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A podcast that brings together primary care providers, healthcare planners, patients, innovators and others to talk about the changes that are happening in primary care in British Columbia.
Morgan: you wanna know some ways
to better coordinate care for
complex patients in your practice?
Do you have specific questions
about how to use an EMR in your team
Sarah: Yeah, me too.
Morgan: Okay, so this is an
EMR in primary care teams.
Ask me anything.
Uh, and I'm happy to say that Sarah's
joined me again for this episode.
Sarah: Everybody missed me.
Right?
It's great to be, uh, back
in the recording booth.
Morgan: It's great to
have you co-hosting again.
How's, uh, season five been?
Sarah: Oh, I'm so excited about it.
So, season five roll call, , is focused
on roles in, in primary care teams,
and we've been going out, , with
members of the ISU team and we've
interviewed, over 25, different folks
and different roles across teams.
And we're really weaving together some
great stories , to do a little bit of
a deep dive, , into how this is all.
Morgan: And season five is coming up
pretty soon, but before then, You've
got some questions for me about
EMRs, uh, that the audience also has.
Sarah: I do like, I, I'm at
the, what does EMR stand for?
Kind of level electronic medical record.
Right?
Um, so in this episode, I'm gonna put you
in the hot seat, Morgan and I have some
Morgan: Perfect.
, let's go.
No promises on how many I'll get through,
uh, but if this structure works, let
us know and, and we'll do it again, and
I'll do my best to answer the question.
Sarah: And if you're listening
and you have questions, you could
send them in and then I could ask
them and pretend they're mine.
/ So first question, when care
planning should teams meet together
or just add to an EMR note?
Morgan: Okay, so that's a,
that's a great question and
the answer is yes or, or both.
And, Or it depends if
you wanna be academic.
So it, it really depends on
the team and the patient.
Let me go, go into, really
answer the question.
I think that kind of like meeting together
and doing a case conference is great
for complex patients where you need to
get on the same page together and then
document it so that real time synchronous
conversation is really important.
Not doing that and just putting stuff
in an emr, I think for a larger team
or a distributed part-time, That
sometimes is, is necessary because
you can't get everybody together.
It's also good when you're updating a care
plan, so you don't need to pull everybody
together for a, a minor update to a care
plan, but something maybe is happening.
You wanna make sure that's, documented,
add it , to the chart, , in the care
plan section of your emr if you, if
you're lucky enough to have that.
And I think the, so the last
thing I'm gonna add here.
There's a sort of a third step,
which would be not just adding
a note, but flagging it for
the people who need to know.
So messaging people so
they can coordinate.
So we're all on the same page.
Sarah: Great.
So the first answer is both,
. So, second question, what if our team
members have to use different EMRs?
Should we fax and scan?
Morgan: Okay.
No.
Gosh no.
Like it's 2023 and we, we
shouldn't be planning to fax.
I know it's easy and it's right there,
but it's not a great, great option.
I think better way to do
this is to change our policy.
Rather than trying to work around it,
uh, especially if we're doing a strategy
that is around team Ace primary care.
So Sarah, I think that, you know, if
people do have to use different EMRs
for any given patient, decide where
the, where the primary record is and,
and try to get everybody to use that.
And then if you have to double enter
or upload, then do it in the other.
And ideally it's actually just a
little bit of double data entry
as opposed to a fax and scan.
I mean, you wanna minimize your double
data entry too, over documenting is,
is that quick road to burnout and
we, we hear it all over the place.
So, I'm not saying write your
full note twice, but if all you're
doing is faxing and scanning in
documents, people aren't gonna.
They won't know to look for them
in the chart because they're
probably in a different spot.
putting a little brief note into the
secondary chart, but ideally, you've,
you've said, let's change our policy
and let's write together in one.
Even if it means I have to learn two
different EMRs because I connected to two
different teams, you know, that's better.
I think for patient care
than the fax and scan.
So I, this one's and maybe I'm averaging
yes once, cuz the last one was both.
This one is, is a hard no for me.
Don't fax and scan if you can help it.
Sarah: So third question, what
templates should our team use?
Morgan: this one is hard too
because it depends on your patients.
what I think is if you are not using
a lot of templates, if you don't know
what a template is, maybe your EMR has
something with a different name to it, A
form or an e formm or something like that.
These are structured or semi-structured
pages that you can use for certain
topics if you're not used to using.
