Thursday, October 30, 2008  EMR not Affected by Merger

The mid-October merger of Allscripts with Misys Healthcare will not in any way slow the pace of the on-schedule departmental phase-in of JUP’s EMR.

While the new company will retain the Allscripts brand name to reinforce a seamless market presence, the merger resulted in a substantially increased  client base that includes150,000 physicians, 700 hospitals, and 6,000 post-acute facilities and homecare agencies.

JUP EMR project management views the Allscripts merger as good news. “Anytime you work with a vendor who has insights from a broad base of physicians that presents an opportunity for clients to benefit from the product development that this representation provides” said Dr. George Valko, Gustave and Valla Amsterdam Associate Professor of Family Medicine and Physician Advocate of JUP’s EMR Team.

Describing his vision of how his company can make a positive impact on healthcare, AllscriptsMisys Chief Executive Officer Glen Tullman said, “You have our commitment to drive safe and secure sharing of information . . . interoperability with every healthcare stakeholder . . . between physicians, their patients, pharmacies, labs, hospitals, long-term care and home health providers, as well as between our own products and even our competitors. This has to happen to improve healthcare and we will lead the way in ensuring that it does.”


Monday, October 20, 2008  Physician Incentives

The Medicare Improvements for Patients and Providers Act (MIPPA), signed into law on July, includes incentives for physicians who adopt and utilize electronic prescriptions. Incentives take effect January 1, 2009. JUP physicians who use the e-Prescribing module will be among the first in the nation to benefit.

In the first four months since e-Prescribing launched to all physicians and providers in Otolaryngology and Family and Community Medicine, more than 11,000 prescriptions have been transmitted electronically to patient pharmacies.

While the details of how the incentives will be earned and enforced are yet to be finalized, the Centers for Medicare & Medicaid Services (CMS) describes the new e-prescribing program as similar to the Physician Quality Reporting Initiative (PQRI) in that it will improve care and pay more for quality care.

The bonus breakdown fro physicians using e-Prescribing will be 2% in 2009 and 2010. From 2011 through 2014, MIPPA has proposed that physicians who use e-Prescribe will be kept whole in their Medicare rates; all others will see a gradual discount in their Medicare rates for each of those years.

Monday, October 13, 2008  Scanning Squad

Just as EMR rollout momentum has swelled, so have patient charts in departments that are not yet live on Allscripts®. That’s why JUP is bridging the gap between its initial scan of more than 6 million pages of patient medical records and the current patient record-scanning needs of its pre-live departments. The EMR Team has contracted with a scanning vendor and created a specialized task force, dubbed the “Scanning Squad,” to manage the process in order to ensure that the current brisk pace of EMR phase-in is maintained.

Pre-live practices, starting with the Division of Internal Medicine, can expect to work with the Scanning Squad during the process of patient document culling and scanning. The EMR Team scoped workflow and vendor needs in accordance with department phase-ins and expects a mid-2009 conclusion.

Monday, October 06, 2008  Super Users

Every department will have them -- and while they don’t wear red capes Super Users have already begun performing good deeds in JUP’s growing EMR user community where they reinforce software training, share user tips, and monitor the pulse of new users as they progress in EMR skills. “Super Users give us invaluable insights as their departments’ physicians and staff learn how to routinely use each EMR module,” said Dr. George Valko, Gustave and Valla Amsterdam Associate Professor of Family Medicine and Physician Advocate of JUP’s EMR Team.

Monday, September 29, 2008  EMR Pace Accelerates

JUP’s Beta Testers are the energetic pacesetters for EMR software training and phase-in. The Departments of Otolaryngology and Family and Community Medicine, representing both ends of the clinical spectrum, partnered with JUP in early 2008 to provide real-world learning labs for the testing and phase-in of Allscripts® EMR. Today the 300 physicians, staff and medical students who work in these two departments have integrated View, Tasking, e-Prescribing, Scanning and Note into their paperless chart routines; and their physicians have electronically transmitted more than 11,000 prescriptions to patient pharmacies. In addition, Family Medicine is trialing the Order module with 6 providers using it to order x-rays and lab tests; and staff using it to complete point-of-care orders.

