Physician Practice
Project
This material was prepared by Florida Medical Quality Assurance, Inc., the Medicare Quality Improvement Organization
Physician Practice
Resource Manual
Doctor’s Office Quality – Information Technology
Table Of Contents
1. Introduction
• Introduction
• FMQAI Team Members
• Acknowledgements
• New Model of Primary Care
• Road Map to Electronic Health Records
2. Assess
• Assessment Phase Checklist • On-Site Assessment
• Professional/Patient Assessments (5) • Staff Activity Surveys (6)
• Personal Skills/Needs Assessment • The Case for Improvement • Assessing Your Practice • Measuring Your Practice (4)
3. Plan
• Plan Phase Checklist • Establish the EHR Team
• Prioritize Ideas/Recommendations • Next Steps Timeline Template
• Change Management and Quality Improvement Processes/Components of a Successful Implementation
• Critical Success Factors
• How to Improve/Setting Aims/Measures/Changes
• Shortening Wait Times: Six Principles for Improved Access
• Checklist for Implementing Open Access Scheduling
• Reduce Scheduling Complexity (5)
• Start On-Time Agreement
• Office Visit Cycle Time
• Unplanned Activity Card
• DOQ-IT Current Return on Investment (ROI) Literature for EHRs
4. Select
• Selection Phase Checklist • Vendor Evaluation Matrix
• DOQ-IT Vendor Letter of Intent List • Contracting Guidelines EHR Vendors • AC Report Link (see section 7)
• RFP Proposal Preparation Link (see section 7) • Glossary, Red Flags, & FAQs
5. Implement
• Implementation Phase Checklist • Common Implementation Problems
• Implementation Options – Incremental vs. Big Bang • Redesign the System
6. Evaluate/Improve
• Evaluation/Improvement Phase Checklist
• QualityNet Exchange for Registration for Data Transmission Link (see section 7) • DOQ-IT Measures Overview & Data Submission Process
• Reliability
• The Model for Chronic Disease Management
• Patients: Assessment of Care for Chronic Conditions • Assessment of Chronic Illness Care (version 3.5)
7. Links To Article And Websites
• Websites for Accessing Tools • Articles for Phases of the Road Map
Information for Healthcare Improvement
Introduction
Quality Improvement Organizations (QIOs), under contract with the Centers for Medicare & Medicaid Services (CMS), are expected to provide assistance to healthcare providers that enables them to develop the capacity for, and to achieve the vision of the program, which is that every person receives the right care every time. QIOs shall accomplish this by working with providers, practitioners, Medicare Advantage organizations, beneficiaries, and other stakeholders in support of quality improvement. Assistance will typically involve seeking to promote improvements in organizational culture, systems adoption and use, and redesign of care processes.
FMQAI, formerly Florida Medical Quality Assurance, Inc., Florida’s Medicare QIO, is excited to work with the healthcare community to improve care received by Medicare patients in all areas of care delivery.
FMQAI’s Physician Practice Team will work with physicians and their office staff to assess how electronic clinical information systems can be used to improve the quality and efficiency of care—with a focus on e-prescribing, e-registry/care management, and deployment of full electronic health record systems (EHRs). FMQAI will assist physicians to select health information technology products, reorganize workflow and care processes to implement EHRs, and undertake quality improvement projects to realize the benefits of EHRs. Following the steps outlined in this manual will promote the potential for success of your EHR investment and care improvement processes. The road to a successful implementation of EHR is challenging and cumbersome. FMQAI is ready to walk with you along the path to a successful implementation in your practice.
FMQAI is also directed to work toward improving indicators of quality for Diabetes, Cardiovascular Disease and Preventive services. The ultimate outcome of the Physician Practice project is to make it possible for Primary Care Practices to transmit quality data, for the targeted indicators, to a secure data warehouse
developed by CMS. This will enable CMS to receive real time, accurate data on which they can build a pay for performance reimbursement program.
The Physician Practice Team Project Coordinators are excited to be participating in this project. This project has the potential to enhance patient outcomes and improve physician satisfaction with their practice and improve provider’s quality of life.
We look forward to working with you and your staff to share with you our knowledge and intervention tools to transform your practice into a winning situation for everyone – patients, providers and staff.
FMQAI
Physician Practice Project Team 5201 West Kennedy Boulevard, Suite 900
Tampa, FL 33609 Toll Free (800) 564-7490 Telephone (813) 354-9111
The Right Care for Every Patient Every Time
FMQAI
Physician Practice Project Team
Diane Chronis, RN, BS Project Director 800-564-7490 x 3558 [email protected] Project Coordinators
Joan Crosby, RN, MS, CPHIT, CPEHR Project Coordinator, DOQ-IT
800-564-7490 x 3537, [email protected]
Laura Gamba, BA, CBA
Senior Project Coordinator, Underserved Populations 800-564-7490 x 3920, [email protected]
Christine Lalios Kuykendall, RHIA, CPHQ Project Coordinator, DOQ-IT
800-564-7490 x 3592, [email protected]
Kathleen Lightbourne, MPH
Project Coordinator, Underserved Populations 800-564-7490, x 3562, [email protected] Darleen Luzod, MS, RN
HIT Project Coordinator, DOQ-IT
800-564-7490 x 3811, [email protected]
Jan Murray, BSN, RN
Project Coordinator, DOQ-IT
800-564-7490 x 3585, [email protected] Sharon Sopczak, RN
Project Coordinator, Underserved Populations 800-564-7490 x 3510, [email protected]
Farah Tavakoli, MSHA, MT-ASCP HIT Project Coordinator, DOQ-IT
800-564-7490 x 3805, [email protected] Chitra Yeshwanth, MS, MPH Project Coordinator 800-564-7490 x 3319, [email protected] Ancillary Staff JiFeng Ma, Ph.D Statistician 800-564-7490 x 3861, [email protected] Bonnie Mason Communication Specialist 800-564-7490 x 3570, [email protected] Cindy Olejnik Administrative Assistant 800-564-7490 x 3578, [email protected]
The Right Care for Every Patient Every Time
Physicians
Ferdinand Richards, MD Medical Director, FMQAI
800-564-7490, [email protected]
Mark Michelman, MD, MBA Clinical Director, FMQAI
800-564-7490, [email protected] R. Scott Hanson, MD, MPH
Physician Consultant 800-564-7490
The Right Care for Every Patient Every Time
ACKNOWLEDGEMENT
FMQAI has derived much of the material in this tool kit from the following: Institute for Healthcare Improvement Website, www.ihi.org
The Dartmouth-Hitchcock Medical Center, www.clinicalmicrosystem.org
The work of Mark Murray, MD, MPA and Catherine Tantau, BSN, MPA, who first created and used the Open Access Scheduling processes and procedures.
