It is always a joy to realize that one works with amazing colleagues. Here is a video (in which I participated), on the emphasis UCHealth is placing on Advance Care Planning, specifically of Durable Power of Attorney for Health care, a Living will, the 5 wishes documents. It is a way for our patients to indicate to us their wishes for end-of-life care.
Equally important, we have made it much easier for patients to submit their own documents and statements directly into their electronic health record through their patient-portal, that we call My Health Connection.
Thank to to our team, and to teams worldwide, who are raising awareness and assisting patients with expressing these very important wishes, and making them known to their healthcare providers.
CMIO’s take? Thank you to our team, and to teams worldwide, who are raising awareness and assisting patients with expressing these very important wishes, and making them known to their healthcare providers.
DENVER — When patients go to see Dr. C.T. Lin for a checkup, they don’t see just Dr. Lin. They see Dr. Lin and Becky.
Becky Peterson, the medical assistant who works with Lin, sits down with patients first and asks them about their symptoms and medical history—questions Lin used to ask. When Lin comes in the room, she stays to take notes and cue up orders for tests and services such as physical therapy. When he leaves, she makes sure the patient understands his instructions.
The division of labor lets Lin stay focused on listening to patients and solving problems. “Now I’m just left with the assessment and the plan—the medical decisions—which is really my job,” Lin says in a quiet moment after seeing a patient at the Denver clinic where he works.
We’ve been trying lots of things in our clinics at UCHealth because there is a national crisis of physician burnout, a national imperative to improve patient satisfaction, a national push towards electronification of healthcare, and a national imperative to improve quality.
This is, so far, a separate initiative of improving teamwork, team-based care, returning joy to healthcare work. In short, we:
Added Medical Assistants to a primary care clinic to invert the usual ratio of 1 MA to 2.5 MD’s, to 2 MA’s per 1 MD.
Created an MA academy to retrain MA’s to work at the top of their certification (about tripling the usual tasks they do in the care of a patient)
Added scheduled time BEFORE a physician visit for MA interview and documentation
Asked the MA to stay in the room and scribe the patient’s history, examination and some parts of the assessment and plan, pend any orders or referrals or prescriptions for the physician
Asked the MA to retrieve any equipment or education needed by physician
The MA then completes post-visit tasks, vaccinations, education, after-visit summary printing, reminders, phlebotomy, followup appointments.
Physicians then move room-to-room as MA’s stay 1 patient ahead
As a result,
Physician burnout falls from 55% to 13%,
MA satisfaction and engagement improves,
Patient satisfaction improves,
Cost-per-visit DOES NOT CHANGE,
Access to care improves (more new patients, shorter wait times)
Quality metrics improve (non-physicians pay more attention to consistent screening for vaccines, colonoscopy, PAP smears, foot exams, prescription renewals, standard monitoring for chronic illness).
I have to acknowledge the hard work of our Family Medicine colleagues at AF Williams Stapleton Family Medicine and the Snow Mesa Poudre Valley Internists clinics in the University of Colorado “UCHealth” system, who pioneered this work, based off of the Care by Design model from Utah. Thank you to those who blazed a trail.
CMIO’s Take? What’s not to like? Despite “who moved my cheese” change-management issues, we’re finding that we run out of qualified MA candidates, we are hiring so many. Is this the doctor of the future? Team-based Healthcare of the future? Was healthcare supposed to be a team-sport from the beginning? It is one vision, and a darned good one so far.
I’m always thankful for great colleagues who do good work. One of our former residents, Jonathan Sprague co-authored a report called “Divergent Care Team Opinions about Online Release of Test Results to an ICU patient.”
At it’s root, was the issue that we routinely signed up outpatients for our patient portal called My Health Connection. We also release ALL laboratory test results immediately to the portal, with no time-delay. This means that physicians and nurses often saw the result AFTER a patient received it online. Despite the anxieties of such an approach, we had decided back in 2008 that all our lab results would be delivered this way; we have released over 2 million results with negligible problems and highly satisfied patients.
In fact, our urology practice, initially hesitant to adopt these “open results” policies, found that 1) likelihood of missing a prostate cancer recurrence was less, since patients were assiduous at checking their own results online and then checking in with their clinic team and 2) one third of their telephone volume DISAPPEARED because patients would routinely call and ask “what was my PSA result this time?” Now, they’re one of our biggest proponents of information transparency.
In this case, a patient in transplant clinic signed up for the portal, got used to viewing results online, and then shared his account with his wife. When he was admitted to ICU after transplant, she continued to check results and found that in-hospital and even in-ICU results showed up on her tablet even before the ICU nurse was aware.
You can imagine the surprise the nurse felt when she responded to the call button: “What are you going to do with this high potassium result? What about that low oxygen result on the blood gas?”
See write up for what we did with this. In the end we resolved this peacefully, and our organization took another step forward, formalizing that inpatient test results would follow our outpatient results release rules:
All lab results are immediately released with no time delay, EXCEPT that qualitative HIV and broad genetics panels ordered by genetics clinic are never shown online.
All radiology and ultrasound are released immediately EXCEPT CT, MRI, PET are delayed 7 days to allow for possible cancer diagnosis to be communicated by physician to patient
All pathology is delayed 14 days to allow multidisciplinary tumor boards to develop a complex treatment plan before releasing the result
CMIO’s take?
1. Nothing ventured, nothing gained.
2. Open Results policies work well for patient satisfaction, patient engagement, and DO NOT adversely impact physicians and staff IF well-communicated and expectations and guidance put in place. We’ve done this for 10 years and have reaped the benefits.
3. Even inpatients can handle test results, it turns out.
From the colors and faces in their photos to the enhancements they make before posting them, Instagram users with a history of depression seem to present the world differently from their peers, according to the study, published this week in the journal EPJ Data Science.
I love work like this; the growing links between disparate databases that lead to innovative ideas, weird conjunctions (Conjunction Junction, anyone?). I could imagine asking our patients to grant us access to their twitter handles, their instagram posts for purposes of diagnosis, follow-up. These are fascinating, uncharted waters.
I look forward to more cool mash-ups like this in the future.
Our Neurosciences and Stroke team worked with our telehealth program, bought a souped-up ambulance, installed a portable (PORTABLE!) CT scanner, and now we can send this ambulance out on any 911 call that sounds like it may be an early stroke.
Unlike current state-of-the-art facilities that take 30-60 minutes AFTER the patient arrives in the Emergency Department to diagnose a stroke, rule-out a bleed, and administer tPA, the clot-busting drug (so called “door-to-needle time”), we now have NEGATIVE door-to-needle times.
In other words, we’re driving to the patient, performing the CT scan IN THEIR DRIVEWAY at home, transmitting images to our neuro-radiologist, using a 2 way video link between neurologist and patient, finalizing a diagnosis, and administering life-saving tPA right there in the driveway. BOOM. “Needle” time occurs before “door” time. Watch the video link above for details. So proud of our teams and the technology we develop to support outstanding patient care.
