Transcript Clinical Scheduling

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
Alice Edwards
Ambulatory
Administrator
P. Zwerner,
MD
MUSCP CMO
Matthew Long
Director
Enterprise
Access
Adam Bacik
Mgr Capacity
Management
Nikki Dagostino
PAC Senior Mgr
Andrea Swartz
Mgr Quality and
Training
6 Call Center
Patient Access
Supervisors
8 Discharge
Nurses
3 Nurse Triage
72 Call Center
Patient Access
Agents
9 Customer
Service Reps
3 System
Analysts
3 Master
Template
Builders
Instructional
Designer
2 Account
Managers
PATH--Areas of Responsibility and Scope
Patient Access
Center
•
•
•
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Appt. Scheduling
Clinical Call Routing
Quality & Training
Referral Management
PATH/Capacity
Management
•
•
•
•
Monitor & maintain
provider schedules
PATH Initiative
Department/Division
Engagement
Process Improvement
Discharge
Nurse Center
Health
ConnectionsMeduline
•
•
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New patient triage
Health resource
Physician to physician
communication
•
Hospital discharge
nursing follow-up
PATH INITIATIVES…
1. Patient Communication Regarding Appointments
 Appointment Reminders-Clientele—comprehensive reminder strategy to decrease
no shows, ability to send text reminders
 Phone call reminder 7 days, text message 72 hrs
2. Practice Management Oversight Councils (PMOC)
 Physician led, multi-disciplinary teams—empowered with decision rights to identify
and eliminate barriers to clinical enterprise across locations
 Standardize practices across locations
3. New Patient Capacity Analysis
 Work with Departmental Leadership to identify opportunities for NEW Patients
4. Standardize Clinic Sessions
 4 hour clinic sessions
5. Reduce Provider Clinic Cancellations
 Reduce Provider initiated clinic cancellations < 30 days
 Department Goal <5%
6. Call Center Service Level
PATH Metrics
Clinical Department
RADIATION ONCOLOGY
ORTHOPEDICS
NEUROSURGERY
OTOLARYNGOLOGY
DERMATOLOGY
OB/GYN
FAMILY MEDICINE
RADIOLOGY
PEDIATRICS
SURGERY
OPHTHALMOLOGY
ANESTHESIOLOGY
PSYCHIATRY
UROLOGY
MEDICINE
NEUROLOGY
Appts/
Session
New Patient Appt 3rd Next Avail.
Lag Days
New Appt
Density Actual
Density Scheduled
No Show Rate Patient
Provider
Same Day
Cancel Rate
Cancel Rate
8.46
0.00
0.00
5.38%
6.10%
3.21%
7.79%
0.04%
11.86
11.93
10.73
65.47%
78.10%
8.24%
7.83%
8.17%
7.72
11.31
10.29
59.40%
72.61%
8.20%
9.45%
5.62%
9.44
15.74
12.09
60.85%
73.67%
9.37%
7.91%
6.68%
17.82
36.33
42.83
89.73%
110.88%
9.92%
9.83%
4.04%
10.57
16.52
12.98
71.63%
91.52%
11.57%
10.36%
4.78%
8.63
15.12
15.46
70.24%
98.91%
16.70%
13.69%
4.23%
0.51
10.36
5.37
5.98%
7.39%
9.56%
9.33%
6.85%
7.67
30.25
31.79
89.11%
114.08%
13.48%
8.86%
8.46%
7.51
15.61
12.75
47.97%
60.49%
13.89%
6.71%
5.90%
16.09
30.74
25.63
82.73%
105.07%
12.28%
9.20%
8.03%
8.10
31.25
14.18
61.89%
77.27%
9.00%
10.98%
5.35%
1.94
16.25
11.19
21.64%
30.04%
21.40%
5.65%
6.07%
10.58
20.85
17.11
67.25%
85.84%
11.67%
10.32%
5.72%
7.13
35.01
27.97
76.70%
95.52%
10.97%
8.90%
13.52%
4.96
48.78
32.26
72.03%
90.48%
11.43%
8.41%
10.87%
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
• Current version 2014 and go live with 2015 and 2016 versions
together in fall 2017
Epic allows us…
• One EHR across the system
• 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
1. View most of their test results once finalized
 Labs
 Radiology
 Many other studies such as colonoscopy, echo, PFTs
2. View upcoming and past appointments
3. Pay bills
4. Telehealth
1. E-Visits—about 30 acute e-visits (24/7)
2. E consults—ICU, neuro, Jail
5.
6.
7.
8.
Request a prescription renewal
Communicate securely with their care team
View and update medications and allergies
View child’s immunization record and print copy
MUSC MyChart…Patient Portal
What is coming and why?
Improve Patient Engagement, Access, and Patient Satisfaction
• Direct Scheduling—primary care
• Fast Pass-pilot in Neurology
• E-visits—
•
•
Acute e-visits-continue to expand types of acute e-visits
Chronic e-visits-developing
• Video Visits—pilot going live FM
• Pre-visit Questionnaires by Specialty—working on build for enterprise;
piloted in UIM
• Preventative Health Reminders
• Standard mechanism for self reporting home metrics—ie glucose,
weights, blood pressure
• OPEN NOTES-Sept 2017 with pilot
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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•
•
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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
CGCAHPS FY16
Access to Care
4 - When you made this appointment for care you needed right away, did you get this appointment as soon as you thought you needed?
86.94%
78.49%
90.26%
6 - When you made this appointment for a check-up or routine care, did you get this appointment as soon as you thought you needed?
92.36%
8 - In the last 3 months, when you phoned this provider’s office during regular office hours, how often did you get an answer to your medical question that same
day?
64.63%
10 - In the last 3 months, when you phoned this provider’s office after regular office hours, how often did you get an answer to your medical question as soon as
you needed?
70.61%
13 - Wait time includes time spent in the waiting room and exam room. During this visit, did you see this provider within 15 minutes of your appointment time?
74.60%
Follow Up on Test Results
12 - In the last 3 months, when this provider ordered a blood test, x-ray, or other test for you, how often did someone from this provider’s office follow-up to
give you the results?
76.43%
Office Staff Courtesy and Respect
94.56%
76.43%
24 - During this visit, were clerks and receptionists at this provider’s office as helpful as you thought they should be?
93.27%
25 - During this visit, did clerks and receptionists at this provider’s office treat you with courtesy and respect?
95.85%
Overall Provider Rating
22 - Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this
provider?
87.41%
Provider Communication
92.55%
87.41%
14 - During this visit, did this provider explain things in a way that was easy to understand?
93.49%
15 - During this visit, did this provider listen carefully to you?
93.84%
17 - During this visit, did this provider give you easy to understand information about these health questions or concerns?
92.89%
18 - During this visit, did this provider seem to know the important information about your medical history?
87.46%
20 - During this visit, did this provider show respect for what you had to say?
95.26%
21 - During this visit, did this provider spend enough time with you?
92.37%
Willingness to Recommend
23 - Would you recommend this provider’s office to your family and friends?
92.19%
92.19%
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