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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 - PowerPoint PPT Presentation
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Ambulatory/EMR update
Bryan Hinch MDAssociate 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– 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
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
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
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.
EMR
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
Where we are at now:
• Application and Build training completed• Building the ‘system’ to commence now (after
design workshop)– A 2 month project
Upcoming Dates
• This week Tue-Thurs: Design Workshop• Oct 29: MD track• 2/9/10: STI goes live• 5/2010: med subspec. Go live
EMR
• ACGME requirement to implement EMR
EMR: what it includes
• Documentation– Visits
• Templates• Dictation• Free text
– Phone notes/messaging• CPOE• E-prescribe– Ohio board of pharmacy regs– Medicare incentive
EMR: what it includes
• Lab review• Outside documentation
management/scanning
EMR hardware
• Glendale and Ruppert has computers in most rooms– Project team knows that they need upgrading,
there is some budget for this
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
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)
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.
Main Campus Collaborative
• COBA is evaluating workflows and helping with future state
• Research volunteers auditing STI charts for me• College of Pharmacy involvement
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
Clinical Alerts
• Can customize clinical alerts to include identifying patients who may qualify for research studies
Timeline
• Excel…
• Questions?
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