Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
Lance Goudzwaard is COO of Panorama Orthopedics & Spine Center. The Denver-based practice employs 250 staff – 150 of which are clinical – across three facilities to care for between 500 and 600 patients each day. The practice has successfully attested for Stage 2 of Meaningful Use on the NextGen system, and participates in quality-based risk programs such as the Bundled Payments for Care Improvement initiative, in which it receives bundled payments based on episodes of care.
Do orthopedics practices face any special challenges when it comes to selecting, implementing, and using healthcare technology?
Panorama Orthopedics offers five different service lines / sub-specialties, each with unique needs. We had difficulty finding an EHR that met the needs of each sub-specialty, and have done a great deal of customization and template creation in order to accommodate the needs of our physicians.
In addition, we are currently implementing a tool to help supplement our patient portal strategy and help keep our doctors, patients, and caregivers connected between visits. Our goal with this technology is to automate the routine aspects of care while tracking patient progress and monitoring clinical areas of concern.
We also tend to be on the cutting (if not bleeding) edge and are always on the lookout for new technologies to improve processes and our ability to care for our patients. We have a number of technologies in place that were not designed to function as a unit and, as you can imagine, that creates challenges in sharing information across platforms.
What types of health IT have you found to be especially beneficial to your physicians? In what ways?
In our experience, most health IT solutions slow our physicians down. Panorama physicians have largely preserved their patient volume over the past few years, amidst the ever-increasing documentation requirements. We have experienced great variability in the quality of documentation, and many of our providers were completing their charts for two to three hours after clinic. Our physicians were growing very frustrated because they were sacrificing precious family time, and still weren’t meeting our documentation quality goals.
We recently implemented Skywriter MD as a way to help our providers record all the appropriate data in the EHR. Physicians and PAs connect to Skywriters using a secure VPN connection, and communicate with the audio function of tablets and laptops. Providers verbalize the orders, tasks, procedure, and visit notes to the Skywriter, and watch their navigation and data entry in real time. Orders, prescriptions, and follow-up activities are printed and/or managed before the patient leaves the clinic, and the note is complete (and of high quality). Our providers are able to focus on the patient and their care, and by offloading the pointing and clicking activity, they move very quickly from one patient to the next, while also focusing more of their attention on the patient rather than the computer screen.
Have you found any particular patient-facing technologies to be especially beneficial? Have patients commented on the change in practice?
Interestingly, one of the most beneficial technologies for patients has been the use of Skywriter MD. Prior to that, our support staff was completely bogged down in helping our providers complete activities before the patient left the clinic, which prohibited them from returning telephone calls and scheduling procedures during the day. Now that the virtual scribes are helping our providers with those tasks, our support staff are greatly improving the quality and timeliness of communication with our patients, which has improved their satisfaction with our clinic. Additionally, since the new technology has improved the efficiency of our providers, they now have time in their day to see more patients, which has reduced our appointment wait times. Overall, I would say that the addition of virtual scribes has reduced the administrative workload of our providers and staff, which has restored the personal touch that is so valuable to our practice.
We also have high hopes for a new application that we are installing to supplement our patient portal. We anticipate that this mobile app will drive greater patient satisfaction and reduce delays by providing pre-operative schedules and instructions, and creating another convenient way to communicate with our staff.
Is Panorama looking into telemedicine? How will you go about selecting a vendor and introducing the service to patients?
Yes, Panorama is looking into telemedicine strategies, but a significant challenge for us is choosing between the number and variety of options. We plan to introduce telemedicine to our practice through a pilot project with our Physical Medicine and Rehabilitation service line, which includes a group of patients that experience repeat visits.
Given the climate in which practices operate today, what challenges are especially keeping you up at night? How are you tackling them?
The combination of regulatory change and declining reimbursement has forced us to find ways to do more with less. Most sophisticated practices like Panorama have already trimmed the fat, and the only way we can thrive in this environment is to find technology that can help us eliminate waste and become more efficient. Looking back, it made no sense to pay physicians and PA’s to be data entry clerks! With Skywriter MD, everyone is focused on their core competencies, and our patients are reaping the rewards.