Lumetra – California’s Medicare Quality Improvement Organization’s DOQ-IT Pilot Program We wish to thank the above persons and facilities who have spent time and effort to put together the pieces of the path that give us the greatest potential for successful redesign of Primary Care Office Practice using Electronic Clinical Information.
The Right Care for Every Patient Every Time
TWENTY-FIRST CENTURY
PRIMARY CARE
•
A personal medical home for each patient
•
Patient-centered care
•
A team approach to care
•
Elimination of barriers to care
•
Advanced information systems, including integrated electronic health records
(EHRs)
•
Redesigned, functional offices
•
Whole-person orientation; culturally sensitive care
•
Care provided within a community context
•
Emphasis on quality and safety
•
Enhanced practice finances (through operating efficiencies and new revenue
streams)
The Right Care for Every Patient Every Time
Electronic Health Record Roadmap
ASSESS
During this step office processes are assessed and analyzed to identify areas that can be improved. This lays the groundwork for planning and prioritizing EMR selection criteria and office redesign projects. In addition it allows you to have a better picture and understanding of the practice patient profile.PLAN
During this step the results of the assessment and analysis are utilized todevelop the priorities for the EMR system you will select. You will identify a Project Team that will participate in the ongoing process. This team will assist in all aspects of the EMR and redesign processes.
SELECT
During this step, using the criteria and plans from your previous work, your team will narrow down to the three to five vendors whose software most closely match your needs. Demonstration scenarios will be developed and vendors will be invited to ‘demo’ their product to you Project Team. At the end of this phase your team will select the EMR best suited to your practice.IMPLEMENT
During this step the Project Team will work with the staff to plan for theimplementation of your system. This is an important step in minimizing the disruption to your office and a successful implementation. The team should be very active in setting up training and assuring that each staff member is trained appropriately.
EVALUATION/
IMPROVEMENT
During this step the impact of the EMR on your practice and staff will be assessed. Process redesign will be reviewed and population management will be discussed and plans will be developed to identify and target the chronic illnesses within your practice. Plans will be generated to manage patients with the most frequently seen chronic illness diagnosis, such as Diabetes, CHF, etc. The ability to transmit data to the CMS Data Warehouse will also be checked.
BEYOND
During future years of your practice the continual use of the EMR system to enhance patient care and outcomes will be available to your practice. Measurement of outcomes will assist you and your staff to provide and monitor care using evidence-based criteria on real time data. You will be able to provide data to payers to support your delivered standard of care. This will promote your ability to negotiate pay for performance reimbursements.
EHR Roadmap
Practice Name: _________________________________________________ Date: _______________________________FMQAI DOQ-IT Team Facilitator: _________________________________ Phone:______________________________ Physician Champion: _____________________________________________ EHR Team Leader: ___________________
Phase Recommended for successful movement along the EHR RoadmapPractice Tasks
Milestone Checklist
To demonstrate measurable movement along the EHR Roadmap
(check the box as each milestone is completed; sign and date when all tasks in phase are complete)
Tools and Services Provided by FMQAI
Assessment
• Complete IT readiness assessment
• Assess current workflow (identify pain points)
• Begin or continue regular staff meetings (at least monthly)
• Assign physician champion
• Organize an EHR selection/implementation team
• Assign an individual (EHR team leader) or team to lead practice changes
• Commit to:
o Full provider engagement to enter data
o Workflow changes necessary to maximize results
IT readiness assessment Readiness/next steps reviews Physician champion assigned
Team leader assigned for practice changes Current workflow processes assessed
Give signed participation agreement to FMQAI Proposed implementation target date
Initials: ________ Date Phase Completed: _________
See Physician Practice Project Manual Section 2
Planning
• goals and priorities (include functions and specific provider needs)
List
• Translate identified EHR goals into available EHR system functions s and features
• Identify staff at lower levels of readiness and address their concerns
• Develop a timeline and project plan
• Gain support from team members and staff and prepare staff for changes
Optional:
• Write RFI/RFPs
• Complete a cost/benefit analysis and ROI for an EHR
Practice has identified goals, priorities and any staff concerns
EHR goals and associated system functions are listed Business plan developed, includes such items as:
- Target implementation schedule/timeline - Estimates of EHR budget and ROI - Measurable EHR goals
Initials: ________ Date Phase Completed: _________
See Physician Practice Project Manual Section 3
Selection
• Attend structured demonstrations at Vendor Fair
• Evaluate vendors and create short list of 2-3 vendors
• Review EHR systems by:
o Run vendors through a practice–specific case cenario o Going on at least one site visit
o Obtaining at least three vendor references
• Identify and select vendor for hardware, office wiring, and necessary network support for all services and products not included in EHR
• Negotiate contracts including all aspects of implementation, training, and technical support
• Continue workflow assessment and changes
Negotiate contracts and financing EHR vendor selected
Hardware vendor selected
Vendor selected for office wiring and cabling needs that are not included in EHR package
Initials: ________ Date Phase Completed: _________
See Physician Practice Project Manual Section 4
Implementation
• Draft EHR system implementation plan and timetable
• Assign data manager/administrator
• Assure data conversion and testing completed
• Assure interfaces completed and tested for:
• Laboratory
• Radiology
• Practice Management (billing and scheduling)
• Referrals
• Assign a “go-live” date
• Train staff
• Celebrate success and address problems
Implementation plan completed Contracts completed and signed Data manager assigned
Data conversion and testing completed Interfaces tested and working properly “Go-live” completed and celebrated
Vendor will be the primary driver of this phase; therefore vendor should be thoroughly engaged in all aspects of the implementation.
