All-Hands Meeting

1. All-Hands Meeting 6/26/08

2. Agenda • Status since GE implementation (Edna Mark and Tom Miller) • What is new for the house staff in 2009? (Tom Miller) • Provider teams • Orientation and pre-clinic conferences • Discuss two current patient-oriented nurse interventions (Judy Martin and Gina Boone) • Intervention based on the yellow sheet • Process for updating immunizations • Update on the clinic website (Cristin Colford) • Plan for house staff patient correspondence (Malinda Williams)

3. Status since GE implementation (Edna Mark and Tom Miller)

4. First of all, thanks for your patience, persistence, and perseverance! • Front desk staff • Phone room staff • Administrative staff • Nursing staff • Providers

5. Issues identified since GE implementation • Currently it is difficult to insert ‘walk-in’ patients or add an extra or make-up clinic (solution identified) • Competing terminologies remain, still using old system for billing (solution identified) • Synchronization of WebCIS and GE schedules (improved, but seeking solution) • Missing same day clinic WebCIS schedules (seeking solution) • Missing data from Televox reminder calls (seeking solution) • Toggling between programs is problematic (seeking solution) • Need for more extensive training (seeking solution) • Takes longer from screen-to-screen to check-in or schedule (seeking solution) • No more resource group numbers • Medicare questionnaire screens went from 3 to 17

6. We must continue to identify and properly report issues • Our clinic administrative staff will make sure issues are correctly documented and reported to: • ISD • GE implementation team • Our PAcE team • Notify Tim Scurlock of any issues by email tscurloc@unch.unc.edu

7. GE Continued(Tom Miller) • Conversion problem • Most appointments beyond July 1 were not scheduled in the A2K, but were entered into the RTC system. • Patient must call for appt • Telvox reminders • Mailings • July and August remain underbooked • Patients not calling? • Televox failures – wrong clinic phone number?

8. Creates false impression that we have extra capacity for new patients Temporary fixes Calls to patients with July RTC’s to schedule appointments. No new patients for faculty until we are sure that we will not be blocking access for current patients with RTC’s. If RTC’s are not generating demand we will need to open up to new patients

9. Templates not available beyond 120 days Patients entered into RTC system Reminders to call 2 weeks before appt needed Must maintain capacity for those patients 20-25 % of appointments Freeze/thaw function 2 appts per half day will thaw 2 weeks in advance 1-2 more acute appts will thaw one week in advance 30-40% of appts will open in the preceding 2 weeks

10. Freeze/Thaw Slots

11. Double booked patients Some faculty are using a template with an extra patient inserted at a 10 min interval Not possible under the GE system GE will permit double booked patients

12. Doublebook Slots(the ‘middle-of-the-road’ template)

13. What is new and old for the house staff in 2009? • Team-based scheduling through GE • Development and utilization of team business cards for patients • Strengthened orientation to clinic resources and enhanced care programs • Incorporation of QI projects into pre-clinic conference curriculum

14. Team Business Card

15. ResidentTeams

16. Clinic Teams and Team Leaders • Shared coverage • Panel transfers • Clinical backup • Evaluation • Mentorship

17. Orientation • First six sessions of Preclinic Conference • Consistent message • Succinct problem oriented presentations • Problem lists • HCM program and immunizations • Lab report letters • Webcis correspondence function

18. Patient-oriented nurse interventions (Judy Martin and Gina Boone)

19. Current state of ‘yellow-sheet’ nurse-based interventions

23. Our plan for updating immunizations • Short-term • Nurses will enter all immunizations administered in clinic under WebCIS immunizations • For patients receiving immunizations, historical data will be entered from WebCIS specialty comments and from patient report • Once immunization info transferred from specialty comments to immunizations, will inactivate specialty comments • Long-term • Seek data entry into WebCIS from billing and registry data

