scholarly journals Developing and implementing linked electronic medical record and administrative data in primary care practice for diabetes in Alberta

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Neil Drummond ◽  
Matt Taylor ◽  
Stephanie Garies ◽  
Marta Shaw ◽  
Boglarka Soos ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Administrative Data ◽  
Primary Care Practice ◽  
Clinical Care ◽  
Family Physicians ◽  
Care Practice ◽  
Patients With Diabetes ◽  
Diabetes Patients

IntroductionUse of administrative health data and primary care electronic medical record data are both ubiquitous in Alberta, but linkage between them at patient level and implementation of the linked data into primary care practice are rare. This demonstration project sought to achieve this for a sample of patients with diabetes. Objectives and ApproachAcademic family physicians in the Department of Family Medicine at the University of Calgary who participate in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) identified diabetes–related variables, either in their EMRs or in administrative data, that they wished to obtain in a linked dataset. Secure data linkage was obtained through Alberta Health Services (the provincial health authority) following transmission of patient mapping files direct from the clinics. The de-identified, linked, patient data was then transferred to CPCSSN-Alberta data managers for processing and displayed to users through an interactive Diabetes Dashboard. Results2598 patients with diabetes were identified using a validated CPCSSN case definition from 47 family physicians in three clinics. CPCSSN EMR data included primary care encounters, date of diagnosis, deprivation index, BMI, blood pressure, comorbidity, diabetes medications prescribed, risk factors, etc. Administrative data included laboratory results (HbA1c, fasting blood glucose, cholesterol, triglycerides, creatinine), medication dispensed, emergency room visits, inpatient admissions and costs. Integrated, interactive provider reports were created and sent to participating physicians. The reports presented the information about diabetes patients at individual provider level, bench-marked at clinic, primary care network and provincial levels. Follow-up with providers led to further dashboard development . We propose to scale up implementation of the integrated diabetes database and dashboard to include all 23,000 CPCSSN-identified diabetes patients in Alberta. Conclusion/ImplicationsIntegration of EMR and administrative data and its application to clinical care, panel management, and quality improvement in primary care, as well as to surveillance and research, was feasible and acceptable to the family physicians participating in this project.

The Electronic Medical Record: Its Role in Disseminating Depression Guidelines in Primary Care Practice

1999 ◽  
Vol 29 (3) ◽  
pp. 267-286 ◽  
Author(s):  
Bruce L. Rollman ◽  
Trae Gilbert ◽  
Henry J. Lowe ◽  
Wishwa N. Kapoor ◽  
Herbert C. Schulberg
Keyword(s):  
Primary Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Primary Care Practice ◽  
Care Practice

Comparison of Colorectal Cancer (CRC) Screening Rates Obtained by Electronic Medical Record (EMR) Query versus Patient-Directed Survey in Primary Care Practice

2018 ◽  
Vol 113 (Supplement) ◽  
pp. S137-S138 ◽  
Author(s):  
Brian McAllister ◽  
Thomas McGarrity ◽  
Christopher T. Soriano ◽  
Jennifer Cooper ◽  
Vonn Walter ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Primary Care Practice ◽  
Care Practice ◽  
Crc Screening

scholarly journals Embedding “Smart” Disease Coding Within Routine Electronic Medical Record Workflow: Prospective Single-Arm Trial

10.2196/16764 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e16764
Author(s):  
Dee Mangin ◽  
Jennifer Lawson ◽  
Krzysztof Adamczyk ◽  
Dale Guenter
Keyword(s):  
Primary Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Prospective Trial ◽  
Baseline Period ◽  
Research Network ◽  
Care Practice ◽  
Intervention Period ◽  
Clinical Workflow ◽  
Disease Registry

