OntarioMD’s Medical Profile Viewer (MPV): Enabling EMR Data to be Viewed by Hospitals Lessons Learned Report Matthew Leduc, Project Manager, OntarioMD May 28, 2013

Real Life Clinical Scenario A 28 year old woman presents at the Emergency Department (E.D.) on a Friday night, complaining of low energy and rapid heart rate. The patient describes herself as healthy and has no chronic or ongoing health conditions. The E.D. physician examines her and orders blood work. Lab results indicate that the patient has severe anemia. Traditional response: Admit patient for observation and additional tests, including blood work and potentially diagnostic imaging. Response with the MPV: Look up blood work conducted by family physician a few months earlier and verify that anemia is chronic. Discharge patient with instructions to follow up with family physician. Send family physician discharge summary directly to his EMR via the Hospital Report Manager (HRM). ©2012 OntarioMD Inc. Confidential, not to be reproduced without permission2

What Will We Cover Today? 1. What is the Medical Profile Viewer (MPV)? 2. What did we learn from this proof of concept? 3. How can we apply these lessons to a broader provincial initiative? 4. Questions?

What is the Medical Profile Viewer? Web-enabled application that provides real- time access to a patient’s clinical data in a primary care provider’s EMR Medical profile includes commonly retrieved summary information and detailed reports Integrates with hospital ADT system to automatically retrieve patient medical profile upon registration in the E.D.; additional search capacity allows retrieval of other patients ©2012 OntarioMD Inc. Confidential, not to be reproduced without permission4

How Do Users Sign In?

What Patient Information is Available?

What About Other Patients?

What is the Summary View of the Patient?

What Comprehensive Information is Available?

Lessons Learned 1. Ease of access is pivotal 2. Access needs to be quick and integrated into workflow 3. Expand access to the care team 4. Sharing EMR data is a new concept for some 5. Data can be an issue 6. To E.D., or not to E.D.? 7. Additional ideas from our users

Ease of Access is Pivotal MPV is accessible through a link in Meditech Requires separate login credentials Requires new patient look-up Broader Issue: Native system integration is gold standard. Interim third party solutions to mimic integration result in varying levels of success The number one barrier to adoption is multiple logins. I would love to regularly use the MPV, but the barrier for me is the logins. - RVH E.D. physician The number one barrier to adoption is multiple logins. I would love to regularly use the MPV, but the barrier for me is the logins. - RVH E.D. physician

Access Needs to be Quick and Integrated into Workflow

Expand Access to the Care Team During the proof of concept, MPV access was strictly limited to E.D. physicians Existing practice in the paper world relies on clerical staff to engage family practices to retrieve patient information Project imposed hierarchy of information access where none otherwise existed My one major suggestion is to allow our clerical staff to access the MPV so they could get me investigation or consultations. - RVH E.D. physician My one major suggestion is to allow our clerical staff to access the MPV so they could get me investigation or consultations. - RVH E.D. physician

Sharing EMR Data is a New Concept for Some While Barrie Community Family Health Team was extremely supportive of MPV initiative: Family physician (progress) notes were excluded from medical profile Family physician preference was to share access exclusively with hospital physicians Patients are frustrated that we don’t have all their information. I think [patients] are surprised how poorly we share information. - RVH E.D. physician Patients are frustrated that we don’t have all their information. I think [patients] are surprised how poorly we share information. - RVH E.D. physician

Data Can Be an Issue Royal Victoria Hospital providers noted that report identification and filing names were not always clear and finding relevant results could be difficult The few times I did take the time to login into the MPV I could not easily find the useful information I needed so I stopped using it. - RVH E.D. physician The few times I did take the time to login into the MPV I could not easily find the useful information I needed so I stopped using it. - RVH E.D. physician There is a need to encourage family physicians to input EMR data in a way that makes the information more useful to other people. - RVH E.D. physician

To E.D., or not to E.D.? I feel the MPV is more beneficial to hospitals and internists. When a patient presents at the ED, my job is to decide whether or not to admit a patient…it is the next doctor who dives into the patient’s case and therefore benefits from having access to the patient’s past medical record - RVH E.D. physician With the past health and active medications and treatments information from MPV, I can probably do the diagnosis before even going to see the patient. - RVH Hospitalist With the past health and active medications and treatments information from MPV, I can probably do the diagnosis before even going to see the patient. - RVH Hospitalist

Additional Ideas from Our Users: 1. Provide access to additional providers and support staff 2. Accelerate ability to find specific information in record 3. Improve screen layout. Must be designed with ease of access and speed in mind It would be great if clicking on the green checkmark on the patient overview page took you directly to the specific patient information. - RVH E.D. physician It would be great if clicking on the green checkmark on the patient overview page took you directly to the specific patient information. - RVH E.D. physician

Questions?

More Information? For more details on: Medical Profile Viewer Hospital Report Manager EMR Adoption Program Please visit the OntarioMD booth #611 or visit