Researchers are advocating for advanced team care to reduce the burden of EHR use on clinicians and lessen the likelihood of physician burnout.
Organizing advanced team care and in-room support for physicians may help to reduce the amount of time clinicians spend on EHR use and free up physicians to focus more of their energy on patient care, according to a report in Annals of Family Medicine.
Christine A. Sinsky, MD, from AMA and Thomas Bodenheimer, MD, MPH with the University of California, San Francisco described the benefits of pairing clinicians with two or three highly-trained medical assistants or nurses during care delivery.
“Primary care teams are underpowered,” wrote the duo. “Teams do not maximally redistribute team functions when clinicians are diverted from activities where they add the most value.”
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Clinicians notoriously spend a significant chunk of their workday on EHR clinical documentation, order entry, billing invoice creation, and other tasks that tether providers to their EHR systems.
The outdated model currently used by many primary care providers leaves physicians running from visit to visit with limited support staff. Furthermore, support staff are often barred from being present during patient encounters.
Implementing an advanced team model with in-room support may help to enable more effective, efficient care coordination and relieve primary care physicians from the stress of low-value tasks.
“Over the past 15 years an intentional, coherent new model of primary care has surfaced in a handful of practices across the country,” wrote Sinsky and Bodenheimer. “Early evidence suggests that this model — advanced team care with in-room support — makes primary care more satisfying to clinicians, staff, and patients, while enhancing quality.”
However, detractors of the new model say physicians have the ability and the time to complete most tasks without the aid of additional support staff.
“Other unhelpful mindsets include the assumptions that technology replaces people, that health care is a transactional endeavor more than a therapeutic relationship, that regulation is the main lever by which to advance quality, and that the principal way to increase net revenue is to reduce overhead,” said the pair.
Within the advanced team care model, medical assistants and nurses serve as care team coordinators. Care team coordinators are trained and supervised by a lead care team coordinator and the clinicians they support.
The more skilled care team coordinators are, the more responsibilities they are able to take off the clinicians’ plate.
“Ideally, an extended care team of additional collocated health professionals, such as a pharmacist, social worker, and behaviorist, support several core teams,” wrote Sinsky and Bodenheimer.
Under this model of are delivery, clinician visits become team visits. Clinicians and care team coordinators conduct in-person visits with patients together, with the care team coordinator starting the visit off by recording a patient’s initial history, asking about symptoms, and performing other tasks.
Clinicians join the visit after ten or 15 minutes.
“The clinician sits face-to-face with the patient (without the computer dividing her attention); deepens the relationship; expands the history; does a focused physical exam; and discusses diagnosis, prognosis, and a collaborative care plan,” the pair wrote.
This strengthens the patient-provider relationship, which helps to improve patient and provider satisfaction.
During the visit, the care team coordinator accesses necessary information in the patients EHR, performs in-room clinical documentation, and enters in any necessary orders.
After the visit, the clinician leaves the room and the care team coordinator reviews the care plan with the patient and arranges any labs, imaging, referrals, or follow-up visits. During this time, the clinician is already starting the next patient visit with the second care team coordinator on their team.
“Between visits, the clinician takes a few minutes to edit and close the previous patient’s note — approving orders if needed and finalizing the assessment and plan,” the duo stated.
Physicians at four different healthcare organizations have implemented this model and achieved improvements in patient satisfaction, clinical productivity, and provider satisfaction.
“It is early in the implementation of advanced team care with in-room support,” wrote Sinsky and Bodenheimer.
“Early adopter teams may be more successful than later entrants because physicians are highly motivated and attract the most competent and enthusiastic staff,” the team continued. “Yet common findings across these sites include increased capacity for patient care and improved satisfaction for patients, staff, and clinicians.”
Date: July 22, 2019
Source: EHRIntelligence