EMR planning, selection and implementation

Introduction

Electronic medical record (EMR) planning, selection and implementation is a major health information technology (IT) project that can serve as the stimulus for or as a resource to the development of a personal learning project (PLP). This planning guide has been developed to help you create one or more PLPs by leveraging your participation in planning, selection and implementation of an EMR.

About Personal Learning Projects

Self-learning occurs as you engage in learning activities where you are responsible for: 

• Identifying a need, goal or objective relevant to an aspect of your professional practice (including clinical, teaching, research or administrative practice). 
• Choosing how you want to learn. 
• Identifying the conclusion or outcome.

PLPs are self-planned learning activities developed to answer a question, issue or problem you have identified. Although the majority of the questions, issues or problems you develop are relevant to your role as a medical expert, PLPs can also address questions relevant to any CanMEDS role. However, evidence suggests that many questions are either not pursued (go unanswered)¹ or are not formulated well², making them difficult to answer.

The question or questions you identify help you create a learning plan that involves selecting relevant sources of information to assist you in reaching a conclusion. Common sources of information include scientific literature (for example, systematic reviews), practice guidelines, talking to experts or colleagues and participating in group learning activities. During EMR implementation, reports or documents that may inform a PLP include the assessments and reports you have prepared to help you with vendor selection and implementation.

The final part of the PLP is reflecting on what you learned or the changes you anticipate making and recording the process and conclusions in MAINPORT.

During EMR planning, selection and implementation, the lead physician may choose to consult experts in health IT change management, transition, privacy and implementation. The physician, as lead or as a clinic stakeholder, is involved in all or various stages of the process. Learning can be documented by process stage.

Before EMR Planning, Selection or Implementation

Step 1: Question development

Identify your stage of involvement and one or two questions you are working to answer. Example questions are provided by stage in Appendix A.

Question 1: _______________________________________________________

Question 2: _______________________________________________________

Step 2: Develop a Learning Plan

The learning plan could include activities such as:

• Reading reports made available to you by consultants. 
• Reading pre-circulated material. 
• Accessing other relevant resources.

Learning During EMR Planning, Selection or Implementation

The formal (meetings with consultants, reviewing your reports, clinic meetings) and informal (collegial discussions) activities are resources you can leverage to answer your question(s). Use the space below to record ideas or evidence that contributes to your learning during the activity.

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

After EMR Planning, Selection or Implementation

Step 3: Define the Learning Outcomes

Reflect what you have done and determine if: 

• You have learned enough to answer the question(s). 
• You need to modify your learning plan and continue learning by exploring additional resources.

The conclusions or outcomes you reach for your practice can include:

• Confirming your current knowledge, skills or practice. 
• Expanding your knowledge, skills, competencies or attitudes. 
• Changing some aspect of your practice. 
• Enhancing your performance or improving practice outcomes.

Documenting What You Learned

Step 4: Document your PLP in MAINPORT

Document the question(s) you pursued and the outcomes you reached in MAINPORT. When accessing MAINPORT using a computer or hand-held device, the documentation templates provide you with two options:

• Document as you learn—enter some information, save as incomplete and add to or revise what you have documented in the future. 
• Enter information in all mandatory fields once the PLP is complete and submit for credit.

In MAINPORT, the template to document each PLP is found in Section 2: Planned Learning. There are several mandatory and optional fields for each PLP.

Record Time Learning

Include the total time (using 15-minute increments) you spent identifying and developing the question(s), accessing and appraising resources, determining learning outcomes and recording the PLP in MAINPORT. Enter the total time and MAINPORT will do the calculations for you.

Example: 

• Developing a question and creating a learning plan – 15 minutes. 
• Reading pre-circulated material – 2 hours. 
• Attending the group learning session relevant to your question – 2 hours. 
• Reflecting on and identifying the conclusion for your practice – 15 minutes. 
• Recording the PLP in MAINPORT – 15 minutes.

