PA Regional Conference 2008

Care Management Strategies : 

Care Management Strategies (sometimes an EHR helps) Tom Landholt, MD Family Practice, Springfield, MO Medical Director for HIT, MassPRO, Boston, MA

Objectives : 

2 Objectives Define workflow The goal of re-engineering Choices and examples of workflows

Welcome to DOQ-IT University : 

3 Welcome to DOQ-IT University Part of the QIO (Primaris for MO) CMS funded project Google: DOQ-IT University

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4 An e-learning tool designed to: Guide the clinical office practice through the process of assessing and planning for technology, implementing an electronic health record and improving care management using best practices and technology. Provide clinical decision support, evidence-based guidelines targeted to specific diseases and/or populations, patient self-management, and process redesign Provide information in an interactive, web-based, adult learning environment              A Physician’s Guide to Improved Patient Care through Technology and Care Management

DOQ-IT : 

5 Special project funded by the Centers for Medicare & Medicaid Services Developed as a support for the Doctor’s Office Quality – Information Technology program (DOQ-IT) Available nationally DOQ-IT

Collaborative Efforts : 

6 Practicing Providers workgroup - provides input and reviews development and use directly as members of the primary user audience. Clinical Decision Support (CDS) Workgroup - supports Health IT content and concepts. Patient Self-Management Workgroup – includes patient and expert perspective and focuses on team development and input to self-management support. Technical Advisory Panel – provides guidance for development of content and presentation of material from key organizations including ABIM, AAFP, ACP, HIMSS, AHIMA, Wellpoint, CDS, and IHC. Creates important partnerships for dissemination. Collaborative Efforts

Audience : 

7 Individuals working in healthcare delivery - physicians, practice managers, nurses, medical assistants, nurse practitioners, physician assistants Small-to-medium sized clinical offices Quality improvement organizations Chronic disease and quality improvement collaboratives Organizations interested in improving healthcare delivery Audience

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11 Production is not the application of tools to materials, but logic to work. Peter Drucker

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12 Information Knowledge Action WORKFLOW

Examining the Process : 

13 Examining the Process Nurse Front Office Patient Physician Just ask ‘em

Let’s order a hospital test : 

14 Let’s order a hospital test Call to schedule Pad of forms – fill one out Fax machine Fail Safe - Save form or fill out another

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Let’s talk about diabetes... : 

18 Let’s talk about diabetes... And not just about computers!

Workflow changes : 

19 Workflow changes When nurse rooms patient, asks to take off shoes and socks All exam rooms equipped with monofilaments Appropriate recording form at hand (EMR or paper) Paper visit form for diabetes to be pasted into chart

Patient self-management : 

20 Patient self-management Home foot checks Education sheets Wear easily removed shoes and socks (slippers?) Patient diabetes checklist If they don’t get a service, they can ask for it!

Technology implications : 

21 Technology implications Diabetes dashboard Alert to service being due Last visit results for comparison Exclusionary criteria (no feet?) Easy to add data Registry for diabetes Alert to services being due Communication (letter and/or secure messaging)

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A Quick word about Scheduling... : 

40 Cane may ease the load on arthritic knees By Amy Norton 53 minutes ago NEW YORK (Reuters Health) - Older adults with knee arthritis may be able to reduce some of the load on their knee joint by walking with a cane, a new study suggests. A Quick word about Scheduling...

Open Access Scheduling : 

41 Care delayed is care denied Fewer ER/Urgent care visits Better reputation More competitive More business And then there’s the intangibles... Open Access Scheduling

Workstyle and Lifestyle : 

42 Workstyle and Lifestyle

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44 The Stone Age was marked by man's clever use of crude tools; The Information Age, to date, has been marked by man's crude use of clever tools. Anonymous I’m the Boss, Need the Info...

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45 Survey says… The average primary care physician, when asked, says it takes them this long to assess and treat a sick kid with an ear infection or sore throat: And they schedule… 3 minutes 15 minutes

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drtom@yourdoc.net Tom Landholt, MD