December 10, 2009

Agenda

New Staff Introductions (Steve Desper) Announcements (Dr. Tom Miller) QI (Kim Young-Wright and Annie Whitney) CQI Success Story (Steve Desper) Clinic Support Website (Dr. Robb Malone) Retinal Camera (Dr. Robb Malone) Phone Messaging (Dr. Cristin Colford) H1N1 vaccine and Guidelines (Dr. Cristin Colford)

Steve Desper

Welcome Kim Ford

Vickie Wheeley

Jamie Walker

Dr. Tom Miller

Congratulations Drs. Marco Aleman, Tim Carey, Paul Chelminski,

Cristin Colford, James Evans, James Kurz, Michael Pignone, and Amy Shaheen have been included in the latest compilation of The Best Doctors in America

Promotions

Dr. Michael Pignone to Full Professor

Service

10 years: Jo Williams

5 years: Bart Scott

Kim Young-Wright and Annie Whitney

QI Team Projects and AccomplishmentsTeam 1

Training of staff on phone/fax protocols

Staff directory Radiology form approval Lab order simplification Phones – Thursday and after

hours Handling misdirected mail Protocol for shredding old forms Standardization of nurse lab kits etc

Team 2

Late clinic – better communication between nurse and provide before visit

Resident huddle checklist Resident Rx refills Phone tree Streamlining resident mail

process Enhanced care appointments Phone room call routing etc

QI Team Projects and AccomplishmentsTeam 3

Managing no shows – GE alerts, visit planners, pre-visit calls, scripts

Late patients tracking Standardized messaging Retinal camera process and flow Narcotics prescription pickup

protocol and Medication lists DME fax cover and order sheet Standardization of brochures Unavailable residents protocol etc

Team 4

Lab form updates and training Encounter form updates Patient flow Clinic signage Change to Side 1 & 2 Lab light installed Standardization of supplies Signs for Thursday late opening etc

Beyond the laundry list Resident messaging project has reduced response time 24

hours or less for 80% of messages.

Home Health Billing project has meant additional $17,778 to the clinic last year and $29,599 so far this year.

No show calling project has reduced no shows to 34%.

Patients report that improved clinic signage has improved clinic flow and reduced misdirection.

Patient lab correspondence project has increased patient satisfaction and reduced call volume.

Phone scripting has reduced the amount of time needed for scheduling so more calls can be handled

And there’s more… Improved lab form project has decreased the number

of unpaid labs.

Fax/phone process has reduced turnaround time. 80% are being handled within 1 business day.

Retinal camera is generating additional dollars for the clinic while providing an important service to our patients.

We should ALL feel REALLY GOOD about these accomplishments!

The Transition – beginning Jan 7

Week Current Future (as of Jan 7) Leads

1st Thursday QI Teams 2 QI Teams Clinic Action Team

Annie, KimSteve, Paul

2nd Thursday Huddles In service Training Steve, Malinda,Jasmine

3rd Thursday QI Teams 2 QI Teams Clinic Action Team

Annie, KimSteve, Paul

4th Thursday Staff Meeting, Quarterly All Hands

Clinic updates and In service Training

Cristin, Steve, Malinda, Jasmine

5th Thursday Clean up and catch up

Clean up and catch up Steve, Malinda,Jasmine

• A new model will be implemented to continue the work and progress we have

already made.

• The new model will streamline how we implement clinic improvements.

• Will also provide the time for staff training.

• All the little things add up!

QI Teams Team Composition: volunteers and some staff recruitment.

Support: Kim & Annie to facilitate teams paired with a leader.

Project topics: from clinic management meetings and staff suggestions.

Methods: longer term, more structured PDSA-based projects.

Metrics: will continue, helps to identify areas for support and improvement.

Project cycle: estimated project time ~3 months.

Staff rotation: new teams will be identified when new projects start.

Q Q

Clinic Action Team

Team Composition: staff not on QI team.

Support: Steve and Paul to coordinate and supervise Action team.

Action Topics: master list of action items generated by managers, from clinic management meeting and staff suggestions.

Methods: task driven, improvement implementation.

Metrics: Actions will be assigned, and signed-off at completion.

Action Cycle: Some tasks may be small individual tasks, some may be a small group and take a few weeks.

Staff rotation: new teams will be identified when new projects start.

A A

We want YOU At last QI team meetings staff were asked to sign-up for QI

or Action team.

Teams will continue to be cross-functional – PBAs, Nursing staff, Support staff, MDs.

If you did not sign up, please let Kim or Annie know your preference.

New teams will begin on 1st Thursday in January, 1/7.

You will be notified before then of your team and meeting place.

Team participation (QI or Action) will be included as part of staff evaluations.

We want your ideas too Suggestions box and forms in staff break room

Suggestion or Idea: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Proposed Solution: (not required)

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Submitted by: (optional)____________________

Suggestions email QI_Suggestions@med.unc.edu

Questions? Comments?

Steve Desper

Departmental write-offs for Medicare Medical Necessity

Departmental write-offs for Medicare Medical Necessity (continued)

New and improved

This new system is live starting today!

You will not be able to use the site until you create a secure login and answer challenge response questions

New Clinic Support Web Site: Why?

Security and privacy

Tracking and reporting is a requirement for NCQA PCMH Level 3

The practice uses a system to track referrals designated as critical until the

specialist or consultant report returns to the practice.

