Case Studies
EMR Facilitates Chronic Disease Management
Dr Bruce Hobson is a family physician in Powell River who’s been in practice for 28 years. His practice consists of three physicians and three MOAs. He also does hospital work, assisting in the OR and working emergency shifts. He moved to an EMR in 2008 as one of the first adopters of the PITO-qualified EMR solutions.
Advice for physicians
“Be patient but just do it! Take the time to enter your historical data properly. Get help from support groups such as PITO’s Communities of Practice and local physician peer mentors.” “Using EMRs to help in clinical decisions will be invaluable in the future; there’s just too much information, too many guidelines, too many medications and too many expectations (both moral and legal) to be able to practice medicine without the help of a computer.”
Population and Individual Goals
Dr Hobson and his staff find that having an EMR gives them more control over all aspects of the practice.
“My EMR has become a major support to me in being able to practice a higher standard of care and to stay abreast of new developments”
In particular, it is now easier to manage patients with chronic conditions, such as abnormal glucose metabolism disorders and cardiovascular diseases (including hypertension), who require a lot of attention. The practice develops population and individual goals (targets) for each patient, records them in the EMR, and keeps track of when to reassess them. This enables them to apply evidence-based guidelines, monitor them carefully, and improve their health outcomes.
Productive Patient Visits
The MOAs can check the practice goals and contact patients with any investigations/ labs that will be due at their next visit. The patient can then have the tests done so that the results are available for discussion at the patient visit. This eliminates the need for a separate phone call, unless the results are significantly abnormal. The visit is more productive and efficient for both the patient and the doctor.
Dr Hobson said: “My EMR has become a major support to me in being able to practice a higher standard of care and to stay abreast of new developments. I can incorporate guidelines, decision making aids, medication choices, links to patient education and other resources into my visit templates and be able to use them while seeing the patient; everything is at my fingertips and as up-to-date as it can be.”
The EMR can generate reminders within the visit for items such as CDM billing, physical exams, specialist follow-ups and other exams. It can also generate Care Plans: all-inclusive ‘packages’ of care items such as prescriptions, investigative tests, problem list items, follow-up tasks, etc. Medications can be grouped according to recommended guidelines, first to last choice.
Challenges
The biggest challenge for Dr Hobson was: “Entering in the data from the paper chart in a meaningful way so that the EMR would become useful to me as quickly as possible. I decided to do most of the data entry myself so that I could decide specifically what I wanted to add as discrete information, such as entering problems, meds, labs, and investigations, and what I wanted to have scanned.”
He also spent time familiarizing himself with his EMR’s functions so that it would be more than just an electronic paper record.
Another challenge was the presence of the computer in the consulting room: “I keep the screen visible to the patient, and use graphs, videos, etc as teaching aids.”