Ultimate Blogging Championship

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  • Data to Decisions eBulletin #47: EMR tools to help you keep getting better

    Better interventions for childhood obesity: New research is exploring how to reduce childhood obesity through better monitoring of infant growth in primary care. Be a part of it by completing a 5-minute, 16-question online survey. Questions? Contact Sarah Carsley for more information. Patient-specific targets for blood sugar control: New tools to set and track individualized targets in the EMR can help you make sure your patients are getting the right care for their needs. Use the diabetes care trend graph in D2D to track your progress. Improving patient experience: If you want D2D 4.1 to show the progress you have made in improving patient experience, you may want to get going now on patient experience surveys. Check out the D2D interpretive notes and suggested data-quality actions, tools from Cliniconex and other patient-survey tools. Enhance your ongoing patient engagement efforts with the new HQO guide, Engaging with Patients and Caregivers about Quality Improvement, plus other patient engagement tools from HQO and AFHTO members and partners. Follow-up after hospitalization: Please join your fellow teams in tracking and reporting follow-up after hospitalization in a way that reflects all the follow-up work done by any member of your team in any way. There are standard EMR tools and work-flow processes to improve consistency in this measure across AFHTO in time for review in D2D 4.1. Recognizing and enhancing the value of the EMR: Minister Eric Hoskins and eHealth Ontario have received Ed Clark’s review of Ontario’s Digital Health Assets, which confirms the significant and ongoing value of digital health infrastructure, and have accepted all of his recommendations in principle. In our submission to Mr. Clark, AFHTO noted the need for continued EMR support and spread of the QIDS Partnership model, stressing the importance of a digital health strategy to move beyond pockets of innovation.

    Help spread the word about D2D – invite others to sign up for the eBulletin. 

  • Individualized HbA1c Targets

    Why?

    Better care for patients with diabetes

    Standardized HbA1C targets do not take into account the complexity and diversity of our patient populations. Even targets that vary by age may not be sufficiently flexible; for example, a frail elderly person should have a higher target than a relatively robust person, even if their age is the same. Developing individualized targets that treat patients as individuals with unique circumstances and needs allows us to ensure that we are delivering the right care to each patient.

    Better measurement of diabetes care

    Simply put, using individualized targets allows us to count how many patients are getting the right care for diabetes, not just how many are meeting an arbitrary standard. One doctor noticed that in her own practice, only 65% of her patients met the standardized target of 0.07% HbA1C. However, when the metric was applied to individualized targets, 71% of her patients were at target. Indicators based on standardized targets fail to reflect the patients who are receiving the right care, when the right care means meeting an HbA1C level that is higher than the standardized target.

    How?

    Several teams have been working on tools to enable the recording and tracking of individualized HbA1C in their EMRs. Some of these are available for use now, and others are still in testing.

    • Denis Tsang, RD at CareFirst FHT, has developed an Encounter Assistant with two checkboxes for HbA1C targets: A1C <0.07 or A1C 0.071-0.085. Clinicians can check off either box after discussion with the physician responsible for determining the patient’s target. The individualized target is then appended to the patient’s cumulative patient profile and visible to all care providers. It is available for download from the Telus Community Portal.
    • Kevin Samson, Physician IT Lead, and Hope Latam, former QIDS Specialist, East Wellington FHT, developed a diabetes-management dashboard which works directly within Telus PS EMR. It provides a summary of each patient’s diabetes management and functions as a “report card” that the doctor can share with the patient. It provides at-a-glance data for the patient’s most recent HbA1C and other diabetes care indicators (creatinine, cholesterol). When an indicator is not within the target range, it shows up in red. By default, the dashboard uses standard targets (e.g.,  07% for HbA1C), but a clinician can easily override this with an individualized value that reflects the right care for that patient. Once this is done, the form will compare the most recent HbA1C value against the individualized target to determine whether the patient is in or out of target. It is currently in testing at two FHTs and will be shared with other users of Telus Practice Solutions once complete.

    Consider raising this as an issue at your EMR Community of Practice, and pressure your vendor to develop a solution. Meanwhile, clinicians can use the “notes” field to start recording individualized HbA1C targets in each patient’s chart. See if your team can agree on a consistent format for this, so any team member can recognize it easily.