The practice uses a system that includes the following information for its referrals:

1. Origination

2. Clinical details (may include but not limited to) Reason for the consultation

Pertinent clinical findings

Support person

Functional status

Family history

Social history

Plan of care

Health care providers

3. Tracking status Receipt of consultant’s report

4. Administrative details Insurance information, including whether the referral requires health plan approval

New Clinic Support Web Site: Home Page http://domis.med.unc.edu/csw/

• Links will be embedded throughout and new ones will developed

Creating User Accounts

To create a new user account for access to the Clinic Support Website, simply click on the “CREATE NEW ACCOUNT” link.

New Clinic Support Website: Create Account http://domis.med.unc.edu/csw/

New Clinic Support Website: Logout is key

Logging out of the website is important.

There are 2 ways to log out….

New Clinic Support Website: Security

Email notices for requests will no longer contain and

specific request information. A message notifies the provider and the appropriate staff.

This notice contains a coded link that will refer you to the proper page to retrieve,

view and print the request.

Login is required to view the request.

A new PULMONARY FUNCTION request has been created; please copy/paste the following URL into your browser and login to retrieve the pdf file for this request.HUhttp://domis.med.unc.edu/csw/index.cfm?requesti

d=12345678901234&requesttype=PULMONARY

FUNCTIONUH

New Clinic Support Website: Summary

What has changed? The old site is gone, new links

are established

Acceptable security is in place

Requirements for reporting have been established

Users must create logins

Login is required to: Make a request

Review a request

Print a request

Logout should become habit

A training manual exists

What remains the same? Ease of use

Types of requests that can be made

Provider order entry screens

What needs to be done now? Identify reporting needs

Establish reports

Milestones reached, new information, and items to be addressed

Assessment of Camera Activity: Business Model

We want a model that:

• Supports Care Assistant effort

• Is a more convenient and satisfying process for patients

• Provides access for patients who otherwise may not be screened

• Helps us meet NCQA standards

We need to develop reporting that is automated and address our ‘wish list’

Assessment of Camera Activity: Payor

Assessment of Camera Activity: Volume

We are below our desired volume to meet our goals:• Need 25 vs. 15 per week

Interesting note:• We are approximately 50% of Ophthalmology's retinal photo interpretation

• Unknown impact on Ophthalmology’s access and appointment use.

Retinal Screening Rates

Retinal Camera Process: Patient Assessment

When compared to traditional retinal screening by dilation, screening by retinal photo:

Reduces patient and companion time requirements and recovery time

Median of 16 vs. 155 minutes

Appears to be more comfortable and fewer side effects

Blurry vision and headache are common otherwise

Results in improved patient satisfaction

May need further evaluation into patients confidence in the photo vs. ophthalmologist

Retinal Camera Process: Process Assessment

0

10

20

30

40

50

Missed (promptnot addressed)

Camera today(successful)

Camera at f/u UNC Eye (recent,upcoming or

referral)

Other (outsideeye, pt refusal, etc)

October

November

Camera Prompt Results

% o

f T

ota

l C

am

era

Pro

mp

ts

Retinal Camera Process: Next Steps

Refine the process and define responsibility Current visit planner prompts:

• Revisit the message― Get regular dilated exams (diabetes specific)

― Getting photos in clinic is our preferred method

• Focus on scheduling

In the patient’s record:Click on create notes tab at the top of the screen. Click phone message from the choices in the box.

Dr. Cristin Colford

Efficiently respond to patient phone calls

Reduce variation in individual physician practices

Document in medical record

This page will come up after you select phone message.

Type in reason for phone message.

Type the recipient’s last name and click search.

This screen comes up with all choices for Reuland.Select the appropriate person from the list.

For quality measuring,carbon copy all messages to Scott Daniels CC yourself so that you can reference as needed CC’d messages are found under correspondence tab

Once a person has been selected, this screen comes up.Type the message under the details box. Click send when finished.

The doctor needs to be paged as well as sending a WebCIS phone message. To page the doctor from WebCIS, click on the reference link found in the left blue column.

Click on the hyperlinks tab at the top of the screen.

Link to WebXchange

You can also page the doctor from the webxchange hospital directory shortcut found on your computer desktop.

This screen will show up when you click on the hospital directory link.

Type in the last and first name of recipient. Press search button.

If you are not sure how to spell the last name. You can type a couple of letters and search that way.You will get a list of names to pick from.

Type in your message asking the doctor to check WebCIS for a phone message along with the pts last name and MR #.Make sure you put your name & phone number on the page as well.Be careful not to hit enter after each sentence. Otherwise your message will be sent prematurely.

Providers… When you take care of a message, send it back to the

person who sent it and they will finalize to WebCIS to close the loop.

Use out of office for WebCIS phone messages

Call hospital operator 6-4131 to make pager unavailable

Set email out of office

Out of Office for Phone Messages

Set out of office on email

Set Out of office for phone messages

Call Hospital Operator and Make Pager Unavailable

Dr. Cristin Colford

H1N1 vaccine UNC Health Care now has substantial supplies of H1N1 vaccine. As per new NC State guidance, H1N1 vaccine can now be offered

to all persons (unless contraindicated). The UNC Hospitals Drug Information Service (966-2373) is

available to assist with answering questions about the vaccines. Additional information on the specific vaccines has been

published in the CDC journal, Morbidity and Mortality Weekly Report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5839a3.htm

UNC Hospitals has been able to obtain additional supplies of seasonal influenza vaccine. This too can be obtained from the UNC Hospitals Pharmacy Department.