Initials: ________ Date Phase Completed: _________
See Physician Practice Project Manual Section 5
Evaluation
• Conduct post go-live reviews of implementation
• Conduct additional staff training as needed
• Evaluate EHR system goals met to date
• Verify vendor has provided technical infrastructure to capture clinical measures for future data submission
Post go-live reviews for EHR goals, implementation and additional staff training completed
Schedule additional staff training
Data capture verification completed with vendor Data submission to CMS
Assess full use of EHR system and address lags Initials: ________ Date Phase Completed: _________
See Physician Practice Project Manual Section 6
Improvement
• Commit to continuous review of clinical and administrative processes
• Identify and target additional care management and process improvement opportunities
• Use EHR to optimize practice of evidence-based medicine
• Continue submission of data to CMS
Re-analyze clinical and administrative processes Review performance reports
Identify quality improvement opportunities
Re-design work processes to use EHR clinical decision support tools with each patient encounter
Initials: ________ Date Phase Completed: _________
See Physician Practice Project Manual Section 6
The Right Care for Every Patient Every Time
Document Review
Assessment Phase Checklist
TASK STARTEDDATE COMPLETED DATE SENT TO
FMQAI INITIALS
On-Site Practice Readiness Assessment with EHR
On-Site Practice Readiness Assessment without EHR
Professionals
• Primary Care Staff Satisfaction Survey Primary Care Practice Profile
Patients
• Patient/Family Satisfaction with Primary Care Practice Access Survey “Point of Service”
Patients
• Primary Care Practice Patient Viewpoint Survey
(Choose one o these two)f Patients
• Through the Eyes of Your Patients
Staff Activity Surveys
• Provider Activity Survey
• RN Activity Survey
• LPN Activity Survey
• MA Activity Survey
• Receptionist Activity Survey
• Activity Survey
Personal Skills Needs Assessment – Microsystems Resources
Case For Improvement
Assessing Your Practice Discoveries and Actions
Measure 3rd Next Available Appointment
Measure Daily Demand
Measure No Show Rate
On-Site Practice Readiness Assessment With EHR
Contact Information
Practice Name:
Team Member Completing Assessment: Physician Practice Staff Interviewed: Assessment Date:
CMS Required Scoring Information
1. Is the practice affiliated with an IPA or a large medical group? Yes No 2. What types of technology is the practice currently using on a regular basis?
______________________________________________________________________________ 3. Does the practice conduct regularly scheduled all-staff meetings (including providers)? Yes No 4. Please indicate staff’s current attitude towards the EMR/HIT system: 5 = Very positive, 4 = Positive,
3 = Neither positive or negative, 2 = Somewhat negative, 1 = Very negative Physicians 1 2 3 4 5
Mid-level providers 1 2 3 4 5
Clinical Staff 1 2 3 4 5
Office Manager 1 2 3 4 5
Administrative staff 1 2 3 4 5
5. Does the practice use the EMR/HIT system to identify patients with one or more chronic conditions or who require preventive services (e.g., identify patients due for influenza vaccination or patients with diabetes who require a HbA1c test)? Yes No Don’t Know
If yes, what does the practice do with the data? ________________________________________ Submit for Pay-for-Performance programs. Yes No
Create reports to use for peer review and feedback Yes No Create reports to use for performance improvement projects Yes No
Schedule preventive services Yes No
Other, please verify: _________________________________________________________
FMQAI Data Collection
Name of PMS System: _________________________ Date began using? _______________________ Name of EMR System: ________________________ Date began using: _______________________
Are they integrated? Yes No
Interfaced? Yes No
Do all staff and providers use the EMR system? Yes No Do all staff and providers use the system in the same manner? Yes No
What components of the Eight Core Capabilities do your EMR:
Health Information and Data: Immediate access to key information, i.e. diagnoses, allergies, lab results and medications. (Patient summary sheet, problem list, medication list, lab results, etc.)
POSSESS USE
Result Management: Ability to quickly access test result, both new and past, in multiple settings. (PDA or other access when away from the office – home, hospital, nursing home, etc.)
Order Management: The ability to enter and store orders for prescriptions, tests and other services. (Direct order messaging to labs, diagnostic facilities, hospital, etc.)
Decision Support: Ability to use reminders, prompts and alerts, computerized decision-support re: screening, drug interactions and evidence-based medicine.
Electronic Communication and Connectivity: Efficient, secure and readily accessible communication among providers and patients. (Secure E-mail for patient and physician communication, Web Site with Patient portal, on-line scheduling, etc.)
Patient Support: Patient access to health records, interactive education and help to carry our home monitoring and self-testing (on practice web site through patient portal, etc.)
Administrative Processes: Scheduling, registration, and billing.
Reporting: The ability to electronically store and retrieve uniform data standards.
How is documentation done in this practice?
Template
Dictation Typing
Voice Recognition
Other, specify: _________________________________ Does this practice use E-Rx? Yes No
How? Printed Faxed E-Fax Electronic Transmission
Does your office staff need additional EMR training to further utilize the EMR for these documents? Yes No Does this practice have interfaces for Lab results? Quest LabCorp Other
Is this practice using any direct digital equipment access? (Check all that apply.) Vital Signs EKG Other
Does this practice have access to their hospital portal for downloading information? Yes No
What can they access? ________________________________________________________________ Does this practice have an efficient scanning system for paper management? Yes No
On-site Assessment 2
Does this practice use the messaging/task system to communicate with staff and in-house providers/departments? Yes No
Does this practice track referrals on the computer? Yes No
Describe the process. ________________________________________________________________
Quality Improvement/Population Management
Is this practice carrying out any Quality Improvement processes at present? Yes No
What are they doing in this area? _______________________________________________________ How does this practice identify patients with specific diseases? Yes No
Explain. __________________________________________________________________________ Does this practice print lists of patients who are overdue for specific care? Yes No
Describe how these lists are used. ______________________________________________________ Does this practice use a registry to monitor and manage chronic illness care? Yes No
Please check all that apply:
Diabetes C-V Disease Hypertension CHF Asthma Coumadin use Preventive screening
MI Cholesterol COPD Depression
Other, specify: _____________________________________
Be more specific about process:
______________________________________________________________________________________ ______________________________________________________________________________________ Does this practice create and print reports from the EMR (not PMS) to monitor care your patient’s receive?
Yes No
What? _______________________________________________________ Does this practice monitor provider performance based on designated measures? Yes No
Policy. __________________________________________________________________________ Involved in any P4P bonus programs? Yes No
What companies? _________________________________________________________________ Does this practice use disease specific templates to facilitate and improve patient care? Yes No
Is this practice doing any Population Management? Yes No
If so, what? _________________________________________________________________ Which groups? ______________________________________________________________ Does this practice use Group Visits? Yes No
What group? ______________________________________________________ Does this practice use Open/Advanced Access scheduling? Yes No
What are their goals for QI? ______________________________________________________ What are their goals for PM? ______________________________________________________ How much time and effort are they willing to devote to QI? _____________________________
Data Transmission
On-site Assessment 4
# Use a separate sheet of paper to complete long processes.
Complete step by step appointment to check out process.#
Complete step by step prescription refill process.#
On-Site Practice Readiness Assessment Without EHR
Contact Information
Practice Name:
Team Member Completing Assessment: Physician Practice Staff Interviewed: Assessment Date:
CMS Required Scoring Information
1. Who will lead the practice’s EMR/HIT system implementation? (Check all that apply.) Physician(s)
Office Manager Mid-Level Provider(s)
Administrative staff (e.g. Medical Records) Clinical Staff (e.g. RN, MA, etc.)
