Flipping Panel Management on Its Head

In medicine, we are frequently inundated with reports on how we as a provider are doing, as well as more global reports on how our practice is performing overall.

Reports come from insurance companies and from the hospital — a barrage of disease- and condition-specific reports, and reports showing how well we are keeping up with guidelines, standards, and recommended interventions for our patients. These reports can sometimes be useful, and globally can help us decide where to put resources to improve access and equity for our patients who are missing opportunities to get the best healthcare they can.

Take, for instance, colon cancer screening. Review of data from these reports shows that there are wide disparities on how often these screening procedures are up to date for our patients, and we are able to provide lists of those patients not up to date to care management navigators and collaborators in gastroenterology who can help us ensure that patients get the testing they need.

In a recent innovation, we have added missing recommended healthcare maintenance and other disease-specific tasks that are identified by the electronic health record, to a flag on our patient schedule so that we can quickly see that a particular patient is due for mammography, flu vaccine, hemoglobin A1c, and a diabetic foot exam. So when an individual patient arrives in our office that day, detailed information is posted right there so that we can see what they’re due for, which we hope will be an additional reminder to help prod us to help them get these things done and all caught up.

But wouldn’t it be great if we could flip things around, and create opportunities for patients to see these things that we believe they needed to do, and streamlined ways for them to make sure they happened?

Right now, we frequently get messages from patients on the portal asking questions about overdue healthcare maintenance items flagged by the electronic health record that are visible to them. “It says on my patient portal that I’m due for the shingles vaccine; do you think I should do this? Do I come into the office, or do you need to send a prescription to my pharmacy?” Or “The system is telling me that I need a colonoscopy, but I think I had one done about 2 years ago with my gastroenterologist in New Jersey. Does this mean I need to do another one?”

Currently these “best practice” alerts are not active in any way, meaning clicking on them doesn’t lead to an order set or any information about why that is noted as being a deficit for the patient. Imagine instead if the patient was sitting at home, reviewing their upcoming appointment, and saw that they were listed as being overdue for colon cancer screening. Clicking on an active link might take them to information about where these recommendations came from and why they were being made for them, and why the system thought they were or were not overdue.

For instance, there could be a link to their last colonoscopy report in our system, such as a report from their colonoscopy done at our center and the subsequent recommendations from their gastroenterologist about when they were going to be due for their next one. Or maybe there would be a link to a PDF of the last colonoscopy they did at their local outside gastroenterologist, with their recommendations about when to do the next one. If there was nothing there, and they had a report of a recent colonoscopy from a local doctor, maybe they could upload that report, send it to us for approval and inclusion in their record, and quickly satisfy this electronic deficit.

Or what if there was an option to select “Cologuard” and have the kit sent to their home? Or a way to select “Declined”, meaning they never ever wanted to do this screening (or maybe just not right now)?

If the system told him they were overdue for an RSV vaccine, there could be a link to information about why it was recommended for them, based on their age or underlying medical conditions, and something as simple as a request button that said, “I would like to get this vaccine,” which would then either send them to their local pharmacy where they could have it done, or, if that vaccine was available in our practice, offer them an appointment with our vaccine nurse and set up an order for me to sign.

My hope is that actively engaging our patients in things they can do to improve their health, and making it as easy as humanly possible for them and for us, can help close these healthcare gaps, and perhaps overcome inequities and barriers that are preventing them from getting them done. Linking them to resources in their community, providing an easy way to catch up and get everything done, could go a long way to making sure they get as healthy as they can be.

“I’m coming in tomorrow for my annual, and I want to check my HbA1c, get the flu shot and the latest COVID-19 booster, schedule my mammogram, and what’s this about checking for hepatitis C?”

Click, click, click, click, click.

Done.

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