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Conversations with Seven Self-Directed PracticesAt the one-year milestone, seven self-directed practice champions reflect upon the challenges and success of the previous year — and their practice transformation goals for the upcoming year. Scroll down to read them all or click the links below to jump to that specific Conversation.
A Conversation with Dr. Kim Leatham
Like so many practices, we are also very challenged to answer and return phone calls in a timely manner. We have many medical assistants who answer phones so patients don’t always get their doctor's MA or the same person when they call. Usually it’s OK, but when things don’t go right, it is a lot of repeat and rework. We don't have a web portal yet and hope/believe that having one will lessen some of the phone call burden. We do use email communication with patients, but we have to cut and paste from the EMR, so it’s not seamless. Our greatest success over the past year has been engaging staff in the concept of a Primary Care Home for patients and really caring about them, really putting them first. We seldom, if ever, see staff saying "it's not my job" anymore. We've really ramped up our chronic planned care for diabetes and depression by training and working hand in hand with RNs. Naturally, we hope to see improved outcomes and better patient satisfaction with this ongoing work… but we are also seeing great RN job satisfaction! It also eases the burden of work on the MDs who participate with their RN. We have several "New Model" goals for the upcoming year…
A Conversation with Dr. Robin Kollman
However, we’ve had some successes. We managed to successfully implement the EMR system without having any of our 20 staff members meltdown or quit! The elements for success include the following:
We continue to implement change. Our "to-do" list for next year includes the following:
I do think TransforMED is on the right track. Something has to happen in primary care medicine if it is going to survive. Major principles for family physicians… 1) Focus on the patients needs appropriately 2) Incorporate technology 3) Be creative with the practice of medicine… recognize that we should be the BEST at chronic and preventive disease management… and then do it! 4) Private practice, organized medicine and academic medicine need to network 5) Learn to sell our specialty and know our worth as a family practitioner.
A Conversation with Dr. Andy Lockman
My greatest personal challenge has come from a sense of frustration that change isn't happening faster! After "seeing the light" in demonstrations of office systems and hearing about experiences of successful change in other practices at the retreat, it's hard to go back to "the way things are" while at the same time knowing how good they CAN be! While not yet complete, our best success has come during our EMR implementation. The actual EMR product and the timing were largely dictated by our health system, but each of our staff members was given a part to play during the planning sessions leading up to the implementation, and in the weekly discussion and troubleshooting sessions after we went live. The staff contributions to redesigning our work flow and working around limitations of the system have been invaluable, and their involvement in the process has given them a sense of personal investment and responsibility that translates to a better working environment for all. We have quite a few goals planned for the next year: 1) With some of the technology components, such as online appointment scheduling, a practice-specific website, and patient portal, we have to wait for a system-wide rollout of products. But, we are involved in the process and trying to make that happen faster, and thinking ahead to how such components will change our workflow. 2) We want to implement a comprehensive program for our asthma patients, one that involves patient flow redesign, group visits, quality and safety, and team approach. Such a program is in development and will be implemented this year. 3) Although our web portal is probably more than a year away, we will redesign our reception area to foster the "medical home" concept with education and wellness promotion resources.
A Conversation with Dr. Teresa Shupe
Last year, my greatest success was just getting opened! It took almost 3 months longer than planned due to construction delays. At this point, my greatest success is how fast the practice is growing, how happy the patients are, and just seeing my dreams become a reality. I believed in my heart things would work out but it was a "leap of faith" to leave a large established practice and try something new on my own.
