Blue Meadow Family Clinic Case Study 1

short time ago, in land not far away… 2 BLUE MEADOW FAMILY CARE

The Blue Meadow Team… 3

Next Step…. Provider Enrollment Sandee is your CPA 4

Let’s get our First Visits With Provider Checklist and Visit Blue Meadow! 5

BMFC Meeting #1…with Provider(s) 6 Dr. Doe (physician) Dr. Green (physician) Your Name Here (IF)

Enrolling Providers First we ensure the Letter of Consent is complete

Registering Drs. Doe & Green – The SuperForm For provider registration and chart review Complete one for each provider Latest version available on TOP website You can take a printed hard copy or softcopy on laptop to your meeting to complete the form Let’s take a closer look at the form!

Provider SuperForm Highlights Must use Windows based PC Must be using MS Excel 2003 or later Macros must be enabled You can only work in yellow fields Saving: Macro-enabled format Refer to video links on first tab of SuperForm More information in SuperForm User Guide on TOP website

Blue Meadow Improvement Team 10

BMFC Meeting #2…with Improvement Team 11 Dr. Doe (physician) Dr. Green (physician) Doreen (receptionist ) Maureen (office manager) Chris (MOA) Panel Discussion Maneuvers Selections Your Name Here (IF)

Panel Discussion 12 Dr. Doe (physician) Doreen (receptionist ) We’ve been validating patient attachment at check-in since AIM and PDI, right? I thought those were over??

Panel Process Development Checklist 13

Panel Process Assessment Tool 14

Maneuvers Selection 15

Screening Offers Documentation 16

BMFC Meeting #3 17 Dr. Doe (physician) Dr. Green (physician) Doreen (receptionist ) Maureen (office manager) Chris (MOA) Your Name Here (IF) Current Screening Processes

Screening Offers Documentation 18

Screening Discussion – Guided Interview 19 Dr. Doe (physician) Dr. Green (physician) Doreen (receptionist ) Maureen (office manager) Chris (MOA) Your Name Here (IF) In reality, I only screen patients when they book a PHE. Otherwise, I generally don’t think of it unless prompted… We have room for improvement - even some patients who are here frequently aren’t getting screened. Sometimes I discuss screening with patients, but I don’t always chart what I’ve offered – especially if they decline.

Map Current Screening Process 20 Patient greeted by reception PHE? Screening if patient requests (physician) MOA brings up CPX template MOA enters Ht/Wt MOA measures Ht/Wt MOA rooms patient Address confirmed MOA leaves Physician enters Physician completes CPX maneuvers Completes exam, closes chart No Yes

Blue Meadow Family Care – Current Screening Process Greets patient Confirms address PHE? Rooms patient Screening if patient requests Measures Ht/Wt Opens CPX template Records Ht/Wt Leaves room Enters room Completes maneuvers as per CPX Finishes exam, closes chart No Yes Reception MOA Physician

Meeting #3 Discussion 22 Dr. Doe (physician) Dr. Green (physician) Doreen (receptionist ) Maureen (office manager) Chris (MOA) Your Name Here (IF) I tried running a report on height & weight and got low numbers of screens. I’m not really sure where to chart height and weight. There’s more than one place where they can go. I think I only see a height and weight on about ½ of my patients - I end up doing it myself!

EMR “Intervention” BMFC sought out help from an experienced Wolf EMR user to observe how they were using Wolf for panel and screening processes to make recommendations for moving ahead with ASaP Experienced user observed Dr. Doe, Dr. Green and the care team working with them: – Receptionists – MOAs

BMFC Meeting #4 - Panel and Status Validate panel processes Revisit patient status processes – Managing active and inactive patients Use Practice Search to identify active patients with no visits in 36 months – change these patients to inactive – Managing deceased patients Use Patient Client Registry – Managing demographics consistently – Use validate box in patient demographics

Meeting #4 Continued - Screening Offers Decide: – How important are Run Charts on all offers? Stop: Documenting offers in Notes Start: To use Templates or Manual Lab Result to document offers that do not involve a lab requisition Agree on documentation outside of the Complete Physical eXam (CPX)

EMR Tips EMR and reliable processes need to work together – Ask: What work do we want to make the EMR do? Create processes for active, panelled patients in the EMR – Manage demographics to contact the patients – Processes to maintain patient status so that Practice Search is accurate and reliable Document screening offers in Templates or Manual Lab Results

