Advances that will generate
buzz in the EMR universe

e Renewal

This spring, we kicked off the activation process for the electronic renewal service. More than 600 doctors at 70 clinics and over 150 pharmacies are already using it. As with any new technology, however, questions and technical hitches emerge along the way. We worked with the Collège des médecins du Québec and the Ordre des pharmaciens du Québec to make sure we could give users valid answers to their questions.

Most of the questions dealt with the following points:

• Collaboration between the pharmacy and the clinic: Who approaches whom? And how do they go about it?
• Is the DSQ confidential and secure?
• Physician’s electronic signature in the DSQ: Does it replace the image of a signature on a copy?

Initially, only pharmacies that use a compatible pharmacy management software can be connected. We are therefore starting with KinLogix and Medesync for clinics, and then AssystRX, UBIK and xDRx for the pharmacies. We expect to be offering the service to other EMRs and other pharmacy banners (Jean Coutu and Familiprix) as quickly as possible. Most of the clinics initially activated had an edge, because their patients’ pharmacies were using compatible software, such as AssystRX, UBIK and xDRx. They were activated quickly as a result.

Many clinics want to be able to communicate with pharmacies electronically and have asked for advice on the approach they should use. As the service is collaborative, the pharmacist and doctors should meet and discuss the matter informally. Pharmacists using pharmacy software that is compatible with e renewal can sign up for the service simply by contacting their account manager. They will be connected to the system quickly.

In Quebec, the DSQ is the only available way to ensure secure, confidential communication between doctors and pharmacists. This has been confirmed by the various regulations adopted in recent years by the Collège des médecins and Ordre des pharmaciens.

You can consult the Collège des médecins publication:

“The use of the Québec Health Record (QHR) (Dossier Santé Québec – DSQ), which allows prescriptions for medications to be shared electronically, satisfies these requirements and those in the Regulation. [. . .] Thus, both the entry and the retrieval of the prescription are done in a secure environment that allows the sender and the recipient to be unequivocally identified while maintaining the confidentiality and the original nature of the communication.”¹

¹ Dossier médical électronique et transmission des ordonnances, by the Direction des enquêtes, Collège des médecins du Québec, February 18, 2018

The electronic signature is the key to the system, as it secures the communication. The Ordre des pharmaciens du Québec provides a definition in the FAQ section of its website [translation]:²:

The e Renewal project addresses a broadly expressed desire to decrease faxing at both clinics and pharmacies. It is an exciting project that we hope will win growing interest in Quebec’s community of doctors and physicians, and will ultimately benefit the patient, the person we’re all working for.

Pharmacogenomics

Pharmacogenomics studies how a person’s genome influences the effect of the medications administered.

A lot of research has been done in this field in the last 10 years, and we have a better understanding of how over 150 drugs affect a patient's body depending on the person’s own genetic profile.

Some drug monographs even contain recommendations in that vein. Pharmacogenomics should help us tweak our patients’ treatment. Drug interactions have been the subject of many a study, but another factor is gene-drug interactions, about which some significant evidentiary data has come to the fore. Pharmacogenomics should not be confused with predictive medicine or evolutionary medicine. A lot more research is required before they can be broadly implemented in a readily usable way, and some ethical issues remain to be dealt with.

The application of genetics involves the use of genetic profiles. A pharmacogenomic profile only deals with a small portion of a patient's genome. It must still be stored in a secure yet accessible location so that health professionals can refer to it in order to treat their patients.

Québec Medical Appointment Scheduler (RVSQ)

Solution overview

When we merged the RVSQ with our EMRs, we were working from the principle that your EMR, whether it is Medesync or KinLogix, had to be your daily tool for managing professionals’ appointments and openings.

An early version of our RVSQ integration is now operational at a very small number of clinics. Deploying this beta version enables us to test and refine our integration and prepare for broader deployment. Let us now introduce the initial version of the integration.

In terms of schedule management, we therefore added the concept of an RVSQ service, which combines the service and reason for consultation, to the components that already had to be defined when creating an opening. This means you still use the business logic you defined through the use of tasks or appointment types, and can now specify which type of RVSQ service you are booking the openings for.