Don't get super keen and try to
use them for everything all at
once you're gonna burn yourself
out of like, which ones do we pick?
Or are we using the right ones together?
I'm using this one for diabetes.
You're using that one for diabetes.
So just pick a few.
And I think that, it depends
on the population of patients.
I probably wouldn't pick diabetes as the
first one to recommend in our practice,
but, A mental health or, um, you know,
an opioid, therapy or HIV Hep C, those
might be ones we would jump on earlier.
care plans, which we just talked about,
I think that's another one that is a good
common one that people could look at.
You don't use them all the time,
but they give you enough structure.
The other area to think about is where are
you going to be, sharing care across a.
Are you gonna be sharing
care for the sore throat?
Probably not, cuz it's just a, you know,
it's most often a single visit, but
you're probably gonna be sharing care
for diabetes or congestive heart failure,
or maybe you've got a social worker in
the team and so you're gonna be thinking
about mental health and behavioral health.
if it's a nurse that's gonna do
wound care or o a t as I mentioned,
the opioid agonist therapy.
So pick one of those areas that
you're gonna do shared care
because the template center really.
Because that provides a shared structure,
a common management that is really,
a way to start building that, that
continuity of management across the team.
And then just to think about
it, uh, in a different way.
what makes you work faster
and better as a team?
you know, when I was younger, I used
to only think about how do I work
better, improve my quality, but I think
we can all take back a bit of time,
and we've talked about this before.
Areas where you might get faster.
So pick templates, it'll speed things up,
and sometimes that's like standardized
notes to hand to the patient, or simple
update note templates for messaging or
case conferencing or things like that.
and then ways of sharing
information with patients.
So there's a whole bunch of
ways that you could streamline
your work through templates.
And that's the other
way to think about it.
So there's the shared care avenue and then
there's the, uh, making things faster.
Hopefully that makes sense.
Sarah: Right.
Yeah, it does.
So, What about the question of, you
know, how can I work better with
a certain role when we think about
using the electronic medical record?
Morgan: Well, I think your whole season
five is gonna talk about different
roles and how to work better together.
but focusing just on the EMR part, EMR is
a tool that helps people work together.
Once they know how they
wanna work together.
that's the first step.
And then, after that is there a template
that you could use as part of that
work would be a reasonable next step.
So if you are thinking about, this
is how we want to approach congestive
heart failure care together, make sure
that the process in the EMR matches.
So it could be that
there's how you divide.
The work and then have it documented in
a way that's divided up the same way.
Pharmacists and med reviews
is a good example too.
ha.
Make sure that there's that, feature
in your EMR for pharmacists to use
or a common place to document it.
for mental health workers
and social workers.
Maybe it's splitting things out
for assessing depression and.
Embedding different, templates and
tools into one section that they're
going to use, and then being able to
access that, as a primary care provider.
But there's that consistent,
sharing of care and, and the
roles and responsibilities, for
general chronic disease management,
splitting up the development of
the plan and the follow up visits.
That's another easy way to go, but
there's definitely more, more conversation
about working with different roles.
And then the next.
Sarah: Right.
So next question.
if our EMR is a chart, um, and we
use it for documenting and reviewing.
How can it help with teamwork?
Morgan: So Sarah, this is more a question
about the chart as a place just to write
notes As opposed to part of the team?
Is that kind of the,
Sarah: Yeah.
Yeah.
Morgan: so first I think
it's common ground.
I think everybody having access to
the same information about patients is
a way that naturally builds up team.
And if you think about it on the flip
side, if you fragment that access,
then you're fragmenting the team.
That pharmacist at the community, uh,
pharmacy doesn't have access to the emr.
They don't know the same
stuff that you know.
the nurse in home care doesn't know
the same stuff that you know, so
therefore it's harder to work together.
EMRs have things like communication,
messaging, coordination for
tasks and things like that.
So there's all of those parts I think
are also ways of, of building the,
the better workflow across the team.
that.
the proactive care planning as
well at at a population level.
It's not the only thing though.
I think, you know, messaging and things
like that are important, but it's not
the only way to build, build up a team.
Of course.
Sarah: Right.
But one aspect that you
can kind of leverage, so.
What are some strategies for using
EMRs to facilitate shared decision
making with patients and involve them
more actively in their care plans?
