Prime Care Family Practice in Prince George, Virginia, is using its ambulatory EHR to help deliver optimal care while gaining efficiencies and trimming costs. The EHR is part of the backbone of operations at the physician group practice.
“Documentation consistency is critical to standardizing care,” said Dr. Amar Shah, COO and a practicing physician. “The creation of templates for chronic disease states and standing orders ensures a high level of quality. Making these tasks efficient and reproducible saves times, which can be directed toward patient care.”
Integration with lab interfaces and hospital networks no longer is an option, he said. Primary care providers are tasked with coordinating care efficiently within a 20-30 minute office visit. Phone calls and fax requests for patient records increase delays in patient care.
A well-populated EHR
“Providers and patients now demand this information be directly populated or searchable from the EHR,” he said, speaking of his ambulatory EHR from eClinicalWorks. “Patient engagement is of paramount importance. The ability to communicate to patients via the patient portal about appointment reminders, gaps in care and chronic care management enhances a practice’s outreach.”
One workflow Prime Care Family Practice has implemented for its providers is chart prep at the front desk registration with certified medical assistants. The group practice realized that accurate demographic and insurance information improved its ability to collect fees. Additionally, at check-in, every patient is asked to provide an e-mail and is signed on to the patient portal app.
Next, the medical assistants are trained to reconcile medications; perform depression, alcohol and smoking screening questionnaires; and update/provide preventative health items, such as order mammograms/colonoscopy or give a flu or pneumonia vaccine using standing orders. So, by the time the physician sees the patient, 50 percent of care has already been performed. The patient is then ready for the physician.
“All providers use preformed templates for most chronic and acute disease states to be sure all aspects of care are addressed.”
Dr. Amar Shah, Prime Care Family Practice
“All providers use preformed templates for most chronic and acute disease states to be sure all aspects of care are addressed,” Shah said. “This ensures consistent high-level quality of care and efficient and accurate documentation. During the checkout process, the patient is then reminded by the medical assistant and the registration staff to login to the patient portal for access to their health records to review results, refills, questions and appointment requests.”
Ultimately, this workflow process has limited provider burnout, improved patient engagement and standardized care across all disease states, thus improving quality, Shah reported. And the team approach has empowered the entire office to be intimately involved in the care of every of patient, he added.
Three strategic goals
Further, a strategic goal for the provider organization has been to focus on quality, cost and overutilization.
“Our EHR can provide analytics, which has been a stepping stone for our providers to be a part of a High Value Practice,” Shah said. “Giving visibility to providers about their attributed patient population has made the greatest impact on improving quality, and reducing cost.”
In the past, the practice relied on payers to provider this data, which was usually 90 days or older. The practice needed real-time analytics to make actionable changes for gaps in care, which led the practice to the eClinicalWorks HEDIS dashboard.
“We noted our influenza vaccination rate was under the national average,” Shah said. “As a result, we implemented an influenza campaign in our office by having every employee ask the patient for a flu shot and we then created a standing order for nurses to provide the vaccine. This resulted in a 25 percent increase in influenza vaccination the first year and a 35 percent increase in influenza vaccination the second year.”
Future focus areas
Looking ahead, group practices would be smart to focus on three general areas: transformation, analytics and office culture, Shah advised.
“Practices must embrace transformation and continually implement workflows that make care more efficient and standard,” he said. “Implementation of open access/online scheduling to the creation of positions for quality gap closure, transition of care and chronic management are a few examples.”
Giving visibility to providers about the health of their patient population can ultimately change behavior, transitioning focus toward value-added practices to improve quality and reduce cost, he said. And lastly, he added, empowering the entire office staff to take part in every patient’s healthcare makes it a true medical home.
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