2. Does the practice currently have an EMR/HIT implementation project manager? Yes No If yes, how many hours per weeks will be devoted for managing the project?
If no, does the practice plan on designating a project manager to the project? Yes No 3. Has the practice engaged a health information technology consultant in addition to QIO staff?
Yes No
If no, does the practice plan to hire a consultant? Yes No
STAFF
4. Does the practice conduct regularly scheduled “all staff” (including providers) meetings? Yes No If yes, how often does the practice staff meet?
Weekly Monthly Quarterly Annually
Other, please specify: _______________________________________________ 5. Has the practice tried to address workflow issues or operational inefficiencies in the past? Yes No
If yes, how successful were these efforts? Very successful Some what successful
Neither successful or unsuccessful Some what unsuccessful
Very unsuccessful
6. Has the practice tried to implement clinical information systems, such as EMR or electronic prescribing, in the
7. How receptive has staff been to efforts to implement clinical information systems or other practice changes? Very receptive
Some what receptive
Neither receptive or unreceptive Some what unreceptive
Very unreceptive
8. Does the practice have other projects either currently going on and/or starting soon that might affect the planning for and/or success of the EMR/HIT implementation project?
Yes No
If yes, please specify: _______________________________________________ 9. Please indicate the current status of the practice’s EMR/HIT system implementation efforts:
CHOOSE: I (see below) II (see page 3)
I.Beginning the process of selecting a system.
Date process began: __________
I a. For each of the groups listed below, please indicate their level of support for an EMR/HIT system: 5 = Very supportive, 4 = Somewhat supportive, 3 = Neither supportive or unsupportive, 2 = Somewhat unsupportive, 1 = Very unsupportive.
Physicians 1 2 3 4 5
Mid-level providers 1 2 3 4 5
Clinical Staff 1 2 3 4 5
Office Manager 1 2 3 4 5
Administrative staff 1 2 3 4 5
I b. Please indicate which of the following EMR/HIT implementation related activities the practice has either
done or plans to do (Check all that apply.).
Have done Plan to do No plans Establish a multidisciplinary implementation team.
Identify practice’s inefficiencies, problems. Map out and analyze key and/or problematic processes/workflows.
Develop written list of EMR/HIT system requirements. Involve staff in EMR/HIT system selection process.
Assess technical proficiency of staff and address identified needs.
I c. What would you and your staff like to gain from participating in the program?
I d. Please indicate how likely the following will be obstacles to the practice’s implementation of an EMR/HIT system. 5 = Very likely, 4 = Some what likely, 3 = Neither likely nor unlikely, 2 = Some what unlikely, 1=Very unlikely
Availability of funds 1 2 3 4 5
Experience with IT 1 2 3 4 5
Physician/Mid-level provider support 1 2 3 4 5
Clinical staff support 1 2 3 4 5
Office manager support 1 2 3 4 5
Administrative staff support 1 2 3 4 5
Inadequate project management 1 2 3 4 5
Technical proficiency of staff 1 2 3 4 5
Inability of physicians/Mid-level
providers to enter data in the system 1 2 3 4 5 Insufficient time to select and implement a system 1 2 3 4 5 Lack of IT infrastructure to support system 1 2 3 4 5 Other, please specify:
II. In the process of implementing a system.
Date vendor/system selected ____________ Name of vendor _______________________
II a. Please indicate which of the following activities the practice completed during its EMR/HIT selection process (Check all that apply.).
Established a multi-disciplinary implementation team. Yes No Identified practice’s inefficiencies, problems, etc. Yes No Mapped out and analyzed key and/or problematic
processes and workflows. Yes No
Developed a written list of EMR/HIT system requirements. Yes No Involved staff in EMR/HIT system selection process. Yes No Communicated to staff the overall goals and reasons
for implementing an EMR. Yes No
Assessed technical proficiency of staff and developed plan
for addressing identified needs. Yes No
II b. Does the practice have a written project plan for implementing the EMR/HIT system? Yes No
II c. Does the practice have a formal written training plan for implementing the EMR/HITsystem? Yes No
II d. Please indicate how likely the following will be obstacles to the practice’s implementation of an EMR.
Physician/Mid-level provider resistance 1 2 3 4 5
Clinical staff resistance 1 2 3 4 5
Office manager support 1 2 3 4 5
Administrative staff resistance 1 2 3 4 5
Inadequate project management 1 2 3 4 5
Inadequate training on EMR/HIT system 1 2 3 4 5 Inability of physicians/mid-level providers to enter
data and use system 1 2 3 4 5 Insufficient time to implement a system 1 2 3 4 5 Insufficient funds for consultants/training 1 2 3 4 5
Other, specify ______________________ 1 2 3 4 5
II e. What would you and your staff like to gain from participating in the program?
FMQAI Data Collection
Does Practice have multiple locations? Yes No How many? _____ Can a patient visit all location? Yes No
Number of exam rooms: _____ Treatment Rooms: _____
STAFF
Total FTE’s: _____
Physicians _____ MA _____ Phlebotomist _____ Front Desk _____ Referral Coord. _____ LPN _____
Billing _____ RN _____
Management _____ Other _____
Is your staff cross-trained to maximize the efficiency of your office? Yes No How do you cover call-ins and vacations? ____________________________________ Does the staff’s assignments make maximum use of their education/training? Yes No
Estimate the total time, each day, that administrative staff spends doing inefficient tasks (looking for charts, redoing work, calling facilities for results, etc) __________________
CHARTS
Estimate average time to pull a chart (includes any prep needed). _____ Estimate average time to locate misplaced charts._____
When are charts pulled for appointed patients? _____
Are these charts prepared prior to patient check-in? Yes No Where are they placed? _____________________________________ Who most often pulls charts? ________________________________ How often are charts “misplaced”? ___________________________ How many patients are seen without their chart? _________________ Identify the process for finding a misplaced chart?________________
Charts pulled per day:
Appointments _____ Billing ______________ Prescription refills _____ Referrals ______________
Lab results _____ Non-patient ______________
Rad./diagnostic results _____ (Pharm, Insurance company, etc.) Other - list: ______________
______________ ______________ Who files loose papers into chart? _______________
Who files charts to the shelf? _______________
LABORATORY
Does office do waived* labs in-house? Yes No Does office do phlebotomy in-house? Yes No Who does this? ______________________
Average number of labs ordered per day. _____ Average number of labs drawn per day. _____
* Simple test for which a license is not required, just a certificate of waiver. Includes U/A dipstick, finger stick glucose, cholesterol, hemoglobin/hematocrit, etc.