Total Time = 4.75 hours which equates to 9.5 credits

Some Practical Suggestions

1. Record questions as you practice:
   Although raising and answering questions is a natural learning strategy for physicians, the majority of questions in a physician’s practice are not pursued. Recording questions as they occur helps you create a learning plan that addresses those issues most relevant to your practice. You can record the questions you have raised but do not have the time to pursue immediately in the MAINPORT “Holding Area.”
2. Each clinical question you develop is a reflection of a specific need you have defined. It is helpful to consider:
   Question content: Is your question intended to focus on: etiology, pathophysiology, clinical features, diagnosis, treatment or management options, prevention or prognosis?
   Question Domains: Have you described the population, the intervention or exposure, the comparison that should be considered or the outcome of interest?
3. The sources of evidence you select will depend in part on the urgency of the need to apply the evidence. For immediate application (for example, at the point of care), consider accessing summarized sources of evidence and/or seeking the advice of colleagues.

For more information on PLPs please contact the Royal College Services Centre at: 1.800.461.95989 or contact the CPD Educator in your province.

References

1. Gorman P., Helfand M. Information seeking in primary care: How physicians choose which clinical questions to pursue and which to leave unanswered. Medical Decision Making 1995,15:113-119.
2. Horsley T, O’Neill J,Campbell C. The quality of questions and use of resources in self-directed learning: Personal learning projects in the maintenance of certification. JCEHP. 29(2):91-97.

Appendix A - EMR Planning, Selection and Implementation Questions by Stage

As a family physician, you participate in a variety of activities that contribute to the maintenance and enhancement of your knowledge and skills. Learning surrounds you—from your daily interaction with patients to mentoring healthcare trainees and participating on medical committees.

Appreciating this, the College of Family Physicians of Canada (CFPC) has developed an innovative means for you to earn Mainpro-C credits at your own pace and at no additional cost. It involves an approach to answering questions through information appraisal and integration, rather than information acquisition—called Linking Learning to Practice (LLP).

What is Linking Learning to Practice?

LLP is a self-administered, semi-structured exercise. It challenges you to look at day-to-day activities as learning opportunities. The LLP submission form helps you identify a question and then guides you through a series of critical inquiry and practice reflection exercises on your way to answering the question.

Each completed Linking Learning to Practice exercise earns you two Mainpro-C credits and two bonus Mainpro-M1 credits.

What Types of Activities are Eligible?

The questions that form the foundation Linking Learning to Practice exercises can stem from a variety of clinical and non-clinical activities, such as:

Questions related to the application of health information technology, such as electronic medical record (EMR) adoption, are eligible. EMR planning, selection and implementation is a major health information technology (IT) project that can serve as a stimulus for or as a resource to the development of a linking learning to practice exercise.

The question or questions you identify help create a learning plan that involves selecting relevant sources of information to assist you in reaching a conclusion. Common sources of information include scientific literature (for example, systematic reviews), practice guidelines, talking to experts or colleagues and participating in group learning activities. During EMR implementation, reports or documents that may inform an LLP exercise include the assessments and reports you have prepared to help you with vendor selection and implementation.

The final part of the LLP exercise is reflecting on what you learned or the changes you anticipate making and the impact this will have on your practice.

During EMR planning, selection and implementation, the lead physician may choose to consult experts in health IT change management, transition, privacy and implementation. The physician as lead or as a clinic stakeholder is involved in all or various stages of the process. Learning can be documented by process stage.

See Appendix A for example practice questions related to EMRs.

How to start

Begin by downloading or reviewing the LLP practice submission form and familiarize yourself with the steps below. It will guide you through these steps:

• Identifying a specific question. 
• Locating the resources to address your question. 
• Analyzing the information and resources as they apply to your question. 
• Reflecting upon the process after a sufficient time period has elapsed.

Once these steps are complete, submit your form to the CFPC to claim your credits.

Visit http://www.cfpc.ca/Linking_Learning_to_Practice/ to download and submit the form.

Appendix A- EMR Planning, Selection and Implementation Questions by Phase

To assist you in identifying questions associated with the application of health information technology and specifically choosing, planning and preparing to implement an EMR, this appendix identifies potential questions by phase.

This self-assessment (complete document available as a PDF, left) can help you see how your electronic medical record (EMR) can improve your ability to care for patients, both as individuals and as populations with specific medical conditions. As your clinic uses more of your EMR's functionality, you will benefit from the power of your EMR.

This tool helps you assess your current EMR use and identify your goals for future use of the EMR.

