Practice Enhancement and Peer Leadership programs help physicians take full advantage of the technology
Now that 82 per cent of primary care providers in Ontario are using electronic medical records software, the mission of OntarioMD, a wholly owned subsidiary of the Ontario Medical Association, has flipped from managing the adoption of EMRs to one of encouraging physicians to take full advantage of the technology.
According to Dr. Darren Larsen, OntarioMD’s chief medical information officer, “the objective is to get EMR maturity up to a point where EMRs can be used for all the greatness that was intended.”
Established in 2004 to assist physicians with the transition from paper charts to EMRs, OntarioMD now focuses its efforts on urging members to use them, “not simply as a word processor for telling a story, but as a way of analyzing populations and practices,” said Larsen.
OntarioMD provides physicians with expert advice and coaching through its EMR Practice Enhancement and Peer Leadership programs. It also certifies vendors of EMR systems, establishes standards they are required to comply with, holds two conferences per year on EMR technology and works with the Ministry of Health and other health-care organizations to roll out and promote applications that link EMRs with other health-care data repositories.
OntarioMD support staff who were responsible in the past for helping physicians with the implementation of EMR systems are now tasked with advising physicians on workflow, data quality and practice efficiency. Practice enhancement advisors meet one-on-one with physicians in their office to perform an EMR progress assessment and develop an action plan to help them get more out of the technology. There is no charge for the service.
Peer leaders, who are doctors with advanced EMR skills, are also available for consultations, said Sarah Hutchison, CEO of OntarioMD, because “we know that physicians learn best from other physicians.”
One enhancement OntarioMD is currently piloting is an EMR dashboard.
The dashboard automatically pulls out data from the EMR and visualizes it to provide physicians with an at-a-glance view of clinical indicators for rostered patients.
For example, it will tell physicians what percentage of women in the recommended age range have had a mammography or cervical cancer screening.
The next step for a physician would be to pull the list of patients who haven’t been screened and decide what to do about the outliers, said Larsen.
“We’re pretty good about doing that for individual patients. If I’m seeing a patient with diabetes or heart disease, that data sits in front of me, but when we’re looking at broader categories of patients, we need to dig deeper.
“Going from a visual example to action seems to be a lot easier than going from an Excel spreadsheet,” said Larsen. “We are able to be impressed more with the need to do something when we see there is a gap, and that’s what the dashboard does.”
Dashboard accuracy, however, is dependent on data integrity. “If you haven’t put the data where it’s meant to be, it’s of no use to anybody.”
There are a lot of examples of physicians in Ontario using their EMRs in creative ways, said Larsen. Some physicians in Thunder Bay, Timmins and Sudbury, for example, have piloted the use of tablets that allow patients to input data in the waiting room prior to their appointment.
“If you have patients with depression and you’re trying to monitor their symptoms, you can ask them to fill out a depression questionnaire because you know that if they’re sitting in front of you, they’re going to answer differently than if they’re answering on their own.”
Other doctors are using integrated, secure email systems and online booking systems.
Larsen is a big believer in using secure email as a means of communication between doctors and patients.
“Doctors have been worried about whether they’d be inundated with emails from patients, but it doesn’t happen. In my practice, I had 1,100 patients and I would get five or six emails a day, and if they weren’t coming in as emails, they’d be phone calls. Answering a question asynchronously via email can prevent a phone call and is much simpler than playing phone tag, so most of us who use it find it really helpful.”
However, it’s important to be mindful of all the rules from the Canadian Medical Protective Association, the College of Physicians and Surgeons and federal government anti-spam legislation.
One issue that doctors face is whether to store data locally or opt for a hosted solution.
“The majority of doctors are storing their data locally, but the software as a service options that vendors are now offering are giving physicians more choice,” said Hutchison. “We’re pretty excited about that and I think more physicians will move into hosted services rather than hold their data locally.
“Cloud services and the movement of data are going to become increasingly important to making patient information available across the continuum.”
“When EMRs got going 10 years ago, the Cloud didn’t exist and there weren’t the hosted options we have today, so physicians had no choice but to get a server in their office,” said Larsen.
Local storage burdens physicians with maintenance and upgrading, while in a hosted environment, all that’s required is a computer and an Internet connection.
A trend to hosted solutions may be inevitable if EMR data is going to be available more widely, but robust, high-speed Internet connectivity will be required, which may not always be the case in the more remote communities across Northern Ontario.
“If your server has to be replaced, that’s a good time to switch,” said Larsen.
The ease of transitioning to a hosted environment depends on data integrity, said Hutchison. “Sometimes, the fields match directly. Sometimes they need a little lift assist.”
“If you’ve done a good job keeping your data nice and clean, things are in the right spaces and everything is as it should be, then most fields can map over,” added Larsen. “If you haven’t paid attention to that and you know you’re going to move over to a new system in six months, then you have time to clean it up. Our change management group can help with that. We’re not going to do it for you, but we’ll make sure that you know what the best path would be.”
Health Report Manager
OntarioMD is playing an important role in the development and deployment of Health Report Manager, which currently delivers discharge summaries from 150 hospital and specialty clinics to more than 7,000 physicians.
“It’s a priority of the government and OntarioMD to connect all hospitals and physicians by the end of the 2017 fiscal year,” said Hutchison. “If the discharge doc is really on the ball and is dictating as the patient is leaving, the family physician can literally have that discharge report in his inbox before the patient has left the building. In terms of impact on follow-up care, we’ve never seen anything more impactful.”
OntarioMD is also responsible for the onboarding of eConsult, an application developed by the Ontario Telemedicine Network that allows family physicians to have online consultations with specialists. eConsult will eventually be integrated with all EMRs certified by OntarioMD.
Further down the road, according to Larsen, we will also see the proliferation of portals that will allow patients to access their health records.
“Giving patients access to their entire record is the only way we’re going to empower them to take charge of their own health. I believe this strongly.
“I don’t think we give patients enough credit for their ability to consume and comprehend this information. I had a portal in my own practice and it was really effective in situations where an 82-year-old patient with dementia has a daughter who’s working and can’t come to every appointment.
“Patient access to their data is the ultimate goal for many of us. Some doctors will push back on that. I just think with education, they’ll see the reasons why it’s beneficial.”