Estimate percentage of lab referrals made to:
Quest _____
LabCorp _____
In-house _____
Local hospital _____
Other _____
Estimate the percentage of lab results received by the following methods: Electronic (E-fax, Lab computer, etc.)
Regular fax
Hard copy (office printer, delivered) Other
RADIOLOGY/DIAGNOSTIC TESTS
Does the office do any in-house x-rays? Yes No Who does this? ________________
How many per day?_____________
How many Radiology or other diagnostic tests are ordered per day? _____ How are the results received for these tests?
Electronic (E-fax, Lab computer, etc.) Regular fax
Hard copy delivered Other
Generally,
Who completes the requisitions for labs, radiology, etc.?
Physician MA Front desk Other How often does staff need to call for test results?
Lab _____
Radiology (MRI, CT, Sonogram, etc.) _____ Other (Cardiology, Neurology, Pulmonary, etc.) _____
How many calls for reports are made in a week?
Lab _____
Radiology _____
Other _____
Describe the process used to follow up on lab reports: Abnormal _____
Routine _____
Does this process ever fail to complete the notification: Yes No How often? _____
PRESCRIPTIONS
Are any prescriptions renewed based on a written policy? Yes No Are calls accepted from patients requesting refills? Yes No
Estimate the average number of new (non-refill, non-renewal) prescriptions written daily by all providers. _____
Estimate the average number of refill, renewal prescriptions that are written daily by all providers. _____ How often does a pharmacy call to clarify a prescription (or ask that it we rewritten) because it
was not legible? _____
REFERRALS
Estimate the average number of referrals processed each week. _____ How are these processed?
Telephone _____%
Fax _____%
Computer _____%
What is the range of time to complete a referral? _____ to _____
TRANSCRIPTION
Do any providers use transcription? Yes No What is your transcription turn around time? _____
Do you ever see patients without the most recent dictation? Yes No What is the average cost of transcription per month? _____
OFFICE PROBLEMS
Please list the three most serious problem processes in your office. 1)
2) 3)
ELECTRONIC MEDICAL RECORDS
What vendors have you reviewed or demo’d? _____________________
_____________________ _____________________ _____________________ _____________________ _____________________ _____________________ On-site Assessment 6 _____________________
QUALITY IMPROVEMENT
Does the office have any formal QA program? Yes No If so, in what areas? (Select below)
Billing/coding accuracy Diabetes CAD CHF
Hypertension Coumadin use Preventive screening
Immunizations Asthma COPD
Other, specify: _____________________________________
Do you have documentation of the 5 most prevalent chronic diseases in the practice? Yes No Please list them:
1. ______________________
2. ______________________
3. ______________________
4. ______________________
5. ______________________
Have you considered any of the following changes to your practice? Open/Advanced Assess Scheduling Yes No
Group Visits Yes No
Education classes Yes No Use of planned visits Yes No
Are you willing to invest time and staff in improving the quality of your patient care processes? Yes No
# Use a separate sheet of paper to complete long processes.
Complete step by step appointment to check out process.#
Complete step by step prescription refill process.#
Complete step by step telephone triage process.#
Professionals
• Creating a joyful work environment starts with a basic understanding of staff perceptions of the practice. All staff members should complete this survey. Use a tally sheet to summarize results.
• Ask all practice staff to complete the Staff Survey. Often you can distribute this survey to any professional who spends time in your practice. Set a deadline of one week and designate a place for the survey to be dropped off. You may have an organization-wide survey in place that you can use to replace this survey, but be sure it is CURRENT data, not months old, and that you are able to capture the data from all professionals specific to the Primary Care Practice workplace.
Primary Care Staff Satisfaction Survey
1. I am treated with respect every day by everyone that works in this practice.
Strongly Agree Agree Disagree Strongly Disagree
2. I am given everything I need—tools, equipment, and encouragement—to make my work meaningful to my life.
Strongly Agree Agree Disagree Strongly Disagree
3. When I do good work, someone in this practice notices that I did it.
Strongly Agree Agree Disagree Strongly Disagree
4. How stressful would you say it is to work in this practice?
Very stressful Somewhat stressful A little stressful Not stressful 5. How easy is it to ask anyone a question about the way we care for patients?
Very easy Easy Difficult Very difficult
6. How would you rate other people’s morale and their attitudes about working here? Excellent Very Good Good Fair Poor 7. This practice is a better place to work than it was 12 months ago.
Strongly Agree Agree Disagree Strongly Disagree
8. I would recommend this practice as a great place to work.
Strongly Agree Agree Disagree Strongly Disagree
9. What would make this practice better for patients?
10. What would make this practice better for those who work here?
Primary Care Practice Profile
A. Purpose:Why does your practice exist?
Site Name: Site Contact: Date: Practice Manager: MD Lead: Nurse Lead:
B. Know Your Patients: Take a close look into your practice, create a “high-level” picture of the PATIENT POPULATION that you serve. Who are they? What resources do they use? How do the patients view the care they receive?
Est. Age Distribution of Patients: %
List Your Top 10 Diagnoses/Conditions
Top Referrals (e.g.
GI Cardiology) Patient Satisfaction Scores
% Excellent
Birth-10 years 1. 6. Experience via phone 11-18 years 2. 7. Length of time to get your appointment 19-45 years 3. 8. Saw who patient wanted to see
46-64 years 4. 9. Satisfaction with personal manner 65-79 years 5. 10. Time spent with person today
80 + years % Females
Pt Population Census: Do these
numbers change by season? (Y/N) # Y/N
Patients seen in a day
Est. # (unique) pts. In Practice
Patients who are frequent users of your practice and their reasons for seeking frequent interactions and visits
Other Clinical microsystems you interact with regularly as you provide care for patients (e.g. OR, VNA)
Patients seen in last week New patients in last month
Disease Specific Health
Outcomes, pg 24 Disenrolling patients in last month
Diabetes HgA1c = Encounters per provider per year Hypertension B/P = Out of Practice Visits
LDL <100 = Condition Sensitive Hospital Rate Emergency Room Visit Rate
*Complete “Through the Eyes of Your Patient”, pg 9
C. Know Your Professionals: Use the following template to create a comprehensive picture of your practice. Who does what and when? Is the right person doing the right activity? Are roles being optimized? Are all roles who contribute to the patient experience listed? What hours are you open for business? How many and what is the duration of your appointment types? How many exam rooms do you currently have? What is the morale of your staff?
