company to help implement this service. When a patient calls our office to book an appointment, one of our receptionists will provide the patient with a link to the website. Once the patient visits the website, they can register and receive a username and password and begin the intake process. Patients will have access to customized questionnaires as well as step by step instructions for those who are not as â¬Ütech-savvy'. If the patient chooses not to answer any particular question, or simply does not know the answer to a given question, the patient can opt to skip that question or stop the intake altogether. Even if the patient decides to close their browser, information is saved automatically without the patient's intervention. Once the intake information is collected, it will be loaded into our EMR system. On the day of the patient's appointment, the physician can review all answers for completeness and accuracy. We believe this process saves our physicians about 5-10 minutes per visit, amounting to about a half-hour savings per day (on an average day, per physician) when using web-based intakes.

Alternatively, on the day of the appointment, our patients can use one of our kiosks which allows them to complete an analogous questionnaire to the web intake. This again saves us time by collecting as much information as possible before the patient even meets with a physician. Of course, these questionnaires are entirely customized.

Since Wilderman Medical Clinic is a multidisciplinary facility, on occasion, it becomes necessary for more than one physician to become involved in patient care. Our EMR system certainly makes this possible since our physicians have easy access to patient charts and relevant medical information. Our physicians are able to consult with each other though our EMR system to give our patients the best care possible.

We believe our EMR system has helped to optimize all aspects of our practice management. In addition to the aforementioned, our EMR system has made even small tasks like responding to a patient's request for medical information more efficient. As our clinic continues to expand and grow, it is nice to know that our EMR system will help us do it in the most efficient way possible.

12:00pm - 1:00pm
1:00pm - 1:30pm
Speakers

Dr. Lopita Banergee, Physician
Dr. Sanjeev Goel, Physician

Learning Objectives

Learn about the innovations occurring the EMR area in primary care/

Presentation Overview

Dr Goel and Dr. Banerjee from the Wise Elephant FHT will discuss the innovations in the use of their EMR that they have been a part of over the past 3 years. Innovative solutions allowing patients to make a eVisits, eRefills and eBook request have transformed the way care is being delivered at Wise Elephant FHT.

Speakers

Dr. Stephen McLaren

Presentation Overview

EMRs can be used to close care gaps, increase office efficiency and improve care. In Primary Care, the patient often drives the encounter's agenda and getting the professional agenda on the table can be a challenge.

This presentation will demonstrate a variety of approaches that harness EMR features to readily shape office deliverables in an efficient and effective manner. Using practical real life examples, from simple through complex, suggestions and workflows will be demonstrated.

Examples:
  • Identify a DATA gap and close it. (ex: focus on and improve CPP Data)
  • Close the loop on lost billing and streamline steps at the same time (ex: flu shots)
  • Maintain health care and system priorities for your Roster (ex: Optimize preventive maneuvers)
  • Identify a CARE gap and close it (ex: immunizations)
  • Introduce new Guidelines to a population (ex: AAA and DXA)
  • Population Health, searches and Boolean Logic
Speakers

Dr. Jeffery Habert

Presentation Overview

Get a better understanding from a CPSO Peer Assessor and a family physician on how your EMR will be utilized during a CPSO Peer Assessment. Learn about the components of your EMR that will play a critical role in the assessment process including the pre-assessment, assessment day and post chart review.

1:00pm - 3:30pm

For current PS Suite users - Get hands on training from your EMR vendor in this workshop.

For current Accuro EMR users - Get hands on training from your EMR vendor in this workshop.

For current ABELMed Inc. users - Get hands on training from your EMR vendor in this workshop.

1:30pm - 2:00pm
Speakers

Dr. Sanjeev Goel, Lead Physician

Learning Objectives
  1. Learn about the key care gaps in the management of asthma in primary care.
  2. Learn about a new computerized decision support technology called The Electronic Asthma Management System (eAMS) for improving primary care asthma management.
  3. Learn about strategies to successfully identify patients with asthma in an Ontario MD certified EMR system
Presentation Overview

Asthma is the third most common chronic disease in adults, affecting 8.1% of the population, or 2.4 million Canadians, and increasing in prevalence. Although effective therapies for asthma exist and well-controlled asthma is achievable in most patients, studies demonstrate that up to 53% of Canadian patients with asthma remain poorly controlled. Three key care gaps responsible for this poor control are: 1) the under recognition of suboptimal asthma control by both physicians and patients; 2) resulting undertreatment of asthma; and 3) physician failure to provide patients with a written self-management asthma action plan (AAP).