  • Medical Assistance in Dying (MAID) Resource

    On June 17, 2016, the federal government passed legislation to amend the criminal code to allow access to Medical Assistance in Dying (MAID) for those who are eligible. To support physicians and nurse practitioners (clinicians), the Ministry of Health and Long-Term Care engaged the Centre for Effective Practice to develop a resource to help clinicians better understand the process to be undertaken for the provision of MAID. Developed as part of Knowledge Translation in Primary Care Initiative under the clinical leadership of Dr. Sandy Buchman, the goal of this resource is to support clinicians (physicians and nurse practitioners) with the provision of MAID and to implement a consistent approach to the process within Ontario. This resource also highlights key considerations and recommends processes for the provision of MAID by medical and nurse practitioners based on extensive consultations with key stakeholder organizations and regulatory bodies. It is intended to supplement, not circumvent, existing regulatory body requirements or institutional processes that have been implemented. The Knowledge Translation in Primary Care Initiative is aimed at developing and disseminating health information and clinical tools to support primary care providers. Its purpose is to improve engagement and enhance communication with primary care providers across Ontario and is a collaboration of the Ontario College of Family Physicians (OCFP) and the Nurse Practitioners’ Association of Ontario (NPAO) and the Centre for Effective Practice (CEP). Relevant Links:

  • Data to Decisions eBulletin #46: Using D2D for annual reporting

    Consider using D2D data for your QIP and annual operating plan: D2D 4.1 will be released in early 2017. You’ll be able to incorporate refreshed data from your new Primary Care Practice Report and use your updated results in your annual program and quality improvement plans. Keep an eye on this page for updates. Speaking of program planning, an updated Program Indicator Catalogue will be coming in January to help you select indicators for your Schedule A report that are more in line with evidence and what your peers are using. Check out the Catalogue and other resources here. Help for your patients with depression: Now that you can identify patients with depression in your EMR (thanks to the standardized query for depression), you may want to be part of a CAMH project to better manage depression and depressive symptoms. It builds on the STOP smoking cessation program that most AFHTO members are already part of. Check out what other teams are doing to get even better at all kinds of things. The AFHTO 2016 Bright Lights winners, poster and concurrent-session presentations are now posted, as are the abstracts from Health Quality Ontario’s 2016 Health Quality Transformation conference, and the winners of the 2016 Minister’s Medals and Honour Roll. There’s a good chance somebody was doing something that might work for you!

    Help spread the word about D2D – invite others to sign up for the eBulletin. 

  • RNAO funding Tobacco and Nicotine Intervention

    Request for Proposal: TNI Implementation Site Application 2016-2017

    The Registered Nurses’ Association of Ontario (RNAO) is requesting applications from interested and eligible health care organizations to become Tobacco and Nicotine Intervention (TNI) Implementation Sites. A letter of intent to apply is due on Nov 30th, 2016. Applications must be received by the RNAO before 4:00 pm EDT on Dec 16th, 2016. RNAO’s TNI Initiative builds on RNAO’s expertise in developing and supporting uptake of clinical best practice guidelines, a program launched in 1999 that has gained wide international adoption. The RNAO TNI Best Practice Initiative has been funded by the Ministry of Health and Long-Term Care since 2007. The purpose of the initiative is to build capacity among nurses and other health care professionals in Ontario to integrate TNI best practices into daily practice. The initiative’s multi-prong system approach recognizes the importance of the leadership role of health organizations, nurses and TNI Champions in supporting individuals and organizations to integrate TNI best practices at the individual, organizational and system levels. To learn more, please visit RNAO’s site.

  • Data to Decisions eBulletin #45: EMR data quality: even better than we were yesterday

    Are you getting the most out of your EMR? The EMR Progress Assessment (EPA) from OntarioMD will show you where you’re at and help you develop a plan to get where you want to be. NEW: QIDS Specialists can now access this tool. If your EMR could show you which patients had depression, how would you make their care even better? Our standardized, tested EMR query can get you started towards building a registry for patients with depression. When your EMR works for you, you can do even better for your patients. Having difficulty finding out who’s getting vaccinated outside your office? Want help sending vaccination records to Public Health? Read how FHT doctors and pharmacy owners collaborated to create a tool that addresses these and other data-sharing challenges. EVEN BETTER: The tool will also help you review your patients’ medications and ensure they get their colon check kits. EMR data quality saves lives AND wins awards! Powassan and Area FHT was awarded “poster of distinction” at HQT for their story about how EMR data quality saves lives. Other measurement highlights from the AFHTO conference: Watch the Bright Lights videos to see the great work happening in teams across the province to enhance care. Concurrent session, poster, and plenary presentations are also available on the AFHTO website. Submit your evaluation of the conference: AFHTO’s annual conference is the best learning and networking opportunity for people who work in and with primary care teams. Please help us to continue, and to continuously improve – if you didn’t fill in the form at the conference, please take a moment to do so now.

    Help spread the word about D2D – invite others to sign up for the eBulletin. 