Current Staff
FTEs
Comment/ Function 3
rd Next Available Cycle Time Days of Operation Hours
Monday Enter names below totals
Use separate sheet if needed PE Follow-up Range Tuesday
MD Total Wednesday
Thursday
Friday
Saturday
NP/PAs Total Sunday
Do you offer the following? Check all that apply. Group Visit
RNs Total E-mail
Web site
RN Clinics
LPNs Total Phone Follow-up
Phone Care Management
Disease Registries
LNA/MAs Total Protocols/Guidelines
Appoint. Type Duration Comment:
Secretaries Total
Others: Staff Satisfaction Scores %
Do you use Float Pool? ____ Yes ____ No
How stressful is the
practice? % Not Satisfied Do you use On-Call? ____ Yes ____ No Would you recommend it
as a good place to work? % Strongly Agree
*Each staff member should complete the Personal Skills Assessment and “The Activity Survey”, pgs 13-15
D. Know Your Processes: How do things get done in the microsystem? Who does what? What are the step-by-step processes? How long does the care process take? Where are the delays? What are the “between” microsystems hand-offs?
1. Track cycle time for patients from the time they check in until they leave the office using the Patient Cycle Time Tool. List ranges of time per provider on this table, pg 16/17
2. Complete the Core and Supporting Process Assessment Tool, pg 18
E. Know Your Patterns: What patterns are present but not acknowledged in your microsystem? What is the leadership and social pattern? How often does the microsystem meet to discuss patient care? Are patients and families involved? What are your results and outcomes?
• What have you successfully changed?
• Does every member of the practice meet
regularly as a team? • What are you most proud of?
• How frequently?
• Do the members of the practice regularly review and discuss safety and reliability
issues? • What is your financial picture?
Patients
• Patients have valuable insight into the quality and process of care we provide. Real time feedback can pave the way for rapid responses and quick tests of change. This “Point of Service” Survey can be completed at the time of the visit to give real time measurement of satisfaction.
• Use the Primary Care Profile to review “Know Your Patients.” Determine if there is information you need to collect or if you can obtain this data within your organization. Remember the aim is to collect and review data and information about your patients and families that might lead to a new design of process and services. • Conduct the Patient/Family Satisfaction Survey for 2 weeks with families if you currently DO NOT have a
method to survey families. If you have a method, be sure the data is up to date and reflects the current state of your practice.
Patient/Family Satisfaction with Primary Care Practice Access Survey
“Point of Service”
Date: Think about this visit.
1. How would you rate your satisfaction with getting through to the office by phone?
Excellent Very Good Good Fair Poor
2. How would you rate your satisfaction with the length of time you waited to get your appointment today?
Excellent Very Good Good Fair Poor
3. Did you see the clinician, or staff member, that you wanted to see today?
Yes No Did not matter who I saw today
4. How would you rate your satisfaction with the personal manner of the person you saw today (courtesy, respect, sensitivity, friendliness)?
Excellent Very Good Good Fair Poor
5. How would you rate your satisfaction with the time spent with the person you saw today?
Excellent Very Good Good Fair Poor
Comments:
Patients
Primary Care Practice Patient Viewpoint Survey
Today’s Office Visit
Please rate the following questions about the visit you just made to this office.
Excellent Very
Good Good Fair Poor 1. The amount of time you waited to get an appointment.
2. Convenience of the location of the office. 3. Getting through to the office by phone. 4. Length of time waiting at the office. 5. Time spent with the person you saw. 6. Explanation of what was done for you.
7. The technical skills (thoroughness, carefulness, competence) of the person you saw. 8. The personal manner (courtesy, respect, sensitivity, friendliness) of the person you saw. 9. The Clinician’s sensitivity to your special needs or concerns.
10. Your satisfaction with getting the help that you needed. 11. Your feeling about the overall quality of the visit.
General Questions
Please answer the general questions about your satisfaction with this practice.
12. If you could go anywhere to get health care, would you choose this practice or would you prefer to go someplace else?
Would choose this practice Might prefer someplace else Not sure
13. I am delighted with everything about this practice because my expectations for service and quality of care are exceeded.
Agree Disagree Not sure
14. In the last 12 months, how many times have you gone to the emergency room for your care?
None One time Two times Three or more times 15. In the last 12 months was it always easy to get a referral to a specialist when you felt like you needed one?
Yes No Does not apply to me
16. In the last 12 months how often did you have to see someone else when you wanted to see your personal doctor or nurse?
Never Sometimes Frequently
17. Are you able to get to your appointments when you choose?
Never Sometimes Always
18. Is there anything our practice can do to improve the care and services for you?
No, I’m satisfied with everything
Yes, some things can be improved
Yes, many things can be improved
Please specify improvement:
19. Did you have any good or bad surprises while receiving your care?
Good Bad No surprises
Please describe:
About You
20. In general, how would you rate your overall health?
Excellent Very good Good Fair Poor
21. What is your age?
Under 25 years 25 – 44 years 45 – 64 years 65 years or older 22. What is your gender?
Female Male
Sources: Medical Outcomes Study (MOS) Visit-Specific Questionnaire (VSQ), 1993 Patient Utilization Questions, Dartmouth Medical School
Patients
• Gain insight into how your patients experience your practice. One simple way to understand the patient experience is to experience the care. Members of the staff should do a "Walk Through" in your practice. Try to make this experience as real as possible, this form can be used to document the experience. You can also capture the patient experience by making an audio or videotape.
Through the Eyes of Your Patients
Tips for making the "Walk Through" most productive:
1. Determine with your staff where the starting point and ending points should be, taking into consideration making the appointment, the actual office visit process, follow-up and other processes.
2. Two members of the staff should role play with each playing a role: patient and partner/family member. 3. Set aside a reasonable amount of time to experience
the patient journey. Consider doing multiple experiences along the patient journey at different times.
4. Make it real. Include time with registration, lab tests, new patient, follow-up and physicals. Sit where the patient sits. Wear what the patient wears. Make a realistic paper trail including chart, lab reports and follow-up.
