1. Ambulatory/EMR update Bryan Hinch MD Associate Director IM Residency Ambulatory MIO

2. Ambulatory 1/3 rule – 1/3 of residents time is outpatient We are over 35% – what counts Outpatient subspecialty GIM Longitudinal Clinic Ambulatory VA

3. Ambulatory Ambulatory Month – Residents spends time in subspecialty clinics outside of Dept of IM Ortho Gyn Adolescent Ophth – Includes time in hem/onc and other IM specialties – Includes time at VA – Includes extra time in GIM Longitudinal Clinic

4. VA VA is a new experience added this year – Incorporated into ambulatory – Will be monthly rotation starting next year – Dr. Nancy Sturtz (Kessler) managing it Lectures weekly – Positive response overall

5. Longitudinal (Continuity) Clinic No longer has minimum/maximum # of patients Has to have 133 clinics in 3 years – Not meeting this last year (prior to new requirements) – Now we are with Restructuring of Ambulatory – No vacation during ambulatory

6. Longitudinal (Continuity) Clinic Data driven feedback – RRC demands we give residents data driven feedback on patient care ABIM practice improvement module Utilizing admitting residents ‘scholarly activity’ time EMR will ease this burden Prelims – If expect prelim to stay as pgy-2 we need to provide Continuity clinic.

7. EMR

8. EMR Project Team Project Manager: Melodie Rufener Project Manager (vendor): Laura Todd Physician Champion: me Ambulatory Subcommittee to ESC – Representatives from clinical informatics – Physician representation – Nursing Representation – Pharmacy representation

9. Where we are at now: Application and Build training completed Building the ‘system’ to commence now (after design workshop) – A 2 month project

10. Upcoming Dates This week Tue-Thurs: Design Workshop Oct 29: MD track 2/9/10: STI goes live 5/2010: med subspec. Go live

11. EMR ACGME requirement to implement EMR

12. EMR: what it includes Documentation – Visits Templates Dictation Free text – Phone notes/messaging CPOE E-prescribe – Ohio board of pharmacy regs – Medicare incentive

13. EMR: what it includes Lab review Outside documentation management/scanning

14. EMR hardware Glendale and Ruppert has computers in most rooms – Project team knows that they need upgrading, there is some budget for this

15. EMR Expect a hit in productivity – How much to block schedules – If we don’t have an EMR: penalties by 2015 Incentive payments – We aren’t counting on it but… – HAC should meet any requirements the feds have for “certified” EMR – Our implementation will meet requirements for meaningful use

16. EMR Inpatient – 5/10: nurse documentation – Fall 2010: CPOE – MD documentation: not yet purchased, likely 2011 – Floor redesign Other IT project – Scanning into HPF (I tried to stop this)

17. Governance Each clinical area will need to take ownership of implementation – Physician (for IM, me with others) – Office manager As clinics get close to going live, they will start reporting updates to ambulatory subcommittee.

18. Main Campus Collaborative COBA is evaluating workflows and helping with future state Research volunteers auditing STI charts for me College of Pharmacy involvement

19. Implementation All modules at the same time Go live preceded by: – Template building – Training super users – Training the rest of office Go live: 1-2 weeks of at the elbow support Go live followed by: follow up support

20. Clinical Alerts Can customize clinical alerts to include identifying patients who may qualify for research studies

21. Timeline Excel…

22. Questions?