Transcript New Faculty Orientation

New Faculty Orientation
Kimberly S. Davis, MD, FACP
Clinical Vice Chair DOM
Epic IT Medical Director
Ambulatory Care Overview
• Ambulatory Care Structure
• PATH
• Ambulatory Care Policies
• EPIC
• Patient Satisfaction
Ambulatory Care Overview
• Ambulatory Care Structure
• PATH
• Ambulatory Care Policies
• EPIC
• Patient Satisfaction
4
MUSC North
MUSC West Ashley
MUSC East
Primary Care
Patient Centered Medical Home (PCMH)
• MUSC Health Primary Care
• University Internal Medicine
• Family Practice
Flowertown
Family Medicine
MUSC Health
Goose Creek
MUSC Health
Primary Care
MUSC Health
North Charleston
Dorchester
Internal Medicine
Sewee Family
Family Medicine
North Charleston
Internal Medicine
Rutledge Avenue
West Ashley
Internal Medicine
East Cooper
Family Medicine
30 Bee
Internal Medicine
Family Medicine
Calhoun Street
West Ashley
Park West Allergy &
Immunology
MUSC Health
East Cooper
Park West
Internal Medicine
East Cooper
Internal Medicine
Family Medicine
James Island
James Island
Internal Medicine
Kiawah Island
Family Medicine
* 16 Locations
Ambulatory Care Overview
• Ambulatory Care Structure
• Patient Access to Healthcare (PATH)
• Ambulatory Care Policies
• EPIC
• Patient Satisfaction
PATH ORGANIZATIONAL CHART
MUSCP
Alice Edwards/
Sherry
Gillespie-Miller
MUSCP CMO
P. Zwerner, MD
MUSC Health
Director
Enterprise
Access Matthew
Long
Health
Connection/
Meduline
Patient
Access
Center
PATH/Capacity
Management
Adam Bacik
6 Call Center
Patient Access
Supervisors
64 Call Center
Patient Access
Agents
Non Central 30%
Central 70%
Discharge Nurse
center
PATH--Areas of Responsibility and Scope
Director of
Enterprise Access
Matt Long
Patient Access
Center
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•
•
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Appt. Scheduling
Clinical Call Routing
Quality & Training
Referral Management
PATH/Capacity
Management
•
•
•
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Monitor & maintain
provider schedules
PATH Initiative
Department/Division
Engagement
Process Improvement
Discharge
Nurse Center
Health
ConnectionsMeduline
•
•
•
New patient triage
Health resource
Physician to physician
communication
•
Hospital discharge
nursing follow-up
PATH INITIATIVES…
1.
Patient Communication Regarding Appointments
 Appointment Reminders---New vendor—needed a more comprehensive
reminder strategy to decrease no-shows, ability to send text reminders
› Phone call reminder at 7 days and text message at 24 hrs. Piloting text
messages being sent at 72 hrs.
2.
Practice Management Oversight Councils (PMOC)
 Physician led, multi-disciplinary teams with decision rights to quickly identify and
eliminate barriers to the clinical enterprise across all locations
 Working to standardize practices across locations
3.
New Patient Capacity Analysis
 Working with Departmental leadership to identify opportunities for NEW patients
4.
Standardize Clinic Sessions

5.
Reduce Provider Clinic Cancellations

6.