5. During the experience note both positive and negative experiences, as well as any surprises. What was frustrating? What was
gratifying? What was confusing? Again, an audio or video tape can be helpful.
6. Debrief your staff on what you did and what you learned.
Date: Staff Members:
Walk Through Begins When: Ends When:
Provider Activity Survey
Position: Providers MD NP PA Resident (please circle one) Name:______________________________
Instructions: The purpose of this worksheet is to gather data on the amount of time you spend performing various activities. Please indicate (estimate) the percentage of time spent performing each activity listed below. Keep in mind; we are seeking to obtain data related to a “typical” period of work. Estimate the average amount of time; over the course of a typical work period (e.g., a week or a month), you spend on the activities listed on the attached table. Try not to represent either a worst-case scenario (i.e., crisis) or a best-case scenario. Estimate the average amount of time (as a percentage of your total time) you typically spend on these activities during a “normal” period. This is not a detailed time study. If an activity you perform is not
included, please add to the list. Make sure that all of your activities are included. The sum of “% of your time” column should equal 100%.
Activity % of Your Time
See Patients in Clinic
• review chart history
• assess/diagnose patient
• determine treatment plan
See Patients in Hospital
• • •
Dictate/Document Patient Encounter
• dictate encounter
• review transcriptions & sign off
Write Prescriptions • • • Complete Forms • referrals • camp/school physicals
Follow-Up Phone Calls
• answer patient messages & requests
Evaluate Test Results
• review results and determine next actions
Manage Charts
• •
Miscellaneous
• CME; attend seminars/attend weekly meeting
• • •
Total 100%
RN Activity Survey
Position: RN Name:______________________________
Instructions: The purpose of this worksheet is to gather data on the amount of time you spend performing various activities. Please indicate (estimate) the percentage of time spent performing each activity listed below. Keep in mind; we are seeking to obtain data related to a “typical” period of work. Estimate the average amount of time; over the course of a typical work period (e.g., a week or a month), you spend on the activities listed on the attached table. Try not to represent either a worst-case scenario (i.e., crisis) or a best-case scenario. Estimate the average amount of time (as a percentage of your total time) you typically spend on these activities during a “normal” period. This is not a detailed time study. If an activity you perform is not included, please add to the list. Make sure that all of your activities are included. The sum of “% of your time” column should equal 100%.
Activity % of Your Time
Triage Patient Issues/Concerns
• phone • face-to-face Patient Education • • •
Direct Patient Care
• see patients in Clinic
• injections
• assist provider with patient visit
Follow-up Phone Calls •
• •
Review and Notify Patients of Lab Results
• normal and follow-up
• drug adjustments Complete Forms • referrals • camp/school physicians Call In Prescriptions • • • Miscellaneous • • • • Total 100%
MA Activity Survey
Position: MA Name:______________________________
Instructions: The purpose of this worksheet is to gather data on the amount of time you spend performing various activities. Please indicate (estimate) the percentage of time spent performing each activity listed below. Keep in mind; we are seeking to obtain data related to a “typical” period of work. Estimate the average amount of time; over the course of a typical work period (e.g., a week or a month), you spend on the activities listed on the attached table. Try not to represent either a worst-case scenario (i.e., crisis) or a best-case scenario. Estimate the average amount of time (as a percentage of your total time) you typically spend on these activities during a “normal” period. This is not a detailed time study. If an activity you perform is not included, please add to the list. Make sure that all of your activities are included. The sum of “% of your time” column should equal 100%.
Activity % of Your Time
Patient Flow
• greet & escort patients to room
• take vitals
Clean/Set up Rooms Between Visits • • Perform Procedures • EKGs • Prepare Charts
• prepare charts for next day appointments
•
Prepare Charts
• prepare charts for next day appointments
•
Manage Patient Messages & Requests •
•
Notify Patients of Lab Results
• normal – mail aways
•
Health Forms •
•
Order Supplies and Stock Rooms • • • Miscellaneous • • • • Total 100%
Clinical Microsystems, “The Place Where Patients, Families and Clinical Teams Meet”: Assessing, Diagnosing and Treating Your
LPN Activity Survey
Position: LPN
Name:______________________________
Instructions: The purpose of this worksheet is to gather data on the amount of time you spend performing various activities. Please indicate (estimate) the percentage of time spent performing each activity listed below. Keep in mind; we are seeking to obtain data related to a “typical” period of work. Estimate the average amount of time; over the course of a typical work period (e.g., a week or a month), you spend on the activities listed on the attached table. Try not to represent either a worst-case scenario (i.e., crisis) or a best-case scenario. Estimate the average amount of time (as a percentage of your total time) you typically spend on these activities during a “normal” period. This is not a detailed time study. If an activity you perform is not included, please add to the list. Make sure that all of your activities are included. The sum of “% of your time” column should equal 100%.
Activity % of Your Time
Direct Patient Care
• see patients in clinic
• injections
• assist provider with patient visits
Patient Flow
• greet and escort patients to room
• take vitals
Clean/Set up Rooms Between Visits
• • Perform Procedures • EKGs • Prepare Charts
• prepare charts for next day appointments
•
Manage Patient Messages & Requests
• •
Notify Patients of Lab Results
• normal – mail aways
•
Health Forms
• •
Order Supplies and Stock Rooms
• • • Miscellaneous • • • • Total 100%
Receptionist Activity Survey
Position: Secretary/Receptionist Name:______________________________ Instructions: The purpose of this worksheet is to gather data on the amount of time you spend performing various activities. Please indicate (estimate) the percentage of time spent performing each activity listed below. Keep in mind; we are seeking to obtain data related to a “typical” period of work. Estimate the average amount of time; over the course of a typical work period (e.g., a week or a month), you spend on the activities listed on the attached table. Try not to represent either a worst-case scenario (i.e., crisis) or a best-case scenario. Estimate the average amount of time (as a percentage of your total time) you typically spend on these activities during a “normal” period. This is not a detailed time study. If an activity you perform is not included, please add to the list. Make sure that all of your activities are included. The sum of “% of your time” column should equal 100%.
