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Michele McDermott, MD, CCD, NCMP The Austin Diagnostic Clinic Describe the experience of The Austin Diagnostic Clinic with our EMR including implementation of Meaningful Use to improve patient care and outcomes Discuss how clinical continuity and coordination of care is supported and enhanced using our EMR Multi-Specialty medical clinic serving Austin and Central Texas. 120 physicians; primary care and 22 specialties Seven clinic locations After hours care Imaging services Laboratory Outpatient Surgical Center 1995: Austin Diagnostic Medical Center established ◦ Clinic and Hospital in one facility ◦ Hospital inpatient records, laboratory and imaging reports in Meditech ◦ Outpatient records in paper charts Need to access reports from Meditech ◦ Desktop PCs for ADC physicians to view reports ◦ Dictated office notes transcribed in to Meditech ◦ Reports from Meditech printed and placed in outpatient charts Quality of care: Multiple providers needing to access medical record at the same time, in different locations Efficiency of care: Reduce time for documents to be placed in paper charts Improve Work Flow: Phone call from patient: write note on paper request chart from medical records \ attach note to chart \ put on stack of charts for physician to respond \ return call file note chart Cost containment ◦ Management of paper records ◦ Cost of dictation, placement of dictated reports in to paper record Desire for a central location within ADC to have all documents in digital form 2 years Advisory Board made up of MIS staff and physicians What features did we want? What product would work best for our needs? What product was affordable? What kind of support, training would be needed? Site visits to view EMRs in use IT Preparation ◦ Training information technology staff ◦ Assessment of equipment needs ◦ Purchasing and installing computers Clinical Preparation ◦ What information would be pulled in to EMR from Meditech? ◦ What order and over what time frame would clinical reports and diagnostic test reports be imported? ADC “went live” with EMR in December, 2001 Step one: ◦ Began with importing existing records that were in digital form. EMR was in viewing mode initially. ◦ Gradual process of eliminating paper copies of reports and dictated notes Step two: ◦ Development of patient encounter forms Phone notes Office visit templates Timeline with precise goals for steps of implementation, ie. “stop printing lab reports 3rd quarter or year two” Testing and validation process performed regularly by MIS team Measurement of physician acceptance and use of EMR tools ◦ Example: How many physicians were creating prescriptions in the EMR Continuous Quality Improvement Process at ADC ◦ Each ADC section responsible for selecting quality measures that relate to their patient population ◦ EMR is used to gather baseline information and change over time ◦ Recognition and awards for the sections with best quality scores and the most improvement ◦ Quality Improvement processes published on ADC website for patient viewing http://www.adclinic.com/quality_reports/menopause-center-breast-cancer-screenings/ http://www.adclinic.com/quality_reports/endocrinoloy-diabetes-management/ Care Alerts Popup Alerts Medication Interaction Warnings Flowsheet ADC Medical Quality Initiatives Health Coaches Prevention Measures Group reporting ( PQRI) Meaningful Use Healthcare cost savings ◦ Shared charting prevents duplicate tests ◦ Improved and more accurate reimbursement coding with improved documentation for highly compensated codes ◦ Reduced medical errors through better access to patient data and error prevention alerts ◦ Improved patient health/quality of care through better disease management and patient education Reduced transcription costs Reduced chart pull, storage, and re-filing costs Electronic prescribing reduces error and re-work, saves time Enhanced ability to meet important regulation requirements such as PQRI and Meaningful Use through alerts that notify physicians to complete key regulatory data elements Reduction of time and resources needed for manual charge entry resulting in more accurate billing and reduction in lost charges Reduction in charge lag days and vendor/insurance denials associated with late filing Limited function (view only) of EMR initially contributed to slow adoption by physicians Policy of optional use slowed implementation Inadequate training of clinicians No financial incentive, significant time commitment Lack of uniformity of EMR patient encounter forms hindered quality of documentation and coordination of care Ability to measure and influence quality of care Patient satisfaction ◦ Coordination of care among specialists ◦ E-prescribing ◦ My ADC Portal: Secure e-mail to physician’s office, appointments, view medical record information Physician and staff satisfaction Financial reward 1. Start with the basics: Problem list, medications, allergies 2. Select a function that will allow an early success. Example: phone notes 3. Design documentation forms to follow work flow 4. Design forms to match the purpose of the encounter and the personnel entering the data 5. Patient encounter forms should meet guidelines and standards for patient visits Reason for Visit, History of Present Illness, Past Medical History, Surgical History, Current Meds, Allergies, Family History, Assessment, Plan 6. Adequate training 7. Share tools and tricks