What Does a Medical Practice In Kenya Have in Common With a Medical Practice in the US?

ProcessAt NCE last year, I got an opportunity to meet  Dr. Sidney Nesbitt. Dr. Nesbitt a pediatrician in Nairobi, Kenya and is very interested in practice management things like work flow improvements, hiring the right staff and working on making his clinic a better place for both him, his staff and his patients.

I recently heard from Dr. Nesbitt. He shared with me that a group of MIT grad students conducted an assessment of his office in Nairobi in an effort to make improvements in several areas of his practice e.g. workflow, checkin, collections, triage of the practice.

In the fall of 2009, a team of four MIT students applied to work with Muthaiga Pediatrics. The clinic’s head had set their goal: to make the most of Muthaiga Pediatrics’ existing resources so as to “provide a much higher level of medical care in a modern highly organized environment [and eventually to] transform the busy single pediatric practice into a growing clinic chain with a strong brand.”

You would think (I certainly did) that a practice in Kenya has little similarities to a practice in the US. However, when you see the teams objective, and what they set out to discover, I was surprised to see that these objectives are not really that different any practice here in the United States.

The students created a work plan that illustrated 3-key areas where they would focus:

  1. Benchmarking against world class pediatrics clinics
  2. Exploring clinic culture and personal issues
  3. Investigating addition of specialties to clinic

After reading the report I was impressed with two things.

First, I was impressed with how meticulous and well planned the students approached the project. From the way the broke down the key issues, to how the planned their research, to how they decided to make the suggestions was brilliantly executed, in my view. This was all evident in their documentation and supporting documents.

I couldn’t help to think, “why can’t a group of MIT students to come to my office and do the same?” I  later told Dr. Nesbitt how jealous I was. The work they did would put more than half of the practice managers consultants to shame.

The next thing that impressed me was the resources they published in their report and provided to Dr. Nesbitt’s as a type of blueprint or hand-book to execute the MIT students recommendations.

Here is what I’m talking about:

  • Project work plan described the goals for the project and breaks down responsibilities and final deliverables to be completed
  • Interim report was delivered by the MIT team to Muthaiga senior management upon their arrival onsite and outlines their research for the project to date
  • Project plan showed a timeline of activities to be undertaken onsite
  • Job descriptions, daily checklists, and reception tracking timesheet helped the team and the staff precisely define and focus on the tasks designated for each staff member and find bottlenecks in patient flow at reception
  • Tracking model and flow charts were used to record and organize the time patients spent waiting and being seen at each of a series of hospital stations during their visits, as well as the decisions the staff members were required to make at each step
  • Patient survey was administered to patients (by choice and with anonymity) to elicit preferences for areas such as appointment scheduling, and the availability of credit and acceptance of insurance
  • Employee survey was used to collect anonymous feedback on staff perceptions of how well the clinic was operating
  • A two-part final presentation given at the end of the MIT team’s onsite work

I encourage you to head over to the Global Health at MIT blog to read the report. There, you will read all about the project and find all the links to the resources listed above.

Improving Operational Efficiency in a Small Practice: Muthaiga Pediatrics 

11 Questions to Ask A Potential EMR Vendor About Their Software

Software demos are notoriously biased. EMR representative will generally show you the stuff that works really well. They will show you the stuff that will make you say, ooh, aaah.

Nothing wrong with that. When I’m showing something off, I want to share the best of what I have too.

But one of our main jobs as leaders of our medical practices, is to shift through the nonsense and get to the nitty gritty.

So how do we know, from a practical stand point, that the software we are evaluating can handle real world examples?

The best way to understand if a piece of software will work for you is to see it in action. Not from a representative’s point of view, but from a practice point of view.

I know what you are thinking… but I don’t know what questions to ask the EMR rep that will help me get a practical sense of how the EMR works.

Wonder no more. Suzanne Berman, MD, SOAPM member extraordinaire, wrote down 11 Questions that I think will really put an EMR through a ringer. As you will see from her questions, she emphasizes the importance of seeing  how the system performs extracting data.

Take a look at these questions and have them ready the next time you meet with an EMR vendor.

  1. “Show me how I recall all asthmatics who haven’t had a spirometry in >6 months.”
  2. “The next time this family calls or comes in, SOMEONE needs to get a correct mailing address. Please mark the chart on all the siblings so it will alert the next time someone opens the chart.”
  3. “Show me all patients who are behind on their checkups.”
  4. “Which of our patients don’t have a current Framitz Flopulitz form on file?”
  5. “I need to pre-order my flu vaccine for next year. I need a breakdown of how many VFC vs payable kids, 6 to 36 months vs big kids we had last year and how many shots/mist we gave; then I need this year’s numbers to extrapolate.”
  6. “I saw a kid with something like this last year — the specialist recommended a great treatment regimen, that I’d like to try again. Nuts, can’t remember that kid’s name. I do remember charting “Spoke with Dr. Matheson” — the specialist. How can I look through all the charts for a teenage girl seen in 2011 where the phrase “Spoke with Dr. Matheson” appears?
  7. Me, Dr. Speedy, and Dr. Talksalot are all vying for a limited number of shared exam rooms. Which of us a) has the most visits; b) runs on time vs. behind; c) has the most patients in the office at once [i.e. does the most double/triple sib appts]?”
  8. “How many active patients do I have? Exclude cross-cover patients, patients who’ve transferred, patients who we discharged, and patients we haven’t seen in X months. Oh yeah, and please show age distribution.”
  9. “How do I mark this kid’s chart as “African-American child adopted by Caucasian couple — do not ask “are you mom?” when family comes in — sensitive issue” so my receptionists stop putting their foot in their mouths?
  10. “I’m doing a sick and a well visit on the same day. Where do I chart the different bits?”
  11. “How can I find all kids who got vaccinated with Lot X? The mfr is recalling that lot.”

Of course you are free to add your own questions based on situations you’ve encountered. Oh, and don’t assume this is all the due diligence you have to do. Search the web. There are tons of articles that can help you with this process as well.

Lastly, I’d like to mention that data input is also important. The program ought to feel intuitive and easy to input data into. But don’t forget the data output. This is often an overlooked aspect of the EMR evaluation.

What question or request would you add to this list?

Dr. Suzanne Berman is a general pediatrician in private practice in Crossville, Tennessee.   Her family works, lives, goes to school, worships, and buys stuff from Walmart all within the 38555 zip code. Dr. Berman is a regular contributor to the Survivor Pediatrics blog. To read all her post, click here.