Background Electronic medical record (EMR) chronic disease measurement can help direct primary care prevention and treatment strategies and plan health services resource management. Incomplete data and poor consistency of coded disease values within EMR problem lists are widespread issues that limit primary and secondary uses of these data. These issues were shared by the McMaster University Sentinel and Information Collaboration (MUSIC), a primary care practice-based research network (PBRN) located in Hamilton, Ontario, Canada. Objective We sought to develop and evaluate the effectiveness of new EMR interface tools aimed at improving the quantity and the consistency of disease codes recorded within the disease registry across the MUSIC PBRN. Methods We used a single-arm prospective trial design with preintervention and postintervention data analysis to assess the effect of the intervention on disease recording volume and quality. The MUSIC network holds data on over 75,080 patients, 37,212 currently rostered. There were 4 MUSIC network clinician champions involved in gap analysis of the disease coding process and in the iterative design of new interface tools. We leveraged terminology standards and factored EMR workflow and usability into a new interface solution that aimed to optimize code selection volume and quality while minimizing physician time burden. The intervention was integrated as part of usual clinical workflow during routine billing activities. Results After implementation of the new interface (June 25, 2017), we assessed the disease registry codes at 3 and 6 months (intervention period) to compare their volume and quality to preintervention levels (baseline period). A total of 17,496 International Classification of Diseases, 9th Revision (ICD9) code values were recorded in the disease registry during the 11.5-year (2006 to mid-2017) baseline period. A large gain in disease recording occurred in the intervention period (8516/17,496, 48.67% over baseline), resulting in a total of 26,774 codes. The coding rate increased by a factor of 11.2, averaging 1419 codes per month over the baseline average rate of 127 codes per month. The proportion of preferred ICD9 codes increased by 17.03% in the intervention period (11,007/17,496, 62.91% vs 7417/9278, 79.94%; χ21=819.4; P<.001). A total of 45.03% (4178/9278) of disease codes were entered by way of the new screen prompt tools, with significant increases between quarters (Jul-Sep: 2507/6140, 40.83% vs Oct-Dec: 1671/3148, 53.08%; χ21=126.2; P<.001). Conclusions The introduction of clinician co-designed, workflow-embedded disease coding tools is a very effective solution to the issues of poor disease coding and quality in EMRs. The substantial effectiveness in a routine care environment demonstrates usability, and the intervention detail described here should be generalizable to any setting. Significant improvements in problem list coding within primary care EMRs can be realized with minimal disruption to routine clinical workflow.

scholarly journals Potential for Integrating Mental Health Specialist Video Consultations in Office-Based Routine Primary Care: Cross-Sectional Qualitative Study Among Family Physicians

10.2196/13382 ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. e13382 ◽  
Author(s):  
Mariell Hoffmann ◽  
Mechthild Hartmann ◽  
Michel Wensing ◽  
Hans-Christoph Friederich ◽  
Markus W Haun
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Study ◽  
Primary Care Practice ◽  
Family Physicians ◽  
Health Conditions ◽  
Care Practice ◽  
Cross Sectional ◽  
Mental Health Specialist ◽  
Health Specialist

Background Although real-time mental health specialist video consultations have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known about their integration into routine practice from the perspective of family physicians. Objective This study aimed to determine the degree to which family physicians advocate that mental health specialist video consultations can be integrated into routine primary care, where most patients with mental health conditions receive treatment. Methods In a cross-sectional qualitative study, we conducted 4 semistructured focus groups and 3 telephonic interviews in a sample of 19 family physicians from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework in a combined bottom-up (data-driven) and top-down strategy for deriving key domains. Results Family physicians indicated that mental health specialist video consultations are a promising and practical way to address the most pressing challenges in current practice, that is, to increase the accessibility and co-ordination of specialized care. Individual health professional factors were the most frequently discussed topics. Specifically, family physicians valued the anticipated clinical outcomes for patients and the anticipated resources set for the primary care practice as major facilitators (16/19, 84%). However, family physicians raised a concern regarding a lack of facial expressions and physical interaction (19/19, 100%), especially in emergency situations. Therefore, most family physicians considered a viable emergency plan for mental health specialist video consultations that clearly delineates the responsibilities and tasks of both family physicians and mental health specialists to be essential (11/19, 58%). Social, political, and legal factors, as well as guideline factors, were hardly discussed as prerequisites for individual family physicians to integrate mental health specialist video consultations into routine care. To facilitate the implementation of future mental health specialist video consultation models, we compiled a checklist of recommendations that covers (1) buy-in from practices (eg, emphasizing logistical and psychological relief for the practice), (2) the engagement of patients (eg, establishing a trusted patient-provider relationship), (3) the setup and conduct of consultations (eg, reliable emergency plans), and (4) the fostering of collaboration between family physicians and mental health specialists (eg, kick-off meetings to build trust). Conclusions By leveraging the primary care practice as a familiar environment for patients, mental health specialist video consultations provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for the determinants of practice as described by the family physicians. Trial Registration German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00012487