We designed an electronic tool, called The Electronic Asthma Management System (eAMS) to specifically address the decision-making uncertainty and clinical time requirements which are the primary reasons behind these care gaps. The eAMS consists of: 1) a tablet computer-based electronic questionnaire which collects asthma parameters directly from patients in the practitioner's waiting room; and 2) a point-of-care computerized clinical decision support system (CCDSS) that receives and processes questionnaire data to produce decision support integrated into the OSCAR electronic medical record (EMR) in real-time (asthma control documentation, corresponding guideline-based medication change recommendations, and a personalized AAP for the patient). The system enables clinicians to review and adjust medication recommendations, to view the AAP, to alter it if necessary, and to deliver it to the patient in a print and/or electronic format (through their online personal health record, called MiDash). Patients are also provided with the URL for a web-based asthma educational program (available at oscarasthma.ca) which includes instructional videos on inhaler technique and reinforces the importance of medication adherence and AAP use.

We launched this tool at two primary care family health teams, recruiting 22 physicians to try it in clinical practice. In order to identify appropriate asthma patients to receive the technology, we first designed several algorithms that might identify asthma patients using EMR data elements, and tested these against 400 clinical charts which we manually reviewed. We found that searching for charts with either "asthma" in the Cumulative Patient Profile or charts in which the billing diagnostic code 493 had been used, had a sensitivity of 90.2%, and a specificity of 84.6% for detecting patients with asthma. Using this information, we identified 882 eligible asthma patients rostered to the 22 physicians.

The system was used in several hundred patients over a 1-year period, and approximately 100 asthma action plans were created. We are currently analyzing all interactions with the system and comparing asthma care in the one year before and the one year after the system was implemented. Finally, we are improving the system by developing a version of the patient questionnaire which enables patients to securely enter data on their smartphone, home desktop, or tablet device, up to a week before an appointment. Finally, we are integrating the system with a patient-oriented asthma app which allows patients to enter asthma symptom and trigger information, presents them with their AAP recommendations in real-time, and provides location-based Air Quality Health Index alerts (on a smartphone/tablet/desktop).

Speakers

Dr. Ian Pun

Learning Objectives
  1. Coding patient lab result information into special fields called measurement fields
  2. Tracking patient lab result data
  3. Searching patient lab result data
Presentation Overview

As of 2014, over 75% of primary care physicians in Ontario have adopted, or are in the process of adopting an EMR.

The EMR is not just a flat static word processor simply for typing notes. It is a dynamic searchable database and as such requires proper data coding into defined data fields from the start.

For effective use of the EMR, it is imperative to input patient lab result information into special fields called measurement fields. You can define any type of measurement to represent any type of numerical or textual data. I will give examples are how to properly code parameters such as bone mass density T score, PSA, Hemoglobulin A1C, Hepatitis B status, cervical pap smear result in my EMR. Some parameters are automatically populated from downloaded lab HL7 data of major labs (GDML, CML, LIfelab), others are imported from the Screening Assessment Registry from Cancer Care Ontario (SAR CCO) and others are manually entered.

In the beginning, your EMR will not have much trackable data but after a few years, this becomes more useful as you can see trends in your patient's blood tests. This requires an investment in the front end loading but will pay off in years to come. Using special queries, I can search my data for abnormal results and proactively recall patients for treatment. For example, I can recall my patients having low BMD's for treatment or I can recall patients with abnormal pap smears for follow-up and vaccination. When a special warning comes out for a medication or a vaccine, I can search my EMR for that particular product and recall the patients. In a timely manner, this improves patient safety and quality of care.

Also, the data can pooled and aggregated for research purposes, trending my performance in a particular condition. I can even map where my patients with concern conditions live in real time. This is useful in an infectious pandemic situation. It would be very tedious to impossible to do this by paper.

Speakers

Sharon Domb, MD, CCFP, FCFP
Debbie Elman, MD, CCFP, FCFP
Jeremy Rezmovitz, MD, CCFP

Presentation Overview

Electronic communications (emails, texting, etc.) have become the norm today for many people for everyday use. Advances in technology have also changed the way health care personnel communicate with patients. Most physicians are well aware of the obligations they are under to protect patients' privacy; however, health care providers continually face new challenges to communicate securely given the rapid evolution of technology. Although convenient, for many reasons, email and texting are not secure modes of communication concerning private health information.

