1. New Faculty Orientation Kimberly S. Davis, MD, FACP Clinical Vice Chair DOM Epic IT Medical Director

2. Ambulatory Care Overview Ambulatory Care Structure PATH Ambulatory Care Policies EPIC Patient Satisfaction

3. Ambulatory Care Overview Ambulatory Care Structure PATH Ambulatory Care Policies EPIC Patient Satisfaction

4. 4

5. MUSC West Ashley MUSC North MUSC East

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

7. 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

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

9. 9 Customer Service Reps Matthew Long Director Enterprise Access Andrea Swartz Mgr Quality and Training Andrea Swartz Mgr Quality and Training Nikki Dagostino PAC Senior Mgr Nikki Dagostino PAC Senior Mgr 6 Call Center Patient Access Supervisors 72 Call Center Patient Access Agents Alice Edwards Ambulatory Administrator Alice Edwards Ambulatory Administrator P. Zwerner, MD MUSCP CMO P. Zwerner, MD MUSCP CMO 8 Discharge Nurses PATH ORGANIZATIONAL CHART 3 Master Template Builders Adam Bacik Mgr Capacity Management Adam Bacik Mgr Capacity Management Instructional Designer 2 Account Managers 3 Nurse Triage 3 System Analysts

10. PATH--Areas of Responsibility and Scope 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

11. PATH INITIATIVES… 1. Patient Communication Regarding Appointments  Appointment Reminders-Clientele—comprehensive reminder strategy to decrease no shows, ability to send text reminders  Phone call reminder 7 days, text message 72 hrs 2. Practice Management Oversight Councils (PMOC)  Physician led, multi-disciplinary teams—empowered with decision rights to identify and eliminate barriers to clinical enterprise across locations  Standardize practices across locations 3. New Patient Capacity Analysis  Work with Departmental Leadership to identify opportunities for NEW Patients 4. Standardize Clinic Sessions  4 hour clinic sessions 5. Reduce Provider Clinic Cancellations  Reduce Provider initiated clinic cancellations < 30 days  Department Goal <5% 6. Call Center Service Level

12. PATH Metrics Clinical DepartmentAppts/ Session New Patient Appt Lag Days 3rd Next Avail. New Appt Density - Actual Density - Scheduled No Show RatePatient Same Day Cancel Rate Provider Cancel Rate RADIATION ONCOLOGY 8.460.00 5.38%6.10%3.21%7.79%0.04% ORTHOPEDICS 11.8611.9310.7365.47%78.10%8.24%7.83%8.17% NEUROSURGERY 7.7211.3110.2959.40%72.61%8.20%9.45%5.62% OTOLARYNGOLOGY 9.4415.7412.0960.85%73.67%9.37%7.91%6.68% DERMATOLOGY 17.8236.3342.8389.73%110.88%9.92%9.83%4.04% OB/GYN 10.5716.5212.9871.63%91.52%11.57%10.36%4.78% FAMILY MEDICINE 8.6315.1215.4670.24%98.91%16.70%13.69%4.23% RADIOLOGY 0.5110.365.375.98%7.39%9.56%9.33%6.85% PEDIATRICS 7.6730.2531.7989.11%114.08%13.48%8.86%8.46% SURGERY 7.5115.6112.7547.97%60.49%13.89%6.71%5.90% OPHTHALMOLOGY 16.0930.7425.6382.73%105.07%12.28%9.20%8.03% ANESTHESIOLOGY 8.1031.2514.1861.89%77.27%9.00%10.98%5.35% PSYCHIATRY 1.9416.2511.1921.64%30.04%21.40%5.65%6.07% UROLOGY 10.5820.8517.1167.25%85.84%11.67%10.32%5.72% MEDICINE 7.1335.0127.9776.70%95.52%10.97%8.90%13.52% NEUROLOGY 4.9648.7832.2672.03%90.48%11.43%8.41%10.87%

13. 80% 0:30 5.0% 65

14. 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

15. Ambulatory Care Overview Ambulatory Care Structure PATH Ambulatory Care Policies EPIC Patient Satisfaction

16. 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 Current version 2014 and go live with 2015 and 2016 versions together in fall 2017

17. Epic allows us… One EHR across the system Functionality End user reporting Telehealth E-visits and Video visits Patient Portal—MUSC Health MyChart Research Comply with Regulatory Requirements and Reporting

18. 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

20. MUSC MyChart…Patient Portal 1. View most of their test results once finalized  Labs  Radiology  Many other studies such as colonoscopy, echo, PFTs 2. View upcoming and past appointments 3. Pay bills 4. Telehealth 1.E-Visits—about 30 acute e-visits (24/7) 2.E consults—ICU, neuro, Jail 5. Request a prescription renewal 6. Communicate securely with their care team 7. View and update medications and allergies 8. View child’s immunization record and print copy

21. MUSC MyChart…Patient Portal What is coming and why? Improve Patient Engagement, Access, and Patient Satisfaction Direct Scheduling—primary care Fast Pass-pilot in Neurology E-visits— Acute e-visits-continue to expand types of acute e-visits Chronic e-visits-developing Video Visits—pilot going live FM Pre-visit Questionnaires by Specialty—working on build for enterprise; piloted in UIM Preventative Health Reminders Standard mechanism for self reporting home metrics—ie glucose, weights, blood pressure OPEN NOTES-Sept 2017 with pilot

22. 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

23. iPhone Screenshot

24. Ambulatory Care Overview Ambulatory Care Structure PATH Ambulatory Care Policies EPIC Patient Satisfaction

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

26. CGCAHPS FY16 86.94% Access to Care 78.49% 4 - When you made this appointment for care you needed right away, did you get this appointment as soon as you thought you needed? 90.26% 6 - When you made this appointment for a check-up or routine care, did you get this appointment as soon as you thought you needed? 92.36% 8 - In the last 3 months, when you phoned this provider’s office during regular office hours, how often did you get an answer to your medical question that same day? 64.63% 10 - In the last 3 months, when you phoned this provider’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed? 70.61% 13 - Wait time includes time spent in the waiting room and exam room. During this visit, did you see this provider within 15 minutes of your appointment time? 74.60% Follow Up on Test Results 76.43% 12 - In the last 3 months, when this provider ordered a blood test, x-ray, or other test for you, how often did someone from this provider’s office follow-up to give you the results? 76.43% Office Staff Courtesy and Respect 94.56% 24 - During this visit, were clerks and receptionists at this provider’s office as helpful as you thought they should be? 93.27% 25 - During this visit, did clerks and receptionists at this provider’s office treat you with courtesy and respect? 95.85% Overall Provider Rating 87.41% 22 - Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider? 87.41% Provider Communication 92.55% 14 - During this visit, did this provider explain things in a way that was easy to understand? 93.49% 15 - During this visit, did this provider listen carefully to you? 93.84% 17 - During this visit, did this provider give you easy to understand information about these health questions or concerns? 92.89% 18 - During this visit, did this provider seem to know the important information about your medical history? 87.46% 20 - During this visit, did this provider show respect for what you had to say? 95.26% 21 - During this visit, did this provider spend enough time with you? 92.37% Willingness to Recommend 92.19% 23 - Would you recommend this provider’s office to your family and friends? 92.19%

28. 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