  • QIDS Specialists access to the EMR Progress Assessment tool: An AFHTO & OntarioMD collaboration

    The OntarioMD/AFHTO EPA collaboration is a project designed to provide QIDS Specialists access to a customized version of the OntarioMD EMR Progress Assessment (EPA). The EPA can then be employed by physicians to assess their current and desired level of EMR maturity. The EPA helps identify areas of improvement and serves as a starting point for conversations about EMR optimization, both at the individual and practice level. The results of the EPA act as a benchmark from which physicians, QIDS Specialists and OntarioMD Practice Enhancement Consultants (PECs) can begin developing a plan to increase practice efficiency and clinical quality. members Objectives

    • Promote the EPA within your FHTs.
    • Assist physicians with EPA completion.
    • Promote EMR Practice Enhancement Program (EPEP) and PEC services.
    • Prepare to work collaboratively with PECs to assist with data capture work.
    • Help support and sustain change (i.e., tools, custom forms, stamps, macros, etc.).

    How to Get Access to the EPA

    Step 1 – Get a Sponsored Account

    • Identify a physician and approach them about becoming your sponsor.
    • Explain the EMR Progress Assessment (EPA) initiative and provide them with a copy of the Sponsored Accounts – Physician Guide.
    • Advise that OntarioMD will provide support throughout the Sponsored Account process.
    Step 2 – Create a Portal Account

    Step 3 – Register for the EPA Webinar

    • OntarioMD will host an online training session to discuss the EPA, the practice/physician engagement process, and answer any questions about this initiative.
    • Session dates will be announced as new accounts are created.
    Step 4 – Ask Questions

    See the attached guides for creating an OntarioMD sponsored account:

    Not sure how to get started? Find a Champion

    • Use your existing relationships within the practice to identify someone willing to complete and promote the EPA to the group (e.g. Executive Director, Lead MD, EMR Champion).

    Create Awareness

    • Educate the group about the benefits of the EPA.
    • Share the results of your EPA to raise awareness and inspire the group to complete their own.
    • Promote the OntarioMD EMR Practice Enhancement Program and Peer Leader Program as services which use the EPA as a starting point in their optimization work.

    Provide Support

    • Advise and re-assure the group that you can support their completion of the EPA (i.e., interpreting the clinical questions, rating EMR maturity, etc.).

    Engage OntarioMD

    • PECs are ready to work collaboratively with QIDS Specialists and the practice on EMR enhancement projects to bridge the gap between “Where I am Now” and “Where I Want to be Next”.

  • 2016 Poster Gallery

    Thank you to all of our poster presenters who came to the AFHTO 2016 conference. Posters were submitted by interprofessional health teams across the province. Like the concurrent session presentations, they represent the full breadth of professions within collaborative primary care and showcase evidence-based, impactful innovations that will be useful to other teams.

    2016 Posters Displays

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  • Data to Decisions eBulletin #44: Did you know you can print your D2D report?

    You can now print the D2D report – even if you didn’t contribute data! You can create a printed version of your team and peer group’s data from the interactive D2D web page. If you didn’t contribute data, you can still print out the performance of your preferred peer group for comparison. This makes it easier to share D2D with others. See a sample printout here. Need help with the interactive D2D web page? View the launch webinar from September 29th for more information about how to use the D2D platform. Calling all EDs: Please complete the D2D survey even if you didn’t contribute data. The survey results help spread the word about the progress AFHTO members are making to advance primary care . Check out the D2D booth at the AFHTO conference! Pick up a special treat, resources about D2D 4.0, tools to increase access to EMR data for improvement and tips to win exciting prizes in the D2D Scavenger Hunt. Health Quality Ontario releases Measuring Up 2016: The goal of Measuring Up is to provide data to drive accountability and improvement. This year’s report gives the broadest look at health care quality to date and points out areas the system can focus on for improvement. Preparing for your 2017-2018 Quality Improvement Plan (QIP)? Check out a recording of a webinar that Health Quality Ontario recently hosted to help primary care teams prepare for their upcoming QIPs. d2d-4_0-timeline-09-29-16

  • Webinar | Choosing Wisely and Patient Centredness: Mutually Exclusive?

    A Primary Care Perspective

    Tune in October 6th, 12PM ET to listen to Dr. Anthony Train (Calgary) and Dr. Kimberly Wintemute (Toronto) suggest communication strategies and practical tools that encourage the kind of shared decision-making in which patients come to understand that some tests and treatments do not add value to their care, and may potentially cause unexpected and/or unforeseen harms. The topics highlighted in this presentation will be based on the Choosing Wisely Canada Family Medicine list ‘5 Things Patients and Physicians Should Question,’  created by the College of Family Physicians of Canada and will include cases on: antibiotics, sedative hypnotics, imaging, and more.

    Join the webinar here.

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