Published on Friday November 22, 2019
In this edition of the eClinicalWorks Podcast, Compass Medical explains how they use eClinicalWorks templates and Order Sets to create a workflow to identify and screen patients at risk for lung cancer. Nearly 3,000 patients have been screened thus far, with numerous cases of early-stage cancer detected and treated.
“This goes back to the reason why we are in healthcare. It may be reducing patient roadblocks for getting access to care, or making the provider more efficient. But at the end of the day it is all about improving the care of a community.”
Dr. Dhrumil Shah, CMIO, Compass Medical
eClinicalWorks’ CCM module helps practices deliver evidence-based care through complying with CMS’ Chronic Care Management program, which reimburses providers for non-face-to-face care to patients with multiple chronic conditions, to improve outcomes and control costs.
Shannon Looney: Welcome to another edition of the eClinicalWorks Podcast. I’m Shannon from the Podcast team and today we’re sitting with Dr. Shah from Compass Medical. Thank you so much for being here, Dr. Shah.
Dr. Dhrumil Shah, MD, CMIO, Family Physician, Compass Medical: Thank you for having me.
Looney: Today we’re going to be talking about provider burnout and how Compass Medical takes a unique approach in combating this. Dr. Shah, can you tell us a little bit about Compass Medical and about yourself, as well?
Dr. Shah: Sure. Compass Medical, we are about 100 providers, six clinical sites, ambulatory medical group in Southeast Massachusetts. We are mainly primary care providers, with some of the subspecialties as part of the group. We have been on eClinicalWorks since 2015, and my role at Compass Medical is Chief Medical Information Officer. As part of that role, I oversee Electronic Health Record, information technology, and data and analytics teams. And Compass has been in the Southeast community, delivering care to about 80,000 patients in our communities where we serve about six clinical sites.
Looney: Wow, great. So let’s talk about that approach that I was referring to before, that unique approach that you are taking to combat provider burnout. Can we talk about this team-based approach a little bit?
Dr. Shah: Sure. As we look at the provider burnout as the industry challenge that every one of us is facing nationally, we take a different approach. I wouldn’t call it unique. We take a step back and look at what is it that we care about. Why are we in healthcare? All of us are in healthcare to make a difference, and we have latched onto a concept that we call Compass Experience, where we combine and integrate patient satisfaction, provider satisfaction, and employee satisfaction all into one major initiative which we started about four or five years ago, which also came about with the eClinicalWorks Go-Live. That for us, as an organization, Compass Experience matters a lot. And as we started taking on that strategic initiative, provider burnout just became one of the industry buzzwords, which we started also to socialize, but started to home in on how we use information technology and data to improve the experience of our end-users.
Looney: Sure. So, for this Compass Experience, how are you making this a better experience for your providers?
Dr. Shah: So, this goes back to the question which you earlier raised about team-based care. So, the way we took the approach to team-based care is every office has a provider where there is a physician or a non-physician, and there’s a set of clinical staff and clerical staff. And when we implemented eClinicalWorks, we took a team-based care approach where we standardized a lot of the work which happens outside of the exam room. So, we started with the approach where a provider in the exam room, what he or she does, rather than focusing on standardizing that, we standardized everything else to the patient journey, from check-in to checkout. And we built a lot of the tools around it.
Looney: Great, great. So, what kind of tools are you utilizing in eClinicalWorks to make this a little bit easier for your providers?
Dr. Shah: So, some of the tools which we are using they come out of the box from eClinicalWorks, such as templates, Order Sets, and we call it one-click templates or smart Order Sets. The reason we call them one-click templates is because they are literally one click for our staff. So, the approach we took is we not only locked down the public template customization to a select group of administrators, but we in-sourced the idea from our superusers of our EHR< our provider champions, and built a lot of the templates for our clinical staff. At the same time, considering the patient’s journey, we also built the templates and Order Sets for the staff, so everyone knows what their part of the script is for the patient journey, which also allows us to build the efficiency around the flow of the patient care.
Looney: That’s great. So, how do you get such a large group of providers and staff to be on board with this movement?
Dr. Shah: It is a challenge. Most physicians, and I’m a primary care physician by background, will usually think that their practice is unique, and the way they approach patient care is unique, which is true for the most part. The reason we were able to achieve most of the provider consensus is because initially we did not really make our focus to change what providers do inside the exam room. So, that was one of the ways that we were able to get the providers’ buy-in early, that standardizing the rest of the visit — from check-in to checkout, how the appointments are made, how the patients are roomed, how referral coordinators are scheduling the referrals, or how the tests are being done — all of these activities throughout the patient journey do not directly affect the provider and the patient interaction in the exam room. And as we started to build success around those activities, more providers started to come along and volunteer their own time to say ‘How can I improve now what I do in the exam room?’ And this is where the personalization comes into play.
Looney: Sure, sure. So I know — I’m going to go back a little bit — I know you had mentioned that there are about 80,000 patients that you see. How do you possibly manage that, from, you know, maybe a front-office experience. How do you combat that amount of patients to be able to give them the care that they need?
