home port: use of tri service work flow (tswf)tswf_cmc...1. hm/cna/lpn contributes to documentation...

Medical Home Port:Use of Tri Service Work Flow

(TSWF)

Clinic Management CourseFY 2014

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World-Class Care…Anytime, Anywhere

History of TSWF

• Wouldn’t it be great if we had a standardized AIM Form in Primary Care that everyone uses?– Army Usability, Navy PC Generic and Air Force Compass were born

• In this Joint environment, wouldn’t it be great if we all used the same form?– Tri‐Service Work Flow (TSWF) was born– Now a shared service in the DHA– Must have unanimous vote to make changes– Must be evidence based to be added

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What is the value of TSWF?

1. HM/CNA/LPN contributes to documentation of HPI/PFSH/ROS/CCPs 2. HM/CNA/LPN delivers a Detailed Hx for review by provider3. PFSH, Current meds, and Chronic care plans all Copy Forward to

future encounters and standardized across all MTFs4. Provider time reduced for HPI & PE portion of notes5. MDM Simplified Coding ensures credit for work documented6. When AHLTA down, paper forms support same workflow7. Note readability improved through standardized location of all

information.8. Works with what you have today9. JC/AAAHC/HSI required items now OUTCOME of workflow10. Training for HM/CNA/LPN and providers simplified and consistent


How to Increase Speed

• AHLTA is slow due in part to corrupt templates– Do not use default templates– Old templates corrupt every time there is an AHLTA update

– Be sure to clear out favorites – RN/LPO clean out old profiles

• Don’t save TSWF as your own; run TSWF off of the Enterprise

• With every update, TSWF is updated

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Total and Core Utilization (Monthly Average)

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0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

Dec‐12 Jan‐13 Feb‐13 Mar‐13 Apr‐13 May‐13 Jun‐13 Jul‐13 Aug‐13

Total

Core

21.2 Mil

13 Mil


Breakout Utilization (Monthly Average)

6

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

Peds General

Peds 0‐23

Peds 6‐18

Peds 2‐5

Procedures

3.4 Mil

0

50,000

100,000

150,000

200,000

250,000

BH

LBP‐CPG

IBHC

Metabolic‐CPG

MHSPHP

217 K

World-Class Care…Anytime, Anywhere 7

Standardized Workflow

Ancillary Staffing Role in Documenting Care


AUDIT‐C screening for ETOH users

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BH and Additional Screening

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Paper Worksheet Mirrors AIM Form

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This form was designed for when AHLTA is

down. It is not intended to be handed to

patients at each visit. They will get mad and

will not do it.


The First 20 Minutes Are Done!(Ideally most of it was done the day

prior for any prebooked visits)

Mini Huddle with Provider & Discuss All Positive Screens


TSWF‐Core – PE


Spine and MSK Tabs


TSWF‐Core – Well Woman

Must check this box in addition to coding Q0091 procedure in

A/P module


TSWF‐Core – Procedures


TSWF‐Core – Exit/CCP tab


TSWF‐Core – Toolbox


TSWF‐Core – Change Log


TSWF‐Core vs CPG forms

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• Although the previous slides show the TSWF‐Core, all TSWF‐CPG forms will be designed with the same content of the first 3 tabs and PE in Core allowing all screening and care to be documented using one form.

• CPG forms have more detailed ROS/PE and CPG POC decision support tools built in.

• CCP for condition being addressed by CPG moved to first tab. All others still available on Exit/CCP tab

• TSWF‐Metabolic (Obesity, HTN, HLD, DM) and TSWF‐LBP updated to new format Aug 2013. Others to follow.


TSWF‐Metabolic‐CPG

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TSWF Resources

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Contact your local AHLTA TrainerVisit Milsuite – numerous training resources https://www.milsuite.mil/book/groups/tswf

Follow on Twitter @TSWFTeamTraining teams available to travel to your MTF

home port: use of tri service work flow (tswf)tswf_cmc...1. hm/cna/lpn contributes to documentation...

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