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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

  1. Optimizing EMR Use: Merging Data, Managing Patients and More Tara Kiran, Sam Davie, Lisa Miller

  2. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Presenter disclosure • Presenters: Tara Kiran • Relationships with commercial interests: • Grants/Research support: None • Speakers bureau/honoraria: None • Consulting fees: None • Other: None

  3. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Presenter disclosure • Presenters: Sam Davie • Relationships with commercial interests: • Grants/Research support: None • Speakers bureau/honoraria: None • Consulting fees: None • Other: None

  4. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Presenter disclosure • Presenters: Lisa Miller • Relationships with commercial interests: • Grants/Research support: None • Speakers bureau/honoraria: None • Consulting fees: None • Other: None

  5. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Disclosure of commercial support • This program has received no financial or in-kind commercial support • There are no other potential commercial conflict(s) of interest

  6. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Mitigating potential bias • N/a

  7. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Learn how to… • 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

  8. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE St. Michael’s Hospital Academic FHT

  9. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Our challenge: measuring screening rates

  10. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE What is the CCO SAR?

  11. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE How do I access the CCO SAR? STEP 1: Help physicians get a OneID account

  12. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE How do I access the CCO SAR? Train your own Local Registration Agent!

  13. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE How do I access the CCO SAR? STEP 2: Help physicians appoint you as a delegate

  14. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE How do I access the CCO SAR? STEP 2: Help physicians appoint you as a delegate Help! 1-866-250-1554

  15. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE How do I access the CCO SAR? STEP 3: Integrate delegation into new MD orientation

  16. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE How do I access the CCO SAR? STEP 4: Sign in and download CCO SARs

  17. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE How accurate is the data in the CCO SAR? We found that… • Breast Cancer • Colorectal Cancer • Cervical Cancer

  18. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE How do I supplement CCO SAR cervical data? • Develop search for pap tests in the EMR • Search for unique identifier (i.e. OHIP #)

  19. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE How do I merge data? • Use software to merge based on unique identifier Pap Test in CCO SAR? Pap Test in EMR? No Yes No 3891 (30%) 1069 (8%) Yes 4118 (31%) 4077 (31%)

  20. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE What do I need to know who’s been screened? CCO EMR BOTH SAR

  21. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Question Do you analyze your QI measures with an equity lens? This could include: • Gender • Income • Immigration • Ethnicity • Many others…

  22. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE

  23. 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

  24. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE How do I look into equity in cancer screening? • Run EMR search for postal code • Get unique identifier • Obtain Postal Code Conversion File • Matches postal codes to neighbourhood income quintile

  25. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE What does the final dataset look like? OHIP # CCO SAR Data EMR Data EMR Postal Income Code Quintile 1234567 -Eligibility -Date of latest A1B 2C3 3 -Date of latest pap test test -Result of test

  26. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Our QI intervention Multifaceted intervention: • Reminder letters for patients

  27. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Our QI intervention Multifaceted intervention: • Physician audit & feedback

  28. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Our QI intervention Multifaceted intervention: • Enhanced point-of-care reminders

  29. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Results – overall screening rates SMHAFHT Cancer Screening Rates Over Time Mar, 2014 Nov, 2014 Mar, 2015 June, 2015 100% 80% Cancer Screening Rate 60% 40% 20% 60% 65% 70% 70% 56% 65% 65% 65% 59% 65% 65% 66% 0% Cervical* Breast Colorectal *Mar 2015 and later rates includes pap tests not captured in the EMR, previous rates did not

  30. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Results – variations in physicians’ screening rates

  31. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Results – equity SMHAFHT Cancer Screening Rates by Neighbourhood Income Quintile - June 30, 2015 Poorest Income Quintile 2 Income Quintile 3 Income Quintile 4 Richest 100% 80% Cancer Screening Rate 60% 40% 20% 67% 69% 69% 70% 72% 59% 61% 67% 65% 72% 63% 65% 67% 64% 74% 0% Cervical Breast Colorectal

  32. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Results – equity SMHAFHT Colorectal Screening Rates by Neighbourhood Income Quintile - June 30, 2015 Poorest Income Quintile 2 Income Quintile 3 Income Quintile 4 Richest 100% 80% Cancer Screening Rate 60% 40% 20% 63% 65% 67% 64% 74% 30% 29% 26% 26% 25% 40% 43% 48% 45% 56% 0% Colorectal FOBT Colonoscopy

  33. OPTIMIZING EMR USE: MERGING DATA, MANAGING PATIENTS AND MORE Key messages • 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

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