Now what…. You carefully analyzed your office needs Submitted an RFP Negotiated the contract Purchased the hardware, installed the network and then the software They have tested it and trained your staff You are in the process of implementing it and……

It is time to tailor the system to your personal needs This section is about templating You can customize parts of your program This is important because… Smooth workflow Saves time Reduces errors

Tailoring - Like a fitting Template - Interact with database No two doctors work the same way Templates help doctors manage patients They help the administrators manage and analyze the practice

First some background Anatomy of the Database

Dictation Another computer Voice Recognition Keyboard MACHINE READABLE MATERIAL STORED IN CONNECTING (RELATED) TABLES CREATED, READ, UPDATED OR DELETED (CRUD) MONITOR FILE PRINT

Essentially, it is a form

Paper form used by Kidney Associates to document dialysis visits

Who builds the template?

Plan form to follow function and workflow

Buttons to other templates Classify by stage Link to web resource mdrd.com Modality choice Action plan by stage Can select diag- nostic & therapeutic options for CKD 1+ Anatomy of a template form - CKD

After designing the form, it can be saved and either used or quickly changed again.

Templates must be modifiable

They are not set in stone Not set in stone –Avoid Macromedia Flash –Use design object oriented, popular design tools –Modifiable within a few minutes –Scalable - move quickly across the Enterprise

Template relations Relate to a large database of medical standards –Medcin Relate to laboratory/Imaging –The template must be able to access fields in your lab data - NPI, ID patient, lab definition, date Relate to your Practice management software –Images, demographics, medications, vital signs Relate to the patient’s central record or PHR

HPI Allows free text. Boxes assure completeness HPI Allows free text. Boxes assure completeness

Common diagnoses are listed. The browse feature allows access to others. Common diagnoses are listed. The browse feature allows access to others.

Form includes Common treatment options Form includes Common treatment options

Buttons link to additional forms for each CKD component Buttons link to additional forms for each CKD component

Completed form for CKD Completed form for CKD

Templating Practice Analytics Database reports –Demographics –Filters –Diagnoses –Labs Assist in marketing, trend analysis, planning Extra cost for application from some vendors

Example: Using a template to capture dialysis billing

Drag and Drop file into right box in order you want reported. Will sort ascending if box is checked COMMENTS  HOSP  Number Visits  Practice ID  Health Plan  Vascular surg  Guest  Shift day  Shift time  Location  COMMENTS  HOSP  Number Visits  Practice ID  Health Plan  Vascular surg  Guest  Shift day  Shift time  Location  Name  Age  ZIP  FDOD  Name  Age  ZIP  FDOD  Report name____________________

The Future: From paper to algorithm to system

Equitable Efficient Patient Centered Timely Effective Safety Corrigan, JM.;Donaldson, MS.;Kohn, LT.;Maguire, SK.; Pike, KC. Crossing the Quality Chasm. A New Health System for the 21st Century. Washington, DC: Institute of Medicine, National Academy of Sciences, National Academy Press; 2001.

Measures Timeliness - Does the form improve patient access, cut waiting time, move data quickly? Patient centered - Spend more time, understand, explain, show empathy and respect Effectiveness - Will it facilitate practicing evidence based medicine? Patient safety - improve workflow and information exchange, reduce distraction, improve volume Equity - Expand access to service Efficiency –Technical - increase functionality through technology –Productive - improve operations and increase value/time –Allocative - can reassign resources doing duplicative tasks

Take home messages The template is a form structure that you or your staff modify to increase the value quality of your practice, efficiency and effectiveness of your service. The form must follow your workflow, be easily modifiable, and will be changed frequently as you discover better ways to handle your patients.