CRAJ Spring 2018

Spring 2018 (Volume 28, Number 1)

Integrating EMRs into Rheumatology Practices

By Vandana Ahluwalia, MD, FRCPC; and Sandra Couto, BSc, BSc Pharm

Physicians continue to implement electronic medical records (EMR) into their practice with the aim of improving the quality of care delivered and work flow efficiency. The integration of EMR solutions into clinical practices has been supported by several provincial agencies. In Ontario, OntarioMD was established to help community physicians select, implement and adopt EMRs.

EMRs continue to revolutionize patient care. Canada Health Infoway reports that 79% of Canadian specialists are currently using EMRs.¹ Rheumatology adoption is slightly lower at 70% with the majority of adoption in Ontario.

It was a daunting task when Ontario physicians were encouraged to transition to EMRs. The certified EMR platforms were created to support primary care physicians and were not fully prepared to support specialists’ needs. In the absence of essential tools and functionality for the rheumatology community, the Ontario Rheumatology Association (ORA) established an EMR subcommittee to identify the needs of the rheumatology community and implement rheumatology-specific tools within existing EMR platforms. The tools that were created included clinical documentation Smart forms (with embedded joint counters, disease activity calculators, PROs and labs), HAQ, BASDAI and BASFI questionnaires, and OBRI Registry Data collection forms.

These forms are available to rheumatologists in other provinces if they are using one of the Ontario specialty-specific EMR platforms (Accuro, Telus-PS or Oscar).

Many physicians report that EMRs have increased their workload, that they are doing more data entry, and that they feel more physician burnout due to increasing requirements for documentation. Some even say that the EMR has altered the physician-patient encounter by reducing eye contact and not sensing the patient’s body language. However, these challenges may be overcome by optimizing the office digital space and making the EMR part of routine practice in a way that enhances the patient-physician relationship. Rheumatologists have integrated kiosks to capture patient-reported outcomes in waiting rooms, and others have developed new EMR tools to facilitate documentation of patient care treatment plans that can be shared jointly with their patients. The ORA recently developed a customized Inflammatory Arthritis Care Plan to support patient self-management. The tool is being integrated into the Accuro EMR platform and will be piloted in a few Ontario rheumatology sites.

With the increased availability and adoption of EMR platforms, data is more readily available to users than ever before. Patients are accessing their personal healthcare information more easily–they can look up their blood work results online, engage in virtual visits through rheumatology telehealth, and in some areas, book their own appointments. Physicians can record and organize key clinical information, they can retrieve and edit it more easily, and with the emergence of individual dashboards, display and interpret data during patient encounters to help them make informed decisions that deliver improved patient care. To support this, the Arthritis Alliance of Canada² has developed a standardized rheumatology core dataset to be used in the EMR. With standardized data collection, measurement of comparative outcomes across users can be easily performed and collectively shared.

Figure 1: Increasing use of EMRs by Ontario community rheumatologists: 2010 to 2016.

Dr. Vandana Ahluwalia, former Corporate Chief of Rheumatology,
William Osler Health System, Brampton, ON

Ms. Sandra Couto, OBRI, Director Partnerships & Stakeholder Relations,
Toronto General Hospital Research Institute, Toronto, ON

References:

1. Canada Health Infoway. Canadian Medical Association (CMA) 2017 Workforce Survey Results. Available at infocentral.infoway-inforoute.ca/en/news-events/infocentral-news/3400-cma-workforce-survey-2017. Accessed March 12, 2018.

2. Development of a Canadian Core Clinical Dataset to Support High-quality Care for Canadian Patients with Rheumatoid Arthritis. J Rheumatol 2017; 44;1813-22.