EMR in View for Hospital-based Practices

Five hospital-based practices now have the ability to access EMR’s View module. Empowered with JUP-customized Allscripts® software, physicians and staffs in the Departments of Anesthesiology, Radiation Oncology, Radiology, Pathology, and Emergency Medicine will be able to view patients’ records without having to place phone calls or fax documents.

EMR Soon to Deliver in OB/GYN

Recent EMR developments in the Department of Obstetrics and Gynecology herald its near-term delivery with the identification and training of the department’s Super Users; the delivery, configuration and placement of equipment; and the culling and scanning of key documents in patient charts. JUP manages these three foundational activities as a pre-live activity before a department’s EMR phase-in begins. OB/GYN’s View module training and phase-in is anticipated at the end of October.

Friday, August 01, 2008  Family Medicine Reports

New information-sharing paradigms that directly benefit patient care are emerging as the largest modular phase-in of EMR continues in Family Medicine, one of JUP’s Beta Test departments since January. While the entire department has access to either one or two EMR modules, eight of the department’s 67 physicians consistently use e-Prescribing in addition to View and Data Entry. The department’s “early adopters” are reporting improvements in clinical-setting performance efficiencies that directly enhance the patient experience -- and one of them, Dr. Richard Wender, chairman of the Department of Family & Community Medicine, is eager to realize even more patient advantages as the three EMR modules are integrated into the clinical routine for all of the department’s practitioners.

Putting Patient Information Together Faster, Before the Exam

“I am always seeing someone else’s patient,” said Dr. Christine Jerpbak, whose practice schedule is four hours per day, three days a week. “EMR helps me put patient information together faster and more efficiently. For example, I might see that the patient saw a family practitioner three weeks ago for something related to today’s visit. I can very quickly see the other physician’s consult notes and treatment plan along with any test results,” said Dr. Jerpbak. She not only credits EMR as helping her to quickly review a patient’s medical history, but also to see what appointments have been scheduled. “A patient came in for a check up and a complaint of knee pain. I saw she had recently had an x-ray and scheduled an appointment to see a rheumatologist in six weeks. During her exam, I reviewed that x-ray, diagnosed arthritis and prescribed a course of treatment for pain. The patient didn’t have to wait six weeks to find out about her arthritis,” said Dr. Jerpbak. “In reviewing another patient’s record before she walked in the [exam room] door, I saw she had a blood test that morning. She was really impressed that I was able to immediately review the lab results with her.

Improving Patient Safety

Noting the large number of medications taken by some patients, Dr. Victor Diaz, the department’s assistant medical director, appreciates the patient safety benefits of EMR’s e-Prescribe module. “Our medical assistants entered all of our patients’ medications into their EMRs so we could view them electronically,” said Dr. Diaz. “EMR helps me check that two doctors aren’t prescribing the same type of medication and it provides a double check against interactions between medications.” In addition, he described EMR’s database of medications as “an additional tool that can help expand a practitioner’s knowledge about the available medications that can be used to treat a condition.”

“The ability to have greater clarity on patient medication is hugely important,” said Dr. Wender who now provides his patients with a print out of their current medications at the end of each office visit. Dr. Wender also noted that in addition to medications, Family Medicine enters into EMR current data about each patient’s alcohol, tobacco, allergies, and family history.

Indirect Physician-to-Physician Communication

“Patients aren’t always the best historians,” said Dr. Diaz who uses EMR to quickly and easily refer to progress notes and recommendations from specialists as treats his patients. “The fact that we [physicians] can actually communicate between departments is going to be huge as the rollout of EMR continues.”

Dr. Wender recently treated a patient who discussed a recent operation but was unable to express herself clearly about what the surgeon had found. While in the exam room “I was able to bring up the op note and then see exactly what she was talking about,” said Dr. Wender.

