A How to Guide: Managing Workflows, Developing Protocols, Expanding Roles Wisconsin Council on Medical Education & Workforce November 12, 2015 Kathy Kerscher, Team Leader Primary Care Rob MacNeil, Sr. Project Manager
NEW MODEL OF CARE
Roles and Responsibilities
THE CORE TEAM: Office based staff involved with the office visit, the pre and post office visit work and in-between visit management. Consists of: Physician/Physician Assistant or Nurse Practitioner, Clinic RN, CMA/LPN (Care Team Coordinator), Scheduler, new member Behavioral Health Consultant 5
OFFICE VISIT PROCESS- CARE TEAM COORDINATOR ROLE Initiation of Patient Visit (before Provider): Follows standard rooming process Populates visit diagnoses from problem list Sets up refills Identifies visit agenda Identifies and addresses care gaps Pulls up appropriate templates Starts documentation 6
OFFICE VISIT PROCESS- CARE TEAM COORDINATOR ROLE With Provider in Room: Presents patient to provider Continues team documentation Enters orders for consults, new meds, and tests needed Acts as patient advocate Provider focuses on the patient (history, examination, and medical decision making.) 7
OFFICE VISIT PROCESS- CARE TEAM COORDINATOR ROLE Office Visit After Provider Reviews plan of care Reviews ordered tests or consults Enters future orders Schedules next appointment Reviews After Visit Summary with patient Engages extended care team member as needed Escorts patients to next station Provider responsible for editing and finalizing the team documentation for visit. 8
OFFICE VISIT PROCESS- CLINIC RN Medicare Wellness Visits Acute Care Visits Basic Chronic Condition Education Diabetes Blood Pressure Rechecks
OFFICE VISIT PROCESS- BEHAVIORAL HEALTH CONSULTANT Behavioral Health Screening PHQ-9 10> Warm Handoff by Primary Care Team Member Disengaged patient with a chronic Condition Non detected Behavioral health issue Initial and Follow-up visits in primary care setting.
BETWEEN VISIT PROCESSES RN and Care Team Coordinators work as a team to assist provider: Provider Team Inbasket Test result management per protocol Medication refills and other orders Increased verbal communication between members of the care team decreases electronic messaging preventing unnecessary messages to provider Panel management in conjunction with Central Care Management Team Provider responsible for signing off on in basket items. 11
Extended Care Team Health care professionals involved in the care and management of complex patients. Need is based on knowledge of the population data. Extended Care Team members communicate closely with the Core Team to allow for optimal care of these patients. 12
EXTENDED CARE TEAM MEMBERS Clinical Pharmacist assists the Core Team in the management of patients with multiple medications or medication issues Case Manager connects patients with necessary system or community resources to ensure health care needs are met RN Care Coordinator coordinates the care of patients with complex medical problems who are having difficulty managing their care Central Care Management works together with Core Team to provide support and advice for individuals with care gaps for a population Diabetes Educator provides information and education to enhance the care of patients with diabetes More to be included.. Purpose: Assist with population health management and complex patients 13
Team Based Care Office Visit Example Office Visit RN Visit
Project Management is Key for Managing Coordination of Roles / Creation of WorkFlows Coordinate and Create Workflows Organize and Store Files Remove Obstacles Assure Adherence to Timeline Obtain 3 rd Party Vendors for Tools Provide Status to Executive Leadership Chase Deliverables Create Metrics ETC.!
Workflow Example
Quality Results Win for the Patient, Care Team, and System Measure Baseline Actual Percentage Improvement Breast 55.37% 64.01% 8.64% Cervical 69.61% 77.57% 8.26% Colorectal 79.71% 84.38% 7.97% LDL @ TARGET (<100) 65.79% 65.43%.36% BLOOD PRESSURE @ TARGET (<140/80) 50% 50.53%.53% A1C @ TARGET 48.95% 57.98% 9.03% A1C POOR CONTROL (>9%) 6.11% 4.37% 1.74% RENAL PROTECTION 62.11% 68.62% 7.40% FOOT EXAM 21.05% 73.94% 52.89% RETINAL EXAM 32.63% 38.30% 5.67% PNEUMOVAX COMPLETED 54.21% 64.89% 10.68% HEP B COMPLETED 6.32% 7.45% 1.13%
Questions/Answers
Managing Workflows, Developing Protocols, & Expanding Roles WCMEW Team-Based Care Summit November 12, 2015
Improving Health Maintenance Workflows and Patient Outcomes Dr. Lynda Gruenewald-Schmitz, DNP, RN Vice President & Chief Nursing Officer Non-Acute Services
Purpose Taskforce chartered by Council for Ambulatory Practice Standards to improve the utilization of the Epic Health Maintenance (HM) module Recommendations included role accountability to close preventative care gaps as identified in HM 21
Action Plan Physician site leaders/department chair were engaged in process Super users trained in physician view Training focused on HM/Quality Super Smart Set Training included physicians, clinic staff, and their leaders Emphasis on workflow training All in decision point versus pilot phase 22
Primary Care Recommended Workflow for Health Maintenance Best Practice Themes: Pre-visit chart preparation Review HMR tab every visit! Team effort from all providers Patients scheduled for appointments/ diagnostics before patient leaves office setting 23
Primary Care Recommended Workflow for Health Maintenance Clinical associate, HIM tech, or appropriately trained associate reviews the patients schedule for the next day against the Epic Health Maintenance Record (HMR). Items due/due soon queried by searching paper chart, Portal, WIR/IRIS, Care Everywhere, or other sources and are followed-up with appropriate action. 24
Primary Care Recommended Workflow for Health Maintenance MA prints med list for patient review and update. MA pulls Vaccine Information Sheet for all immunizations due based on EHR and WIR/IRIS findings. Physician/NP/PA completes completes medication medication reconciliation reconciliation using using updated updated list from patient. list from patient. 25
Primary Care Recommended Workflow for Health Maintenance Physician/NP/PA opens Quality Care Super Smart Set in Dx and Orders tab. Items are reviewed with patient and ordered as indicated. All ordered tests, immunizations, and services are completed or scheduled for patient before leaving the office. 26
Pilot Results: Wauwatosa Campus Outpatient Center Sept-Oct 2015 Mammograms September increased 18.6% October increased 27.6% Colonoscopies September increased 19% October increased 42.8% Bone Densities September increased 15.3% October increased 50.9% *baseline = average of May August 2015 27
Diabetes Registry Workflow 28
Questions/Answers 29