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Blue Meadow Family Clinic

Case Study

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short time ago, in land not far away…

BLUE MEADOW

FAMILY CARE

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The Blue Meadow Team…

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Next Step….

• Provider Enrollment• Sandee is your CPA

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

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BMFC Meeting #1…with Provider(s)

Dr. Doe (physician)

Dr. Green (physician)

Your Name Here (IF)

Enrolling Providers

• First we ensure the Letter of Consent is complete

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!

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

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Blue Meadow Improvement Team

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BMFC Meeting #2…with Improvement Team

Dr. Doe (physician)

Dr. Green (physician)

Doreen (receptionist)

Maureen (office

manager)Chris

(MOA)

• Panel Discussion• Maneuvers

Selections

Your Name Here (IF)

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Panel Discussion

Dr. Doe (physician)

Doreen (receptionist)

We’ve been validating patient attachment at check-in since AIM

and PDI, right?

I thought those were over??

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Panel Process Development Checklist

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Panel Process Assessment Tool

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Maneuvers Selection

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Screening Offers Documentation

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BMFC Meeting #3

Dr. Doe (physician)

Dr. Green (physician)

Doreen (receptionist)

Maureen (office

manager)Chris

(MOA)

Your Name Here (IF)

• Current Screening Processes

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Screening Offers Documentation

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Screening Discussion – Guided Interview

Dr. Doe (physician)

Dr. Green (physician)

Doreen (receptionist)

Maureen (office

manager)Chris

(MOA)

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.

Sometimes I discuss screening with patients, but I don’t always chart

what I’ve offered – especially if they decline.

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Map Current Screening Process

Patient greeted by reception

PHE?

Screening if patient

requests (physician)

MOA brings up

CPX template

MOA enters Ht/Wt

MOA measures

Ht/Wt

MOA rooms patient

Address confirmed

MOA leaves

Physician enters

Physician completes

CPX maneuvers

Completes exam, closes chart

No

Yes

Blue Meadow Family Care – Current Screening Process

Greets patient

Confirms address

PHE?

Rooms patient

Screening if patient requests

Measures Ht/Wt

Opens CPX template

Records Ht/Wt

Leaves room

Enters roomCompletes maneuvers as per CPX

Finishes exam,

closes chart

No

Yes

Reception

MOA

Physician

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Meeting #3 Discussion

Dr. Doe (physician)

Dr. Green (physician)

Doreen (receptionist)

Maureen (office

manager)Chris

(MOA)

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.

I think I only see a height and weight on about ½ of

my patients - I end up doing it myself!

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

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

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)

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

BMFC Meeting #5

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Dr. Doe (physician)

Dr. Green (physician)

Doreen (receptionist)

Maureen (office

manager)Chris

(MOA)

• Applying QI ToolsYour Name Here (IF)

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Why are screening offers not documented in a standard way?

No standardized

documentation of screening

Patients

Procedures

Providers/Team Policies

Places/Equipment

Cause/Effect Diagram (“Fishbone”)

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MFI/PDSA • Read both sides of the BMFC plan

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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

Physician

Completes encounter

BMFC Future State Process (Opportunistic)

Escorts Patient to Exam Area

Mammogram Due?

• prints req for pt• enters in EMR

PAP Due? • offers • enters in EMR

MOA

Checks Reminders in Patient Chart

Colorectal Due?• provides FOBT kit &/OR makes colonoscopy referral, as needed• updates EMR

Greets patient

Validates in EMR:• Address/phone• Primary provider• Status (active)

Reception

Patient >18?

Checks Height & Weight

Rooms Patient• opens EMR chart

• enters Ht & Wt

BP Due?• check BP• enters in EMR

Exercise Due?• # minutes/week• enters in EMR

Tobacco Use Due?• check status• enters in EMR

Alcohol Use Due?• drinks/week• enters in EMR

Patient >40?

DM & Plasma Lipid Profile Due

• prints lab req and instructions

•enters in EMR

Patient >50?

Addresses primary reason

for visit

CV Risk Due? • enters values into Framingham Risk Calculator• enters in EMR

D5

D6

• 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

BMFC Future State Process (Outreach)

Consults ‘Monthly Maneuver

List’*

MOA

Opens each patient chart on

the list and checks status of all 12

maneuvers

Selects appropriate

maneuver for current month

Using EMR, generates list of patients overdue for that maneuver

Phones Patient

Using script, informs of all

overdue maneuvers and offers screening

As appropriate, offers

appointment or to fax req(s) to lab of

choice.

Documents offer(s) of

screening in patient chart

Monthly Maneuver List*January - BPFebruary – Height/WeightMarch - Exercise AssessmentApril – Pap testMay – Tobacco Use AssessmentJune –Alcohol Use AssessmentJuly – Plasma Lipid ProfileAugust – Diabetes ScreenSeptember – Colorectal ScreenOctober - MammographyNovember – CV Risk CalculatorDecember – Influenza Vaccine

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 %.

Provider/Staff

Procedures

Person/Patients

Policies

Place/Equipment

Effect

1 2 3 4 5 6 7 80

5

10

15

20

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Series 1Target

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.

What have we learned about the way we currently do things?

Insert ‘cause & effect diagram’ OR ‘process map’ OR ‘pareto diagram’ OR ‘5 whys’

EXTENDICARE FALCONBRIDGE- PUAP COLLABORATIVE WOUND WARRIORS TEAM CASE FOR ACTION

WHAT WE DID TEAM

RESULTS

Kim Lapierre, KinesiologistSylvie Clark RN ADOC

Angela Perreault PSW

Nicole Viel, DietitianStefanie Lavallee RN

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Discussion & Questions