Dr. Jerpbak said, “EMR is a great way for physicians to indirectly communicate [with each other] about a patient.”  She noted that Jefferson medical students, who have view-only access to EMR “catch on very fast. They can look at the EMR beforehand and go into the exam room with more knowledge about the patient who is walking in the door.”

Improving Efficiency in Clinical Practice

Even at this early stage of rollout, EMR is bringing many time efficiencies into Family Medicine’s practices. Automatic reminders appear as practitioners enter data into patient records; and personalized ‘favorites’ menu allows them to see the list of medicines they most frequently prescribe for a diagnosis. EMR is also used at the front desk by staff members who enter the arrival time of each patient. As a result, any physician or staff member can look on their computer to see the number and names of patients currently in the waiting room.

Apart from these practice-benefitting features Dr. Diaz said, “I love the fact that I can prescribe through EMR. I can go from the patient’s list of medications and reformat them as prescriptions and send them electronically to the patient’s pharmacy. It’s fantastic when I send off a prescription and [at the end of the exam] the patient asks, ‘where’s my script?”” Practitioners find that e-Prescribing is not only time efficient for new prescriptions, but also that refills can be ordered with one click.

“Most delightful of all, with EMR we never have an office visit where we have to look for a chart,” said Dr. Wender. As a result, the time physicians spend with patients is more productive because of EMR. Echoing this sentiment, Dr. Jerpbak said, “In the past, I had to leave the exam room to look something up or find a chart or get some correspondence or ask someone to find something. Now, I have all the information I need and don’t have to leave the exam room when I’m with a patient. It’s wonderful.”

Department Goal:  100% Trained, Uniformity of Use

As of July, three EMR modules, View, Data Entry and e-Prescribing, are in various levels of use by Family Medicine. The department is now focused on having every physician and nurse practitioner trained and using the modules uniformly. “We want everyone following our work flow plan for EMR: every time, every patient.” said Dr. Wender who stressed training as paramount to success. “We’re getting [individualized] help for those people who may not be as technology-minded as others. We know they don’t want to slow down their schedules [during their learning curves].”

Dr. James Studdiford benefitted from classroom and one-on-one training to learn the first two modules of EMR, is in the process of learning e-Prescribing, and has already registered to learn Tasking, the department’s next-scheduled module. Describing his introduction to EMR, Dr. Studdiford said, “It was a quantum leap. It took me a while to get a feel for it, but I caught on to its method of thinking and categorizing. Once I saw the potential and understood the simplicity of entering the patient history and medications, I got a kick out of using it.” Dr. Studdiford anticipates he will take advantage of EMR tutoring after his classroom training as new modules are added.

After using two EMR modules for several months, Dr. Studdiford moved to a practice that uses only one -- a “view-only” environment. “It was an adjustment but I got over it pretty quickly,” said Dr. Studdiford. Looking forward to the department’s expansion of EMR use he said, “EMR is here to stay. It’s part and parcel of where medicine is going in 50 states. I don’t want to be left out of the loop.”

Tuesday, May 27, 2008  EMR Module to Recognize Speech

Shortly after the Beta launch, JUP learned that Dr. Christopher Skidmore, an instructor in the Department of Neurology, was already a user of software that is planned to be a module of JUP's EMR: DragonTM NaturallySpeaking®. An off-the-shelf speech recognition program, Dragon is used for medical transcriptions. Dr. Skidmore uses Dragon in combination with Microsoft® Word and a Dictaphone plugged into his computer's USB port.

As a Dragon user, Dr. Skidmore describes himself as now being self sufficient in his ability to dictate and transcribe his own patient notes without the need for, or an expense of, hiring an outside medical transcription service. According to Dr. Skidmore, "I can record directly into my computer and the software instantly transcribes my words while I'm watching the screen, or I can use my Dictaphone to record, and later plug it into my computer and it transcribes automatically." Dr. Skidmore believes that the Dragon software module will add value to JUP's EMR.

