RCHC Community Project Abstracts

Back to subject search page or search by preceptor site The Decision To Transition: Paper Charts vs. Electronic Medical Records (EMR) Project Date: 9/7/2009 Choosing to switch from paper charts to electronic medical records (EMR) is a major decision, philosophically and financially, for physicians and clinics. This study attempted to compare and contrast the advantages and disadvantages of paper charts vs. EMR and to identify the attitudes that physicians in Grants Pass, OR have towards these two systems. The methodology for this study was qualitative and an interview approach was utilized. Four physicians were interviewed based upon their time spent using paper charts/EMR and their intention of transitioning to EMR. Physician concerns for transition to EMR included quality of patient care, financial stability, time efficiency and impact on quality of life. Recommendations from physicians currently using EMR were included for health care providers considering the transition from paper charts to EMR. The Use of Pre-Printed Order Sets for Inpatient Community Acquired Pneumonia Treatment to Increase Compliance with National Quality Measures in a Rural Hospital Project Date: 8/4/2008 Physician order sets for specific inpatient diagnoses are a potential method to decrease the incidence of medical errors. Computerized physician order entry (CPOE) is the gold standard of order sets and has been shown to decrease adverse events in larger hospitals. However, the cost of implementing CPOE is often financially infeasible for smaller, rural hospitals. An alternative is to CPOE is the use of pre-printed physician order sets for inpatient treatment. This study analyses the use of pre-printed order sets for meeting national quality measures for the treatment of community-acquired pneumonia in a 21 bed rural hospital located in Florence, Oregon. The data set collected was too small to draw any conclusion whether pre-printed order sets increased compliance with national standards. However, the pre-printed order set was used on only 22% (7/32) of pneumonia patients in the study. Increasing physician usage of the order set will be necessary to determine if pre-printed order sets are more effective in achieving national benchmarks. Emergency Preparedness of Non-hospital Medical Offices in Astoria, OR Project Date: 12/31/2007 The problem studied is emergency preparedness of non-hospital medical offices in Astoria, OR. The population in question includes all the residents of Astoria. The methods used include in person interviews of physicians and office managers. The findings are that there were few offices that were prepared for a recent local disaster. This has however, brought to light the importance of a disaster plan for non-hospital facilities. The final product of this project is a plan of action for the education and collaborative disaster planning by local physicians' offices and the emergency preparedness/safety coordinator of Columbia Memorial Hospital. Bringing order to chaos: Improving the referral system at North Bend Medical Center Project Date: 2/13/2006 The process of referring a patient from a primary care office to a specialist has become increasingly complicated in both dealing with insurance companies as well as the office-to-office referral. This has the unfortunate consequence of creating a barrier to patient care as well as adding an enormous financial burden to medical offices in the form of administrative duties. The pediatric clinic at North Bend Medical Center identified a need to address this problem in order to increase efficiency and save money. The goal of this project was to clearly define the problem, understand its cause, and develop a potential solution. This was accomplished through a literature search to understand the problem from a broader perspective, and interviews with key people involved in the referral process throughout the state of Oregon. Ultimately two potential solutions to the problem at NBMC were identified: one, the need for appropriate staffing in order to handle the increased demands of the referral process, and two, the need for a referral guide that identified specialists that NBMC commonly refers patients to, contact information, as well as the necessary procedure one must go through in order to refer a patient. For this project, the referral resource was created and has been well received in the office. In the intervening time, an additional office staff member has been hired to handle referrals that will start in the near future. Diabetes management in John Day, Oregon: a summary of objective measures of diabetes care and the impact of an appointment reminder system on HbA1c testing frequency Project Date: 1/2/2006 BACKGROUND: The prevalence of type II diabetes is growing nationwide, a trend that includes both urban and rural areas. Intensive diabetes management is a cooperative process between patients and their health care providers: providers have an opportunity to help their patients intervene in an otherwise progressive disease by prescribing medications to improve glycemic control, blood pressure, and cholesterol, screening for complications, and encouraging appropriate lifestyle modifications. Rural settings have the unique challenge