Ontario MD peer leader offers EMR advice

Dr. Yves Raymond, physician peer leader, Timmins

Dr. Yves Raymond, physician peer leader, Timmins

Dr. Yves Raymond began using EMRs in 1999

Dr. Yves Raymond, a family physician practising with the Timmins Family Health Team, has been using electronic medical record software since 1999.

“When I came to Timmins, there were already 15 avid EMR users here,” he recalled. “At that time, less than one per cent of doctors in Ontario were using EMRs.”

By 2004, when the province began pushing EMRs, there were 15 to 20 docs in Timmins using a variety of systems. Thinking it would be best if they all standardized on one product, they had a meeting and began checking out the dozen or so vendor offerings on the market.

The first EMR they chose didn’t work out, so they went back to the drawing board and settled on Practice Solutions, a Telus product that started out as MacMedical, then NetMedical and was at one point owned by the Canadian Medical Association. Raymond was user number 245.

“I have been involved with the implementation of a variety of EMRs and have had a lot of experience with them. That’s why when the Peer Leader program came out, I thought this is something I can do.”

Raymond helps colleagues in Timmins who want to take advantage of the advanced functionality of their EMRs and has consulted with one doc in Kapuskasing in his role as a peer leader.

“As physicians, we don’t usually use our EMRs to their full potential because we’re busy and we’re used to charting, so a lot of us end up using our EMRs that way, but they’re a lot more powerful than that,” he said.

Raymond figures that 50 per cent of physicians use their EMRs very superficially, 40 per cent take advantage of some of the functionality to improve workflow, and only 10 per cent are avid users.

“Everybody should be prescribing from their EMRs and completing their cumulative patient profiles. If these two things are in there, it’s a lot easier for physicians to write consults and communicate with other health-care providers. The cumulative patient profile (in Practice Solutions) is a summary of the patient’s health care, and if you provide that to other health-care providers, it goes a long way.”

Raymond also recommends the use of flowsheets.

EMRs are divided into different sections, he explains. There’s one for labs, one for imaging, one for consultations.

“The problem is that you have to go to all these different sections to view data that is helpful for one particular condition. A flowsheet can go into those sections, pull out the data you’re trying to look at and show it to you at the click of a mouse.

“If a patient has anemia, for example, I want to know their CBC (complete blood count). I want to know what their iron levels are, their Vitamin B12, their folic acid. I also want to know if they’ve had a gastroscopy or a colonoscopy, if they’ve had a barium enema or if they’ve had any CT scans. For me to get that information, I would have to go to five different spots, but if I create a flowsheet, it can gather that information and show it to me in one spot, so it saves me a lot of time.

“A flowsheet is also helpful if I’m following a diabetic patient and I want to know if they’ve seen an optometrist for their eyes. I want to know about their blood pressure counts over time, their hemoglobin AIC and if their kidney function is worsening. I want to know if I’ve done a foot exam in the last year. It’s much better to have the EMR get that information for me.”

Flowsheets are easy to create in Practice Solutions, but only 10 per cent of the 32 docs in the Timmins Family Health Team use them.

Raymond also recommends the use of Encounter Assistants in Practice Solutions.

“In our group, we created an Encounter Assistant for coding the common conditions in our patients’ charts. Normally, it might take 45 seconds to code something, but if you use an Encounter Assistant, it takes three seconds. Where it’s really useful is when you’re converting from paper to an EMR, or you’re mass coding a patient.”

Coding is important if physicians want to have an overview of their practice and the illnesses of their patients, said Raymond.

“We use the coding to figure out what we should be focusing on and how we can better care for our patients.”

Reminders are also useful.

“You can create a reminder for any condition. For example, for COPD I can create a reminder to tell patients to stop smoking.”

An EMR is basically a huge database, said Raymond.

“But if all you do is put data in and never take it out to look at it, it’s just a fancy way of charting. Physicians should be asking questions about their patients and what they can do for them. You may find out that only 30 per cent of your diabetes patients are getting eye exams. If that’s the case, you may want to talk to the optometrist in town. It’s all about how you can better care for your patients based on the data in your system.”

Physicians interested in a consult with an EMR peer leader should email peer.leader.program@ontariomd.com.

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