Theme 5. Advancing manageable meaningful measurement
Presentation Materials (members only)
Leveraging convergence of healthcare delivery, business dynamics and technology advancements to advance collection and utilization of meaningful COPD patient data Beyond an electronic paper file - Optimizing your EMR for population-based measurement Data Tracking: Creating Your Own Path How do you make the most of your EMR? Six teams pitch their methods for optimizing custom queries to gather precise, meaningful data. Join moderator/”dragon” Darren Larson of OntarioMD as he presides over this lively, fast-paced session.
(I) Quality Based Improvements in Care (QBIC): How EMR Data can Transform Care
Presenters
- Centre for Family Medicine FHT:
- Dr. Mohamed Alarakhia, Director, eHealth Centre of Excellence, Family Physician, eHealth Centre of Excellence
- Ted Alexander, MA, Research Associate, eHealth Centre of Excellence
- Masood Darr, Technical Specialist, eHealth Centre of Excellence
- Kathryn Flanigan, Nurse Practioner
Presentation Materials (members only):
- To view the presentation slides, click here.
- Materials will be posted following the 2015 Conference.
Learning Objectives
- Attendees will learn how to use EMR templates with simple clinical decision support tools to facilitate care of patients
- Attendees will increase awareness of enhanced use of EMR to identify patients with chronic conditions
- With the use of structured data in EMR, attendees will be introduced to a model that can help predict at-risk patients in need of additional support.
Summary
Quality Based Improvement in Care (QBIC) is based on the understanding that optimizing primary care’s use of electronic medical records (EMRs) is essential to supporting improvements in our health care system and achieving positive health outcomes at the patient, practice and population levels. With support from an eHealth coach and Information Technology expert, 91 primary care clinicians in 6 primary care organizations were able to enhance quality improvement, chronic disease management best practices and information management. Furthermore, after clinicians were encouraged to document chronic diseases in a structured way, reminders were created in 2 pilot Family Health Teams. After six months, data was evaluated linking workflow to patient outcomes using these reminders. Furthermore, a model was created using structured EMR data to identify at-risk patients who require further support. This advanced use of the EMR will be critical as primary care organizations use system-level strategies to achieve higher quality care while reducing costs (e.g. Health Links patients).
(II) Data Tracking: Creating Your Own Path
Presenters
- Burlington FHT:
- Melonie Mawhiney, Clinic Manager
- Caitlin Grzeslo, Program Co-ordinator
Presentation Materials (members only)
- Materials will be posted following the 2015 Conference.
Learning Objectives
The key learnings are how to approach data tracking to work around EMR limitations. With some ‘out of the box’ thinking, you can customize data measurements based on unique programs and services, IHP roles etc. This improves program management as well as eliminating manual tracking for Ministry reports. It provides efficient and effective reporting of statistics and performance measures for the AOP, QIP and quarterly reports. Chronic Disease Management also benefits from queries and other reports developed through QIDSS support by identifying specific health issues in patient charts. Data integrity is also improved through comparative analysis.
Summary
“You can’t manage what you can’t measure” That was our mantra in developing our data tracking system. We will describe how we used ‘fake’ billing codes and unused data fields to measure patient encounters by type and by program. Through innovative thinking, we found ways to extract data from our EMR (Oscar) that did not have the specific functionality we wanted, allowing us to measure what we wanted, not just what was available. With support from our QIDSS, we developed specific queries for programs based upon the performance indicators in our QIP. We can measure time spent by IHP on various tasks and programs with the next step being a ‘Return on Investment’ analysis with the return being measured by patient outcomes. We are able to better manage our Chronic Disease preventions and target patients that would benefit from one of our programs. Our QIP has significantly improved through allowing us to set realistic targets that can be justified by statistics. We can now measure the QIP performance indicators efficiently, effectively and most importantly, accurately. Given the Ministry’s emphasis on providing “solid evidence of the value of FHTS/NPLCs and team-based care” our FHT can demonstrate this is a quantifiable versus qualitative manner.
