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OS11 - Diversity in Implementation (ID 17)
- Event: e-Health 2017 Virtual Meeting
- Type: Oral Session
- Track: Clinical and Executive
- Presentations: 1
- Coordinates: 6/06/2017, 10:30 AM - 12:00 PM, Room 205D
OS11.05 - Pharmacist Modifications to an EMR in Primary Care: Lessons Learned (ID 73)
Purpose/Objectives: Pharmacists in Primary Care increasingly rely on Electronic Medical Records (EMRs) to support patient care. EMRs are associated with increased quality of patient care, reduced healthcare errors, and enhanced appropriateness of care.1 In Canada, commercially available EMRs are physician-centric and not aligned with pharmacist logic or documentation needs for clinical and collaborative practice. The Pharmacists Clinic team at the UBC Faculty of Pharmaceutical Sciences has been working with a software specialist to design, modify or build, and pilot 3 new pharmacist-specific modules in the OSCAR EMR: the Medication module, the Disease/Indication module, and the Healthcare Team module. The purpose of this presentation is to share the clinical, administrative, and workflow lessons learned from a pharmacist perspective in a growing and innovative area of practice. 1. Canada Health Infoway from https://www.infoway-inforoute.ca/en/
Methodology/Approach: The approach to determining the clinician needs and priorities for EMR modifications were done in a comprehensive and iterative way. An analysis of pharmacist-best practices and needs in primary care was conducted, including an examination of the scope of practice and anticipated growth based on regulatory changes. Modifications to the EMR were also prioritized based on an environmental scan of other primary care practices across North America in the literature. We established a standardized ticket-based approach for communication between clinicians and software specialist. A clinic IT Lead was tasked with piloting any modifications and working directly with the software specialist. Once testing was complete, the modifications were shared with the rest of the clinician team, training sessions were scheduled, and updates to the necessary administrative documents (policy and procedures, training packages) were done. Modifications were then submitted to OSCAR Canada for review with the goal of being incorporated into future OSCAR releases.
Finding/Results: The modules have been integrated into the workflow of the Clinic for over 3800 patients. The pharmacist-specific EMR modifications were an innovative way to monitor patient clinical statuses and assess key performance indicators among others. Pharmacist logic in a comprehensive assessment required the most design changes to the Medication Module. Unexpectedly, significant modifications to other areas of the EMR were required to create a more interprofessional-friendly application rather than pharmacist-specific. The Medication module was structured in a best-possible medication history format, including prescriber and disease indication. The Disease module uses indication-based prescribing and has over 330 ICD9 disease codes translated into patient-friendly synonyms. The Healthcare Team module indicates other healthcare professionals involved in the patient's care, such as a community pharmacist or nurse. In the first year, clinicians linked 4510 medications to 905 disease indications (20%). This increased to 72% in the second year with 6334 medications linked to 4567 disease indications. In addition, over 71% of patient records have more than 1 documented healthcare team member.
Conclusion/Implication/Recommendations: There are significant changes occurring in primary care and pharmacist scope of practice that necessitate the growth of traditional EMRs. The lessons learned from the development and piloting of new EMR modifications by the UBC Pharmacists Clinic can provide invaluable lessons for any team.
140 Character Summary: The Pharmacists Clinic at the UBC Faculty of Pharmacy has designed, modified, and built 3 modules in an EMR: Medications, Disease/Indications, and Healthcare Team.
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