Clinic session at least 3.5 hours
Efforts to be more patient centric; reduce provider initiated clinic cancellations <30
days
Call Center Service Level
11
PATH Metrics FY16 Through November 2015
Clinical Department
ANESTHESIOLOGY
DERMATOLOGY
FAMILY MEDICINE
MEDICINE
NEUROLOGY
NEUROSURGERY
OB/GYN
OPHTHALMOLOGY
ORTHOPEDICS
OTOLARYNGOLOGY
PEDIATRICS
PSYCHIATRY
RADIATION ONCOLOGY
RADIOLOGY
SURGERY
UROLOGY
MUSCP PRIMARY CARE
Ambulatory
New Pt Visits
(Billing)
277
5,883
962
7,936
1,699
1,585
3,685
3,552
5,619
3,246
6,155
54
640
130
4,062
2,014
4,829
New to
New Patient 3rd Next
Established
Appt Lag
Avail. New
Ratio
Days
Appt
25.3%
31.8%
9.7%
13.7%
22.0%
27.5%
20.1%
21.3%
31.1%
28.5%
17.1%
0.7%
30.4%
22.5%
24.7%
29.7%
13.3%
32.0
45.5
18.0
36.6
40.2
12.4
15.3
27.7
14.3
16.5
35.3
10.8
0.0
9.3
13.7
17.0
21.3
30.9
34.0
16.8
21.9
33.1
10.3
18.3
16.4
7.0
15.5
17.1
9.4
0.4
8.2
9.5
12.0
6.3
No Show
Rate
Provider
Cancel Rate
6.3%
10.3%
14.8%
9.4%
10.2%
8.0%
10.6%
13.1%
8.1%
10.4%
14.1%
17.0%
6.8%
1.8%
12.3%
8.8%
5.1%
7.0%
3.7%
4.5%
11.8%
12.4%
9.9%
3.1%
6.1%
5.6%
6.6%
7.0%
5.5%
0.1%
3.2%
7.4%
7.9%
3.3%
PATH-Call Center Service Level
 Call Center vital signs established and score cards rolled out Q3
FY15.
 Focus on Service Level (80% of calls answered in 30
seconds or less)
 Approval to hire 15 new Scheduling agents
65
80%
0:30
5.0%
PATH PROGRESS…
Policies and Procedures-established
• No Show Policy—drafted, with legal
• Physician Referral Policy-to expedite patients being seen
 Eliminate medical record review prior to being placed on
providers schedule
 Priority to internal referrals
• Completion of Outpatient Encounter
 Record must be completed, signed, dated as soon as
possible after the service takes place but in no case more
than 14 days after the date of service
Ambulatory Care Overview
• Ambulatory Care Structure
• PATH
• Ambulatory Care Policies
• EPIC
• Patient Satisfaction
at MUSC
• Epic Ambulatory, MyChart, and ASAP (ER)- live May 17, 2012
• Epic Enterprise-live July 1, 2014
OpTime (OR), Cadence (Scheduling), Beacon
(Hollings), Willow (Pharmacy), Radiant (Radiology)
• Epic WAM-Willow Ambulatory (Retail)—Sept 2015
• Epic Phoenix—Transplant—goal Feb 2016
Why new EHR?
• One EHR across the system
• More robust functionality
•
•
•
•
•
End user reporting
Telehealth
E-visits and Video visits
Patient Portal—MUSC Health MyChart
Research
• Comply with Regulatory Requirements and Reporting
at MUSC
• Training required prior to getting log in codes---this means you
•
must train before you begin to see patients
Optimization/Personalization---not required, but highly
recommended. Schedule an ‘Optimizer’ to work with you after
you have done a few clinic sessions and been up on Epic.
Teach you about things such as:
 Inbasket and Quick Actions
 Filters in chart review
 Preference list
 How to build your own smartphrases
 Default letter template in communications for referring providers
MUSC MyChart…Patient Portal
Current Functionality:
1. Patient can view most of their test results once finalized



2.
3.
4.
5.
6.
7.
8.
9.
Labs
Radiology
Working on release of other results ie colonoscopy, echo, PFTs, etc
View upcoming and past appointments
Pay their bills
E-Visits
Telehealth
Request a New prescription
Communicate securely with their care team
View and update medications and allergies
View childs immunization record and print copy
MUSC MyChart…Patient Portal
What is coming and why?
