1. Pre EMR Preparation Dr Dean Brown December 2009

2. SIX AREAS DEFINE YOUR COMMUNITY DEFINE YOUR COMMUNITY EMR BASICS EMR BASICS IT SKILLS IT SKILLS REVIEW WORKFLOW REVIEW WORKFLOW PHYSICAL SETUP PHYSICAL SETUP CHART PREPARATION CHART PREPARATION

3. DEFINE YOUR COMMUNITY OFFICE TEAM OFFICE TEAM OTHER PRACTICES OTHER PRACTICES

4. DEFINE YOUR COMMUNITY OFFICE TEAM OFFICE TEAM –It is coming a big adjustment a big adjustment –Reassure staff: it works, it’s worldwide, you’ll give support, ‘we’re in it together’ –One year adjustment (6mo pre, 6 mo post) –Get staff input –Establish a process: meet q2 - 4 wk, assign tasks, report back, continue 3-6 mo+ post implementation

5. DEFINE YOUR COMMUNITY OTHER PRACTICES OTHER PRACTICES –Canvas other offices and practices –Consider COP: ‘Group of practices or area providing service to a population, using a common EMR’ 50% of PITO placements 50% of PITO placements –Gain leverage when talking to hospital, labs, providers, vendors, hardware suppliers –Vendor selection, mutual support, staff exchange, etc

6. LEARN EMR BASICS Major Elements are similar to paper: Demographics, Clinical Profile (Allerg, Meds, Problem List, Past, Investigations) Progress notes, Supporting documents Major Elements are similar to paper: Demographics, Clinical Profile (Allerg, Meds, Problem List, Past, Investigations) Progress notes, Supporting documents Most data is digital but some is not ie. scanned documents Most data is digital but some is not ie. scanned documents A wider context: EMR, EHR, PPN, ASP, CDM A wider context: EMR, EHR, PPN, ASP, CDM Workflow is similar, but some added elements: Workflow is similar, but some added elements: –Financials, CDM, www, stats, protocols, decision support, bill as you go Spend time at www.emrtoolkit.ca, www.canadianemr.ca and www.pito.bc.ca Spend time at www.emrtoolkit.ca, www.canadianemr.ca and www.pito.bc.cawww.emrtoolkit.cawww.canadianemr.cawww.pito.bc.cawww.emrtoolkit.cawww.canadianemr.cawww.pito.bc.ca

7. IT SKILLS Consider getting a Laptop for your own use Consider getting a Laptop for your own use Consider a PDA Consider a PDA Keyboarding: aim for 20 wpm: handwriting is ~15 wpm. Use correct fingers and home keys (F,J) Keyboarding: aim for 20 wpm: handwriting is ~15 wpm. Use correct fingers and home keys (F,J) Learn PC basics: Learn PC basics: –Startup, proper shutdown, reboot –Scan and save, print –Keyboard = mouse (ie almost everything can be done on mouse or keyboard) –Manage 2 or more open windows with Alt+Tab –Manage/change local printers –Email: download, send, save –Check out Word, Excel, Powerpoint –Be familiar with file and directory management using the ‘C’ drive –Minimize EMR and use desktop

8. REVIEW WORKFLOW Review common scenarios, how do they go now, how might you do them with EMR Review common scenarios, how do they go now, how might you do them with EMR –Making an appointment, –Walkin –Making a referral, sending a letter, booking an appointment –Private Billing –WCB –Arranging followup or callback –Filing: what results come from where, MD review, how will it get filed? –Scanned documents vs ‘integrated’ data –Filing Consults and other analog documents

9. PHYSICAL SETUP Identify 2 maintenance people : MD and MOA Identify 2 maintenance people : MD and MOA Get broadband – Shaw or Telus Get broadband – Shaw or Telus Unclutter office Unclutter office Find Storage Find Storage Move out old charts Move out old charts Consider where people and machines go: server, monitors, laptops, printers, fax, scanners, MF, wires Consider where people and machines go: server, monitors, laptops, printers, fax, scanners, MF, wires Approx one printer per MD Approx one printer per MD Create workspace: plan outlets, cables and cords, work surfaces Create workspace: plan outlets, cables and cords, work surfaces Buy scanners, try them out. Fujitsu ScanSnap vs Panasonic Moonlander Buy scanners, try them out. Fujitsu ScanSnap vs Panasonic Moonlander Plan for storage of paper charts (preferably off-site and out of your way) Plan for storage of paper charts (preferably off-site and out of your way)

10. CHART PREPARATION Start soon …. Start soon …. Don’t wait for go-live …. Don’t wait for go-live ….

11. CHART PREPARATION (con’t) For each patient For each patient Summary Sheet Meds Allergies Problems Meds Allergies Problems Enter this data manually into EMR eg. first encounter after go-live Enter this data manually into EMR eg. first encounter after go-live Download summary sheet here… Download summary sheet here… Download summary sheet here… Download summary sheet here… Summary Documents : 5-15 sheets max Pull out and paper-clip them together: … Pull out and paper-clip them together: … Progress notes: the last 1-2 yr Progress notes: the last 1-2 yr Essential Lab, Imaging, and Consults in last 5-10 yr Essential Lab, Imaging, and Consults in last 5-10 yr Scan together into EMR as one big document called ‘Chart Summary’ Scan together into EMR as one big document called ‘Chart Summary’

12. CHART PREPARATION (con’t) Suggestions: Suggestions: –Start now …. –Do everyone who comes in –Call in some elderly and/or complex patients Tell them to bring pill bottles Tell them to bring pill bottles You may be able to combine this with complex care planning You may be able to combine this with complex care planning –Hire students or staff after-hours to prepare charts –Keep a list, or put stickers on charts that are ready

13. Discussion…

14. Thanks… Dean Brown MD Dean Brown MD –Local Pito Physician Rep –604.551.4821 –dvbrown@shaw.ca dvbrown@shaw.ca –www.deanbrown.ca