As one of Lincoln, Nebraska’s safety net clinics, Lincoln Family Medicine Center is focused on underserved populations, including large Medicaid and Medicare populations. It is also the training site for family medicine residents. “The clinic came out of the need for training family medicine doctors to basically go out into rural Nebraska and fill the need for primary care,” explains Tina Kearney, MD, one of the center’s faculty providers and clinic director.
Achieving this vision while continuing to deliver the best patient care possible requires serious flexibility. The center’s roster of providers changes every year as residents graduate and matriculate. To accommodate training, faculty and resident providers only see patients part-time in half-day shifts, with schedules shifting every week. As a result, ensuring continuity of care and enabling effective care coordination was challenging.
For years, the center’s IT vendor made that work harder, not easier. The center’s services lacked a dedicated billing component and had limited quality-tracking capabilities. Clunky front-office workflows made it difficult to manage schedules and monitor patients. Staff were also responsible for updating their own servers, a process that often went awry. Ready to make a change, the center began the search for a new vendor and selected athenahealth in 2014. Since then, athenahealth has enabled the center to better manage administrative and clinical complexity, so they can focus on continuing to deliver great care while training Nebraska’s next generation of family medicine physicians.
Intuitive clinical workflows help ensure residents and faculty never miss a step
Because they’re expected to prepare for situations that rarely occur outside of residency, a resident’s life is in some respects more complicated than a licensed, full-time physician’s. That training creates well-rounded residents, Kearney says, but it also means that they feel the pain of every inconvenience in their EHR. “All that training adds a lot of complexity to their workflows,” she says. “With our previous EHRs, it felt like everything you tried to do in the encounter just slowed you down.”
After switching to athenahealth’s EHR, the residents’ experience improved inside and outside the exam room. Enforcing good documentation is a challenge with so few full-time providers, so the center relies on athenahealth’s intuitive clinical workflows to ensure providers capture everything they need to, Kearney explains. “Everything is accounted for during the encounter,” she continues. “In every patient chart you’re in, you can click on the quality tab and see what’s flagged. You don’t have to worry about remembering to order refills or tests—you just scroll down and there it is.”
The ability to build custom reports or use pre-built reports improved the center’s ability to meet quality program requirements, including submitting Medicaid volume reports. In 2017, nine of the center’s enrolled providers achieved a high-performing Composite Performance Score and became eligible for positive payment adjustments in 2019.
Integrated messaging and photo-sharing capabilities improve care coordination
Because providers only see patients part-time, the center uses a team-based approach to ensure continuity of care. Patients may not always be able to see the same provider, Kearney explains, but the goal is to have them seen seen by a provider from the same team. To support this approach, the center relies on two tools – athenaText and athenaCapture – to effectively coordinate care outside the exam room and in between patient visits.
With athenaText, providers can securely send messages to each other over a HIPAA-compliant channel. Providers can receive an athenaText message and respond from any location without logging into the athenaNet application. athenaCapture allows providers to take and share photos with each other. “One of our providers can take a photo of a rash and someone else can pull it up later while following up with the same patient and use it for comparison,” Kearney says. “It’s fantastic to have that objective information in the EHR so you can track your patient’s progress.”
athenahealth’s clinical inbox has also made supervising residents easier. Providers use the inbox to see pending tasks, including lab results that need to be reviewed and orders that require sign-off. It also allows Kearney to easily delegate and reassign work by enabling her to easily toggle back and forth across her residents’ clinical inboxes. “When you’re covering another provider, you can just add their inbox to yours,” Kearney adds. “You don’t have to go searching for stuff.”
Cloud-based services streamline scheduling, check-in, and billing
One of the biggest challenges the center faces is managing resident and faculty schedules. Two mid-level physician assistants are the only providers that see patients full-time; the center’s residents and faculty members only see patients in four to five half-day shifts every week. The center’s previous services could not keep up with the complexity of their scheduling needs. But athenahealth’s built-in scheduling capabilities have turned that around.
Today, staff can create customized scheduling templates for different departments and visit types. And because their calendars are integrated into their EHR, providers have access to up-to-date schedules. “They all want something just a bit different, whether it be the length of the appointment or the ability to schedule a procedure room, or schedule an appointment with a non-provider,” Brenda Bacon, the center’s office manager, says. “We’ve been able to accommodate all of that.”
Tracking a patient’s visit from start to finish has also become easier. With their previous vendor, the center’s staff had to use paper intake forms that providers and staff would pass off to each other during the visit. Moving to an integrated solution, in which their EHR and revenue cycle management services share data, has changed that, eliminating the need for paper forms. And because athenahealth automates time-consuming work like insurance verification, the center’s staff and patients can both save time during the check-in process.
Billing has also improved as athenahealth teams have taken manual work off the center’s plate, including submitting claims, managing denials, and sending statements. As a result, the center has seen an 18-percent increase in average daily charges and an 18-percent decrease in average days in accounts receivable. “The whole workflow in our front office, from check-in to dropping that claim off is so much more efficient than it used to be,” Bacon explains. “We’re not printing out forms every time. That’s been a great timesaver and increased efficiency in checking patients in quickly.”
An EHR residents call home about
Like residents anywhere, Bacon and Kearney both explain, residents at the center often complain about their EHR. But soon after they graduate and begin practicing elsewhere, many residents have only fond memories of athenahealth services. “A number of our residents call me after they graduate and tell me how much they miss athena,” Kearney says. “Suddenly, they’re saying, ‘Now we understand why you said athena was way easier. We wish we had it back.’”