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Focus on the Practice: Challenges, Choices, & Change

"Focus on the Practice: Challenges, Choices, & Change" was the title of a two-day pre-session course offered to attendees at Internal Medicine 2008. Thanks to the generous support of the Physicians' Foundation for Health Systems Excellence, this course was videotaped so that many could benefit from the experience of these presenters. As the title suggests, each of these presentations is focused on some challenging aspect of modern healthcare.

  • Frederick E. Turton, MD, MBA, FACP
    "Getting in the Flow: Manufacturing Techniques Applied to Medical Practice"
    (play time 52 min) In this presentation, Dr. Turton uses industry's "Theory of Constraints" to describe how practices get bottlenecked and ineffective. Turton offers "batch & queue" techniques to improve practice efficiency by changing upstream & downstream zones of work and patterns of delegation.

  • Michael J. Kasher, MPA, CMPE
    "Financial Issues: Challenges Facing Small Practices"
    (play time 46 min 40 sec) MGMA tracks many types of indicators. Mr. Kasher, who is MGMA's Director of Survey Operations, discusses trends in compensation, changing reimbursements, increasing costs, and what you can do to enhance operations.

  • Michael S. Barr, MD, MBA, FACP
    "The Patient-Centered Medical Home: Key Characteristics"
    (play time 26 min 40 sec) ACP Senior Vice President of the Medical Practice, Professionalism and Quality Division, discusses basic principles of the Patient Centered Medical Home, a patient-centered physician-guided model of health care.

  • Dawn E. Clancy, MD, MSCR, FACP
    "Group Visits and Type 2 Diabetes: Is There Safety in Numbers?"
    (play time 37 min 30 sec) Dr. Clancy has been investigating group visits for several years and has published her findings in numerous articles. In this presentation, she discusses pros and cons of group visits: describes group visits, identifies benefits and challenges, and discusses methods to increase the value of them for both patients and clinicians.

  • Richard J. Baron, MD, FACP
    "Enhancing Patient Care Through Improved Access & Communication"
    (play time 51 min 30 sec) How accessible are you to your patients? Dr. Baron suggests asking yourself several questions: Do you offer extended hours? When is your next available physical? How are acute patients scheduled? Do you use voice mail (telephone trees)? How do you handle phone calls? Do you use email with your patients? Dr. Baron discusses the pros and cons of Open Access and how to implement it in your practice.

  • Vincenza Snow, MD, FACP
    "The Role of Measurement in Practice-Based Quality Improvement"
    (play time 36 min 30 sec) Quality Improvement entails three factors: outcome measures, process measures, and balancing measures. Unlike research projects, Quality Improvement can be monitored using small samples patients plotted over time. Dr. Snow discusses how an active Quality Improvement program can improve clinical, operational, and financial outcomes.

  • Georgia L. Newman, MD, FACP
    "Adventures with the Telephone: The Bad, The Ugly, and The Good…Eventually"
    (play time 39 min) Dr. Newman's practice was one of 30 that participated in the Center for Practice Innovation project. In this presentation, she describes her journey from a chaotic and dysfunctional office workflow to one of success - by analyzing the problem, researching potential solutions, and changing processes through use of PDSA.

  • Paula M. Woodward, MPH, RN, CCM
    "How Can We Help Marilyn? A Case Study in Self-Management Support"
    (play time 33 min) Using a case study to illustrate her points, Ms. Woodward discusses the inter-relationship between health literacy, patient self management support, and successful patient self-mangement.

  • Panel Discussion Day 1
    (play time 47 min) Four speakers from Day 1 field a variety of questions from the audience. Frederick E. Turton, MD, MBA, FACP; Michael J. Kasher, MPA, CMPE; Georgia L. Newman, MD, FACP; and Paula M. Woodward, MPH, RN, CCM discuss office workflow, practice organization, patient self management support, adding mid-level clinicians, etc.

  • L. Gordon Moore, MD
    "Good Things Come in Small Packages: Ideal Medical Practices"
    (play time 45 min) Dr. Moore is a well known speaker on the concept of "Ideal Medical Practices." He discusses the need to focus on productive interactions, examines internal and external systems that impact upon practice, and highlights the need to be patient centered.

  • Rodney Hornbake, MD, FACP
    "Using Data for Quality: Patient Registries & EMRs"
    (play time 48 min 30 sec) "You can't manage what you can't measure." Dr. Hornbake discusses how using patient registries can impact on outcomes by providing practices with their own real-time and easily accessible clinical data.

  • Peter Basch, MD, FACP
    "Adding Value to the EHR: Integrating Decision Support, ePrescribing, and Patient E-mail"
    (play time 58 min) Dr. Basch talks about making full use of an EMR by utilizing electronic decision support, integrating e-prescribing, and using secure email with patients.

  • Ted Eytan, MD, MPH
    "Technology in Action: Transforming Health Care to Serve Patients Better"
    (play time 48 min) In this lively discussion, Dr. Eytan describes the interactive system used by Group Health Cooperative in Seattle, Washington, a large integrated health care system. Group Health Cooperative uses a "system-wide online shared health record (SHR) as part of a secure member portal that allows enrollees to access their medical records online; provides secure e-mail access to physicians; and offers the ability to complete an electronic health risk assessment (e-HRA), an interactive online questionnaire that helps pinpoint care needs and access individualized health information."

  • Maria E. Rudolph, MPH
    "EHR Implementation: Keys to Success for Small Practices"
    (play time 47 min 30 sec) Ms. Rudolph describes critical success factors involved in adopting an EHR such as specific components of selection, planning, and implementation.

  • Panel Discussion Day 2
    (play time 1 hour 42 min) Rodney Hornbake, MD, FACP; Peter Basch, MD, FACP; Ted Eytan, MD, MPH; and Maria E. Rudolph, MPH answer questions from the audience including whether or not to purchase an integrated EHR, using stand alone ancillaries such as electronic prescribing, use of registries, office workflow changes, etc.