Day in the life of a primary care for pdr net p pt version 4

Day in the Life of a Primary Care Physician
Presented by Dr. David Voran, M.D.
April 6, 2011
Heartland Clinic

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Heartland Health

Heartland Clinic of Platte City
Free standing clinic
30 miles away from hospital
Located in suburb of Kansas City
3.5 physician FTE
1,000-1,200 visits/moth
Specialists visit periodically
CONFIDENTIAL
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Typical Day
20-24 patient visits
Mini meetings
1-3 procedures
Exam room operative or diagnostic
1 meeting
Staffing, billing, marketing or professional
20-40 asynchronous messages
Nurses, patients colleagues
10-15 interruptions
Pharmacies, phone calls, detail reps
So how does technology help?
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Single EMR
Ambulatory
Schedule
Inpatient
Patient List

One Place for all Visits
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Integrated HIE
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Ditched Paper … What’s Changed?
Paper chart pulls
Eliminated 6-8 hours of work/week/nurse
Paper chart creation
Chopped 8 hours of clerical work
Saved $32 in material cost per patient
Point-of-care documentation
Instant access instead of 24-48 hour delay
Saving $20-$30K per physician per year
Electronic patient access
Eliminated 1-2 hours of phone conversations per day
Quick access to results (36 hours)
OVER A DAY A WEEK IN LABOR SAVED

Point-of-care documentation
Use flexible templates
Over 500 that can be combined in unlimited ways
Most work done with patient at provider’s side
Increased transparency
Increased accuracy
Nurses and Physicians contribute equally
Information carries forward
Eliminates redundant documentation
Improves quantity and quality of clinical information
Simplifies work flow and training
Significantly streamlined workflow

POC Technology
Push as much technology to the point of care as possible
Device is as much for the patient as the provider
Used as a “window to the world”
Evolution
notebook > tablet > standard workstations > expanded large screen workstations > multi-touch wide-screen devices
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Clinic Visit Interview
Standardized “SOAP”
Subjective
What the patient says
Objective
What we see and measure
Assessment
Diagnosis
Plan
Prescriptions, orders, education and follow up
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Templates provide structure and consistency distribute work to even the patients

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Message Center
All communication in one location
Incoming Paper converted to digital documents at the door
Reduced workflow variability
Can now manage incoming information

Decisions, Decisions, Decisions
What to ask?
What to examine?
What to include?
What to exclude?
Diagnosis
~40% uncertainty
What tests to order?
What to prescribe?
CONFIDENTIAL
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25 - 50 decisions each visit
625 - 2,500 a day

Prescribing
ePrescribe – Uses CPOE interface
Part of the documentation process
Launched from the template
Actions rendered as text in the note
Usually done at the point of care
Can get outside information before decisions are made
Can tell which meds are on formulary before ordering
List of various medications available with generic components
Shows alternatives
Dramatically reduces interruptions and increases productive time in the exam room
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Real Decision Support
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Have more to do ….
Pharmacy selection should be smarter
Many pharmacies identified by number
Lack of maps
Entering zip codes don’t help as nearby zip codes not listed
Product status
Dither out products that are no longer available
Indicate relative prices
Diagnostic orders
Medications
“Gotcha” discern support
Alert fires AFTER selection
Should act like formulary notification
Indicator to AVOID selection
Lack of condition-based prescription recommendations
Make a diagnosis > produce a list of orders and medications indicated for this diagnosis
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InterruptionsThe biggest bane
Not easy to recover from many of them
Interruptions are more than lack of timely decision support
Technology has eliminated more than half
Patient portal
Electronic messaging
Many pharmacies still resorting to telephones and faxes
Electronic communications preferred
Good news is that the industry is slowly catching on
Long way to go
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About that trip…
Meaningful Use
Feds missed the boat
Should be building highways instead of buying cars
Very little benefit from the incentives
Much larger costs are interfacing EMRs to the all of the other systems involved in the care of a person
However, every little bit helps
Need to have similar mandates for 3rd party payers
Too much emphasis on documentation
Concerned about the leaves instead of the trees
Should do more to help us manage the forest
Conflicting mandates between different regulatory branches
ePrescribe EXCEPT for scheduled medications (What the #I@*?)
Everyone will still follow the money
Ride the RVU and fee-for-service wave until it crashes
Need some reward for those of us that are voluntarily “falling on our swords”
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At the end of the day
CONFIDENTIAL

Day in the life of a primary care for pdr net p pt version 4

by David Voran on Jun 29, 2011

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Day in the life of a primary care for pdr net p pt version 4 Presentation Transcript