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SNMHI Summit 2011LEARN • SHARE • TRANSFORM

Optimizing HIT for Medical Home Workflows

Clinica Family Health Services-People’s Clinic Lori Bender, Clinic Director

Session 1EMarch 7, 11:00 AM -12:30 PM

2SNMHI

About Clinica Family Health Services• FQHC based out of Lafayette, Colorado• Four clinics:

– People’s Clinic & Lafayette in Boulder County– Thornton & Pecos in Adams County

• 170,000 visits– Physical, Behavioral, and Dental

• 38,000 active patients• 50% uninsured• 40% Medicaid• 5% CHP+• 56% < Poverty• 98% <200% of Poverty• 91% women and kids

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HIT for Team Based Care

• Improve workflows for population based care– Templates– Registries– Workflows

• Outcome reports• Email web portal • Measuring patient experience • Conducting & spreading group visits

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Providing team care using registries• Team members enter data into EMR templates

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Providing team care using registries• Templates feed into registries that focus on population-

based health management– Diabetes, Prenatal, Hypertension, Depression

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Providing team care using registries• Workflows have explicit direction for each team

members role according to evidence-based algorithms

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Registry Work for the Team

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Diabetes Registry by Team and Provider

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Population Based ManagementIt takes a team!

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Meaningful Data for Meaningful ChangePecos Red - Average HbA1C

7

7.2

7.4

7.6

7.8

8

8.2

8.4

8.6

8.8

9

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Ave

rage

A1C Clinica

PecosRed PodRed Provider

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Web portal

• Email web portal through EHR allowing patients to: – request forms & records– ask questions (general, referrals, medications) – updates on referrals and test results– request medication refills– request appointments

• Safe for communicating PHI

• Sends communications into patients medical record

• Hearing impaired patients & working patients can communicate with team

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-20

0

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6/2009 7/2009 8/2009

-17 -17 -17

13 14 14

-4 -3 -4

5 5 5

18 20 20

96 5

8 9 915

23 22

67 68 68

Min

utes

Clinica Campesina Cycle Time Intervals

Arrival TimeWait Time from ArrivalWait Time from ApptTimeNurseMATime with ClinicianTimeNurseMAWorkupTimeClinicianWorkupTime with ECSTotal Cycle Time

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0

10

20

30

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60

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7/2009 8/2009 9/2009 10/2009 11/2009 12/2009

Min

utes

Clinica Campesina - Total Cycle Time

0

10

20

30

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50

60

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7/2009 8/2009 9/2009 10/2009 11/2009 12/2009Date

Perc

ent

Percent Value Added Time

Goal = 60%

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Group Visits at Clinica

Began experimenting with group visits in 2001

Increase capacity

Provide services in an alternative and facilitative setting

Group Visits at Pecos Clinic in 2009• 4434 patient visits• Approx 9% of patient care provided at clinic • 15% of all OB

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Group Visit Models• Access Groups

– Includes WCC, Newborn, Initial Prenatal, Cold and Flu GVs,– Improve access to scarce resources at high demand– Group leadership focus is on didactic education

• Continuity Groups– Includes Diabetes, Depression, Centering Pregnancy, Centering

Parenting, HPV Group– Group leadership focus in on facilitation, behavior change and

self management support

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Use registry to identify group visit patients

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The health assessment occurs in group setting

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A facilitative leadership style is used

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SNMHI: Initial Barriers to Spreading Groups at People’s

• People’s Clinic had not yet fully integrated group visits into patient care

– New building, new setting– Not many scheduled groups– Staff not coordinated with conducting groups– Didn’t get regular feedback from patients – Group visit setting not yet efficient & effective way of

providing care

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Evaluating Group Visits to Improve Workflow and Access at People’s

• Site leadership/interested staff met weekly – Review group flow – Identify new group visits – Better group organization – Correct blocking or staff and providers– Room reservations– Reminder calls – Patient survey – Sent staff to observe groups at other clinics

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Outcomes: PCMH Transformation on Group Visit Focus

• Increased number of continuity and access groups– 6 Providers have diabetic group visits– During cold and flu, 1 group visit daily– 1 INP group a week (rotating between Spanish and English)– 3 chronic pain groups meeting bi-monthly– Adolescent physical group visit

• Obtained more consistent patient feedback

• Improved staff feedback following groups

• Improved planning/execution for subsequent groups

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Lessons Learned for SNMHI: Optimizing HIT Workflows

• Cross functional team needed for managing all aspects of groups.

• Group workflow improvement takes administrative, leadership, and staff support.

• HIT alone doesn’t do the trick…need staff buy in

• PCMH project: availability of HIT is what helps motivate staff to create needed groups and gives them the tools to make it happen.

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Questions?