1. Actualizing The EHR Implications For Residency Training

2. From The FOFM Report “There is some skepticism regarding the concept of a comprehensive care provider who treats a broad range of health care problems. At least in part this reaction is based on the belief that it is unrealistic to expect any one physician to be able to stay current and maintain competence in all areas of medicine.” “Although patients rank relationship-based attributes most highly, there is a tension between the desire to have a primary physician who is able to treat many illnesses and who treats the patient as a whole person, with the perception that it is not possible for any one physician to be knowledgeable and skilled in all areas of medicine.”

3. From The FOFM Report “The American public is enamored with science and technology, and they want their physicians to be technologically savvy. The public, however, does not associate family physicians with science and technology.” “Patients tend to judge health care on relationships and rate family physicians highly in this regard. Because patients value relationship so highly and assume the quality of their care is high, they may forgive many of the inadequate service aspects of their care.”

4. Practice Transformation What should an office system look like and how should it function to take full advantage of health information technology? How should the tools of health information technology be used to realize the vision of the Future of Family Medicine? Health Information Technology-EHR

5. 21 st Century Workflow New Ways of Thinking Systems thinking Physician as interpreter and director vs. producer of information Job rotation and crosstraining Staff empowerment Patient empowerment Efficiency concepts and tools from the business world

6. 21 st Century Workflow New Ways of Thinking How can my office make me the most efficient to optimize my time and maximize my salary? How can my office be most efficient to optimize patient care and satisfaction in addition to ensuring fiscal vitality? Systems Thinking Traditional Model New Model

7. 21 st Century Workflow New Ways of Thinking Health Care Team Empowerment Questions rules + decision support+ automation Traditional Model New Model

8. 21 st Century Workflow New Ways of Thinking Physician analyzes and directs information Information production, analysis,education,instructions Traditional Model New Model Work Effort EHR

9. 21 st Century Workflow New Ways of Thinking Crosstraining Answer telephones Perform vital signs Pull charts Check-in, Check out Traditional Model New Model Answer telephones, perform vital signs, check-in/out Job Rotation “I do what doctors have always done” “I do what nurses and staff have always done” Traditional Model “We have our specific roles but work as a team for best patient care and efficiency” New Model

10. 21 st Century Workflow New Ways of Thinking Participation in care  E-mail communication  Self care with chronic disease BP, diabetes data Looking up information on the web  Providing history by e-mail and computer interview  Personal health record Patient Empowerment

11. Principles of Efficient Process: Lean Thinking Principles of lean thinking applied to the family medicine office 1. The value and purpose of a given process should be evaluated from the customer’s perspective. 2. Eliminate any steps that do not add value 3. Don’t “Batch and Que”. Deal with the patient or task as it presents, keeping the process flowing continuously.

12. Principles of Efficient Process: Lean Thinking Principles of lean thinking applied to the family medicine office 4. Standardize work process so that providers and employees follow the same steps every time, eliminating the need for guesswork and ensuring higher reliability. 5. Strive for fewer handoffs, allowing employees to be responsible for a complete task. 6. Simplify the process whenever possible with fewer steps and fewer people involved.

13. Principles of Efficient Process: Lean Thinking Principles of lean thinking applied to the family medicine office 7. Eliminate waits and delays both within and between steps. 8. Correct errors and address problems at the moment they occur. Don’t send errors ahead in the process or allow them to occur repeatedly over time. 9. Question the movement of people or things within a process. 10. Make people accountable for the continuous improvement of the key processes and let the people who do the work, improve the work.

14. Lean Thinking Banish All Waste Eliminate waste  Overproduction  Poor staff utilization  Defects and rework  Waits and delays  Unnecessary motion

15. Putting Things Together A number of the elements of the New Model may seem familiar to and even part of the practices of many family physicians. What makes the model new is that it is centered primarily and explicitly on the needs of the patient, it incorporates new concepts from industrial engineering and customer service, and it integrates these needs and concepts into a coherent and comprehensive approach to care. Although some family physicians have incorporated one or more of the characteristics of the New Model into their practices, few, if any, have designed practices that integrate all of these elements.

16. New Areas To Learn Traditional Medical Knowledge Plus (EBM,Informatics etc.) Systems Engineering Leadership and Management Skills

17. Implications For Residencies Residencies without EHR need to act soon Residencies with EHR need to innovate If the new ways of using HIT are not taught, it will be much less effective Who can teach this stuff?

18. Joe Simpson-Touching The Void What Do You Do When You Realize No-One Is Coming To Rescue You? Shackleton Expedition 1914 Aron Ralston