of meeting the needs of their patients and complying with complex documentation requirements without the benefits of extra staff or record systems dedicated to diabetes care. OBJECTIVE: The goals of this project were to summarize current objective measures of diabetes care in Dr. Holland’s practice in John Day, OR, assess the management of diabetes before and after the implementation of an appointment reminder system started in July 2003, and create a record system that the nursing staff can use to help improve the documentation of diabetes care. METHODS: A chart review of all patients with diabetes in Dr. Holland’s practice was performed. RESULTS: The chart review identified an average HbA1c of 7.5, blood pressure of 140/74, total cholesterol of 161, triglycerides of 169, HDL of 35, and LDL of 91. The implementation of the appointment reminder system on July 2003 improved the frequency of HbA1c testing. Finally, a database was generated to aid in identifying patients due for an appointment and in documenting vitals, exam findings, and lab values. CONCLUSIONS: Objective measures of diabetes control in Dr. Holland’s practice have been described, and strengths and areas for improvement were identified. Dr. Holland and the nursing staff plan to use the database generated as part of this chart review to aid in reminding patients about their appointments and in documenting diabetes care. Practice Management of Tillamook’s Bay Ocean Medical Office: An Overview Project Date: 1/3/2005 The majority of medical practices are owned and managed by the physicians. Yet in medical school and residency, no course covers the skills and steps necessary to set up one’s own practice. The goal of this project was to provide an overview of the business of a medical practice based on internet resources and interviews with office personnel. In a small, rural medical practice, each staff member performs a number of duties in order for the office to run efficiently and provide quality care for the patients. Managing a medical practice requires not only seeing patients, but also understanding many other details that are never taught in medical school. Medical Billing in the Emergency Room in Reedsport, OR Project Date: 3/29/2004 Medical billing is an essential aspect of a physicians practice. Determining the appropriate code entails a subjective evaluation of the complexity of a visit. Accurate coding requires a delicate balance between maintaining financial viability and avoiding bureaucratic intervention. In this report, I analyzed the current billing trends in the ER at Lower Umpqua Hospital in Reedsport, OR. 115 ER visits from 11 physicians were reviewed and billing codes were assigned according to the 2004 CPT guidelines. The actual codes were then collected and compared with the evaluated codes. On average, physicians billed for 86% of the total potential billing. This equates to 145 under-billing in the ER, which results in decreased revenue for the hospital. Financial burdens to rural health care systems in Oregon have resulted in the loss of some services and even the closing of hospitals. Improved understanding and application of the current CPT guidelines for medical billing can help stabilized financial viability and ensure continued health care in rural communities. Comparisons of the Medical Office Staff Needs in Rural Hermiston Oregon Versus Urban Portland Oregon Project Date: 2/11/2002 This study sought to determine the differences between the staffing needs and availability of trained office staff in the rural Hermiston Oregon area versus the urban Portland Oregon area. The design was to survey practices in Hermiston and Portland metropolitan areas and compare the results. It was found that the physicians in Hermiston preferred staff with a higher level of education and had a harder time finding trained office staff of any level of education to work in their offices, where as the Portland clinics preferred staff with a lower level education and had less difficulty finding staff of any educational level. The report discusses that more research is needed in the area to better identify needs and gives some recommendations on recruiting better trained office staff. The Importance of Efficient Office Practice in Meeting the Health Needs of the Community Project Date: 5/6/2002 Working with the neediest members of the community results in lower reimbursement for the physician meeting these needs. The lower reimbursement rates for patients on publicly-funded insurance have made it impossible for physicians in some communities to continue caring for these patients. For physicians who continue to see patients with public insurance, the expense of caring for these patients must be kept to a minimum. By creating efficient processes for billing and other functions in the office, expenses can be kept to a minimum, which helps enable a practice to continue to care for the most vulnerable patients. This project focused on creating an efficient billing process that gathers all of the necessary information for making successful claims to insurers for services rendered. Additionally, time was spent training staff on using billing software to streamline the process and maximize efficiency. Back to subject search page or search by preceptor site