It should take 15 to 25 minutes to complete the assessment. The assessment consists of three main areas:

•  Patient Care Processes
•  Clinic Operations Management
•  Population Care Processes

When you decide it is time for your clinic to transition to an electronic medical record (EMR) solution, you may have concerns about the technical abilities of physicians and clinic staff.

It is important to remember that basic computer skills can be learned quickly and effectively by most people, especially when learning takes place in an accommodating and helpful environment.

It will benefit your transition to an EMR if clinic physicians and staff are able to complete the following computer tasks successfully:

• Turn the computer on and off, use the computer Start menu, enter passwords and use the login function.
• Use a computer mouse.
• Be familiar with the keyboard layout and understand what the different keys can do.
• Use the Internet to find a website.
• Navigate Internet websites and be able to move back and forward through different screens.
• Save files in specific places and print them.
• Send email messages and attach files to email messages.
• Create, open, save and format word processing documents.

Learning new computer skills can feel overwhelming at first, but if you start slowly, it becomes easier with practice.

Resources for Beginners

Alberta Community Colleges

Across Alberta, local community colleges offer beginner courses in computer basics and or keyboarding. These courses provide participants the opportunity to become comfortable with the basic features of Microsoft Windows, MacIntosh (Macs), Microsoft Word and the Internet. Once you have learned the basics, additional courses are available in more advanced areas like the Microsoft Office Suite (Word, Excel, Outlook).

The following website provides a listing of universities and community colleges in Alberta: http://alis.alberta.ca/ec/ep/aas/post-secondary.html.

Online Guides

If someone can help you get onto the Internet, there are are resources that can help you understand computer basics on a personal computer (PC) or Mac.

• Computer Basics for Beginners (www.computerbasicsguide.com) – contains easy to read instructions for those needing to learn how to use a PC.
• Mac 101: Get started with the Mac (www.apple.com/support/mac101/) – will help you become familiar with using a Mac computer.
• PCs All-in-one For Dummies (www.dummies.com/how-to/content/pcs-allinone-for-dummies-cheat-sheet.html) – provides a general overview of using a PC for those new to computers.
• Computers for Seniors for Dummies (www.dummies.com/how-to/content/computers-for-seniors-for-dummies-cheat-sheet.html) – provides a general overview of computer use for seniors.
• Basic Tasks in Word 2010 (office.microsoft.com/en-us/word-help/basic-tasks-in-word-2010-HA101830016.aspx) – provides general instruction and a review of basic tasks in Microsoft Word 2010.

Public libraries

The Edmonton and Calgary public libraries have free courses and one-on-one coaching for library members who have no experience using computers. You can learn topics such as computer basics, using the Internet, using email and word processing.

Contact your local branch or see the following websites for further details:

• Edmonton Public Library (www.epl.ca)
• Calgary Public Library (calgarylibrary.ca)

A listing of Alberta public libraries is available at www.thealbertalibrary.ab.ca/about/members.html.

Touch Typing

Touch typing is a valuable skill for someone wishing to take full advantage of the keyboard. The following websites can help you learn to touch type:

• Learn Keyboard Typing (www.learnkeyboardtyping.com) – shows proper hand position and use of each finger.
• Typing Tutor (www-2.cs.cmu.edu/~rvirga/TypingTutor.html) – once you have learned proper positioning, this simple exercise will help to improve your touch typing skills.
• Mavis Beacon Typing (www.mavisbeacon.com) – programs are available for purchase online and also on CD and DVD.

Using a Computer Mouse

You will need to know how to use a computer mouse when you are using an EMR. It is easy to practice moving the cursor, and clicking and holding. An online game of Solitaire gives you practice using your mouse.

Play this game online at worldofsolitaire.com.

Advanced Training

National Seminars Training – Star 12

National Seminars offers webinars, live seminars and online learning resources. A membership at Star 12 will help someone who wants to bring their computer skills from the basic level to a proficient or advanced level. Topics include Microsoft Office Suite (Word, Excel, Outlook) and business seminars. This training is suitable for the clinic manager or business manager seeking to augment their skills and knowledge. For more information, see the National Seminars training website at www.nationalseminarstraining.com.

Books

Learning more about Microsoft Office tools is valuable for anyone using a computer. Books and reference guides provide good instruction on how to complete basic and advanced tasks. They are available at your local library or bookstore.