PCMH at Queens Long Island Medical Group

QUEENS, NY

CLIENT PROFILE:

  • Multi-speciality
  • 240,000 patients per year
  • More than 350 physicians
  • 22 medical offices

OUTCOMES:

  • Decreased calls by patients to practice
  • More care provided for patients at time of visit
  • Faster patient flow at time of visit
  • Improved adherence and compliance

Allscripts Enterprise EHR™

Queens Long Island Medical Group (QLIMG) is one of the largest medical groups in the New York metropolitan area, with more than 350 physicians in 22 medical offices throughout Queens, Nassau County and Suffolk County. It is the largest physician-owned and operated multi-speciality medical practice group in the tri-state area, serving more than 240,000 patients annually.

Starting in 2001, QLIMG made a commitment to keeping the community healthy by implementing Allscripts Enterprise Electronic Health Record (EHR) to automate and connect its caregivers with the broader healthcare community. QLIMG was the first medical group in the country to go live on every module of the Allscripts system.

In 2007 as part of its culture of continuous improvement, QLIMG embarked on a journey to certify its facilities as a Physician Practice Connections®-Patient-Centered Medical Home (PPC®-PCMH™).

The patient-centered medical home is a mode l for care provided by physician practices that seeks to strengthen the physician-patient relationship by replacing episodic care based on illnesses and patient complaints with coordinated care and a long-term healing relationship.

The physician-led care team is responsible for providing all of the patient's health care needs and, when needed, arranges for appropriate care with other qualified physicians. The medical home also emphasizes enhanced care through open scheduling, expanded hours and communication between patients, physicians and staff.

Opportunities

The PCMH model of care requires technology that allows for integration of information from multiple, diverse sources into a single system to support comprehensive medical information needs. Among many requirements, system s must include up-to-date and accurate problem and medication lists, information about each patient encounter, referral and order tracking and a patient web interface.

The National Committee for Quality Assurance (NCQA) developed a medical home certification tool known as Physician Practice Connections- Patient Centered Medical Home. Recognition is awarded from levels 1-3, depending on the degree to which requirements are satisfied, with the goal being a Level 3 and a score of over 75 out of 100 points.

EHR serves as the central nervous system of this new model, and without it, not even a Level 1 certification is attainable. The EHR is the core component of receiving certification in the NCQA Physician Practice Connections®-Patient-Centered Medical Home (PPC®- PCMH™ model. The technology transcends across all of the quality standards needed to achieve certification.

Certification addresses the following nine standards:

  • Access and communication
  • Patient tracking and  registry functions
  • Care management
  • Patient self-management support
  • Electronic prescribing
  • Test tracking
  • Referral tracking
  • Performance reporting and  improvement
  • Advanced electronic communications

OLIMG's Flushing North practice was the pilot location for the PCMH transition. The practice employed six PCP physicians, all of whom felt overwhelmed, underpaid and frustrated. Virtually all clinical workflows were funneled through the physicians. There was limited team structure and much of the  staff  was underutilized or not utilized in the appropriate  capacity. Consequently, providers were staying two to three hours beyond office hours each day just to keep up--leading to increased aggravation, dissatisfaction and inefficiency.

Allscripts Enterprise EHR was the  tool to make the  Patient-Centered Medical Home possible for the  practice-with the hopes of increased patient and staff satisfaction and, most importantly, higher quality of care.

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Solutions

Achieving certification required OLIMG to completely re-engineer office workflow to enable a care team redesign and completely integrate EHR technology for registries, clinical decision support, population management, patient engagement, quality reporting and secure, as well as ubiquitous data access and exchange.

Core principles of the approach were to:

  • Move all possible interventions away from the physical visit
  • Use every member of the  team to the highest level of licensure and ability
  • Facilitate daily care team "huddles"
  • Make EHR use mandatory

The rollout of the PCMH was in two phases. Phase one was to bring the practice to Level 2 NCOA. Phase two was to bring the practice to Level 3 NCOA. Level 3 involves more proactive outreach to patients and the Allscripts Enterprise EHR enables OLIMG to pull data from the system daily to identify and reach out to at-risk patients.

By re-engineer workflows, the Flushing North practice was able  to achieve Level 3 NCQA certification and today utilizes its registry for chronic and preventative care management in order to provide proactive outreach to patients, as well  as to track tests and referrals, utilize case management and employ hospitalists.

With the practice’s diabetes patients, for example, all patients with a glucose level of 7 or 8 mmol/L now receive calls from RN Care Managers who request that they come into the office, attend a diabetes education class and participate in managing their condition.

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Outcomes

After rigorous evaluation by the  NCQA on many aspects of OLIMG's medical office practices and  performance, OLIMG's Flushing North facility became the  first practice in the state  of New York to achieve NCQA recognition as a level 3 PPC-PCMH-the highest level  of  recognition achievable-in September of 2008.

"We were able to use Allscripts Enterprise EHR to essentially transform the Flushing North office into a PCMH model that fundamentally changed how our physicians practice medicine," said Dr. Thomas Auer, Chief Medical Officer for OLIMG.

Many tasks that had been performed by providers are now executed by the care team using a certified workflow and protocol. As a result, the practice was able to increase productivity while reducing the number of on-site physicians required from six to four.

Staff at Flushing North has noticed a complete transformation within the practice. Even small things like noise level have changed, making the practice environment less chaotic and more serene.

"EHR also provides us with a huge competitive advantage that we actively market in our community. Our patient’s com e in knowing what it is and the advantages it provides," Fortini said.

Overall, OLIMG estimates that the implementation and certification of its PCMH, with the help of Allscripts Enterprise EHR, has resulted in a substantial savings of time and resources and improved MD production by over 20 percent while decreasing staff expenses by 14 percent.

"Allscripts Enterprise EHR has and continues to be the backbone of the transformation. It has been one of our primary vehicles for quality of care and coordination of care and its gaining speed," Fortini said.

LOOKING FORWARD

OLIMG has already implemented the PCMH model in three additional offices and has implementation plans for all of its 22 offices. In addition, OLIMG is looking forward to upgrading to Allscripts Enterprise Version 11 with in the coming year.

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"EHR has been central to our re-engineering. Now, through the use of EHR and more efficient workflows, the right people are doing the right tasks and physicians are able to focus on care issues."

Robert Fortini Chief Medical Affairs Officer Queens Long Island Medical Group

"We were able to use Allscripts Enterprise EHR to essentially transform the Flushing North office into a PCMH model that fundamentally changed how our physicians practice medicine.

Thomas Auer, MD, Chief Medical Officer, Queens Long Island Medical Group

OUTCOMES:

  • Decreased calls by patients to practice
  • More care provided for patients at time of visit
  • Faster patient flow at time of visit
  • Improved adherence and compliance
  • Improved access  to PCP
  • Increased scheduling capacity through division of labor and electronic pathways
  • Increased job satisfaction of primary care  staff
  • Significant increase in access to behavioral health and MNT services
  • Improved MD production by over 20 percent while decreasing staff expenses by 14 percent