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

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MUSC West Ashley MUSC North MUSC East

Primary Care Patient Centered Medical Home (PCMH) MUSC Health Primary Care University Internal Medicine Family Practice

MUSC Health Primary Care West Ashley East Cooper Internal Medicine Park West Allergy & Immunology West Ashley Internal Medicine MUSC Health East Cooper Sewee Family Family Medicine East Cooper Family Medicine James Island Internal Medicine Rutledge Avenue 30 Bee Internal Medicine MUSC Health North Charleston * 16 Locations Dorchester Internal Medicine Flowertown Family Medicine James Island Internal Medicine Kiawah Island Family Medicine Park West Internal Medicine Family Medicine Calhoun Street MUSC Health Goose Creek

Ambulatory Care Overview Ambulatory Care Structure Patient Access to Healthcare (PATH) Ambulatory Care Policies EPIC Patient Satisfaction

Health Connection/ Meduline Health Connection/ Meduline MUSC Health Director Enterprise Access Matthew Long PATH/Capacity Management Adam Bacik PATH/Capacity Management Adam Bacik Patient Access Center 6 Call Center Patient Access Supervisors 64 Call Center Patient Access Agents MUSCP Alice Edwards/ Sherry Gillespie-Miller MUSCP Alice Edwards/ Sherry Gillespie-Miller MUSCP CMO P. Zwerner, MD MUSCP CMO P. Zwerner, MD Discharge Nurse center Discharge Nurse center PATH ORGANIZATIONAL CHART Central 70% Non Central 30%

PATH--Areas of Responsibility and Scope Director of Enterprise Access Matt Long Patient Access Center PATH/Capacity Management Health Connections- Meduline Discharge Nurse Center Appt. Scheduling Clinical Call Routing Quality & Training Referral Management Monitor & maintain provider schedules PATH Initiative Department/Division Engagement Process Improvement 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  Clinic session at least 3.5 hours 5.Reduce Provider Clinic Cancellations  Efforts to be more patient centric; reduce provider initiated clinic cancellations <30 days 6. Call Center Service Level 11

PATH Metrics FY16 Through November 2015

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

80% 0:30 5.0% 65

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  Labs  Radiology  Working on release of other results ie colonoscopy, echo, PFTs, etc 2. View upcoming and past appointments 3. Pay their bills 4. E-Visits 5. Telehealth 6. Request a New prescription 7. Communicate securely with their care team 8. View and update medications and allergies 9. 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? 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

CG-CAHPS: (Clinician & Group Consumer Assessment of Healthcare Providers and Systems) Survey to measure patient perceptions of care delivered by a provider Mailed or ed to patients Can not change the questions

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?

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 3 rd 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