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D. Fawcett

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    OS19 - Expanding EMR Use in Communities (ID 29)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 1
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      OS19.04 - Optimizing your EMR: Tools and Processes for Understanding Patient Panels (ID 430)

      D. Fawcett, Community Practice and Quality, Doctors of BC; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: Within the context of the patient medical home model of primary care, having accurate patient registries within EMRs was highlighted by the GPSC as an essential component for proactive and quality patient care. In order to facilitate this process, the Practice Support Program (PSP) partnered with BC EMR vendors to build EMR based tools to provide more intuitive reporting functions for understanding your patient panel. PSP regional support teams (RSTs) were trained and deployed to assist physician in optimizing their EMR functionality.

      Methodology/Approach: The initial tools were built with three of the major EMRs in BC (Telus MedAccess/Wolf, and Intrahealth Profile), allowing both RSTs and physicians to easily view panel counts, using either a simple dashboard or reporting interface. This reduced the need to run multiple reports within the EMR. The EMR reporting tools were designed to query standardized disease codes pulled from patient charts to identify prevalence of patients with active status, polypharmacy use, and diagnostic codes for 15 disease indicators. RSTs were trained to provide in-practice support to physicians and their teams in using the tools and improve patient coding methods. We hypothesized that active patient status and polypharmacy prevalence would decrease, and disease registry prevalence’s would increase. These changes would indicate improved patient data quality and allow for comprehensive problem summaries. Physicians were asked to choose 3-5 indicators to manage and provide their baseline and post clean-up scores to the provincial office, along with an evaluation to assess the functionality of the tools and skill set of the RSTs. Additionally, focus groups were conducted at the end of the initial pilot with RSTs and physicians to evaluate the success of the pilot phase, and to inform improvement opportunities. Questions were designed to assess motivators, barriers, and facilitators of action.

      Finding/Results: Over 400 general practitioners (GPs) have now enrolled to use the EMR based tools across BC. The average physician rated somewhat satisfied with the functionality of the EMR panel clean-up tools, and very satisfied with the coaching support. The findings were in line with our hypothesis; based on the subset of physicians who reported their scores, the average active patient status went down by 22% and each of the disease prevalence averages increased. Polypharmacy also showed an average decrease of 54% of patients on 5+ medications and 52% on 10+ medications. Focus groups revealed that participation was influenced by perceived benefits, normative beliefs, and perceived control. Perceived benefits included themes like preparing for retirement, normative beliefs included themes around peer support and community initiatives, and perceived control themes included EMR skill level, tool usability, and availability of resources. Specific barriers included lack of time, lack of strong RST relationships within some clinics, and technical problems with the tools.

      Conclusion/Implications/Recommendations: Overall, the initiative continues to be successful in meeting its objectives. The EMR tools facilitated the process of panel management, are a helpful for RST coordinators to engage the physicians in good data entry practices, and act as a stepping off point for other PSP support services.

      140 Character Summary: The Practice Support Program has helped over 400 General Practitioners to better understand their patient panels with innovative EMR tools, and coaching support.

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