Sustainability

Clinics use team care to cut time doctors spend on clerical tasks

A Chicago health care organization is finding a new way to cut down on the time their physicians spend hunting and pecking in the EHR.

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 two CTCs who are involved in rooming the patient and documenting an advanced history, allowing the doctor to spend more time with each patient.

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Committed to making physician burnout a thing of the past, the AMA has studied, and is currently addressing issues causing and fueling physician burnout—including time constraints, technology and regulations—to better understand and reduce the challenges physicians face. By focusing on factors causing burnout at the system-level, the AMA assesses an organization’s well-being and offers guidance and targeted solutions to support physician well-being and satisfaction. 

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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.

CTCs take on clerical roles to allow medical assistants to work closely with the patients, nurse practitioners and physicians. Training for CTCs consists of two 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 six to eight weeks of training off the floor, which includes learning the process, testing tasks and learning about common conditions.

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“It was a big learning curve at first, but they feel very empowered and 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.

Set agenda, meet the patient

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.

“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.

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

New guidelines for team-based care were released by the Centers for Medicare and Medicaid Services (CMS) in 2018, allowing for ancillary staff, such as CTCs, to document certain aspects of a patient visit in the EHR while simultaneously acknowledging that the information does not need to be re-documented by the billing practitioner.

In an effort to clarify new and existing regulations, the AMA launched its Debunking Regulatory Myths site, which provides resources that are intended to provide 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.