More Tara Kiran, Sam Davie, Lisa Miller OPTIMIZING EMR USE: MERGING - - PowerPoint PPT Presentation

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More Tara Kiran, Sam Davie, Lisa Miller OPTIMIZING EMR USE: MERGING - - PowerPoint PPT Presentation

Apr 21, 2023 361 likes •706 views

Optimizing EMR Use: Merging Data, Managing Patients and More Tara Kiran, Sam Davie, Lisa Miller OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Presenter disclosure Presenters: Tara Kiran Relationships with commercial

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Optimizing EMR Use: Merging Data, Managing Patients and More

Tara Kiran, Sam Davie, Lisa Miller

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  • Presenters: Tara Kiran
  • Relationships with commercial interests:
  • Grants/Research support: None
  • Speakers bureau/honoraria: None
  • Consulting fees: None
  • Other: None

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

Presenter disclosure

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SLIDE 3
  • Presenters: Sam Davie
  • Relationships with commercial interests:
  • Grants/Research support: None
  • Speakers bureau/honoraria: None
  • Consulting fees: None
  • Other: None

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

Presenter disclosure

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SLIDE 4
  • Presenters: Lisa Miller
  • Relationships with commercial interests:
  • Grants/Research support: None
  • Speakers bureau/honoraria: None
  • Consulting fees: None
  • Other: None

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

Presenter disclosure

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SLIDE 5
  • This program has received no financial or in-kind

commercial support

  • There are no other potential commercial conflict(s) of

interest

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

Disclosure of commercial support

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SLIDE 6
  • N/a

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

Mitigating potential bias

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Learn how to…

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

  • Access the Cancer Care Ontario Screening Activity Report
  • Merge it with your EMR data
  • Use patient postal codes to understand equity
  • Use the data to measure and drive improvement
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  • St. Michael’s Hospital Academic FHT

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

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Our challenge: measuring screening rates

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

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What is the CCO SAR?

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

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How do I access the CCO SAR?

STEP 1: Help physicians get a OneID account

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

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How do I access the CCO SAR?

Train your own Local Registration Agent!

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

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How do I access the CCO SAR?

STEP 2: Help physicians appoint you as a delegate

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

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How do I access the CCO SAR?

STEP 2: Help physicians appoint you as a delegate

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

Help! 1-866-250-1554

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How do I access the CCO SAR?

STEP 3: Integrate delegation into new MD orientation

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

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How do I access the CCO SAR?

STEP 4: Sign in and download CCO SARs

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

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How accurate is the data in the CCO SAR?

We found that…

  • Breast Cancer
  • Colorectal Cancer
  • Cervical Cancer

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

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  • Develop search for pap tests in the EMR
  • Search for unique identifier (i.e. OHIP #)

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

How do I supplement CCO SAR cervical data?

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How do I merge data?

  • Use software to merge based on unique identifier

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

Pap Test in CCO SAR? Pap Test in EMR? No Yes No 3891 (30%) 1069 (8%) Yes 4118 (31%) 4077 (31%)

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What do I need to know who’s been screened?

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

EMR CCO SAR BOTH

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Do you analyze your QI measures with an equity lens? This could include:

  • Gender
  • Income
  • Immigration
  • Ethnicity
  • Many others…

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

Question

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OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

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OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

Measuring poverty can be challenging

  • Ask patients
  • Income and # of people it supports
  • “do you ever have difficulty meeting ends meet at

the end of the month?

  • Whether receiving OW or ODSP
  • Use a proxy
  • Neighbourhood income quintile
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  • Run EMR search for postal code
  • Get unique identifier
  • Obtain Postal Code Conversion File
  • Matches postal codes to neighbourhood income

quintile

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

How do I look into equity in cancer screening?

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OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

What does the final dataset look like?

OHIP # CCO SAR Data EMR Data EMR Postal Code Income Quintile 1234567

  • Eligibility
  • Date of latest

test

  • Result of test
  • Date of latest

pap test A1B 2C3 3

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Multifaceted intervention:

  • Reminder letters

for patients

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

Our QI intervention

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Multifaceted intervention:

  • Physician audit

& feedback

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

Our QI intervention

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Multifaceted intervention:

  • Enhanced point-of-care reminders

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

Our QI intervention

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Results – overall screening rates

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

60% 56% 59% 65% 65% 65% 70% 65% 65% 70% 65% 66% 0% 20% 40% 60% 80% 100% Cervical* Breast Colorectal Cancer Screening Rate

SMHAFHT Cancer Screening Rates Over Time

Mar, 2014 Nov, 2014 Mar, 2015 June, 2015

*Mar 2015 and later rates includes pap tests not captured in the EMR, previous rates did not

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Results – variations in physicians’ screening rates

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

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Results – equity

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

67% 59% 63% 69% 61% 65% 69% 67% 67% 70% 65% 64% 72% 72% 74% 0% 20% 40% 60% 80% 100% Cervical Breast Colorectal Cancer Screening Rate

SMHAFHT Cancer Screening Rates by Neighbourhood Income Quintile - June 30, 2015

Poorest Income Quintile 2 Income Quintile 3 Income Quintile 4 Richest

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Results – equity

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

63% 30% 40% 65% 29% 43% 67% 26% 48% 64% 26% 45% 74% 25% 56% 0% 20% 40% 60% 80% 100% Colorectal FOBT Colonoscopy Cancer Screening Rate

SMHAFHT Colorectal Screening Rates by Neighbourhood Income Quintile - June 30, 2015

Poorest Income Quintile 2 Income Quintile 3 Income Quintile 4 Richest

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  • Patient postal code is one way of looking for income

disparities in your practice

  • Data cleanliness is important, but sometimes it’s more

efficient to work around it

  • Using merged data can give you more accurate data than

any one source alone

OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

Key messages