AUTOMATED APPOINTMENT REMINDER PROJECT

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1 Creating healthier communities through collaboration, partnership, and implementation of innovative programs Coalition of Safety Net Access Providers September 2010 SPA 2 providers will work collaboratively to provide timely and convenient access to appropriate, high quality, coordinated specialty care to the low-income, under and uninsured residents of the San Fernando and Santa Clarita Valleys. AUTOMATED APPOINTMENT REMINDER PROJECT n the planning phase of the Kaiser Specialty Care Initiative, one of the major concerns identified was the high volume of patients who failed to keep their appointment. C-SNAP members felt this could be the result of many things; transportation barriers, excessive wait times, and patients unaware they had an appointment scheduled. The current process is to mail letters letting the patients know when they have an appointment. Sometimes patients did not receive the letters until the day of and/or after the appointment date. The C-SNAP implementation team determined that one area of focus should be to see if we instituted interventions whether we could reduce the no-show rate. Our consultants researched possible solutions and recommended that we work with 4Patient Care, an agency with a proven track record of decreasing no-show rates in various healthcare settings including teaching facilities. 4Patient Care provides automated communication services via phone (using interactive speech recognition), , SMS, web, and postal means. Since there would be an exchange of protected health information, in addition to just signing a business associates agreement, Los Angeles County Council needed to review everything and present it to the County Board of Supervisors for approval. This challenge delayed the project longer than anticipated. From start to finish this was time consuming. We received approval in May 2010 to proceed! Olive View-UCLA Medical Center staff determined that to achieve the greatest success, it was important to inform patients about the new automated appointment reminder system so they would better understand the importance of providing accurate contact information. In an effort to increase access to specialty care by reducing the no-show rate, 4PatientCare began performing appointment reminder and confirmations for patients scheduled at the Olive View-UCLA Medical Center Neurology specialty clinic on August 30. The hope is to reduce the no-show rate and identify patients who cannot keep their appointment and make them available to other waiting patients. After implementation in Neurology, other specialty clinics will be implemented. The outcomes of this pilot will be detailed in a future newsletter.

2 REFERRAL DATA July 2009 June 2010 The graphs below reflect referral data for fiscal year for five specialty clinics within ValleyCare including volume of referrals, wait time for an appointment, failure to keep an appointment, and denial rates. PHYSICIAN SPECIALTY TRAINING SESSIONS The physician specialty training sub-committee continues to meet and discuss ideas for upcoming training sessions. The committee consists of Dr. Christine Bower Baca, MD, a UCLA Neurologist and Robert Wood Johnson Clinical Scholar, David Campa, MD, Chief Medical Officer, Northeast Valley Health Corporation, Roger Peeks, MD, Chief Medical Officer, Valley Community Clinic, and Joni Novosel, Director, Valley Care Community Consortium. In addition to the committee members, C-SNAP contracted with Michael Rodriguez, MD, MPH, Professor and Vice Chair of Research, George F. Kneller Endowed Chair in Family Medicine, UCLA Department of Family Medicine, to take on the role of facilitator for the sub-committee. In the last issue of the newsletter we shared information from the last neurology specialty care training session. Currently, Dr. Bower Baca is conducting a referral audit that will steer the curriculum for the next training session. The team is in the very initial stages of developing a pilot shadowing project. Over the next quarter, the sub-committee will continue to meet and plan. Look for a more detailed update in the next newsletter.

3 RPS IMPROVEMENTS Migration to new servers The biggest improvement to RPS occurred on May 3 when we moved the application to newer, bigger, and much faster servers. Since then we have not had problems with the slow-downs and crashes that plagued the system in the last year. The new servers also have much more disk space available so we no longer have to worry about running out any time soon. Response time has seen huge improvements. Team initiation of referrals A link has been added to the Team Referrals sub-tab under the Referral Initiation tab to allow users to find referrals started by other members of their team so they can be updated/submitted. This allows a physician to start a referral and have other office personnel update the referral and upload documents and then submit the referral when it is complete. The link to allow team members to search for Referrals Pending Additional Information has been moved up to make it easier to find those referrals that have been returned for additional information before they can be approved. Searching for a clinic Trying to guess what clinical service a clinical activity can be found under has been an issue with RPS for a long time, so a link has been added to the referral initiation screen to allow the initiator to search for possible clinics to send the referral to. Clicking on this link will bring up the screen to the right of this page. Simply enter a word in the clinic name and hit the Search button at the top of the screen; RPS will show a list of clinics with that contains the word somewhere in their name. Clinics that do not accept referrals using RPS will be grayed out on the list. These clinics are on the list so that people do not keep trying to find clinics that are closed or don t accept referrals using RPS for some other reason. Right now you will have to remember the clinical service and activity and manually enter them on the initiation screen as you always had to. We are hoping to make it so you can select a clinic on this screen and have it automatically show up on the initiation screen in the future. Reports In an effort to cut down on report requests and give users the ability to write their own reports, we are designing screens to allow RPS users to pull down some basic raw data that they can then import into Excel. Several reports have already been created for DHS referral centers. Further reports are planned for referral centers, sites, managed care, clinical reviewers, and initiators. Please send suggestions about what kind of data you would like to see to hbuchbinder@dhs.lacounty.gov. RPS2 Rewrite of RPS DHS is still on target for a 2011 rewrite of the RPS system to enhance its functionality while preserving as much of the familiar interface as possible.