(III) Beyond an Electronic Paper File – Optimizing Your EMR for Population-Based Measurement
Presenters
- Partnering for Quality, South West CCAC
- Rachel LaBonte, Program Lead
- Gina Palmese, eHealth Coach
Presentation Materials (members only):
- Materials will be posted following the 2015 Conference.
Learning Objectives
Participants will:
- gain a shared understanding of challenges that exist in optimizing the use of EMRs in primary care settings;
- gain an understanding that improving the use of basic/intermediate functionality is often a prerequisite for using intermediate/advanced features (e.g. queries and reports depend on good data integrity, structured and searchable data) and;
- learn a few tips/tricks to help them optimize the current use of their EMR and next steps to population-based care (multiple EMRs will be discussed).
Summary
With 80% of health care encounters occurring in primary care settings the vast majority of patient data is collected and managed at the primary care level and the transformative change to be undertaken will be reliant on information management supports and tools. Not all users are using their EMR to its fullest potential. Through the results of the Primary Care EMR Needs Assessment, primary care physicians, nurse practitioners and physician assistants have demonstrated that they are comfortable using EMRs for episodic care, however challenged to shift EMR use for practice level management. Through the optimization of EMR use for practice level management, primary care practices will be positioned to achieve positive health outcomes at both individual and population levels, leveraging the full benefits of EMR adoption. This further provides a significant opportunity to optimize the use of EMRs for chronic disease prevention and management and delivery of quality patient care. This presentation will not only outline high level results of the EMR needs assessment but will also highlight the rest of the journey towards population-based care. NOTE: This presentation will cover multiple EMR systems.
(IV) Leveraging Convergence of Healthcare Delivery, Business Dynamics and Technology Advancements to Advance Collection and Utilization of Meaningful COPD Patient Data
Presenters
- Couchiching FHT:
- Stephanie Kersta, MSc, Health Promoter
- Greg Armstrong, MD, Lead Physician
- Stephen Graper, President, Healthcare Together Ltd
- Doug Kavanagh, Founder, Cognisant MD
Authors and Contributors
- Liz McCormick, IT Manager, Couchiching FHT
Presentation Materials (members only):
- Materials will be posted following the 2015 Conference.
Learning Objectives
- Become aware of an optimal healthcare delivery method and process to:
- Integrate a multi-disciplinary, cross functional team into a QI initiative that will optimize COPD population management (prevention and treatment)
- Use patient generated health data to identify patient needs and resource requirements
- Understand key insights into developing strategic business partnerships with complimentary core competencies and resources to enable FHT’s to achieve CDM (chronic disease management) goals
- Increased awareness of technology advancements to enable rule based processes to optimize efficient and timely collection of patient self-reported clinical insights with direct Telus PSS EMR integration.
Summary
Couchiching FHT (CFHT) insights demonstrated a need to enhance screening of its COPD population to achieve prevention and management goals. It sought an innovative way to engage patients, efficiently collect key COPD clinical insights that could be leveraged in the EMR. CFHT also recognized the need for an internally aligned team, to leverage strategic partnerships and to adopt new technology to ensure success. Through the use of a cloud-based clinical platform, the CFHT is now enabled to use rule-based technology to collect smoking status information, promote smoking cessation programs, inquire about the patient’s desire to quit smoking, complete the Canadian Lung Health Test screening tool and the MRC dyspnea scale. Additionally, email consent and address collection occurs. All of this data is self-reported by the patient, can occur in just a few minutes and is immediately integrated directly into the patient’s EMR. This standardized data entry can be used to identify patient’s needs, direct internal resources (ie. program referral, spirometry required, bill for smoking cessation…) and communicate cross functionally through customized clinical notes. This presentation will:
- Describe current vs desired status of the CFHT COPD population registry and management
- Present an overview of the current COPD data collection processes and gaps compared to processes utilizing new technology
- Identify the value of developing strategic partnerships with private industry that can leverage technology advancements, therapeutic insights, project management and critical resources.
- Highlight the benefit of a multi-disciplinary, cross-functional team with physicians and staff aligned on the QI initiative.