In 2013, the Canadian Medical Protective Association (CMPA) issued recommendations regarding physicians' duties and responsibilities when using electronic communications (Using Electronic Communications, Protecting Privacy, CMPA October 2013). This document states that "physicians wanting to make limited use of unencrypted email and text messages should advise their patients of how these messages will be used, the type of information that will be sent, and how the emails or texts will be processed. Patients should also be informed about the risks of using email or text messages, and their agreement and the discussion should be documented in the record. Physicians should consider using a written consent form to document the patient's consent to using email communication and to acknowledge the associated risk". Many physicians, and their staff, continue to communicate with patients via email without appropriate consent, given that collecting appropriate consent, and documenting it, can be a time-consuming process.

At the Sunnybrook Academic Family Health Team, a group with 13 physicians and associated allied health professionals, we began collecting written email consent from patients in December 2014. Written consent forms were obtained either on paper, and then scanned into the EMR, or via mobile tablets with a direct, secure, upload to the Electronic Medical Record (EMR). The written consent explained to patients that email communication is potentially unsecure, that the patient had the responsibility to advise the office if his/her email address changed, and other potential pitfalls of using this technology. Whether by paper or tablet, the end result was the same in the EMR ⬠a clear record of whether patients had "granted" or "refused" consent to email, along with their email address. This allows members of the health care team to readily know if a patient is agreeable to email communication or not.

We will discuss the process of introducing the mobile tablet technology, as well as the benefits and challenges faced during implementation and usage.

2:00pm - 2:30pm
Speakers

Mrs. Jessie Rumble, Health Promoter RN, MScN
Mrs. Deb Hedges, Informatics Specialist

Learning Objectives
  1. Participants will learn how to optimize the use of the encounter assistants in managing data and promoting team-wide adoption of a standardized documentation process.
  2. Participants will explore the challenges and lessons learned in ministry reporting and sustaining high quality data entry and collection
Presentation Overview

In late 2014, Two Rivers Family Health Team completely revolutionized how providers track patient visits for the purposes of the Ontario Ministry of Health and Long Term Care reporting. Through the use of encounter assistants and blind billing/tracking codes, clinicians are now recording patient visits in a consistent and standardized manner. The encounter assistants are completed at every patient interaction, both direct and indirect care, and are primarily used to track ministry visits for FHT clinicians which includes Registered Nurses, Registered Practical Nurses, Registered Dieticians, Nurse Practitioners, and Social Workers. Each unique billing code records the type of visit such as acute and episodic, chronic disease management, or health promotion. Secondly, the encounter assistants offer a provider-friendly and easy process to record the care provided. Custom forms are integrated into the encounter assistants so providers simply have to click and insert. They act as a reminder and forced function to ensure consistent documentation, which thereby promotes high quality data entry. Finally, practice points and best practice recommendations are embedded in the encounter/custom forms and will "pop up" if a certain type of care is selected. Custom forms and the use of custom toolbars act as health teaching aids for providers and are updated regularly to reflect current best practice guidelines. Providers report that the encounter assistants "make documentation easy" and are "very simple to use." Feedback shows that not only do the encounter assistants offer a promising model to record patient visits and track ministry statistics, but they also support the use of standardized, best practices and act as a reminder for clinicians to document significant health indicators. This presentation will demonstrate how encounter assistants are used to track FHT clinician patient visits, manage high-quality data for reporting purposes, and how custom forms and toolbars are used to support best practice and promote consistency in documentation.

Speakers

Dr. Anne DuVall

Presentation Overview

The Barrie and Community Family Health Team with 87 physicians, has partnered with Cancer Care Ontario in a project to encourage physicians to discuss and document advance care plans with patients. They are also developing a community wide Palliative Care program to provide access to high quality palliative care by family physicians to all patients that require this service.

Learn about:
  • Documents for standardized Advance Care Plans and Palliative Care visits useful for physicians who perform this care frequently and occasionally.
  • Standardized documentation for data collection regarding patient care.
  • How standardized information can be shared with other caregivers (ie on call coverage)
  • Documents to track the level of function and care needs of patients for clinical decision making
  • Embedded decision support tools that include links to instructional videos and educational materials for how to use the EMR tools as well as standards of practice.
Speakers

Elizabeth Keller, VP, Product Management, OntarioMD

Learning Objectives

Ontarians often wait too long and travel too far for a specialist's advice. When a specialist's advice is needed, the level of collaboration amongst providers varies greatly.

OntarioMD, with the Ministry of Health and Long-Term Care, eHealth Ontario, Ontario Telemedicine Network (OTN) eConsult and the Champlain Local Health Integration Network BASE eConsult, is working to reduce wait times for a specialist's advice using an eConsult Service.

Presentation Overview
Methodology/Approach:

A provincial eConsult service would respond to a significant demand from clinicians.

