1. Patients and FHC: Love or Hate Relationship
Patients and FHC: Love or Hate Relationship? NHCS Series Part III February 14, 2008
Marfatia
Support:
Vikram Arora, MD
Shannon Bolon, MD
Lauren Jonkman, PharmD
Ruta, Marfatia, MD
Katie Sullivan, PharmD
Stephen Wilson, MD
Presenters:
Megan Barkell, PharmD
Stanley Chan, MD
(Jihad Irani, MD)
Jennifer Middleton, MD
Laura Miller, MD

2. NHCS Curriculum Goals
Consider innovative ways of delivering patient care in the outpatient setting
Define the process for implementing any practice-based change
Understand the barriers to developing a new health care system and methods of overcoming these barriers
Critically evaluate proposals for health care reforms

3. NHCS Series: Part I EHR add on’s Instant medical records E-visit
QI projects and practice improvement
Online portal
E-prescribing
One sentence about each
IMR – allowing transparency to patients and the ability for patients to update and view medical records anywhere at anytime. Improves efficiency. Facilitates the office visit
E-visit… Virtual office visit
QI projects… patient registry for chronic disease management and health maintenance.
Online portal is a patient portal – a portable, accessible patient health record. (home) – way to … allows patient schedule appointments, pay bills, obtain labs, get RX renewals, virtual office visit
E-prescribing… fast approach to sending prescriptions electronically to pharmacies to decrease errors and increase satisfaction.

4. NHCS Series: Part II Healthcare reform debate Current system
Employer mandate
Individual mandate
Public program expansion
Single payer: National Health Insurance
Current system: support the status quo
Employer mandate.. For working men and women
The All for One Individual Mandate with allow all persons to have accessible healthcare coverage regardless of income, social or economic status
Single payer: The program would be a combination of social insurance and public assistance in which we all pay into the health care fund.
Public program expansion: By expanding eligibility of the existent programs, we can create a patchwork of coverage for the uninsured and underinsured, while leaving the private insurance market intact.
Which one won??

5. Today’s Objectives Contrast two ways of office operations
List ways to improve office efficiency
Discuss methods of developing patient-centered care

6. Overview: Scenario 1 vs. Scenario 2
Pre-visit
Patient-physician encounter
Ancillary services
First scenario– is the patient check in … take notice to the different tools, techniques for each,
Patient
resident RN and receptionist– Megan picks
5 volunteers for Laurie’s skit – will hold signs far apart from each other

7. Pre-visit: Scenario 1 Pick residents
1 for receptionist – behind podium
2nd for RN – send to door

9. Pre-visit: Scenario 2

10. Fingerprint Recognition

11. Computer Check-in

13. Pre-visit Discussion
What are some benefits and barriers associated with each scenario?
Please have some answers to questions too
1st way
cheaper??
Cost with second scenario
Time saver with second scenario
Education for patients while in doctor’s office

14. Encounter: Scenario 1

16. Encounter: Scenario 2

17. Reviews Patient’s E-history

18. Screen Freezes

19. Reviews Patient History in PDA

20. Patient-Physician Encounter
What differences did you see between the 2 settings (tools, techniques etc.)?
What worked well, what didn’t?
What did you think of the transparency??

21. Ancillary Services: Scenario 1

22. Labs

23. Pulmonary Function Test

24. Allergist

25. X-Ray

26. Pharmacy

28. Ancillary Services: Scenario 2

29. Medical Home

30. Ancillary Services What are some barriers associated with each way?
How did these scenarios incorporate patient-centered care?
All in one place
Website to find out results of tests with patient having full access

31. Wrap-up Waste The patient’s needs Transparency What did you observe?
How might it be decreased?
The patient’s needs
Anticipated?
Ways to do so?
Transparency
Benefits
Drawbacks
What were some of the EHR add’on’s and
List ways to improve office efficiency
Discuss methods of developing patient-centered care
What are some of the barriers to implementation of ….
How did the pre-visit differ between the two approaches?
What were some ways that the patient-physician encounter improved office efficiency in either approach?
Contrast two ways of office operations
Where were they?
EMR
E-visit
E-prescribing
Decreased waste?
Do you think one way improved patient-centered care?
How?

32. Wrap-up Team approach to care
What would need to change to make a team work?
Medical home
What elements of a medical home do we already have at the FHCs?
What’s missing?
What were some of the EHR add’on’s and
List ways to improve office efficiency
Discuss methods of developing patient-centered care
What are some of the barriers to implementation of ….
How did the pre-visit differ between the two approaches?
What were some ways that the patient-physician encounter improved office efficiency in either approach?
Contrast two ways of office operations
Where were they?
EMR
E-visit
E-prescribing
Decreased waste?
Do you think one way improved patient-centered care?
How?

33. Happy Valentine’s Day