Monday, May 19, 2008  JUP Rolls Out Newest EMR Version

Across the nation, healthcare networks currently using TouchWorks™ EMR are in the process of upgrading to its newest version which is the one being introduced by JUP. By selecting the most comprehensive application level of TouchWorks™ EMR, JUP has eliminated the need to implement an upgrade soon after its introduction. This means that JUP is not only pioneering the new software’s clinical customization, but also best practices for its training and launch. This serves to underscore why the aggressive Alpha Test with Department of Otolaryngology was so vital to JUP. Among the many lessons learned is that EMR modules need to be phased in to real-world clinical use – and JUP’s subsequent Beta Test is proving this to be the right approach.

First Look at EMR Reveals Immediate Benefits to Physicians

Physicians new to EMR will understand its benefits the first time they view a patient’s file. All medical information including test reports are literally at their fingertips. Physicians no longer have to leave their patients during office visits to hunt for test results.
Physicians and staff have been introduced to EMR in a “view only” mode, which provides them with access to a patient’s medical history and all test results -- even if the patient has 20-30 years of recorded medical history. All JUP patients’ data from TJUH labs, imaging, op notes, discharge summaries, etc. are now flowing into the EMR.

Monday, May 12, 2008  Beta Test Rolls Out

EMR Beta Testing launched in April as a phased-in module approach in two departments representing each end of the clinical setting spectrum: Otolaryngology and Family Medicine. Both departments partnered with JUP to phase in the first two EMR modules, View and Data Entry. Significantly, at the time of its EMR introduction, Family Medicine experienced and successfully managed historic levels of patient volume. Six weeks after the Beta launch both departments’ added a new EMR module, with each department trialing a different one.

Family Medicine Integrates ‘e-Prescribing’

Family Medicine, a department of 65 physicians, is phasing in e-Prescribing, the EMR module that electronically sends prescriptions to patient-selected pharmacies. In addition to reducing paperwork, e-Prescribing saves time. Prescriptions written during a patient’s office visit are electronically transmitted to the pharmacy with the push of a button. To date, eight physicians have integrated e-Prescribing into their practices. Several of their patients have reported that they have picked up their prescriptions on the way home from their office visits. After all Family Medicine clinicians have phased in e-Prescribing, their next phase of the Beta Test will add a fourth module, Tasking, which is currently in testing by the Department of Otolaryngology.

Otolaryngology Trials ‘Tasking’

The Department of Otolaryngology is currently phasing in Tasking, the EMR module used by staff to forward inbound patient and physician telephone calls to the appropriate department or practice team member. Tasking benefits practice management by automatically tracking the call assignment and facilitates patient recordkeeping as team members input their informational or activity response to the inbound call. Two Otolaryngologists currently use and provide feedback to JUP on Tasking. The other seven will phase it in over coming months.

Productive Feedback on EMR

Departmental feedback to JUP has been positive regarding their phasing in of three EMR modules. Training for each module takes on average about 2 hours depending on the subject matter. Depending upon the EMR module topic, physician and staff training is delivered either online or in a classroom setting and the training approach matched to the student. If dual training methodology is available, Productive use in a clinical setting of the new EMR module is immediate.

Monday, May 05, 2008  Alpha Test Results In

April’s EMR Alpha Test set an aggressive goal: quickly uncover the glitches that inherently exist in new software introduced to clinical settings. Volunteering for JUP’s two-week EMR Alpha Test, the Department of Otolaryngology, which daily sees 350-550 patients, trained on the software before simultaneously launching all eight modules.

As EMR software was tested so were patience levels of Otolaryngologists, yet practice productivity was maintained despite the challenges of rigorous application testing. Their software scrutiny and professional stamina resulted in a successful Alpha Test because the department effectively pinpointed 40 critical areas of needed improvement to the EMR software. The constructive criticism provided vital information that JUP and its vendor used to create EMR software refinements. Improved as a result, EMR is now in its Beta Test phase and is used in daily practice by the Department of Otolaryngology.

Monday, April 07, 2008  Website Getting a New Look

The JUP Electronic Medical Record Website is getting a new and exciting make-over. The new site will help you keep track of the EMR Project with Updates, Events and Articles.