Other jurisdictions found that an eConsult Service should be established before an eReferral system for non-urgent patient care. Research indicated that 25-40% of referrals could be eliminated through an eConsult service, which could reduce wait times, improve the patient experience and potentially save millions of dollars in unnecessary travel and travel grants by moving the information, not the patient.

Phase 1 of Ontario's provincial eConsult initiative examines existing eConsult service models with primary care providers (PCPs) and specialists for one year ending September 2015, and includes a formal Benefits Evaluation.

Over 2,500 PCPs and 175 specialists are targeted to perform over 10,000 eConsults. PCPs request non-urgent eConsults and specialists respond using the respective services' web-based platforms.

The proof of concept is exploring how to capitalize on existing workflow so PCPs can send a question with relevant patient information from their EMR. EMR vendors will trial the integration of their OntarioMD-approved EMRs with the OTN eConsult service to inform the draft eConsult EMR Specification for Ontario.

Findings/Results:

The metrics and results during this Proof of Concept phase are contained in a third party Benefits Evaluation which will inform the provincial eConsult Service in Phase 2.

The presentation highlights:

  • Reducing patient wait times and improving access
  • Provider experience using new "virtual care" mechanisms like eConsult
  • Lessons learned about which health conditions lend themselves best to an eConsult
  • Quick tips for Ontario PCPs to ask the right questions using eConsult
  • Providing other Canadian jurisdictions with data to support broader use of virtual care systems like eConsult and eReferral

Conclusions/Implications/Recommendations:

Increasing the use of virtual health care delivery mechanisms is becoming a necessity for most jurisdictions to potentially create more sustainable health care delivery models.

The enthusiasm and rapid adoption of the Ontario eConsult initiative indicates the significant need and value proposition for a Provincial eConsult Service.

Lessons learned from this initiative will provide guidance in in developing:

  1. Clinical Guidelines to effectively request and respond to an eConsult
  2. Change management support for EMR workflow integration
  3. Adoption considerations including optimal user profiles
  4. Compensation models to best incentivize the use of virtual care
  5. Privacy/consent/medical legal implications, etc.

The findings derived from the formal Benefits Evaluation from Ontario also offer solid data for other jurisdictions to use.

2:45pm - 3:15pm

Hear about how to successfully select and transition EMR records between two different EMR systems. Learn about best practices for planning for the migration of your data.

An interactive discussion on how to improve your practice management using your EMR. An experienced Clinic Manager will share experiences focusing on communication, analysis, billing and forms in an EMR environment.

Speakers

Robert Lee, Director of Business Development and Special Projects, Toronto East General Hospital

Learning Objectives
  1. Understand how HRM and your EMR can be used for quality improvement and patient safety
Presentation Overview

At SETFHT, we have been developing programs to provide better care to our high-risk, complex patients. We know that when complex patients are discharged home, they are in a highly vulnerable state. Studies show that they are at high risk of having an adverse event. Medication errors are the most common and most of these are preventable. In efforts to improve primary care of discharged patients and to prevent avoidable hospital readmissions, Health Quality Ontario (HQO) has set a target for Family Health Teams to attempt to see each patient within 7 days of discharge from hospital, for those patients with a specific case mix group that makes them more likely to be readmitted. These conditions include cardiac conditions, CHF, COPD, Diabetes, GI disorders and Stroke. We have also included patients admitted for mental health conditions in order to proactively connect them with care and services.

We have developed a process using HRM and our EMR (Practice Solutions) to track hospital discharges for the purpose of offering patients immediate follow up appointment, and to complete medication reconciliation in the chart before the patient even attends for their appointment. While the high-level goal is to improve patient safety for our most complex patients, we also hoped to: reduce medication errors and prevent harm from any errors; maintain accurate records to reduce future error; reduce readmission rates.

Toronto East General Hospital shares discharge data via HRM on a daily basis. Those reports are reviewed by our Care Navigator. She will contact patients to establish follow up appointments, for those who wish to come in. She also identifies patients with medication changes and forwards the HRM reports to our pharmacist, who completes medication reconciliation in PS, and then messages the physician or nurse practitioner with an alert about the changes. The HRM data is inputted to the patient's chart and available to the primary care provider when the patient next visits.

The data from PS indicates that 59% of patients attended for post-discharge appointments within 7 days of discharge, 79% attended within 14 days of discharge, 15% were institutionalized (mental health or long term care), 13% were re-admitted to hospital within 30 days, and 100% of patients with changes to their medications had their medications updated in the EMR.