Activity % of Your Time
Manage Incoming Phone Calls
• schedule appointments
• take referral request information
• transfer to triage
• take messages for patient requests
• route calls
Reschedule Patient Appointments
• call “bumped” and/or “no show” patients to reschedule
•
Call Confirmation to Patients
• •
Manage Front Desk/Patient Requests
• greet patients; answer questions
• schedule labs, referrals, etc. after office visit
Service Sheets/Paperwork
• review service sheets
• prepare batching sheet
Miscellaneous • • • • Total 100%
The Right Care for Every Patient Every Time
Activity Survey
Position:___________________________ Name:______________________________ Instructions: The purpose of this worksheet is to gather data on the amount of time you spend performing
various activities. Please indicate (estimate) the percentage of time spent performing each activity listed below. Keep in mind; we are seeking to obtain data related to a “typical” period of work. Estimate the average amount of time; over the course of a typical work period (e.g., a week or a month), you spend on the activities listed on the attached table. Try not to represent either a worst-case scenario (i.e., crisis) or a best-case scenario. Estimate the average amount of time (as a percentage of your total time) you typically spend on these activities during a “normal” period. This is not a detailed time study. If an activity you perform is not included, please add to the list. Make sure that all of your activities are included. The sum of “% of your time” column should equal 100%.
Activity % of Your Time
Miscellaneous
The Right Care for Every Patient Every Time
Personal Skills
Needs Assessment - Microsystem Resources
Development of each member in the practice is key to success. The Personal Skills Assessment tool can help determine education and training needs of each staff member. Each member completes an individual survey and then discusses the action plan with leadership and other staff. A plan is developed to help members achieve goals and be the best they can be.
Personal Skills Needs Assessment Skill Needs Assessment Tool
Name:________________________________ Unit:_________________________________ Role:_________________________________ Date:_________________________________
Technical Skills: Work Home Want to Learn
Never Use Occasionally Frequently Please rate the following on where and
how often you use them
CIS* 1 2 3 4 5 6 7 8 9 10
E-mail 1 2 3 4 5 6 7 8 9 10
Central Dictation 1 2 3 4 5 6 7 8 9 10
Digital Dictation Link 1 2 3 4 5 6 7 8 9 10 PDA (i.e., Palm Pilot) 1 2 3 4 5 6 7 8 9 10 Word Processing (e.g. Word) 1 2 3 4 5 6 7 8 9 10 Spreadsheet (e.g., Excel) 1 2 3 4 5 6 7 8 9 10 Presentation (e.g., Powerpoint) 1 2 3 4 5 6 7 8 9 10 Database (e.g., Access or File Maker Pro) 1 2 3 4 5 6 7 8 9 10 Patient database/statistics 1 2 3 4 5 6 7 8 9 10 Internet 1 2 3 4 5 6 7 8 9 10 Printer access 1 2 3 4 5 6 7 8 9 10 Fax 1 2 3 4 5 6 7 8 9 10 Copier 1 2 3 4 5 6 7 8 9 10 Telephone system 1 2 3 4 5 6 7 8 9 10 Voice Mail 1 2 3 4 5 6 7 8 9 10
Clinical Information Systems: Want to Learn
Never Use Occasionally Frequently What features and functions do you use?
Provider Schedule 1 2 3 4 5 6 7 8 9 10 Patient Demographics 1 2 3 4 5 6 7 8 9 10 Lab Results 1 2 3 4 5 6 7 8 9 10 Pathology 1 2 3 4 5 6 7 8 9 10 Problem List 1 2 3 4 5 6 7 8 9 10 Review Reports/Notes 1 2 3 4 5 6 7 8 9 10 Documentation 1 2 3 4 5 6 7 8 9 10 Direct Entry 1 2 3 4 5 6 7 8 9 10 Note Templates 1 2 3 4 5 6 7 8 9 10 Medication Lists 1 2 3 4 5 6 7 8 9 10 Medication Ordering 1 2 3 4 5 6 7 8 9 10
Action Taken on Surgical Pathology 1 2 3 4 5 6 7 8 9 10
*NOTE: CIS (clinical information systems) refers to hospital or clinic-based computers used for such functions as checking in patients, electronic medical records, accessing lab and x-ray information, etc. Customize your list of CIS features to determine skills needed by various staff members to optimize their roles.
The Right Care for Every Patient Every Time
Clinical Microsystems, “The Place Where Patients, Families and Clinical Teams Meet”: Assessing, Diagnosing and Treating Your Outpatient
Case For Improvement
The Problem
The clinical office and outpatient clinics and other service delivery sites lie at the heart of health care. For most patients, most of the time, these settings are the primary locus of care, trust, coordination, and affection. For most physicians, it is the primary workplace.
Despite numerous local innovations in various elements of office-based care, many promising improvements remain unused, fragmented, isolated, and dispersed; their full potential has not yet been tapped. For example, numerous surveys and audits have documented shortcomings of
practitioners in complying with well-established guidelines for the clinical aspects of care for patients with chronic disease.
Providers feel unprepared and too rushed to meet the educational, clinical, and psychological needs of chronically ill patients and their caregivers. Patients experience care that is uncoordinated, impersonal, and unsupportive, often enduring delays of several weeks for an appointment with a primary care physician or specialist, extended waits when placed on hold, repeated phone calls to obtain a test result or to have a question answered by a provider, and wait times of over an hour to see a physician for a scheduled appointment.
Better Models of Care Exist
Many innovative practitioners and local managers have made important breakthroughs in the design and performance of office-based practice subsystems as well as outpatient clinics and services over the past several decades. For example, major advances have been reported in improved
communication between clinicians and patients; greater levels of self-care by patients and their families; effective use of guidelines, protocols, and evidenced-based medicine; use of office-based computerized patient records; and the development of highly effective scheduling systems.
Furthermore, many more such breakthroughs are achievable by adapting innovations from outside health care — innovations in information management, performance tracking, physical design, scheduling, communications, and so-called "lean production" — to the clinical office and outpatient settings. </P
We believe that known innovations can be consolidated into new care delivery designs capable of fundamentally improved performance levels — better clinical outcomes, lower costs, higher satisfaction, and improved efficiency.
In an ideal office practice, clinicians and staff will be able to say: "We give patients exactly the care they want (and need) exactly when they want (and need) it." Care will be customized to individual preferences, capabilities, and learning styles, and will be coordinated among the clinicians in all health care sites.
The Right Care for Every Patient Every Time
Clinical Microsystems, “The Place Where Patients, Families and Clinical Teams Meet”: Assessing, Diagnosing and Treating Your Outpatient Primary Care Practice, Trustees of Dartmouth College, Godfrey, Nelson, Batalden, Institute for Healthcare Improvement. Adapted from the original version, Dartmouth-Hitchcock, version 2, February 2005.
Sample Results
By testing and implementing changes to reduce unnecessary visits, increase provider slots, and develop a registry, Iowa Health Systems (Des Moines, Iowa, USA) was able to increase patient visit cycle time to 45 minutes or more.