Georgia L. Newman MD

1
Georgia L. Newman MD

• Disclosure of Financial Relationships
• Georgia L. Newman, MD
• Has no relationship(s) with any proprietary
  entity(s) producing health care goods or
  services.

2
(No Transcript)
3
The Bad, The Ugly,and The Good eventually.

• Adventures with the
• Telephone

4
The Oberlin Clinic

• Multispecialty Group Practice, founded in 1952.
• Essentially bankrupt in 1999.
• Physicians temporarily employed by Allen Hospital
• Physicians pink-slipped in 2001.

5
Oberlin Internal Medicine Associates

• Started from scratch in 2001.
• Two internists formed single specialty practice
• Unsuccessfully recruited third internist-twice
• Now have part-time nurse practitioner

6
Telephone System-2001

• Multiple incoming lines with rollover features
• Additional portable phones with separate
  extensions for in-office communication.
• Three experienced secretaries from the Oberlin
  Clinic.

7
THE BAD

• Telephone structure in 2006

8
Oberlin Internal MedicinePlease Hold

• Oberlin Internal Medicine.
• Please Hold.
• Oberlin Internal Medicine.
• Please Hold.
• Please HOLD

9
(No Transcript)
10
MORE BAD

• ALL CALLS coming in to secretaries with multiple
  lines lit up.
• Patients standing at window, checking in.
• Patients at desk, checking out.
• Nurses and doctors coming up to desk with
  requests

11
(No Transcript)
12
Portable Phones

• Too heavy
• Calls interrupted patient care
• Nurses refused to carry phone
• 2/3 doctors also left phone in office

13
THE UGLY

• Refills, Messages and Requests

14
Refills

• 30 of secretaries time
• Error prone. Pt. spelling from bottle.
• Once or twice a day?
• Frequent spelling errors
• Pt frequently JUST in office. Forgot to mention
  prescriptions or hadnt checked

15
Typical Refill

• Lanoxin .125 mg Glyburide 5 mg
• Lisinopril 10 mg Metformin 500 mg
• Coreg 12.5 mg Lasix 40 mg
• Omeprazole 20 mg
• Need one for pharmacy and one for 3 month
  mail-in. ALMOST OUT!!!!!

16
Need Chart to address issue

• Secretary leaves desk, goes to Chart room
• Finds Chart
• Message, refill on chart, placed on Drs desk
• Wait for Chart to be put back in Secs pile to
  call pt or pharmacy

17

• THE BLACK HOLE

18
Need Chart

• Sec goes to Chart Room
• No chart
• Looks up last visit
• Goes to office 1
• Searches 25 piles for date in question
• Goes to office 2
• Looks in piles on desk
• Goes to office 3

19

• Pt calls back 2-3 times
• to check if task completed

20
Refills First Fix

• Notices in waiting room and exam room.
• BRING YOUR PILLS WITH YOU

21
Refills- Second Fix

• Dedicated refill line.
• Secretaries transferred refill calls to refill
  line
• When time permitted, took refill information,
  found chart and gave to Dr.

22
Refills- Third Fix

• Started charging 7.00 for all refills between
  office visits
• HMO patient complained to HMO. Not in contract to
  charge patients. All HMO patients told to come
  in for brief office visits just to refill meds.
  Copay 10

23
Refills- Fourth Fix

• After several ERRORS, decided to have patients
  call PHARMACY and have pharmacy call or fax
  refill request

24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
MESSAGES

• Urgent TRY to find chart same process. If
  initial efforts unsuccessful, give message to
  nurse.
• Non-urgentTRY to find chart.
• Keep looking
• Message on chart in pile on Drs desk.

28
The GOOD

• Finally

29
(No Transcript)
30
NEW phone system in 2007.

• Older phones replaced
• Secretaries given headsets
• Also using e-ClinicalWorks

31
(No Transcript)
32
TELEPHONE MENU

• Call 911 for emergency.
• To reach secretary, press 1
• Message hours, services, etc
• To request a refill. Please call the pharmacy
  and have them contact us.
• To speak with Cindy, press 2 Carol, press 3
  Jen, press 4
• To speak with billing manager, press 5

33
MESSAGES

• Most of the time, pt leaves message since nurse
  with patient.
• Nurse listens to phone messages and can
• Call pt back whenever she has time
• Consult with doctor
• Make appt, or send to sec for appt.
• Handle simple refill requests

34
MESSAGES

• Hospitals, Physicians, Nursing homes--press 1 to
  get secretary
• Message entered as telephone encounter, sent to
  doctor to address.
• Doctor decides on action, sends back to secretary
  or nurse to make call.
• All information part of permanent record

35
EMR-eClinicalworks

• NO CHART PULLS
• No chart piles to go through to find information
  to answer message, refill.
• All information on patient is available in front
  of staff at time of call

36
As POGO said

• We have met the enemy,
• And they is us

37
The UGLY

• Reduced and tiny

38
(No Transcript)
39
In Conclusion
40
Press 1

• THINK about processes
• EMPOWER staff to work to their highest potential

41
Press 2

• Do YOUR part

42
Press 3

• If possible
• Charge a fee

43
Press 4

• Good Luck