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My name is Lynne Nemeth, I'm an associate professor of nursing at the Medical University of
South Carolina and I'm an investigator in PPRNet which is a practice based research network.
In our pilot study, we implemented electronic standing orders into the
daily workflow of eight primary care practices from around the country.
A standing order authorizes nursing or other clinical staff to
act on and execute a medical order without a clinician's exam.
We used patient information from an electronic healthcare record also known as an EHR to
develop a standing order protocol for 15 screening immunization and diabetes care measures.
This approach engaged all members of the primary care team, empowered the
clinical staff and activated patients to participate in their own healthcare.
I'm doctor Steven Johnson; I'm the senior doctor at the New London Family Practice.
Before the SO-TRIP project, our medical assistants actually had a very limited role in patient care.
They would just take patients' blood pressure, ask them why
they were here in four words or less, and come out of the room.
We did this project because we know that time constraints and
competing obligations undermine the delivery of preventive services.
Health IT can be an important way to improve preventive and chronic care.
We used the health maintenance table of the EHR to record the services that were due
for the patient based on age, gender, and medical process or diagnosis that they had.
And any of the needed procedures for the patient would show up in
red indicating that they were due to be addressed at that visit.
New London exhibited a very successful response to this study's implementation and they provide a good
exemplar story of how primary care practices can improve on measures that they're concerned with.
We saw this as an opportunity to expand what they did to
empower them and to involve them more in the patient care.
The medical assistants also by doing that, feel more
involved; they get more connected with the patients;
they take more pride in their work; and I think overall
contributes to a morale boost for the office so it's a win-win.
My name is Theresa Jump and I'm a medical assistant and
I was one of the liaisons on the research project.
I went to three conferences to learn about the project
to take it back and teach it to my coworkers.
My name is Meredith, I'm a medical assistant here. When I first heard
about the project I was a little nervous because of the extra work
but I was excited because it would give more one-on-one time
with the patient instead of just putting them in a room.
I'm also talking to them more about their health, and get more of a sense of empowerment.
Some people just think you are a medical assistant but I think we do so
much and people don't really know what goes on behind the scenes really.
Doctor Johnson has the patient's chart setup so when you click
it open everything that the patient is due for will be red,
and the whole idea is when you get them up to date the red comes out, and every time a patient
has all the red out of their chart we get a gold star. And so many gold stars lead to prizes.
Now it’s a focus in the practice to do it all the time. It's in front of our faces every time we open the chart.
So even if the person is here for a cold or the flu - if they are due for a shot, the medical
assistant just orders it so it doesn’t take any more time and these things get done.
So, as you know one of the things we try to do is not only look for
things that are wrong but prevent other bad things from happening.
We talked about exercise already. That’s the main thing. Taking off a couple of pounds.
Your tetanus shot is all set and we're going to do some blood work on you.
Our patient is benefiting by getting all the health maintenance procedures that they should have.
One good example I think is the shingles vaccine, which I think in a lot of
practices is on the back burner so our numbers are pretty good for that,
and I've had enough patients who have gotten shingles after refusing
the vaccine to know that we're helping a whole lot of folks.
At the end of the study across all practices, six of the fifteen measures were significantly improved.
I feel that this is important because we're not utilizing all of the staff to
their fullest potential in the health care system without standing orders.
Primary care providers are very busy. They have a lot of competing demands. Patients have their own agendas too;
so that when they come in to see a provider for a regular visit, these are things that
can be addressed very easily rather than wait for it to be brought up independently.
So this really just provides a natural segway into improving the delivery of preventive services.