24. Update on the clinic website (Cristin Colford)

25. Where are we now?Phase 1

27. What happens when I use one of these forms? • Clinic Block/Unblock/Freeze/Add • Sent to Phillis (copied to backups Wanda and Paul) • If RTC request, must send ‘received’ after receipt of request, and ‘completed’ when action completed • If non=RTC request, must complete request with 24 hours and send ‘completed’ message to requester • Continuity Appointments • Sent to Wanda, (copied to backup Nola and Edna) • Send ‘received’ after receipt of request and schedule the requested appointment • No further confirmation is required • Enhanced Care Appointments • Sent to Angela (copied to backup Maria and Edna) • Send ‘received’ after receipt of request and schedule the requested appointment • Forward email to extender that the patient is scheduled with (include Kelly Hayes, if Pain) • No further confirmation is required • Specialty Referrals • Sent to Erika (copied to backup Angela and Edna) • Send ‘received’ after receipt of request • Send WebCIS message to physician when referral scheduled only if it is checked as a priority referral. If it is not a priority referral, no further confirmation is required

28. What happens when I use one of these forms? • Phlebotomy Forms • Sent to Johnnie (copied to backup Tim and Edna) • Send ‘received’ after receipt of request • No further confirmation is required • Print form and get preceptor to sign. Keep in box at front desk where patient will pick up form before going to lab. (Remember to check boxes at both front desks.) • Ancillary Referrals • Sent to Johnnie (copied to backup Tim and Edna) • Send ‘received’ after receipt of request, and schedule requested ancillary • No further confirmation is required • Nurse Assistance Request • Sent to Mindy (copied to backup Faye and Judy) • Complete requested task • Close loop: Copy and paste in WebCIS message with reminder to provider to finalize to WebCIS record. • Add-on Labs • Sent to Mindy (copied to backup Faye and Judy) • Complete requested task • Close loop: Copy and paste in WebCIS message with reminder to provider to finalize to WebCIS

29. What happens if I get a grayed box or an error message? • Greyed box • Press ‘Reply’ and copy to Jo Williams jo_williams@med.unc.edu • Ask the requester to resubmit the request form • Error message • Notify Jo Williams jo_williams@med.unc.edu • Be explicit in the type and verbiage of the error message

30. Specialty referral form:Phase 1

31. Survey Results ( 14 house staff) ADEMOLA ADEROJU, CQI June 18, 2008

32. Where are we going?Phase 2 • Meetings to develop by-in and consensus regarding direct submission of requests • Ancillaries and lab (Tom Miller) • Division administrators meeting (Robb Malone) • Departmental administration, Bruce Wicks (Robb Malone) • Enhancing security with minimal complications • Addition of electronic signature • Additional features to improve reliability • Example: validate check digits and authenticate users • Ability to track, document, and report activity

33. Plan for house staff patient correspondence (Malinda Williams)

34. Patient Lab Correspondence Process • Provider: • Your WebCIS contact person is Sherea Burnett. • Use WebCIS correspondence. Link from Lab Alerts under Messages in the Activity List. • Create letter using the template. WebCIS Admin allows users to create macros with prefilled text. • Route letter to Sherea Burnett or print letter and place in clinic outbox.

35. Patient Lab Correspondence Process • Staff: • Retrieval and Printing: In WebCIS: Activity List > Correspondence > folder icon to open each document > Print. (Remember to use clinic letterhead for resident correspondence.) This document is saved to record when it is sent to you. After printing, delete it. • Mailing: Fold documents, accordion-style, and stuff in window envelopes with the patient address visible in the window. Mail. • Turnaround Time: 24 hours. • Planned Absence: Coverage will be approved by Malinda Williams. Sherea then forwards her WebCIS messages to the designated back-up. • Unplanned Absence: Malinda notifies IT to have Sherea’s messages forwarded to a designated back-up. • Personnel Changes: Malinda notifies Jo Williams. Jo updates the protocol and notifies all residents via their listserv and posts this information in the Resident Workrooms.