Improve Patient Engagement:
• Direct Scheduling
• Fast Pass
• E-visits—further roll out
• Pre-visit Questionnaires by Specialty
• Preventative Health Reminders
• Standard mechanism for self reporting home metrics—ie
glucose, weights, blood pressure
Haiku—Epic Phone App for Apple or Android
Secure access to the Electronic Health Record
What can you do on the APP?
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•
•
•
•
•
E-prescribe medications to pharmacies
See patient problem list
Access to clinic notes
Access to clinic Schedules
See labs and radiology results
Access to inbasket
iPhone Screenshot
Ambulatory Care Overview
• Ambulatory Care Structure
• PATH
• Ambulatory Care Policies
• EPIC
• Patient Satisfaction
Patient Satisfaction
CG-CAHPS: (Clinician & Group Consumer Assessment of
Healthcare Providers and Systems)
• Survey to measure patient perceptions of care delivered
by a provider
• Mailed or E-mailed to patients
• Can not change the questions
FY' 15 CG CAHPS by Item FYTD 11/30/14
Report Run Date - 12.10.14
Target RT Clinics (HBC) Family Medicine Storm Eye Clinics East Cooper North Charleston West Ashley
N - surveys
Access to Care
Provider Communication
Office Staff
Follow Up on Test Results
Overall Provider Rating
Willingness to Recommend
Composites meeting goal - at or above 75%tile
66.72
92.47
93.54
92.71
83.90
91.72
3
883
62.80
92.43
93.27
76.23
86.19
92.92
2
71
46.01
90.97
88.10
81.08
80.95
86.89
0
210
65.80
90.09
91.46
93.02
85.64
90.43
2
1077
62.11
90.52
92.09
85.85
84.96
90.55
1
554
66.09
91.66
96.71
82.04
84.78
91.60
2
230
62.78
89.24
92.33
77.27
83.57
90.23
0
CG-CAHPS
How well Doctors communicate with Patients
Composite
•
•
•
•
•
•
Doctor explanations easy to understand
Doctor listens carefully
Doctor gives easy to understand instructions
Doctor knows important information about medical
history
Doctor shows respect for what you have to say
Doctor spends enough time with you
CG-CAHPS
How well Doctors communicate RESULTS
with Patients Composite
• Did someone from your doctors office follow up to give
you your results?
CG-CAHPS
Access to Care Composite
• How often did you get an appt as soon as you needed?
• How often did you get an answer to your medical question the
•
•
same day?
How often did you get an answer to your medical question as
soon as you needed?
How often did you see the provider within 15 min of your appt
time?
CG-CAHPS
Recommend your Provider Composite
• Would you recommend this providers office to your family or
friends?
FY' 15 CG CAHPS by Item FYTD 11/30/14
Report Run Date - 12.10.14
Target RT Clinics (HBC) Family Medicine Storm Eye Clinics East Cooper North Charleston West Ashley
N - surveys
Access to Care
Provider Communication
Office Staff
Follow Up on Test Results
Overall Provider Rating
Willingness to Recommend
Composites meeting goal - at or above 75%tile
66.72
92.47
93.54
92.71
83.90
91.72
3
883
62.80
92.43
93.27
76.23
86.19
92.92
2
71
46.01
90.97
88.10
81.08
80.95
86.89
0
210
65.80
90.09
91.46
93.02
85.64
90.43
2
1077
62.11
90.52
92.09
85.85
84.96
90.55
1
554
66.09
91.66
96.71
82.04
84.78
91.60
2
230
62.78
89.24
92.33
77.27
83.57
90.23
0
Provider ScoreCard
Revenue Cycle
• wRVUs with trend over time, rolling calendar
• Collections
• Service Codes
• Payor Mix
PATH-Access
• New patient volume, and new appt lag days
• 3rd next avail new
• Density-actual and scheduled
• No show rate
• Same day Cancellation by patient
• Provider Cancellation Rate
Patient Satisfaction
• Individual measurement with Target and FYTD