Webinar – Using EMRs for Chronic Disease Management

March 3, 2011

Funding to support this Webinar has been provided by Hewle-Packard Dr. Michelle Greiver

• Practice description: – Community-based family practice in Toronto – 1,300 patients – Part of interdisciplinary team (North York Family Health Team) – 3 physicians, 1 nurse practitioner in the office – 60 physicians are members of the NYFHT • EMR used: – Nightingale EMR, since 2006 Practice Profile

• Practice description (1092 adult patients) – 77% female – Taking part in a Quality collaborative since 2009 – Part of national primary care EMR chronic disease surveillance system (CPCSSN) • Chronic Disease prevalence (adults) – 80 patients with diabetes (7%) – 89 COPD (8%) – 207 hypertension (19%) – 16 CHF (1%) – 27 confirmed asthma (2%) Benefits of EMR for CDM

You cannot improve what you cannot measure • We decided to code important chronic conditions so that we could build disease registries • We enter data consistently in the EMR so it can be measured • We invested time and resources in measurement and audits • All team members use the EMR • We have CDM flowsheets and templates, with associated alerts and reminders • We use the EMR to audit and mail reminders to patients who are overdue (diabetic, no eye exam for 2 years) Screenshot Screenshot

6 CDM reminders for any chronic conditions this patient has: “HM button” Screenshot

8 Take Home Points

• Decide and agree: which chronic conditions you would like to focus on? • Involve everyone in your practice • Enter your data carefully and consistently • Use the features that your EMR offers • Try small steps to improve care • Measure what you did and see if it worked, then keep going • Use what you learned in one chronic condition to improve other conditions Dr. Nora Curran-Blaney

• 3 Physician Family Practice – Oakville, ON – 2 physicians work concurrently – flexible schedule • 30 years practice experience • EMR used: Healthscreen • Remote access version • Experience using tablet computers Practice Profile

• 1348 rostered patients • 519 over 50 yrs • Chronic Disease prevalence – Hypertension – (400 pts.) – Obesity – BMI over 33 (100 pts.) – Diabetes Mellitus – (30-40 pts.) – Heart failure – (10 pts.) Benefits of EMR for CDM

• Ability to develop clinical queries • Active use of a patient profile – Hand printed copy of profile to patient • Used of coded data display – Requires discipline of data entry for future use • Colour coding • eFax directly from EMR • Simplification of referrals • Cancer surveillance 13

Take Home Points

• EMR usability is critical • Encourage patient self management – Not yet using a patient portal • Record information during the encounter • Patient feedback – Most feel management is improved with EMR – Less chance for error or that information has been forgotten – Worry about privacy and power outages Michael Brand, Clinic Manager Associate Medical Centre, Taber, Ab.

• 12 Physician Family Medicine Clinic • Member of Chinook Primary Care Network • Using Wolf EMR since 2007 Practice Profile

• Approx. 18,000 patients in catchment area • Team based Care • Physician is team lead with mix of NP, RNs, LPNs, Psychiatric RN, Psychologist, Dietician, Health Coach & MOAs • Large Senior & “ESL” Populations • 19 bed Acute Care Hospital • 100 bed LTC Facility Benefits of EMR for CDM

• All CDM Monitoring is managed through use of “Rules” within EMR • Rules define a population and provide alert at Point of Care • All Clinic Staff are tasked with dealing with relevant rules when in contact with a patient • CDM Run charts are used to track performance over time • Results are posted for all to see

Take Home Points

• Rules are constantly changing and evolving based on population and updates to CDM guidelines • Patients appreciate the comprehensive level of care & develop trust in the team. • Staff feel strong sense of accomplishment when they see positive results. • Overall system costs decrease (ER Visits & Admissions) through comprehensive clinic based Chronic Disease Management Unlimited access to medical intelligence

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March 3, 2011

Funding to support this Webinar has been provided by Hewle-Packard