Blue Meadow Family Clinic

1. Blue Meadow Family Clinic Case Study

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

3. The Blue Meadow Team…

4. Next Step…. • Provider Enrollment • Sandee is your CPA

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

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

7. Enrolling Providers • First we ensure the Letter of Consent is complete

8. 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!

9. 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

10. Blue Meadow Improvement Team

11. BMFC Meeting #2…with Improvement Team Your Name Here (IF) • Panel Discussion • Maneuvers Selections

12. Panel Discussion We’ve been validating patient attachment at check-in since AIM and PDI, right? I thought those were over??

13. Panel Process Development Checklist

14. Panel Process Assessment Tool

15. Maneuvers Selection

16. Screening Offers Documentation

17. BMFC Meeting #3 Your Name Here (IF) • Current Screening Processes

18. Screening Offers Documentation

19. Screening Discussion – Guided Interview Sometimes I discuss screening with patients, but I don’t always chart what I’ve offered – especially if they decline. 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.

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

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

22. Meeting #3 Discussion I think I only see a height and weight on about ½ of my patients - I end up doing it myself! 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.

23. 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

24. 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

25. 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)

26. 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

27. BMFC Meeting #5 Your Name Here (IF) • Applying QI Tools

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

29. MFI/PDSA • Read both sides of the BMFC plan

30. 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

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

32. BMFC Future State Process (Outreach) MOA Consults ‘Monthly Maneuver List’* Phones Patient • 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 Using script, informs of all overdue maneuvers and offers screening Selects appropriate maneuver for current month As appropriate, offers appointment or to fax req(s) to lab of choice. Using EMR, generates list of patients overdue for that maneuver 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 Opens each patient chart on the list and checks status of all 12 maneuvers Documents offer(s) of screening in patient chart

33. ABC Clinic Improvement Board for “Topic” Names of People Working on this Improvement What are we trying to accomplish?The NAME clinic will improve (increase/reduce) by 50% the percentage of our patients on 5 or more medications, seen weekly, who have been referred for a poly-pharmacy review for optimal care., by DATE 3 MONTHS FROM NOW, from current rate of x % to 1.5x %. • What have we learned about the way we currently do things? • Insert ‘cause & effect diagram’ OR ‘process map’ OR ‘pareto diagram’ OR ‘5 whys’ • 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.

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

36. Discussion & Questions