ABSTRACT
BACKGROUND: Electronic medical record (EMR) adoption among Canadian primary care physicians continues to grow. In Ontario, >80% of primary care providers now use EMRs. Adopting an EMR does not guarantee better practice management or patient care; however, EMR users must understand how to effectively use it before they can realize its full benefit. OntarioMD developed an EMR Practice Enhancement Program (EPEP) to overcome challenges of clinicians and staff in finding time to learn a new technology or workflow. EPEP deploys practice consultants to work with clinicians onsite to harness their EMR toward practice management and patient care goals. OBJECTIVE: This paper aims to illustrate the application of the EPEP approach to address practice-level factors that impede or enhance the effective use of EMRs to support patient outcomes and population health. The secondary objective is to draw attention to the potential impact of this practice-level work to population health (system-level), as priority population health indicators are addressed by quality improvement work at the practice-level. METHODS: EPEP's team of practice consultants work with clinicians to identify gaps in their knowledge of EMR functionality, analyze workflow, review EMR data quality, and develop action plans with achievable tasks. Consultants establish baselines for data quality in key clinical indicators and EMR proficiency using OntarioMD-developed maturity assessment tools. We reassessed and compared postengagement, data quality, and maturity. Three examples illustrating the EPEP approach and results are presented to illuminate strengths, limitations, and implications for further analysis. In each example, a different consultant was responsible for engaging with the practice to conduct the EPEP method. No standard timeframe exists for an EPEP engagement, as requirements differ from practice to practice, and EPEP tailors its approach and timeframe according to the needs of the practice. RESULTS: After presenting findings of the initial data quality review, workflow, and gap analysis to the practice, consultants worked with practices to develop action plans and begin implementing recommendations. Each practice had different objectives in engaging the EPEP; here, we compared improvements across measures that were common priorities among all 3-screening (colorectal, cervical, and breast), diabetes diagnosis, and documentation of the smoking status. Consultants collected postengagement data at intervals (approximately 6, 12, and 18 months) to assess the sustainability of the changes. The postengagement assessment showed data quality improvements across several measures, and new confidence in their data enabled practices to implement more advanced functions (such as toolbars) and targeted initiatives for subpopulations of patients. CONCLUSIONS: Applying on-site support to analyze gaps in EMR knowledge and use, identify efficiencies to improve workflow, and correct data quality issues can make dramatic improvements in a practice's EMR proficiency, allowing practices to experience greater benefit from their EMR, and consequently, improve their patient care.
ABSTRACT
INTRODUCTION: The understanding of testicular physiology, pathology, and male fertility issues requires knowledge of male germ cell death, energy production and oxygen consumption. The aim of this study was to examine the effect of a new donor of exogenous nitric oxide, di-propylen-three amin-NONOate (DPTA/NO), on the oxygen consumption by freshly isolated rats' testis interstitial cells. MATERIAL AND METHODS: Rats' testis interstitial cells (ISC) were isolated according to Anakwe method and oxygen consumption was measured in an ex vivo bath. The ISC were stimulated with glutamate (0.5 M, 20 microl). DPTA (10(-3) - 10(-6) M) was added and its effect was tested in the absence of ADP (state 4 of respiration) and after that in the presence of ADP (state 3). The reaction was followed for 10 minutes and for each concentration the measurement was done in duplicate. The same measurements without treatment of DPTA/NO were done for control group. RESULTS: DPTA/NO (10(-4) - 10(-6) M) reduced the oxygen consumption rate compared with the control group. The inhibition of respiration was not noticed in concentration of 10(-3) M. In V3 respiratory phase, all tested concentrations of DPTA/NO (10(-3) - l0(-6) M) decreased the oxygen consumption rate in comparison with the control group. CONCLUSION: Our results demonstrate that a NO donor, DPTA/NO (10(-3) - 10(-6) M) inhibits oxygen consumption in isolated rat testis interstitial cells in a manner that could be concentration dependent. Because of limited number of measurements this was not fully proved and additional experiments are needed.
