EMR: Making It Work For Physicians

Transcription

1 EMR: Making It Work For Physicians M O A Spring Scientific C onvention Jeffrey Williamson, D O Williamson Family M edicine 6785 M yers Lake A ve, Rockford, M I contact@williamsonfm.org 5/ 20/ 2017

2 Goals -This talk is assuming you H ave an EM R Can work with it in it s most basic form Want to improve your efficiency Want to increase your accuracy Want to increase your billable codes M ostly! H ave it work FO R you, N O T the other way around!

3 Goals: My Experience I Don t want to lose the patient experience. I enjoy seeing patients, having a conversation, being in contact with them and making a connection. M y goal is to spend the day going from patient to patient, listening to concerns, providing positive preventive care and enjoying the human interaction as much as possible. U sing the technology to automate and streamline to serve that mission is goal.

4 The Way it Was 3X5 C ards Paper (C H A RTS!!) Dictation iphone/ C omputer erx Stand A lone Registries PDF based lab and D I results

5 EMR (EHR) of 2017 Evaluated and C ertified by C EH RT Technology has come a long way and most provide the necessary functions. Be sure yours is certified to handle the upcoming requirements and to make your life EA SIER! C EH RT standards for full functionality were required by A pril of 2017, and have now been pushed back to A pril of In M ichigan Primary vendors of EPIC, M ckesson and A LLSC RIPTS have full functionality to the 2015 C riteria as of today. ec W, C erner, A thena, Q uest, G reenway among others are expecting full functionality certification to the 2015 criteria (currently to 2014 criteria) by June C heck your EM R and the C EH RT (chpl.healthit.gov) webpage to ensure you are getting all you can from your provider.

6 In a Perfect World.. EM R captures the FU LL experience of the visit C aptured full billable PC M H, M eaningful U se, PQ RS, M A C RA,M IPS, etc G uidance and A ssistance C omprehensive

7 and EASY??

8 We chose eclinicalworks. Many of you don t have a choice, but for us, it s focus on the many aspects of primary care and ease of use are what sold us.

9 What do you think of when you think of the future of medicine?

10 M aybe This?

11 There may be a place for this future of medicine, but it is not my vision.

12 Like This?

13 Or more like this?

14 High Tech to Avoid Large Intrusive Disrespectful C old Impersonal Forms for Forms sake

15 High Tech That Works FOR us Small Simple (or seemingly so) Fast U nobtrusive

16 Items and Procedures I have found that serve that purpose

17 Small, Efficient Devices and Computers Fujitsu Lifebook Small efficient computers (C onvertible Tablets) iphone or A ndroid: For hand held EC G, Epocrates, A pps, G ood Rx. M aybe in the future, Pulse O x and Blood sugar checks. Kardia (A live EC G )

18 Templates Pre-made through your EM R or other clinicians Your own C ustom (I recommend. I have #630) D ragon/ Siri Dot phrases or Dropdowns (eg Notify Patient, all normal This is where you can build in all of your correct optimal codes for the template, including your E&M and G codes, C odes, PQ RS etc. as well as ensuring that your templates provides adequate documentation for your level of service.

19 Web Portal Portal frees up the phone. M any tasks that would otherwise take staff and phone time go directly to the web portal. The two prime examples are Web M essages to the C linician and Lab and Diagnostic Imaging results. Web M essages are directly from the patient to the clinical or designated staff Lab/ D iagnostic Imaging are posted to the patient with a comment from the clinician. The Web M essages allow the clinician to read the patients question/ comment in their own words, and generally, are willing to get that response in a day or two, even late and early hours. I have not found it intrusive or inappropriate from my patients.

20 Ink Faxes A key piece in my efficiency is to: See a document in the EMR as a PDF (or TIFF) > Oxygen Renewals, Physical Therapy Orders Pull out a digital pen or use my finger on a tablet Sign it, date it Hit Fax > Dropdown to list of Vendors Send D O N E Your EM R probably has this function, check with your vendor to add it to your workflow!

21 Remote Desktops We created a server with V irtual M achines that could be accessed remotely on any kind of computer in Since that time, it has become commonplace and is a necessary part of our workflow. O ur Biller works on a V irtual M achine H osted in the office securely from home over an hour away. Clinicians can get on to see their home screen and EMR to act on questions on call or work on charts from home. New HTTPS cloud sites are beginning to make this obsolete, but the principle remains the same.

22 erx and EPCS We began electronically prescribing medications in 2006 through a vendor called Dr. First. It was a great introduction into the future of medicine and really prepared us well for full EMR. If any of you are still on just paper, I would recommend this as a first step. Favorite lists, U sual dosages, dosage calculator, A llergy and Interaction A lerts are all quickly available for you. The advent of EPC S (Electronic Prescribing of C ontrolled Substances) in 2015 made the final piece in erx. We use a Fob, but fingerprint scanners and O ne Time codes are also available.

23 Registry (integrated) H aving discreet data entered into the built in Registry of our EM R allows us to run reports on: Specified D iagnosis to follow: D iabetes, D ementia Specified Labs or V itals: A 1C, Blood Pressures etc. M IPS programs M A C RA programs M U programs Patient C entered M edical home program IF you have registry functionality that is offsite, but allows you to access it, it can serve the same purpose (WELLC EN TIV E)

24 Order Sets A popup window or page that brings the most up to date choices of orders and items for evaluation for a particular diagnosis or complaint. A vailable in real time within the EM R. C an be customized as well. In my opinion, good for those infrequent diagnosis and lab orders and for preparing a set with a handout for the patient. N ot as useful on an every single patient basis. Also, in my opinion, I think the public thinks the challenge in medicine is making the diagnosis, hence many of the future ideas are having some kind of checklist computer come up with a diagnosis and treatment. I find the real time use in order sets for the specialized labs, imaging and newest evidence based treatment choices as well as patient information printouts. A n article from C ornell U niversity in July of 2014 suggested that providers with access to real time decision making tools and evidence based guidelines made safer and more appropriate clinical decisions compared to colleagues who did not have access to these

25 Health System Interface We receive discreet data: Labs, Imaging, M RI reports, ER Reports, C onsult Letters; From the H ospitals and M ed-centers, both local to G rand Rapids and the Detroit area. They drop right in to the patients Labs/ D ocuments. Q uest Labs or Spectrum Labs: Direct Results to chart. Radiology Interpretation of X -rays done in office.

26 Independent Portals N ot quite fully integrated yet, are portals we can open from the desktop: Remote access to the H ospitals where I am on Staff ED RS - Electronic D eath C ertificate Registry System, no more dirty copies and fax. M A PS (now called PM P A WA RxE) Home Health Companies (if you chose, we don t See Ink Faxes) D urable M edical C ompanies (D itto)

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28 Questions?