Morgan: I like this question.
so EMR side, you've gotta have some time
to be able to work with your patients and
that's where I think that the team has a
different capacity to engage patients in
it and, and different ways of engaging.
So there's that part of it.
If you haven't been sharing your.
With patients, you should do that.
That's a huge change.
Just, just turning the monitor
in an inpatient encounter.
showing graphs, printing those graphs.
If, if you're can do it in person
or sharing screen and showing graphs
of, where things are going, which
way is the blood pressure going?
Which way is your diabetes going?
What happened when this meg got started?
Talking through some of those,
those things is one way to
actively engage patients.
If you write your notes with the
intention of sharing them, not only
does it change how you write, but
then you also get to share them.
And that is, is a really, uh,
valuable way for patients to see,
uh, how much they're engaged.
And if you print out a graph where you
print out anything, I say scribble on it.
Uh, highlight something.
Um, uh, circle something that's
important for the patient and share it.
That personal touch that goes
a long way to having a patient
feel connected with their plan.
Sarah: Yeah, I still remember the first
time that my primary care provider kind
of automated their office and, and did
that share screen thing with me, and
I saw my record for the first time.
And, uh, it was really impressive.
And, and I don't wanna say that
it made me believe them more,
but I think it totally did.
I was like, oh, yeah, you can see.
I see.
Now
Morgan: I remember, 20 years ago or
something, going to a place where
somebody was using an electronic record
and they had this big screen in front
of them and literally the patient could
only see the eyes of the provider.
Sarah: I
Morgan: So it was, it was a physical
barrier to connecting with the patient.
And the actual best way to do it
is to have it as a triangle where
the EMR is a partner, and then you
can both be looking at the screen.
Sarah: So how can primary care
teams use EMRs to enhance care
coordination with external healthcare
providers like specialists,
hospitals, and community services?
This.
Morgan: So this would be somebody
who's not necessarily like,
who's not on your team, right?
They're, they're part of the patient's
circle of care, but not on your team.
And they're never gonna
get access to the record.
I think, you know, sharing,
sharing some key notes as you go.
As a primary care provider,
what I found helpful
when I start charting, I actually
start with the idea that that
note is gonna get shared.
So that's gonna go to the psychiatrist.
And I'll let my patient know, you know,
if that's what we're talking about.
But that way as I start to write,
I add just enough context and that
then really helps the other person
as opposed to then having to sit down
afterwards do your doctor, just as a
let you know, I saw this and I have to
write a whole separate note for them.
Or I scribble something that's not leg.
This is kind of a two birds
with one stone kind of approach.
And I think that works well for home
care, that works well for specialists
and other community services.
and it doesn't take that much extra time.
And then you can just send
off, I was just gonna say fax.
You could fax off, um, that one page note.
And then the other thing that I'm gonna
kind of cheat on this question is if
you have close clinical collaborators
who aren't part of the team.
that I think is so valuable if you
got the space, is to do inReach.
Get them to come into your clinic and
work with you, even if it's like a half
day every month or every once in a while.
And then get them to use your emr.
And that way they can soak in some
of the notes about the patient, uh,
that they're gonna see that day.
And if they're open to that, that's
a really great way of also building
that, relationship So, kind of a
cheaty answer to your question.
Sarah: Okay, so you've convinced me
the EMR isn't just an electronic thing
that you can use to keep records.
It really can sort of support,
the teamwork side of things,
Morgan: think so.
Sarah: but, well, that's, that's
all the questions that I've got.
But you've changed my mind.
Morgan: Okay, well that wasn't so bad.
Only six hours of um, me rambling on.
I mean, that's not all you've got
though, cuz you're a season producer for
season five it's coming up pretty soon.
Sarah: And I already said how cool
it's gonna be, but it really is.
, , I'm very excited about,
uh, about this season.
And, and, you know, the best thing
is, is we finally have had the
opportunity to go out and speak with
all the different people who we've
been wanting to talk to for so long.
Right.
, so, so many good stories to.
Morgan: I'm looking forward to it.
We've been prepping some of the episodes
I think that this episode's gonna wrap up
our mini season four on technology for.
And, uh, we're gonna start off, uh,
season five, uh, in the next couple weeks.
Sarah: And, you know, this was fun.
I liked the Morgan in the
hot seat, kind of model.
So if you do have more
questions, please email us.
this, this is great.
So our email address again
is issu family med.ubc.ca.