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Users of 3 different EMRs (Wolf Medical, Nightingale and Healthscreen) explain how they use their EMRs for chronic disease patient populations and discuss some of the benefits and challenges of using EMRs for complex patient care.

Host: Dr. Alan Brookstone


Dr. Michelle Greiver - Family Physician, North York Family Health Team (Nightingale)
Dr. Nora Curran-Blaney - Family Physician, Appleby College Medical (Healthscreen)
Mike Brand, Clinic Manager, Associate Medical Centre, Taber, Alberta (Wolf Medical)
David Mosher, Healthcare Business Manager, Hewlett-Packard (Canada)

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  1. 1. Webinar – Using EMRs for Chronic Disease Management <ul><li>March 3, 2011 </li></ul>Funding to support this Webinar has been provided by Hewlett-Packard
  2. 2. Dr. Michelle Greiver <ul><li>Practice description: </li></ul><ul><ul><li>Community-based family practice in Toronto </li></ul></ul><ul><ul><li>1,300 patients </li></ul></ul><ul><ul><li>Part of interdisciplinary team (North York Family Health Team) </li></ul></ul><ul><ul><li>3 physicians, 1 nurse practitioner in the office </li></ul></ul><ul><ul><li>60 physicians are members of the NYFHT </li></ul></ul><ul><li>EMR used: </li></ul><ul><ul><li>Nightingale EMR, since 2006 </li></ul></ul>
  3. 3. Practice Profile <ul><li>Practice description (1092 adult patients) </li></ul><ul><ul><li>77% female </li></ul></ul><ul><ul><li>Taking part in a Quality collaborative since 2009 </li></ul></ul><ul><ul><li>Part of national primary care EMR chronic disease surveillance system (CPCSSN) </li></ul></ul><ul><li>Chronic Disease prevalence (adults) </li></ul><ul><ul><li>80 patients with diabetes (7%) </li></ul></ul><ul><ul><li>89 COPD (8%) </li></ul></ul><ul><ul><li>207 hypertension (19%) </li></ul></ul><ul><ul><li>16 CHF (1%) </li></ul></ul><ul><ul><li>27 confirmed asthma (2%) </li></ul></ul>
  4. 4. Benefits of EMR for CDM <ul><li>You cannot improve what you cannot measure </li></ul><ul><li>We decided to code important chronic conditions so that we could build disease registries </li></ul><ul><li>We enter data consistently in the EMR so it can be measured </li></ul><ul><li>We invested time and resources in measurement and audits </li></ul><ul><li>All team members use the EMR </li></ul><ul><li>We have CDM flowsheets and templates, with associated alerts and reminders </li></ul><ul><li>We use the EMR to audit and mail reminders to patients who are overdue (diabetic, no eye exam for 2 years) </li></ul>
  5. 5. Screenshot
  6. 6. Screenshot
  7. 7. CDM reminders for any chronic conditions this patient has: “HM button”
  8. 8. Screenshot
  9. 9. Take Home Points <ul><li>Decide and agree: which chronic conditions you would like to focus on? </li></ul><ul><li>Involve everyone in your practice </li></ul><ul><li>Enter your data carefully and consistently </li></ul><ul><li>Use the features that your EMR offers </li></ul><ul><li>Try small steps to improve care </li></ul><ul><li>Measure what you did and see if it worked, then keep going </li></ul><ul><li>Use what you learned in one chronic condition to improve other conditions </li></ul>
  10. 10. Dr. Nora Curran-Blaney <ul><li>3 Physician Family Practice – Oakville, ON </li></ul><ul><ul><li>2 physicians work concurrently – flexible schedule </li></ul></ul><ul><li>30 years practice experience </li></ul><ul><li>EMR used: Healthscreen </li></ul><ul><li>Remote access version </li></ul><ul><li>Experience using tablet computers </li></ul>
  11. 11. Practice Profile <ul><li>1348 rostered patients </li></ul><ul><li>519 over 50 yrs </li></ul><ul><li>Chronic Disease prevalence </li></ul><ul><ul><li>Hypertension – (400 pts.) </li></ul></ul><ul><ul><li>Obesity – BMI over 33 (100 pts.) </li></ul></ul><ul><ul><li>Diabetes Mellitus – (30-40 pts.) </li></ul></ul><ul><ul><li>Heart failure – (10 pts.) </li></ul></ul>
  12. 12. Benefits of EMR for CDM <ul><li>Ability to develop clinical queries </li></ul><ul><li>Active use of a patient profile </li></ul><ul><ul><li>Hand printed copy of profile to patient </li></ul></ul><ul><li>Used of coded data display </li></ul><ul><ul><li>Requires discipline of data entry for future use </li></ul></ul><ul><li>Colour coding </li></ul><ul><li>eFax directly from EMR </li></ul><ul><li>Simplification of referrals </li></ul><ul><li>Cancer surveillance </li></ul>