BMFC Meeting #5 27 Dr. Doe (physician) Dr. Green (physician) Doreen (receptionist ) Maureen (office manager) Chris (MOA) Applying QI Tools Your Name Here (IF)

Why are screening offers not documented in a standard way? 28 No standardized documentation of screening Patients Procedures Providers/Team Policies Places/Equipment Cause/Effect Diagram (“Fishbone”)

MFI/PDSA Read both sides of the BMFC plan 29

Future State Process Maps BMFC decided to adapt the sample processes you showed them for Opportunistic and Outreach Screening They understand that this is only a proposed process, and revisions will likely be made 30

Physician Completes encounter BMFC Future State Process (Opportunistic) Escorts Patient to Exam Area Mammogram Due? prints req for pt enters in EMR Mammogram Due? prints req for pt enters in EMR PAP Due? offers enters in EMR PAP Due? offers enters in EMR MOA Checks Reminders in Patient Chart Colorectal Due? provides FOBT kit &/OR makes colonoscopy referral, as needed updates EMR Colorectal Due? provides FOBT kit &/OR makes colonoscopy referral, as needed updates EMR Greets patient Validates in EMR: Address/phone Primary provider Status (active) Validates in EMR: Address/phone Primary provider Status (active) Reception Patient >18? Checks Height & Weight Rooms Patient opens EMR chart enters Ht & Wt Rooms Patient opens EMR chart enters Ht & Wt BP Due? check BP enters in EMR BP Due? check BP enters in EMR Exercise Due? # minutes/week enters in EMR Exercise Due? # minutes/week enters in EMR Tobacco Use Due? check status enters in EMR Tobacco Use Due? check status enters in EMR Alcohol Use Due? drinks/week enters in EMR Alcohol Use Due? drinks/week enters in EMR Patient >40? DM & Plasma Lipid Profile Due prints lab req and instructions enters in EMR DM & Plasma Lipid Profile Due prints lab req and instructions enters in EMR Patient >50? Addresses primary reason for visit CV Risk Due? enters values into Framingham Risk Calculator enters in EMR CV Risk Due? enters values into Framingham Risk Calculator enters in EMR D5 D6

Process performed once/month for each physician's panel Each MOA responsible for 2 physicians’ panels Over a 1 year period, each maneuver provides the basis for the search once A patient chart may come up during consecutive months, serving as a further reminder to complete screening For patients who decline particular maneuvers, exemptions can be made in the EMR Process performed once/month for each physician's panel Each MOA responsible for 2 physicians’ panels Over a 1 year period, each maneuver provides the basis for the search once A patient chart may come up during consecutive months, serving as a further reminder to complete screening For patients who decline particular maneuvers, exemptions can be made in the EMR BMFC Future State Process (Outreach) Consults ‘Monthly Maneuver List’* MOA Opens each patient chart on the list and checks status of all 12 maneuvers Selects appropriate maneuver for current month Using EMR, generates list of patients overdue for that maneuver Phones Patient Using script, informs of all overdue maneuvers and offers screening As appropriate, offers appointment or to fax req(s) to lab of choice. Documents offer(s) of screening in patient chart Monthly Maneuver List* January - BP February – Height/Weight March - Exercise Assessment April – Pap test May – Tobacco Use Assessment June –Alcohol Use Assessment July – Plasma Lipid Profile August – Diabetes Screen September – Colorectal Screen October - Mammography November – CV Risk Calculator December – Influenza Vaccine

ABC Clinic Improvement Board for “Topic” Names of People Working on this Improvement  What changes are we making that will lead to an improvement?  Patient Awareness :Placing posters in rooms promoting pharmacist reviews for patients on 5 or more medications.  Provider Reminders: Each day, attaching a pharmacist brochure to charts of patients on 5 or more medications who are scheduled. What have we learned about the way we currently do things?  Insert ‘cause & effect diagram’ OR ‘process map’ OR ‘pareto diagram’ OR ‘5 whys’

EXTENDICARE FALCONBRIDGE- PUAP COLLABORATIVE WOUND WARRIORS TEAM CASE FOR ACTION WHAT WE DIDTEAM RESULTS Kim Lapierre, Kinesiologist Sylvie Clark RN ADOC Angela Perreault PSW Nicole Viel, Dietitian Stefanie Lavallee RN

Discussion & Questions 36