(V) Leading Edge Custom Queries and their Applications Across Ontario
Presenters
- Hope Latam, QIDSS, East Wellington FHT
- Windsor FHT:
- Brice Wong, QIDSS
- Sara Dalo, QIDSS
Authors and Contributors
- Michelle Karker, ED, East Wellington FHT
Presentation Materials (members only):
- Materials will be posted following the 2015 Conference.
Learning Objectives
Participants will gain an understanding of the different types of data in the EMR, and learn how structured data leads to higher data quality. They will be able to take home knowledge of different data extraction tools, in particular the Telus PS custom queries for extracting data from the custom forms. Participants will also learn the various ways FHTs are using the extracted data to guide program development, track staff utilization, and improve patient care. Finally they will gain knowledge about the AFTHO QIDSS program and how it facilitates the development and sharing of data management concepts and tools to FHTs across the province.
Summary
The presentation will introduce the various types of data in EMRs; free text, stamps, encounter assistants and custom forms. It will have a focus on custom forms and how they are ideal for entering structured data into the EMR. We will then discuss the challenges we faced getting data out of the custom forms. This lead to the development and deployment of the custom queries across Ontario with the funding, guidance, and support from AFTHO. The presentation will then review how East Wellington FHT has used the queries to pull valuable data for a wide range of applications. Other QIDSS will then discuss how they have implemented the queries at their FHTs, and what they are using them for. We’ll conclude with the impact this new data has had on the FHTs, and what others can do to use and apply this same methodology.
(VI) Optimizing EMRs to Accurately Identify COPD and other Chronic Disease Patients
Presenters
- Sara Dalo, QIDSS, Amherstburg | Central Lambton | Chatham-Kent | Harrow Health Centre | Leamington & Area | Rapids | Thamesview | Tilbury District | Windsor FHTs
- Brice Wong, QIDSS, Amherstburg | Central Lambton | Chatham-Kent | Harrow Health Centre | Leamington & Area | Rapids | Thamesview | Tilbury District | Windsor FHT
- Thiv Paramsothy, QIDSS, East GTA FHT | Scarborough Academic FHT | West Durham FHT | Carefirst FHT
Authors and Contributors
- Greg Mitchell, Knowledge Translation and Exchange Specialist, QIDS Program, AFHTO
- Chad Moore, QIDSS, North Simcoe FHT
- Allison Palmer, QIDSS, Brockton & Area FHT
- Sandra Taylor Owen, QIDSS, Central Hastings FHT
- Hope Latam, QIDSS, East Wellington FHT
Presentation Materials (members only):
- Materials will be posted following the 2015 Conference.
Learning Objectives
This initiative will allow EMR users to reliably generate a list of patients with COPD. Patients already coded/documented as having COPD can be filtered out, so those patients unclearly identified can be reviewed by the primary provider and properly documented in the EMR. EMR- specific instructions and other resources are available for FHTs as they undergo the process of making data quality improvements in their EMRs. Although this presentation is specific to COPD, the development of additional comprehensive queries, for top chronic conditions (ie. diabetes, hypertension, dementia…), are currently underway and will be available in the near future.
Summary
Approximately 12% of Ontarians have COPD and is a leading cause of hospitalization and death in Canada. Primary Care is continuously looking for ways to identify patients living with COPD and linking them with appropriate services that will help them manage their health to reduce ED visits and hospitalizations, and improve overall quality of life. The presentation would include a live demonstration and clearly outline processes around data clean-up initiatives that will optimize the EMR. There will also be next steps around which stakeholders in the community setting can provide services or support for patients identified with having COPD, such as OLA. The Algorithm Project Team is currently in the process of working on the next search for Diabetes and there will be more to come. The data generated could also assist with improving the accuracy and ease of Ministry reporting. This initiative has been broadcasted on several weekly QIDSS calls and professional development sessions, but the AFHTO conference would be an ideal opportunity to share it with members abroad since many can benefit from this search. A significant number of FHTs across Ontario have reported they do not have a reliable COPD registry, which is a drawback since registries allow for identification and tracking for patients with specific conditions, facilitate delivery of health care and track their progress. This solution can allow FHTs to manage their patients effectively and help overcome fragmented care and improve coordination services.