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Ambulatory/EMR update

Ambulatory/EMR update. Bryan Hinch MD Associate Director IM Residency Ambulatory MIO. Ambulatory. 1/3 rule 1/3 of residents time is outpatient We are over 35% what counts Outpatient subspecialty GIM Longitudinal Clinic Ambulatory VA. Ambulatory. Ambulatory Month

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Ambulatory/EMR update

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  1. Ambulatory/EMR update Bryan Hinch MD Associate Director IM Residency Ambulatory MIO

  2. Ambulatory • 1/3 rule • 1/3 of residents time is outpatient • We are over 35% • what counts • Outpatient subspecialty • GIM Longitudinal Clinic • Ambulatory • VA

  3. Ambulatory • Ambulatory Month • Residents spends time in subspecialty clinics outside of Dept of IM • Ortho • Gyn • Adolescent • Ophth • Includes time in hem/onc and other IM specialties • Includes time at VA • Includes extra time in GIM Longitudinal Clinic

  4. VA • VA is a new experience added this year • Incorporated into ambulatory • Will be monthly rotation starting next year • Dr. Nancy Sturtz (Kessler) managing it • Lectures weekly • Positive response overall

  5. Longitudinal (Continuity) Clinic • No longer has minimum/maximum # of patients • Has to have 133 clinics in 3 years • Not meeting this last year (prior to new requirements) • Now we are with • Restructuring of Ambulatory • No vacation during ambulatory

  6. Longitudinal (Continuity) Clinic • Data driven feedback • RRC demands we give residents data driven feedback on patient care • ABIM practice improvement module • Utilizing admitting residents ‘scholarly activity’ time • EMR will ease this burden • Prelims • If expect prelim to stay as pgy-2 we need to provide Continuity clinic.

  7. EMR

  8. EMR Project Team • Project Manager: Melodie Rufener • Project Manager (vendor): Laura Todd • Physician Champion: me • Ambulatory Subcommittee to ESC • Representatives from clinical informatics • Physician representation • Nursing Representation • Pharmacy representation

  9. Where we are at now: • Application and Build training completed • Building the ‘system’ to commence now (after design workshop) • A 2 month project

  10. Upcoming Dates • This week Tue-Thurs: Design Workshop • Oct 29: MD track • 2/9/10: STI goes live • 5/2010: med subspec. Go live

  11. EMR • ACGME requirement to implement EMR

  12. EMR: what it includes • Documentation • Visits • Templates • Dictation • Free text • Phone notes/messaging • CPOE • E-prescribe • Ohio board of pharmacy regs • Medicare incentive

  13. EMR: what it includes • Lab review • Outside documentation management/scanning

  14. EMR hardware • Glendale and Ruppert has computers in most rooms • Project team knows that they need upgrading, there is some budget for this

  15. EMR • Expect a hit in productivity • How much to block schedules • If we don’t have an EMR: penalties by 2015 • Incentive payments • We aren’t counting on it but… • HAC should meet any requirements the feds have for “certified” EMR • Our implementation will meet requirements for meaningful use

  16. EMR • Inpatient • 5/10: nurse documentation • Fall 2010: CPOE • MD documentation: not yet purchased, likely 2011 • Floor redesign • Other IT project • Scanning into HPF (I tried to stop this)

  17. Governance • Each clinical area will need to take ownership of implementation • Physician (for IM, me with others) • Office manager • As clinics get close to going live, they will start reporting updates to ambulatory subcommittee.

  18. Main Campus Collaborative • COBA is evaluating workflows and helping with future state • Research volunteers auditing STI charts for me • College of Pharmacy involvement

  19. Implementation • All modules at the same time • Go live preceded by: • Template building • Training super users • Training the rest of office • Go live: 1-2 weeks of at the elbow support • Go live followed by: follow up support

  20. Clinical Alerts • Can customize clinical alerts to include identifying patients who may qualify for research studies

  21. Timeline • Excel…

  22. Questions?

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