1545hrs Physician Information Technology: The EMR & Ophthalmology - Jeremy Smith

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To give PITO background and where to go with specialists

8-15% EMR adoption in BC; canada supposedly 23%

Other countries almost 100%

What is holding people back from adopting?

Barriers identified:

- set up and maintenance, not just the money but the time with 3-6 months of potential turmoil which can take 1 year to smooth out

- those who have had more than 1 year would never go back

- others concerned about data loss b/o etherial electrons

- success and failures of the past, would like to get rid of charts but then they get what is under the tip of the iceberg to help the team transition

- looked at what alberta and ontario had done re costs, planning, change management

Started with 4 principles

- learn from those ahaed of us, focus on clinical practice, prepare for future and interoperability and privacy concerns

2006-2012 Master agreement with secure private network provided and 70% reimbursement of equipment cost and software, specific vendor requirements, etc

- hope to support 4-4,500 of the 5,000 docs in BC

- currently have 2,000 enrolled

- cover one time and ongoing costs, etc, free access to private physician network

- local implementation and transition support services

1. express interest

2. intake and orientation

3. planning and analysis

4. procurement

5. implementation

6. yadda yadda

Communities of practice

- typically groups in community or specialty get together who have common goals which could benefit from an EMR

- for specialists, this COP model helps find a solution to meet their needs

150 of 2,000 docs in programs live on new PITO qualified EMR.

Has been looking at specialists in general and particular specialists

About 50% of 8,000 physicians are specialists

- about 700 - 1,000 docs in hospital setting

- about 1,000 who are in psychiatry and other specialties that don't lend well to an EMR

- some are in and out of hospital so much they really need module of hospital system

- then different ends of the spectrum of needs amongst specialists from basic scheduling, billing to full blown drawing, etc

Key for specialists

- efficient referral/consult functionality

- simple/flexible screen design

- capture data in templates during consult and have it produce consult report

- pre built diangostic and OR bookings

- billing

- remote access

Ophthalmology has surgical, primarily episodic, and primarily longitudinal/chronic care

Ophthalmology is the one specialty with specific requirements

Recognize need to meet with each specialty group to go forward

Specialist physician champions

New program for template development; 95% same needs for all docs but this last 5% needs the work to get the right templates for ophthalmology. Therefore, by getting groups of all those specialists together, makes it worth the vendors' time/money.

Interfacing of data between systems exists for meds but not yet for referral notes but that is being worked on now

Working with different health authorities a barrier; eg breakdown barriers like firewalls to hospital data on patients

Ophthalmology specifically:

Core EMR requirements same as for other docs

Same list of templates, consult generation, drawing tools, device integration needs seen in other specialists but really key to ophthalmology

Adoption by ophthalmology very slow in the province

No one EMR identified in the province as the clear winner

Not just the complete solution; some just want the basic functionality

Opportunities and next steps

- in depth requirements for ophthalmology

- form Ophthalmology COP

- breakout session following this talk to help shape the direction