When the time slot is created, the appointment type and its colour are the information spotlighted in the agenda. A symbol (a fleur-de-lis) appears to indicate that the opening was also booked in the RVSQ. Indicator colours or the addition of a lock show whether the time slot is public, i.e. it can be reserved using the RVSQ, or private, meaning that only the clinic can reserve that time.

Due to the replication, clinics need only keep updating their professionals’ schedules in the EMR. Based on the rules the clinic defines, it is then copied to the RVSQ. There is thus no need to use the RVSQ to create, change or delete professionals’ agendas, as all these actions take place in the EMR.

The same goes for appointments. When an EMR user wants to assign an appointment to a patient, he or she keeps using the EMR. If the time slot was defined as private, the appointment replicates in the RVSQ and availability is not validated, since the slot is reserved for the clinic. If it is public, the EMR then checks with the RVSQ to make sure the slot has not been filled by a patient via the RVSQ site; if not, the appointment can be booked. If the slot is no longer available, the user can select a new opening, or force an additional appointment to be added.

Appointments that patients add via the RVSQ site are added to the EMR through a synchronization mechanism that runs every five minutes. Together, the two mechanisms make sure that agendas contain all of the appointments, and the EMR remains the sole appointment tool the clinic uses.

All appointments that are known to the RVSQ, regardless of their origin, are flagged with an icon indicating that.

As you can see, the service has been designed to keep you well informed of interactions with the RVSQ, while retaining the EMR as your sole tool. Keep up to date on the trial's progress to find out when you will be able to integrate with the RVSQ.

Pediatric module

Medesync

Medesync's pediatric module enables you to track various patient growth curves accurately, and in accordance with recognized standards.

For greater precision, we recently added a third decimal place to the clinical weight datum, which can translate into a percentile difference of up to 0.5.

In order to quickly pin down why a line item is at variance with a patient's normal growth curve, you can now add a comment to the clinical data.

Hovering your mouse over it makes the comment pop up over the item in question.

Lastly, you can now view and print the curves in a format recognized in Canada because we have added a PDF format that uses the WHO growth curves for Canada.

The following curves can now be viewed for the first and second set of individual curves for boys and girls:

• Birth to 24 months: Length/height for age and weight for age
• Birth to 24 months: Head circumference for age and weight for age
• 2 to 19 years: Height for age and weight for age
• 2 to 19 years: Body mass index (BMI) for age

The table that appears on the curves is populated with clinical data, including the comment.

With these additional features, we hope our new pediatric module will meet all of your expectations.

KinLogix

Using the standard, recognized WHO modules, the KinLogix pediatric module provides an opportunity to properly track growth curves for both term and premature babies.

Once they have entered the data on weight, size or head circumference, health professionals can now display the infant's growth curve. They can choose between the first and second set of WHO curves to view the child's growth.

For premature babies, professionals can not only specify the child’s gestational age, but also ask Kinlogix to add another curve that is based on the child's gestational age.

We hope that this flexibility and the options available give you the tools you need to properly monitor the growth of your patients, big or small.

Message template

Many of you regularly write the same type of memo when you create a message or task.

Did you know that you can set up message (or task) templates to speed up communications within your organization?

Here's how to create message templates:

• Draw up a list of your clinic's recurrent communications (e.g. “Request for appointment following test results” or “Request to prepare documents”). * Note: The templates will be available to the whole clinic.
• In Medesync, place your cursor on “Gestion” (management) in the purple menu bar at the top of the screen. Go down to “Organization settings” (Réglages de l’organisation) and click on “Message templates” (Gabarits de messages).

  

• On the new page, click on “Add” (Ajouter) at the top right.
• As with a regular message or task, enter:
  • The name of the recipient(s) (not mandatory – the option allows you to pre-address a message or task).
  • Message subject (e.g. Appointment for abnormal lab results).
  • In the body of the message, enter the details for what the recipients do.

    

• Click “Save.”

You have just created a new message template.

Now delegate a task using the example we just created:

• Place your cursor on the “Messaging” menu in the purple menu bar at the top of the screen, and click on “Send message.”
• In the “Subject” field, start to write the subject of the desired message template (e.g. “Appointment...”)
• Select the correct template from the list that appears.

  

• Finish creating the message or task (e.g. enter a patient referral, change the priority, or apply a “Recall date,” add information to the body of the message, etc.).

  

• Click “Send.”

Having templates available to help create routine messages and tasks will save time and help make you and your team more efficient.