The building of Bon Secours Health System's Advanced Medical Home1 began with a walk-through—an assessment of bricks and mortar, explains Robert Fortini, vice president and chief clinical officer at Bon Secours Health System.
In Phase 1 of our Advanced Medical Home project, my team goes into a practice and does a basic workflow discovery—an assessment of bricks and mortar. Oftentimes, the physical plant is not effectively used.
Our objective in a primary care practice is to give each physician at least three or four exam rooms whenever possible. We will do that in a number of different ways, even if it means putting up walls or moving charts out now that we are electronic, or eliminating sample medication closets. We will do whatever it takes to achieve those three rooms per physician.
Next, we review the staff that is providing clinical support. We have developed competency assessment tools for patient service representative (PSR) staff, medical assistant (MA) staff, several different levels of licensed practical nurse (LPN) and our registered nurse (RN) navigator, which is the embedded case manager.
Third, we do an analysis of the physician’s panel size and risk acuity levels and form teams. Team formation is a difficult thing to do because you not only have to assess skills, licensures, panel size and patient acuity, but you also have to take personalities into consideration as well. That is the single most difficult obstacle to being effective.
Fourth, we introduce equipment and training on that equipment so the staff has tools they can use. We do wave testing point of care again, the objective being to eliminate that patient behavioral component and capture an actionable result on the spot before they leave the office. Their hypoglycemic agent or their Coumadin® dose could be titrated accordingly.
Fifth, we do optimization training with the use of our electronic medical record (EMR). We make sure everyone knows how to navigate and is comfortable with the documentation we require. We also use a coding training for the physician’s staff.
Finally, we have a set of metrics to establish baseline so we measure performance.
1. The Advanced Medical home is a model developed by the American College of Physicians involving the use of evidence-based medicine, clinical decision support tools, the Chronic Care Model, and other strategies to manage a patient population.↩
Robert Fortini, PNP, is vice president and chief clinical officer for Bon Secours Medical Group in Richmond, Virginia. He is responsible for facilitating provider adoption of EMR, coordinating clinical transformation to a patient-centered medical home care delivery model, and facilitating participation in available pay for performance initiatives as well as physician advocacy and affairs.