scholarly journals Building capacity to support smoking cessation amongst Family Physicians in Romania: The Challenges of VBA in Primary Care Practice

2018 ◽  
Vol 4 (Supplement) ◽  
Author(s):  
Catalina Panaitescu ◽  
Cristina Isar ◽  
Adriana Antohe ◽  
Carmen Busneag ◽  
Juliet McDonnell ◽  
...  
Keyword(s):  
Primary Care ◽  
Smoking Cessation ◽  
Primary Care Practice ◽  
Family Physicians ◽  
Care Practice ◽  
Building Capacity

scholarly journals Improving Patient Access to Diabetic Retinopathy Screening Through Telemedicine

Iproceedings ◽  
10.2196/15193 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e15193
Author(s):  
Tiffany Wandy ◽  
Michael Kiritsy ◽  
Daniel Durand
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Primary Care Practice ◽  
Primary Care Providers ◽  
Care Practice ◽  
Type I ◽  
Screening Measure ◽  
Diabetic Retinopathy Screening ◽  
Patients With Diabetes ◽  
Retinopathy Screening

Background The LifeBridge Health (LBH) Accountable Care Organization (ACO) serves approximately 20,000 Medicare beneficiaries, many of whom have type I or type II diabetes. Diabetic retinopathy (DR) screening is extremely important in helping to preserve patient’s eyesight and overall functional status. However, like many other organizations, LBH has struggled with low compliance rates for DR screening. As result, LBH searched for a solution to improve DR screening care and improve ACO quality and financial performance. Objective LifeBridge sought a telemedicine diagnostic solution that was easy for our physicians and clinic teams to use that would enable improved management of patients with diabetes. A pilot was initiated at three large primary care practice locations in the last quarter of 2017. Two of the locations received table top cameras, while the other location received a more mobile, hand held unit. Working with a dedicated LBH IRIS team, the practices created and implemented workflows, documented processes, and instilled best practices. Methods We used a pre-post test design to measure whether implementation of this tool enabled providers to better meet the diabetic retinopathy screening measure. We included the final months of 2017 in the preperiod to account for any operational changes required to implement the new workflow. Manual chart abstraction of patients seen in the previous 4/6 weeks who were eligible to determine the proportion of patients who met the measure. This was done quarterly in every primary care practice throughout the organization. One of the three practice sites was changed halfway through 2018 and switched to another; however, both practices were included in the analysis. We also compared the number of diabetes patients in the populations of each of the four practices. A two sample z test with a P value of .05 was used to test for statistical significance. Results As of April 2019, 810 patients were screened for diabetic retinopathy. Of these, 33.1% (282 patients) were diagnosed with pathology. Approximately 15.6% (n=133) were diagnosed with DR. We also identified 87 patients who are considered “IRIS saves” patients who had pathology identified that was serious enough to put them at imminent risk of losing their sight. For all patients requiring follow up, direct referrals were made to our in-network ophthalmologists at Krieger Eye Institute for treatment that these patients would not have otherwise received. Statistical comparison of DR screening performance of practices pre and post implementation showed mean screening rates of 38.5% and 47.2%, respectively, with P=.01. Conclusions IRIS screenings allowed our primary care providers to provide more comprehensive care to patients with diabetes, eliminating the need for additional office visits. Having IRIS available in the practice was able to demonstrably improve performance in the diabetic retinopathy screening measure. As a result, primary care providerss with IRIS helped facilitate access to care, thus making it easier for patients make better choices related to their health outcomes. We hope to further use the data to study HbA1c control, medication adherence, and cost/utilization in those diagnosed with retinopathy compared to those with a negative screening.

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