Finding the 'organic flow' in pre-visit care plans

By Chelsea Rice | July 14, 2017


Borinquen Health Care Center, a federally qualified health center in Miami, needed an easier way to manage quality reporting for its patient-centered medical home model.

Borinquen's providers were spending a lot of time handling pre- and post-visit planning tasks, such as retroactively compiling reports about what occurred during patient visits. For two years, Diego Shmuels, M.D., Borinquen's director of clinical practice management, tried a variety of workflows and systems to improve the data collection process.

But every option put too big a burden on the provider to lead the charge. Then, in 2016, Shmuels came across the cloud-based clinical decision support platform Avhana, a partner in athenahealth's More Disruption Please program.

Avhana integrates with electronic health record systems to incorporate as many as half of the American Medical Association's recommended pre-visit care planning steps into a technology-based workflow.

Working off a checklist

Clinical decision support tools such as Avhana's are designed to address a common problem in healthcare — and a common cause of physician burnout. According to a new study in Health Affairs, on average, physicians spend three hours a day on administrative tasks — almost the same amount of time they spend seeing patients.

The medical practices that have shaved off the most administrative time, says Avhana cofounder Noah Weiner, are those that enable non-clinical staff to handle pre- and post-visit planning.

“Empowering the medical assistant to do more of the work upfront saves time for the provider," he explains.

Before the patient visit, the Avhana platform curates a list of possible clinical interventions based on gaps in care and quality measures. Then it alerts front office staff to reach out to patients with reminders about appointments and missing lab results.

Just before the visit, Avhana serves up a recommended checklist for the care plan, so the staff can open the patient record, select the targeted interventions, and plan the visit accordingly. After the encounter, it offers reports for quality teams to assist in process improvement. Weiner says the technology can save providers 40 minutes per day.

Checklists have been found to improve the consistency of care in clinical settings. But checklists also form the backbone of pre-visit care planning. Shmuels says Avhana's personalized patient and provider checklists have streamlined the visit for every patient, and allow Borinquen to adapt a patient record workflow to customizable handoffs.

And because the technology pings the care team at different points before, during, and after the appointment, staff bears less of the burden to remember each step in the process.

Sharing the data

At Borinquen, the first full-time provider and staff team on the new system outperformed the others by 10 percent across quality performance metrics. Reporting metrics improved for tobacco screening and cessation, controlling high blood pressure, screening for adult weight and cervical and colorectal cancer.

Being able to isolate and share quality data, Shmuels says, helps him communicate the potential for success to other providers, and report on practice-by-practice performance to the leadership team.

And because reminders are integrated into Avhana's software, he says, he doesn't feel the pressure to hound providers about what they need to do to meet quality initiatives. "It's a much more organic flow," he says.

Chelsea Rice is a senior writer for athenaInsight. Follow her on Twitter @ChelseaRice.

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