Dr. Shah: That’s really an important question, because this is a problem which we just highlighted, is a true problem in the industry, what we call access. Getting the access to the care in the world of total medical expense and a value-based medicine is not just limited to a face-to-face visit anymore. So, what we have done so far is about 80,000 patients — which are distributed among our six clinical sites — they have access to care, not just face-to-face but also some of the non-face-to-face services, such as Chronic Care Management and Complex Care Management, and some of the other Transitional of Care Management programs. So we use eClinicalWorks to document a lot of those clinical programs. At the same time, as far as access is considered, we utilize some of the data which exists in providers’ schedules, as simple as it may sound, a provider’s schedule can be a powerful tool to visualize what is happening today. So, for example, if a primary care provider is taking care of about a 2,000-patient panel, you need to have about 15 to 20 Annual Wellness Visit slots in a week for Medicare. This is not a magic number, this comes through simple data analytics, through eBO, and practice management software. And as we look at what is happening today and put those numbers in front of the provider, this is where we are using the concepts such as power-scripting and power-scheduling for providers who are able to take care of the large patient panel.
Looney: Wow, that’s a great way to utilize the schedule, just to kind of keep everybody scheduled and make sure you’re able to see all your patients and everything. So, Dr. Shah, can you tell us a little bit more about the other programs that you’re utilizing within eClinicalWorks?
Dr. Shah: Sure. So, as I mentioned, Chronic Care Management is one. But one of the recent ones which we are totally proud of over the last two-and-a-half years is what we refer to as the lung cancer screening program. As most of us know, lung cancer is the third major, leading cause of death in the United States among men and women. And up until 2014 and ‘15, there was no screening test available. When the evidence-based clinical guidelines came about, and a new screening test was made available, such as lung cancer low-dose CT scan, we also wanted to start doing that. But we hit some roadblocks. There are a lot of regulatory and billing requirements, there are a lot of documentation requirements. So, what we did is we utilized the eClinicalWorks existing framework and we built some of the templates and Order Sets and linkage around it, and built an entire team-based workflow. So, for example, if a patient walks in for an Annual Wellness Visit, and they are in criteria where they fit for lung cancer screening, staff gets training on how to screen them, use a one-click template, collect the necessary data points, and if the patient screens positive for lung cancer screening eligibility, then the provider will use what we call smart Order Sets, where they just make three clicks, select “all,” and order, which will put all the treatment elements required for regulatory billing and clinical compliance necessary to document a shared decision-making. This may sound like heavy lifting, but once we build the tools, this program really has done amazing success for us. Today, we have saved about 39 lives since we have started in, I believe, May of 2017.
Looney: So, it kind of seems like you’re taking this personalized approach to benefit both providers and patients. And Compass Medical seems to be doing a really good job of that. Is this something that any practice could do? Do you have any advice for any of our other practices that might be interested?
Dr. Shah: Yes, absolutely. I think we are not an in-patient facility, and just like many practices, we have primary care, and not a large amount of specialists in-house. Or, we do not have a lot of the specialists that are needed for a successful lung cancer screening program. But that didn’t stop us from pursuing this. So, my advice for other practices would be start from wherever you are, and look around and build a relationship with your local specialist network, and find a lung cancer screening center which already is doing American College of Radiology-accredited lung cancer. We have our own lung cancer CT scan.
Looney: That’s great. So, you’re utilizing all of the tools that currently exist in eClinicalWorks to make this a better experience for your providers and your patients all around. So, I think there’s something to be said for that. So, can we talk about — I know you mentioned a little bit about these personalized workflows, and the templates and the Order Sets. I just kind of wanted to highlight the fact that you’re taking this approach to train the whole staff, not only on what they’re supposed to be doing but why they’re supposed to be doing it.
Dr. Shah: Yeah, absolutely. I think this goes back to the reason why we are in healthcare. So, as part of our training when our EHR team and some of the other team members who are going and educating the end-users, we always try to tie the workflows and the clicks or the keystrokes they are making to why is it that they are doing it. It may not always be about saving lives. It may be at times reducing patient roadblocks for getting the access to the care, or it could be sometimes making the provider efficient, but at the end of the day it is all about improving the care of a community.
Dr. Shah: And we try to work with our clinical team and build a clinical success story. What we believe to be success for tackling provider experience and provider burnout is it’s time in 2019 that we don’t treat Electronic Health Records or any healthcare technology as just a data-entry tool, but we ask more this technology: What can this technology do for us? And as you start to change that paradigm as a leadership and team which supports this technology, it creates a success organically.
Looney: Absolutely. Well, thank you so much for having us today, Dr. Shah. It was really nice to hear about all of your approaches to combat this provider burnout and making it a more personalized Compass Experience for your patients.
If you want to learn more about of the topics we discussed today, you can talk to your SAM or you can visit my.eclinicalworks.com. For more episodes of eClinicalWorks Podcast, you can visit YouTube, iTunes, or my.eclinicalworks.com.