  13. 13.
  14. 16. Take Home Points <ul><li>EMR usability is critical </li></ul><ul><li>Encourage patient self management </li></ul><ul><ul><li>Not yet using a patient portal </li></ul></ul><ul><li>Record information during the encounter </li></ul><ul><li>Patient feedback </li></ul><ul><ul><li>Most feel management is improved with EMR </li></ul></ul><ul><ul><li>Less chance for error or that information has been forgotten </li></ul></ul><ul><ul><li>Worry about privacy and power outages </li></ul></ul>
  15. 17. Michael Brand, Clinic Manager Associate Medical Centre, Taber, Ab. <ul><li>12 Physician Family Medicine Clinic </li></ul><ul><li>Member of Chinook Primary Care Network </li></ul><ul><li>Using Wolf EMR since 2007 </li></ul>
  16. 18. Practice Profile <ul><li>Approx. 18,000 patients in catchment area </li></ul><ul><li>Team based Care </li></ul><ul><li>Physician is team lead with mix of NP, RNs, LPNs, Psychiatric RN, Psychologist, Dietician, Health Coach & MOAs </li></ul><ul><li>Large Senior & “ESL” Populations </li></ul><ul><li>19 bed Acute Care Hospital </li></ul><ul><li>100 bed LTC Facility </li></ul>
  17. 19. Benefits of EMR for CDM <ul><li>All CDM Monitoring is managed through use of “Rules” within EMR </li></ul><ul><li>Rules define a population and provide alert at Point of Care </li></ul><ul><li>All Clinic Staff are tasked with dealing with relevant rules when in contact with a patient </li></ul><ul><li>CDM Run charts are used to track performance over time </li></ul><ul><li>Results are posted for all to see </li></ul>
  18. 23. Take Home Points <ul><li>Rules are constantly changing and evolving based on population and updates to CDM guidelines </li></ul><ul><li>Patients appreciate the comprehensive level of care & develop trust in the team. </li></ul><ul><li>Staff feel strong sense of accomplishment when they see positive results. </li></ul><ul><li>Overall system costs decrease (ER Visits & Admissions) through comprehensive clinic based Chronic Disease Management </li></ul>
  20. 25. THREE NEW webOS DEVICES FROM HP TouchPad Pre3 Veer
  21. 26. HP TouchPAD <ul><li>- Power of webOS as a multi-device </li></ul><ul><li>Platform </li></ul><ul><li>“ Instant on” productivity tools </li></ul><ul><li>webOS multi-tasking </li></ul><ul><li>View and edit Microsoft Word and </li></ul><ul><li>Excel files </li></ul><ul><li>- Video calling </li></ul><ul><li>- Wireless printing to tens of millions of </li></ul><ul><li>HP printers </li></ul><ul><li>- Beats Audio support </li></ul><ul><li>Catalogue with thousands for business, </li></ul><ul><li>Health, fitness, fun, etc </li></ul>
  22. 27. Bridging the gap between smartphones and tablets Share a URL by tapping a webOS phone to the TouchPad
  23. 28. HP Touchpad Available Summer 2011 <ul><li>1.6 pounds, 190mm x 242 mm x 13.7 mm </li></ul><ul><li>9.7-inch diagonal, 1024 x 768 capacitive display </li></ul><ul><li>1.3 megapixel webcam </li></ul><ul><li>Video Calling </li></ul><ul><li>Beats Audio technology </li></ul><ul><li>Stereo speakers </li></ul><ul><li>Wi-Fi, 3G, and 4G options </li></ul><ul><li>802.11 b/g/n </li></ul><ul><li>Bluetooth 2.1 + EDR </li></ul><ul><li>16 + 32 GB storage </li></ul><ul><li>Gyro, accelerometer, compass </li></ul><ul><li>Dual Core 1.2GHz processor </li></ul>
  24. 29. Choose the right instrument for the job <ul><ul><ul><li>Entry-level mobile computing for added productivity at low cost </li></ul></ul></ul><ul><ul><ul><li>Ultra-compact mobility packed with impressive features, including optional touch screen with gesture support </li></ul></ul></ul><ul><ul><ul><li>Ideal mobility for a controlled, secured environment </li></ul></ul></ul>HP Mobile Thin Client HP Mini HP <ul><ul><ul><li>Current technologies, extensive configurability, enhanced security and support for more demanding users </li></ul></ul></ul>HP ProBook <ul><ul><ul><li>Best-in-class design, leading technologies, and feature-rich with greater security, enhanced manageability, and premium support </li></ul></ul></ul>HP EliteBook <ul><ul><ul><li>Get full PC functionality and maximum portability, stay connected 2 , plus choose from pen or touch capabilities. </li></ul></ul></ul>HP TouchPad/Slate
  25. 30. Questions & Discussion
  26. 31. Webinar – Using EMRs for Chronic Disease Management <ul><li>March 3, 2011 </li></ul>Funding to support this Webinar has been provided by Hewlett-Packard