4 TELE-DERMATOLOGY PROJECT During the planning phase of the Kaiser Permanente grant, Dermatology was identified as one of the top five specialty needs. In efforts to reduce wait time to obtain an appointment with a Dermatology specialist and improve access to care, the C-SNAP group chose to add a tele-medicine approach as one of the prongs of our fourpronged approach to improve access to specialty care. We are now piloting the Tele- Dermatology approach at two sites: Tarzana Treatment Center and ValleyCare San Fernando Health Center. One is a non-fqhc primary health clinic and the other is a Los Angeles County operated health clinic. For the Santa Clarita, San Fernando, and Antelope Valleys, Olive View-UCLA Medical Center and Mid- Valley Comprehensive Health Center are the main resources for dermatological care for uninsured patients. This approach was selected for the following reasons: Increase patient access to care Utilize effective low-cost technology Enhance health care delivery in primary care setting Easily sustainable technology Able to transmit photos via current RPS system Once the C-SNAP group selected the two sites to begin using tele-dermatology, Dr. Marc Goldyne, MD, PhD, FAAD, Clinical Professor of Dermatology, UC San Camera and Illumination Francisco, was contacted to provide training to staff at both sites. The training sessions were conducted over a two-day time frame with a half day for oneon-one training and discussion between Dr. Goldyne and Dr. Jeremy Kampp, the Dermatologist working with us to read scans and provide consults back to the primary care physicians. The training

5 sessions were very well attended with over 35 clinic staff being trained on all aspects of successful implementation strategies for a tele-dermatology program. The sites selected are using different systems for storing and forwarding patient photos. While the San Fernando Health Center is using RPS for all scans, Tarzana Treatment Center is using their own Iron Clad HIPAA compliant system. Tarzana Treatment Center has provided access via secured passwords to Dr. Kampp. At Tarzana Treatment Center the exchange of scans has already begun to occur. We look forward to reporting in our next newsletters some of the facts on how many patients were able to be treated effectively in their primary care setting, how many needed to be referred into the specialty clinic, and the potential reduction in appointment waiting time. All of the steps are in place to begin storing and forwarding scans from the San Fernando Health Center. Because the San Fernando Health Center is operated by LA County Department of Health Services, there were several steps required to be implemented at San Fernando Health Center that were not required at Tarzana Treatment Center, including the creation of the Nursing Competency Checklist and specific policies and procedures which Dr. Kampp and nursing leadership developed. Some of the concerns and challenges for implementing tele-dermatology within all the Public-Private Partner (PPP) clinic sites in SPA 2 was the issue of malpractice liability and Scope of Practice changes which are needed for FQHC designated clinics that currently do not have dermatology listed as a service provided. It was determined that piloting and measuring the success of these two programs would be beneficial to the C-SNAP group before full implementation occurred. This ramping up will allow these sites to work out any glitches and to test the effectiveness of using RPS to scan photos. One goal is to show the effectiveness of this project in setting a standard for best practice of care for Dermatology patients. Positive outcomes will facilitate replication at Olive View-UCLA Medical Center, incorporating tele-dermatology as an effective way to provide access to those patients that are the most acute. To protect all parties involved, C-SNAP has worked with Campania TeleMed to purchase liability insurance to cover the Dermatologist and Valley Care Community Consortium as the lead agency on the project. During training, Dr. Goldyne quoted an article demonstrating that medicine is always slow to adopt clinical innovation. That it will ever come into general use, notwithstanding its value, is extremely doubtful; because its beneficial application requires much time and gives a good bit of trouble both to the patient and the practitioner; because its hue and character are foreign and opposed to all our habits and associations. This article was in the London Times in 1834 and was Dermascope referring to the Stethoscope. It is estimated that the common use of telemedicine will also take time to be implemented widely even though there have been proven positive outcomes. Here in SPA 2, the C-SNAP group is willing to adapt to change, a big plus for the coalition, and will help us continue to move forward with our goals of increasing access to care in the Dermatology specialty clinics.

6 DAYS TO THE NEXT APPOINTMENT FOR REFERRALS THROUGH RPS Service August 2010 Cardiology 37 Chest 126 Dermatology 44 Diabetic 111 Endocrinology 204 Gastroenterology 25 Hematology 29 Infectious Disease 16 Infectious Disease-Specialty 42 MDA Neuromuscular 42 Memory Loss 56 Neurology 148 Oncology 29 Orthopedic Adult 22 Podiatry 66 Renal 72 Rheumatology 205 OB/GYN - Antepartum/Genetics 0 OB/GYN - Gynecology Endocrinology 168 OB/GYN - Gynecology -Urology 86 OB/GYN - Gynecology After Care 26 OB/GYN - Gynecology PAP/ Colpo 48 OB/GYN - Gynecology (Re-design Clinic) 90 OB/GYN - Gynecology - Oncology (Re-design Clinic) 55 OB/GYN - High Risk Prenatal 20 OB/GYN - Prenatal Intake 8 OB/GYN - Post Partum 56 OB/GYN - Sterilization English 25 OB/GYN - Sterilization Spanish 8 Surgery Audiology 180 Surgery Breast 5 Surgery Cleft Palate 34 Surgery ENT 37 Surgery General 25 Surgery Laser (Part of Optometry) 71 Surgery Ophthalmology 70 Surgery Optometry 30 Surgery Plastic 52 Surgery Proctology 75 Surgery Urology 43 Surgery Vascular 54 C-SNAP UPDATES Valley Care Community Consortium Bonnie Bailer, President Joni Novosel, Executive Director Carla Niño, Editor