At the Health IT Summit in New York City on Sept. 27, sponsored by Healthcare Informatics, Salvatore Volpe, M.D, chief medical officer at Staten Island Performing Provider Systems, LLC urged physician leaders to adopt and deploy health IT to increase efficiency and improve patient care within Patient-Centered Medical Home (PCMH) practices.
Volpe gave the keynote presentation Tuesday morning to kick off the New York Health IT Summit. While advocating the use of health IT, he also urged physician leaders in the audience to provide patients copies of their full progress notes to better coordinate care as part of PCMHs.
“Give the note to your patients, you will make a difference. It’s about communication between the doctor and the patient, between the doc and doc, and it’s a big piece of the picture,” he said.
Volpe’s Staten Island practice has operated as a PCMH model since 2008, and during his discussion at the Health IT Summit in NY, Volpe outlined the important role health IT can play in providing coordinated, integrated patient care.
Perhaps surprisingly, according to the results of an online, real-time poll of the audience, 32 percent of Health IT Summit attendees said they were unfamiliar with the term “PCMH,” with half reporting they were familiar with the term and only 16 percent reporting they are a part of a PCMH as a healthcare staff member. “It’s possible that people are involved in a PCMH without knowing what it is,” Volpe said.
By contrast, 22 percent of members said they provide some clinical care using telemedicine technology and 28 percent of attendees have been patients who received telemedicine services. About half of attendees provide clinical care without any telemedicine services.
According to the American Academy of Family Physicians, PCMH is a model of care that aims to transform the delivery of comprehensive primary care to children, adolescents, and adults. Through the medical home model, practices seek to improve the quality, effectiveness, and efficiency of the care they deliver while responding to each patient’s unique needs and preferences.
The American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association developed the 2007 Joint Principles of the Patient-Centered Medical Home. According to these principles, PCMHs are physician-led practices that provide comprehensive care at all stages of life and care that is integrated and coordinated. And, PCMH practices commit to enhancing patients’ access to care.
Regarding the use of health IT, Volpe noted that few primary care practices are taking advantage of technology. He cited a recent American Medical Association digital survey that found a gap between enthusiasm for technology and current actual use of it.
According to Volpe, the AMA survey found that 28 percent of clinicians using clinical decision support tools, while 26 percent are using patient engagement and half are leveraging consumer access to data through patient portals. “Forty-two percent are using workflow enhancement, and that should be 90 percent,” he said. “If you can work more efficiently, you can spend more time with patients or see a few more patients during the day.”
At his primary care practice, Volpe said his care team, every day, has what he referred to as a “team huddle” to review each day’s patients and their records, including looking at the patients’ previous appointments, what tests were ordered and other doctors the patient has visited. “Technology can make that team huddle more efficient,” he said.
He added, “Most electronic health records [EHRs] do not have a team huddle view of the patient. For those of you into developing software, that would be a good idea, anything that makes my team huddle more efficient and enables me to know a little bit more by the time I see the patient or makes my staff more efficient.”
Volpe said his practice provides patients with printed copy of their fully progress notes. “I think that’s critical, at least for the next five years,” he said.
“The reason I give out paper notes is during the discharge process, my wife, who is sitting at the discharge counter, she is looking at the monitor and patient is looking at the paper printout and my wife is highlighting the assessment and the plan. It’s important to have this dialogue and make sure you’re on the same page. Sometimes, you leave things out, and the best time to find that error is before the patient leaves the room. WE give them the note and encourage them to read the rest of the note,” he said.
When the patient is provided the progress note and takes it home, this enables their spouse or significant other to review the note as well and provides an opportunity for their spouse to notice if anything information is missing, Volpe said.
“The last reason for giving out the paper note is that sometimes storms occur, and on Staten Island, we lost power for weeks. The people who were able to get better continuity of care had a paper copy of their progress note,” he said. “We had nurse sand doctors going out and the paper note informs the nurses about the patient and what medications they are on, what allergies they have, what cardiologist they see. In my note, there is a medical history and summary and a list of current medications.”
“Again, the emphasis is on sharing information with patients,” he said.
Volpe also encouraged healthcare providers to use language translation technology, such as voice and video capabilities to better communicate with patients. “If a patient doesn’t understand, they are unlikely to follow through.” Additionally, he said patient portals, and especially portals integrated with a practice’s EHR system, can be a vital tool.
Volpe also said he was excited about the promise of machine learning technology, such as IBM Watson cognitive technology, in the clinical setting. “Imagine using Watson’s analytics capabilities to consider all the prior cases, and the state-of-the-art clinical knowledge in the medical literature and clinical best practices to help a physician advance a diagnosis and guide a course of treatment.”