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Success Story: Team Approach to Visit Documentation Saves Time

Based on an American Medical Association news article published May 9, 2019 and Sara Berg's interview with Aesha Patel, family nurse practitioner, Heartland Health Centers, Chicago, IL.

Learn how care team coordinators (CTCs) can be an integral part of a high-functioning care team to keep a practice running smoothly.

What Was the Problem?

A Chicago health care organization needed to find a new way to cut down on the time their physicians spend hunting and pecking in the electronic health record (EHR).

Developing the Intervention

At Heartland Health Centers, care team coordinators (CTCs) document certain aspects of the patient visit to ensure nurse practitioners and physicians have more quality one-on-one time with patients. Each primary care physician has 2 CTCs who are involved in rooming the patient and documenting an advanced history, allowing the doctor to spend more time with each patient.

“It takes a lot of work from all roles, especially the providers and patients, to be willing to teach and explain things,” said Patel. “That really makes a big difference in how the CTCs do and how quick they are able to grasp onto the concepts and how confident they are as well.”

Aesha Patel, NP

CTCs take on clerical roles to allow medical assistants to work closely with the patients, nurse practitioners, and physicians (Figure 1). Training for CTCs consists of 2 weeks of education on how to use the EHR and doing hands-on demonstration of the clinical tasks needed. After this intense training, CTCs complete about 6 to 8 weeks of training off the floor, which includes learning the process, testing tasks, and learning about common conditions.

“It was a big learning curve at first, but they feel very empowered and are an integral part of the team—they're making a difference,” said Aesha Patel, a family nurse practitioner at Heartland Health Centers. “Our physicians are definitely happier. Things are working more smoothly.”

Physicians “are spending less time on administrative tasks, more face-to-face time with the patient and less pajama time after work,” she added. Figure 1 shows the 3 clinical workflows where CTCs are integrated.

Figure 1. CTCs are Integrated into the Clinic Workflow

Meet the patient, set the agenda

Following recommended expanded rooming processes, a CTC will bring patients to the exam room after they complete their check-in. There, the CTC will gather an advanced history from the patient, review any preventive care needs, complete any medication reconciliation, and set the agenda. The CTC will ensure the vital signs, blood pressure, temperature, and respiratory rate are all taken and entered into the EHR.

Participate in huddles

Every morning, the entire team meets to discuss the complete schedule for the day and highlight any patients who need extra time or referrals to the behavioral health consultant, health coach or health educator.

In addition, CTCs participate in brief mini-huddles after meeting with patients throughout the day to share their notes before the doctor meets with the patient. This allows the physician to enter the exam room with a full understanding of the patient's needs and eliminates physician time spent on EHR tasks.

“We have a really, really amazing group of providers and CTCs, so everyone is willing to teach and learn from each other,” she added.

In an effort to clarify new and existing regulations about tasks such as allowing ancillary staff to document certain aspects of the patient visit in the EHR without re-documentation by the billing practitioner, the AMA launched its Debunking Regulatory Myths site. The site provides resources that are intended to give clear guidance on how to interpret regulatory guidelines for day-to-day clinical practice so physicians and their teams can focus on what matters most – streamlining clinical workflow processes, improving patient outcomes, and increasing physician satisfaction. The site offers clarification on ancillary staff documentation and a variety of resources for your practice to use.

About the Organization

Heartland Health Centers is a federally qualified health center with 17 locations and serves a population of about 26 000 patients in the Chicago area.

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Article Information

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

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