A Conversation with Dr. David Loxterkamp
A Conversation with Dr. Edward Schwager
We have had a number of successes contributing to a better practice and better patient care. Our EMR system was well underway at the start of the NDP, and the recent recall of Zelnorm and concerns about Avandia demonstrated the critical value of an EMR system. Within a few hours, we had identified all of our patients who had been prescribed these drugs and could communicate our recommendations to them. Efficiency using the EMR continues to get better, and immediate access to patients’ charts during the work day and after office hours when on call has been a great benefit. We have freed up chart storage space for other support staff work and have decreased (by attrition) our medical records staff without loss of productivity. Advanced open access scheduling is overall a positive for our patients. Overall, they prefer calling us the day they want to be seen rather than calling for an appointment 6-12 weeks in the future. If we succeed in "right-sizing" our practices, we may be able to achieve the goal of having our receptionists fulfill every request when they ask "when would you like to be seen?" Finally, I am beginning to see our ability to do some more advanced quality of care monitoring and improvement. We have a small project on immunizations in the works. As we implement health care maintenance guideline reminders and some chronic disease guideline reminders in the EMR, I am confident we will document the excellence of patient care we provide and improve upon it. Our next "New Model" component goal will be implementation of group medical visits (GMA). The GMA is hoped to increase our patients’ access to us, invigorate the providers with a new way of providing care, and even improve patient care and their satisfaction. Full implementation of our EMR is an ongoing project, as is the need to further our quality of monitoring and improvement. We need to continue to work on all of this while we keep practice expenses in line and generate appropriate revenue.
A Conversation with
Our greatest success thus far has been the growth of our practice. It has surpassed all projections. We love the growth and the patients love the new innovative services we offer like Advanced Access and EMR. This year we also implemented and improved our on-line services. Our goals for the next year: we have added 2 new physicians to the group, and we plan to assess the implementation of group visits. We also intend to improve our Advanced Access scheduling to allow more openings per day as our patient panel grows. We will also continue implementing patient portal options. Finally, we plan to have a staff retreat to increase our understanding of our growing team and practice.
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The greatest challenge over the past year was to put computers in the exam room so we could document during the exam. We had been using an EMR for a couple years but now we had to learn to use it with the patient. It is no small feat and some have been very challenged by it. One has to learn how to not ignore the patient as you are looking at the computer and documenting as you go. The key is to involve the patient in the EMR process… some physicians are marvelous at doing this, others are still afraid of losing eye contact with the patient.
The greatest challenge over the past year has probably been the same as so many FM physicians: just finding thetime, energy, finances, and administrative support to keep implementing change in the practice… while still running a busy active practice.
Our greatest challenge over the past year came from dealing with staff turnover (this was in all but one case a natural career progression for the employees, not related to the NDP). This made me realize just how successful our teambuilding efforts over the prior 4 years had been. Now that we have assembled a new staff, we're off to a good start, but still have much ground to travel.
Because my practice is just starting, I've faced many challenges just to get up and running. In some ways I feel I've had an advantage over an established practice because I didn't have any back-log of scheduled patients to work through or any old records to scan into the new EMR, just the ones new patients have brought me. (I've tried to keep this to a minimum for most healthy people and kids, just getting last 1-2 years of records and immunization records.) The upfront costs of starting with an EMR were fairly high but I'm optimistic it will pay off in the next 2-3 years. Financially, the whole process has been costly, and I've had to change my lifestyle temporarily (I hope!) to get everything up and running.
Our greatest challenge of the past year is changing old habits and pushing toward complete implementation of projects. Even though everyone "bought in" to our web portal, it has been a constant challenge to get all the providers to promote it and demonstrate it to patients. Also, it is always difficult to find the time to improve the practice while practicing full-time. It is the challenge of fixing the car while driving it.
Our greatest challenge for implementing further change and "New Model" components is lack of time. The pressure on each of us to see patients is dramatic. This is not due to simple financial pressures, but patient demand. I just completed an analysis of our providers’ active patients, and each of our 5 physicians have 500-1000 more patients than we can easily accommodate and fully succeed with true open access scheduling (i.e., do today’s work today). Hence, our "open access scheduling" is completely full by 8:30 in the morning. We are so busy working IN the practice that there is little time to work ON the practice.
Our greatest challenge with implementing change has been dealing with a Healthcare Network vision and budget. We are more than ready and willing to take on all the new challenges, but as a new practice, the revenue is not always there to support implementation. In addition, being part of a Healthcare Network limits our system choices, so we spend a lot of time trying to figure out workarounds to offer more.
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