Data Collection in Private Practice and Implementation with Electronic Medical Records Martin J Bergman, MD Chief—Rheumatology Taylor Hospital Ridley Park, PA

Patient Encounters The average Rheumatologist sees: –19 encounters/day-- 4 days/wk –3574 patient visits/year Practice Benchmarking for the Rheumatologist, ACR and the Health Care Group, August 2003

% of Office-based Physicians using EMR CDC-National Center for Health Statistics--2006

% of Office-based Physicians using EMR CDC-National Center for Health Statistics--2006

Use of Billing Software vs EMR CDC-National Center for Health Statistics--2006

Obstacles to EMR Cost –Ranges from $5000 to >$30000 Loss of Productivity –“Steep learning curve” Integration into Group Setting –Networking –Competing practice styles Technophobia

Advantages of EMR Decrease in Practice expenses –Dictation services and Ancillary staff Increased productivity –Elimination of “after hours” dictation Improved quality of documentation –Improved patient care –Improved documentation for reimbursement Ability to extract data for personal use

Data Collected Demographics –Age –Sex –Employment status Diagnoses –Active and Co-morbid Medications –Active and Past

Data Collected Labs Patient reported measures –Pain –Patient Global –Function (MDHAQ) –RAPID –Fatigue –MD Global –Tender and Swollen Joint Counts –DAS28

Data collection is facilitated through the use of questionnaires

Patient “checks in” and is given questionnaire by the receptionist Patient completes questionnaire while waiting for visit Physician “eyeballs” questionnaire and “scores” Results of questionnaire are entered into computer “Standard” office visit begins

Methods of Entering Data Paper questionnaire –Manually entered or scanned Desktop –Increase in physical space required PDA –Small screen and small size is advantage and disadvantage Laptop –Cost

Entering data into a computer does not decrease productivity Computer Paper T Pincus, M Bergman, Y Yazici, J Roth, C Swearingen Abstract 1764 ACR 2006 Washington DC

Uses of Data “Extract” data for personal use –Monitor individual patient responses –Monitory practice outcomes “Extract” for collaborative use Share with existing databases –National Data Bank for Rheumatic Diseases –CORRONA May require reformatting

Graphing of Patient Response MTX ADA

Practice Statistics

Duration of Treatment vs. RAPID

DAS28 vs RAPID

Summary Private Practioners are a valuable and underutilized source of useful clinical data Computerized records can be a means or collecting clinical data –Low cost –Efficient –Comprehensive Choice of system is dependent on the needs of the practitioner(s)

Summary Collected data has multiple uses –Monitoring individual patient outcomes –Monitoring practice performance –Participation in large databases –Participation in small, independent research