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The Automated Physician Office

The Automated Physician Office. PHIPA Summit Allen Ausford M.D. C.C.F.P. F.C.F.P Associate Clinical Professor. Presenter’s Background. Family Physician in Edmonton for 24 years Suburban Practice with Hospital Privileges 3000 patients – all ages

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The Automated Physician Office

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  1. The Automated Physician Office PHIPA Summit Allen Ausford M.D. C.C.F.P. F.C.F.P Associate Clinical Professor

  2. Presenter’s Background • Family Physician in Edmonton for 24 years • Suburban Practice with Hospital Privileges • 3000 patients – all ages • Continuous Care “Fee-For-Service” Practice • Teach Medical Students / Residents • Fully automated clinic on the “Electronic Journey” • 1 year into the formation of our Primary Care Network in West Edmonton (45 physicians)

  3. Alberta We//net ASP pilot project PIN: Design Team / Chair of PIN Stewardship Committee Provincial EHR: Design Team Capital Health Region EHR (netCARE) Clinical Design Team, Patient Advisory Committee, Medical Advisory Committee EMR Selection Committee Physician Office System Program Change Management Demo Clinic Physician Mentorship Program Canada Health Infoway Change Management Advisory Committee End User Acceptance Consultant Alberta College of Physicians and Surgeons Chair of Information Technology Committee Alberta Health and Wellness Clinical Decision Support Environmental Scan Australia EHR Initiative Advisor / Presenter Involvement

  4. Components of a Family Practice Automated Office • Scheduling • Billing • Office Support Tools • Electronic Medical Record (EMR) • Electronic Health Record (EHR) • Knowledge Tools • Shared Information Tools • Clinical Decision Support Tools All above component may have overlap with each other

  5. Why Automate the Practice?Clinical Decision Support Synchronous Proximity Guide Assist Type Reminder Asynchronous Alert Reference Passive Active Directive Mode

  6. Local Definitions • Electronic Medical Record (EMR) • Equivalent to the office paper chart • Detailed local clinical encounter information • Not Shared – with few exceptions (can be pushed) • Read / Write • Electronic Health Record (EHR) • Not used with every patient encounter • Subset of pertinent global clinical information • Shared Information Tool (is pulled) • Read mainly

  7. A Typical Day • Breakfast 06:45hr • netCare (Regional EHR) • check Hospital Lists and Hospital Lab/DI/Reports results • Rise (Scheduler)/Purkinje (EMR) • check Office Schedule, E-mail, In Box (Office Lab and Messages) • Misericordia Hospital 07:30hr • Rounds on in-hospital patients • Paper charts with use of EMR remote access / EHR • Office 09:00hr • 33 – 38 continuous care patients – all applications used • Home 1900hr • Complete charting (if needed) via remote access to EMR • On-call issues assisted with EMR / EHR’s

  8. EHR Patient Lists

  9. EHR Demographics / Event Hx

  10. EHR Lab Table

  11. Security and Privacy • Alberta Health Information Act • Initially patients “out” until consented “in” • Changed to “in” unless opt “out” • Protecting Information • “Masking” vs. “Blocking” • “Partial” vs. “Global” • Two factor authentication • Security RSA FOB’s required for external access • Privacy Impact Assessment required • Staff Privacy Manual and Oath of Confidentiality

  12. Contingency and Backup • Contingency • How to function if your computer system goes down • Backup • Mirroring locally, RAID systems • Tape / Portable HD taken off site – encrypted • Lock down staff external drives and ports • Virus / Spyware Protection

  13. Clinical Stories • Young girl with recurrent urinary tract infections • Elderly lady with detached retina • Middle aged man with abdominal pain

  14. What have we learned:

  15. What have we learned: • EHR and EMR are two distinct applications • Continuity of Information is not Continuity of Care (requires Provider-Patient relationship) • Change Management is important and must be properly resourced • Peer Champions are critical to success • Integration must be planned concurrently

  16. Ministry of Health Office of the Information and Privacy Commissioner Regional Health Authorities Hospital Systems Public Representatives Information Technology Medical Associations Medical Regulatory Bodies Pharmacy Associations Pharmacy Regulatory Bodies Other Allied Health Care Provider Associations and Regulatory Bodies What have we learned: • Need all stakeholders aligned

  17. What have we learned: • Privacy Requirements must be Balanced • Too much and no one will use the system • Too little and provider/patient confidence is eroded • Privacy Impact Assessment Tools are important • All stakeholders need to understand the concept of “Risks vs. Benefits” as it is a major principle of appropriate patient care decision making.

  18. Questions

  19. Web Sources • Alberta Health and Wellness: www.health.gov.ab.ca/ • Alberta Medical Association: www.albertadoctors.org/ • Alberta Wellnet: www.albertawellnet.org/ • Canada Health Infoway: www.infoway-inforoute.ca/ • Canadian Center for Health Evidence: www.cche.net/ • Canadian Medical Association: www.cma.ca/ • Capital Health – Edmonton www.capitalhealth.ca/ • College of Physicians and Surgeons: www.cpsa.ab.ca/ • Health Information Act of Alberta. OIPC: www.oipc.ab.ca/hia/

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