2. Michael Martineau, Dr. Alan Brookstone,

3. Presenters Dr. Alan Brookstone – CanadianEMR founder Michael Martineau – eHealth consultant and commentator Lessons Learned EMR Selection & Implementation Office & Ancillary Equipment Handling Paper Issues Interoperability Data Quality CanadianEMR Podcasts 1 st podcast – 3 Sept ‘08 47 podcasts 4 Roundtables 13:24 average duration 31 May 20102Physician Use of IT: Lessons Learned

4. 31 May 20103Physician Use of IT: Lessons Learned

5. Evaluate with own use cases Look at system in operation in similar setting Consider vendor support as a critical selection criteria Involve staff in the selection process Be patient, process takes time 31 May 20104Physician Use of IT: Lessons Learned

6. Majority of functionality same as GPs Major considerations for specialists: Typically work in two environments Often have teaching commitments Need to send letters to referring physicians 31 May 20105Physician Use of IT: Lessons Learned

7. Clearly define requirements Communicate, communicate, communicate Engage / involve staff Work closely with EMR vendor Practice, Practice, Practice Plan for go-live period Maintain a +ve attitude and sense of humour 31 May 20106Physician Use of IT: Lessons Learned

8. 31 May 20107Physician Use of IT: Lessons Learned 6 to 12 months Source: Dr. Kevin Leonard

9. Non-functional requirement Quality attribute to assess user interface Cannot be directly measured Three levels to consider: Biomechanical Cognitive Social Consider carefully during system selection Can improve usability of existing EMR 31 May 20108Physician Use of IT: Lessons Learned

10. Take “preventive care” approach Engage multiple times: At least several times during 1 st 12 to 18 months Ideally every 3 months during 1 st year Support continued learning 31 May 20109Physician Use of IT: Lessons Learned

11. 31 May 201010Physician Use of IT: Lessons Learned

12. Don’t need to scan every piece of paper Prepare electronic charts prior to “go-live” date Ensure that paper charts are current Start with charts for upcoming appointments Populate lists – allergies, medications, and allergies Clean up and scan chart summaries Active medications / dosages Check allergies Ensure anaphylactic reactions noted 31 May 201011Physician Use of IT: Lessons Learned

13. Avoid hybrid patient record Paper arrives by various means (mail, courier, etc) Scan into EMR Use commercial grade scanning equipment Designed to handle large volumes Particularly important in multi-doctor office Create project to design / implement workflow Understand current workflow for incoming paper Design new workflow based on scanning 31 May 201012Physician Use of IT: Lessons Learned

14. 31 May 201013Physician Use of IT: Lessons Learned

15. If computer not in the right spot it won’t be used Consider exam room layout Patient care area Patient consulting area Consider lighting EMR impacts on office design: Save 20% to 25% on floor space Reduce foot traffic -> time savings 31 May 201014Physician Use of IT: Lessons Learned

16. Different criteria from selecting home system Consider an integrated package of hardware and software Five year evergreen horizon 31 May 20115Physician Use of IT: Lessons Learned

17. Consider multiple printers in each exam room Buy multiple copies of inexpensive printer Selection criteria: Time to print 1 st page Noise level Try at home 31 May 201016Physician Use of IT: Lessons Learned

18. Consider as an alternative to typing Minimum hardware requirements Dual core CPU @ 2GHz or better 2 Gbytes of RAM Invest time to become proficient At least one hour per day Couple of weeks to couple of months needed 31 May 201017Physician Use of IT: Lessons Learned

19. 31 May 201018Physician Use of IT: Lessons Learned

20. Significant challenge Hindered by privacy concerns / policies / legislation Raised frequently by specialists Information exchange key to working in teams Single system, multiple data sources preferred Limited value in “viewer”-based approaches Don’t want to switch mindsets when viewing data Don’t want to have to transcribe to import information Enables advanced EMR functions 31 May 201019Physician Use of IT: Lessons Learned

21. All GPs have an EMR 22 different products MEDCOM supports exchange of information Created in 1990’s Defines standards and approves software Scalable architecture - 5M+ messages per month Single standard for: Lab results Discharge summaries ePrescriptions 31 May 201020Physician Use of IT: Lessons Learned

22. All GPs and majority of specialists have an EMR Healthcare reform in 90’s was major driver Focus on primary care Need to submit information for claims and payments Private sector driven Highly competitive and dynamic IT market Innovative products and services Private sector HIE – HealthLink Support exchange of 40 different message types Receives reports from 60 different sources 31 May 201021Physician Use of IT: Lessons Learned

23. 31 May 201022Physician Use of IT: Lessons Learned

24. Interoperability drives need for data quality EMRs not designed for population based care Use EMR as information management tool: Be more consistent in coding Code at a high level; don’t be too granular Code diagnosis and medications Clean existing data Make all labels consistent using ICD codes Make sure patients labeled appropriately with respect to disease 31 May 201023Physician Use of IT: Lessons Learned

25. 31 May 201024Physician Use of IT: Lessons Learned

26. 31 May 201025Physician Use of IT: Lessons Learned "I hate paper records. I think that they are terrible, inefficient, and bad for patient care" “If you keep thinking and working as you did with paper records then the quality of care won't change” “Requires an up front investment that some physicians don't want to make” “A good doctor is good doctor no matter what tool they use” “Give physicians more tools to provide improved care and patient safety”

27. Michael Martineau michael.martineau@avenant.ca Blog: eHealthMusings.ca Dr. Alan Brookstone alan.brookstone@canadianemr.ca Web: CanadianEMR.ca 31 May 201026Physician Use of IT: Lessons Learned

28. 31 May 201027Physician Use of IT: Lessons Learned

29. General sign of “health” re: client relationships Allow clients to speak with single voice User groups develop in different ways: Local Develop naturally Support clients in limited geographic area Tend to support functionality and delivery of care a region National Facilitated by vendor Allow for sharing with colleagues outside the local community Often a vehicle to provide input re: product evolution 31 May 201028Physician Use of IT: Lessons Learned

30. Power outage is an eventuality Consider minimum equipment required One computer at front desk Computer for each physician External connection (ASP) or Server (Local) Install UPS for each req’d piece of equipment 31 May 201029Physician Use of IT: Lessons Learned