3:15pm - 3:45pm
Speakers

Dr. Marco Lo, Founder, Magenta Health
Mr. Keith Chung, Founder, Magenta Health

Learning Objectives
  1. It is achievable for small clinics to commission & fund the development of custom software integrated with OntarioMD-certified EMRs.
  2. Small software projects can result in dramatic improvements within the operation of a primary care clinic.
  3. Provide concrete examples of how ideas progressed from conception to deployment.
Presentation Overview

While each OntarioMD-certified EMR already successfully accomplishes a vast array of tasks, there will always be problems or tasks not addressed. In such situations, one option is for EMR users to commission & fund the development of custom software and/or integrations designed to resolve issues of specific concern.

Our clinic, Magenta Health, has taken this approach three times within our first year of operation, to solve three specific problems. The first was the absence of a sufficiently robust online scheduling solution to enable patients to schedule any and all appointments online. We successfully worked with Veribook, a Canadian online scheduling company, to integrate their existing solution with the OntarioMD-certified EMR that we selected and this system is now used to schedule 95%+ of all appointments online, with no human interaction.

The second was a vision for a tablet based workflow system that would enable the status of all staff, rooms, and patients to be visible and editable at a glance. We worked with two freelance developers to develop a fully custom solution with one-way integration with the OntarioMD-certified EMR that we selected. In particular, one lesson learned is that simple read-only integrations can be achieved relatively easily if using a web-based EMR.

The third was a goal of addressing a common problem that we encountered of test results not being received, and patients inquiring about the status of their test. We worked with four freelance developers to develop a fully custom solution, again with one-way integration.

One important consideration is that we sought to work with software developers who appreciated that there may be commercialization opportunities available and that the systems and integrations designed and developed may have applicability to other primary care clinics. This approach materially reduces the cost of development, and also drives the development of more robust & scalable software. For us, supporting the development and commercialization of innovative technologies is one key benefit of this approach.

While each project involved significant investment of time, effort, and money (e.g. $10 ⬠35K), our calculations revealed a clear return on investment for our small clinic of 7 family doctors. This return on investment has been successfully seen, and we continue to look for additional projects to undertake.

Speakers

Dr. Dale Guenter, Associate Professor
Dr. Inge Schabort, Associate Professor, IMG Coordinator, Academic Half Day Coordinator

Learning Objectives
  1. Understand how a CDSS for pain management can be developed effectively in the primary care environment
  2. Appreciate what features a CDSS can integrate in order to improve compliance with guideline-based practice and quality of care
  3. Recognize how a CDSS can improve education of new health professionals and their patients through "in the moment" clinical guidance
Presentation Overview

Chronic pain is common in Canada, with management presenting challenges for both patients and primary care providers. Chronic pain management often involves a high burden of effort for clinicians, with tension in clinician-patient relationships, frequent and prolonged visits with high emotional intensity, poor patient compliance, poor clinical outcomes, and sometimes refusal of access to care for those who identify as having chronic pain.

With the increase in use of electronic medical records (EMRs), it is now possible to embed chronic management tools such as computerized decision support systems (CDSS) for clinicians to use at the point of care. We developed a CDSS to aid inter-professional primary care clinicians in assessing, monitoring and managing chronic pain. CDSS development involved engagement with end-users to assess their needs as well as usability of the initial CDSS. Based on feedback, the CDSS was modified to improve usability.

The CDSS provides EMRs with the ability to "think" about pain and to teach clinicians about evidence-based guidelines while providing patient care. The CDSS is integrated with other chronic disease management tools so that workflow in assessing and monitoring individuals with multiple chronic conditions is efficient and effective. Promoting and supporting Canadian guidelines for neuropathic pain (NeP) and for low back pain (LBP), the CDSS contains tools for general chronic pain management, tools for communication with specialists and insurance providers, and tools for patient self-management. Features of the CDSS guide clinicians to make pain diagnoses, make treatment decisions, change treatment strategies, make referrals, educate patients and providers, set and monitor self-management goals, monitor disease and monitor responses to treatment. Many of the components are compatible with tablet and smart phone technology, and will be available in the future on a personal health record platform for direct access by patients.

This session will discuss the development and implementation of a CDSS for chronic pain management. Lessons learned will be highlighted.

4:00pm - 6:00pm
Speaker

David Schieck, MD on behalf of the Ontario Medical Association

Presentation Overview

Are you currently practicing in a Primary Care Model and would like to learn more about billing? The OMA will be presenting a seminar on Primary Care Billing for family physicians, focusing on the FHO model. This session will cover primary care codes and give you a better understanding of topics such as premiums, Q codes and bonuses available.

To see information and presentations from past conferences, please visit our Events Archive.



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