William Miller, MD
Lessons Learned: Solutions
Updated: Apr 26, 2022
Last week, we discussed some of the problems that developed at Adventist Health (AH) Mendocino Coast Medical Offices as a result of the implementation of a new electronic medical record (EMR) system, Cerner. This implementation did not go as smoothly as planned and many of the clinic patients were negatively impacted as a result. This week, I’d like to share more about the actions taken address the challenges and the work that still needs to be done.
“Since the Cerner start date our team has made tremendous progress learning how to use the new software and adapting it to our daily workflows. We went with Cerner because we felt that this software will improve our overall office efficiencies and the way we provide care to our patients,” said Paul Kulas, Clinic Executive for AH Mendocino. “The journey initially was difficult, but what is coming out is a more confident and well-trained staff and providers that are more capable of using some of the beneficial aspects of the software than they were a couple months ago.”
Another solution has been the contracting of an outside call center to ensure that the phones are getting answered quickly and improve patient access. “This has been a bright spot for us and is helpful even if we hadn’t implemented Cerner,” Kulas said. “Our call center has taken over 20,000 calls since we partnered with them early November, 2021. They can schedule appointments with our providers, take messages and triage calls that are of a more urgent nature directly to one of our clinic nurses.” The phone tree is also being realigned to give patients more options to improve their ability to get through to the right person more easily.
The national staffing shortage continues to affect healthcare on the Coast. To address this, we have conducted two career fairs locally and has been aggressively recruiting. “We have hired and retained four new medical assistants, however, there aren’t a lot of people applying,” said Clara Slaughter, Director of Clinic Operations. “We still have 15 open positions, 6 are for medical assistants, one medical records technician and 7 registration clerks. We will provide training if someone does not have experience. I know there are people in the community looking for jobs and I encourage them to apply because our clinic is a great place to work and can be incredibly rewarding.”
The clinic is also recruiting new primary care providers and expanding specialist services. “In the last two years the clinic has brought on 14 permanent providers, that’s amazing considering the challenges that rural hospitals have in recruiting nationwide,” said Slaughter. “We continue to recruit for an orthopedic surgeon and a GI specialist. New services that started at the coast in the last year have included behavior health services, and ear-nose-and-throat. We have added a wellness program that includes a certified wellness coach, a substance use counselor and a registered dietician/diabetes educator.” The clinic plans to further expand access to specialty care through a telehealth link that will allow patients to be seen in the clinic by a remote physician, thus making it easier so that the patient will not have to travel far away to see a specialist.
Completing referrals remains challenging. “We have one referral specialist and we are recruiting two more,” Slaughter said. “We have additional people in place to help manage referrals, our goal is to decrease the time it takes to turn around a referral which is currently two weeks. Urgent referrals are given priority and handled immediately. There are a lot of steps that must be done to complete a referral including getting authorization from insurance which is what takes the most time.”
The prescription refill bug was the first issue we realized when we went live, thanks to our patients who alerted us. The problem was with the interface between the local pharmacy and the clinic provider which was not allowing the request go through. “This problem was fixed in early November and works much better now,” said Dr. Zoe Berna, Clinic Medical Director. “We now have a dedicated person managing the refill requests daily and we are tracking it to keep the turnaround within less than 48 hours. We ask that patients initiate a refill request through their pharmacy and do this 3-5 days in advance of when you will run out of your medication.”
The clinic has upgraded its patient internet portal to a program that is easier to use than the previous one. Signing up is simple and can be done at any clinic visit or by calling the clinic or visiting http://www.MyAdventistHealthPortal.org. The portal can also be used through a phone app “MyAdventistHealth” The portal can be used to make appointments and send messages to a provider. The staff will respond to such messages on the same business day if possible. Appointments can also be made through the AH website: http://www.adventisthealth.org/mendocino-coast/ or by calling the clinic at 707-961-4631.
The clinic uses text messages to remind patients of upcoming appointments. This is being upgraded to a new product called “Get Well”. In addition to sending appointment reminders, it will reach out to patients with reminders about their preventative health screens, such as mammograms, and when they are due for annual wellness visits.
“We are deeply sorry that we were not able to deliver exceptional care as a result of our transition to the new electronic medical record system,” said Judson Howe, president of Adventist Health in Mendocino County. “Change can be difficult, but it also brings with it a promise of better systems and ultimately, better experience for those we serve. We value your trust in caring for your friends and family that’s why we strive to give the best experience every time. Our team is working on addressing the issues and with the lessons learned, we are now better informed and prepared for the next phase of our EMR transition. With your help, we can only get better. If you are still experiencing issues or have any other feedback, please share them with us, by calling 707-463-7362 or email email@example.com. Thank you.”