All Hands Meeting

1. All Hands Meeting December 10, 2009

2. 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)

3. Staffing Updates Steve Desper

4. Welcome • Kim Ford • Vickie Wheeley • Jamie Walker

5. Announcements Dr. Tom Miller

6. 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

7. CQI Transition and Updates Kim Young-Wright and Annie Whitney

8. QI Team Projects and Accomplishments Team 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

9. QI Team Projects and Accomplishments Team 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

10. 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

11. 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!

12. The Transition – beginning Jan 7 • 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!

13. QI Teams Q Q • 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.

14. Clinic Action Team A A • 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.

15. 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.

16. 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?

17. CQI success story Steve Desper

18. Departmental write-offs for Medicare Medical Necessity

19. Departmental write-offs for Medicare Medical Necessity (continued)

20. Clinic Support Website upgrades New and improved

21. 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

22. 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 Preliminary reports will be coming next month! Who is going where for what and by when . Who ordered what for whom that is still pending or was not done.

23. New Clinic Support Web Site: Home Page http://domis.med.unc.edu/csw/ • Links will be embedded throughout and new ones will developed

24. New Clinic Support Website: Create Account http://domis.med.unc.edu/csw/ Creating User Accounts To create a new user account for access to the Clinic Support Website, simply click on the “CREATE NEW ACCOUNT” link.

25. New Clinic Support Website: Logout is key Logging out of the website is important. There are 2 ways to log out….

26. 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?requestid=12345678901234&requesttype=PULMONARY FUNCTIONUH

27. 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

28. Retinal Screening Milestones reached, new information, and items to be addressed

29. 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’

30. Assessment of Camera Activity: Payor

31. 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.

32. Retinal Screening Rates

33. 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

34. Retinal Camera Process: Process Assessment

35. 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

36. 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.

37. Phone messaging Dr. Cristin Colford

38. Goal Efficiently respond to patient phone calls Reduce variation in individual physician practices Document in medical record

39. This page will come up after you select phone message.

40. Type in reason for phone message.

41. Type the recipient’s last name and click search.

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

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

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

45. 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.

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

47. Link to WebXchange

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

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

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