This project aimed to increase efficiency by having health coaches attend office visits with clinicians to document lab orders in the electronic health record during the clinical encounter.
- Community outpatient clinic
- Clinical tasks, like ordering laboratory tests, are a known burden and distraction for clinicians.
- Iora Health identified laboratory test ordering as a point of inefficiency. There was inconsistency in how labs were ordered during visits, which led to high error rates on ordering labs, increased patient waiting, and added stress for phlebotomists and health coaches involved in care.
- Health coaches are already an integral component of Iora Health’s team-based approach to patient care. Each patient is assigned his/her own health coach, who helps the patient set goals and serves as a resource, partner, and cheerleader.
Patient Population Served and Payor Information
- Iora Health has 24 different locations in seven states. It serves adults 65+ and works primarily with Medicare Advantage plans.
- Jeffrey Panzer, MD, MS, now with Heartland Health Centers & Alliance Chicago, spearheaded this effort at Iora Health.
- This intervention required no additional funding, outside of time spent by employees of the organization.
Research + Planning
- After identifying that lab ordering was an issue, a team was assembled to create a solution to the problem. The team included all those affected by lab orders: phlebotomists, health coaches, providers, and clinical team manager.
- This group performed a root cause analysis to generate a process map in order to examine the current state of lab ordering and develop an appropriate intervention.
- Clinical encounters in Iora Health’s practices already involved having a health coach in the room with the physician and patient. Thus, the new project involved giving pre-existing health coaches greater responsibility during the encounter in response to the increasing clinical burden placed on physicians.
Tools or Products Developed
- atext: a text expander that allows someone to order labs with the proper LabCorp code, list the ordering provider, and provide the patient with the approximate cost.
- Health coaches learned via extensive observation and overlap with clinicians’ daily work. No further training was required for the implementation of this project, as health coaches were already familiar with the EHR.
- Electronic medical record
Team Members Involved
- Health Coach
- Prior to patients visiting the clinic, team members identify which patients with appointments that day might need labs during their morning huddle.
- When a patient comes to the clinic for an appointment, both the clinician and the health coach are present in the exam room with the patient.
- As the clinician conducts the patient interview, the clinician says out loud which laboratory tests he/she would like to order, and the health coach creates an order for the test(s) in the EHR using the atext (text expander).
- At the end of the clinical encounter, the clinician reviews and signs off on the order(s) that the health coach generated.
- No additional money was required to support the project. Costs included:
- Time spent by clinical team to develop intervention (weekly one-hour meetings for 3 months, with additional follow-up work).
- Time spent by tech-savvy provider to create the atext that drove the process.
Where We Are
- This pilot project has been completed.
- % adherence to standard process: all care team members understood their role and the steps they needed to take in the process to deliver a positive member experience.
- Lab ordering error rate: errors were defined as one or both of the following not being completed properly:
- The lab atext used with ordering provider name and diagnosis code (s) and pasted into task comments
- The tracking board was updated with phlebotomist’s name/patient location.
- Phlebotomist experience: the phlebotomist received completed and accurate orders and did not have to go looking for health coaches or providers to re-enter orders or clarify which labs needed to be drawn.
- Patient experience: patients did not have to wait as long to have labs drawn as care teams were proactively identifying which members needed labs during the morning huddle.
- This project improved clinical workflows, enhanced effectiveness and efficiency in ordering laboratory tests, and resulted in more engagement of non-clinical team members.
- Major organizational changes slowed down QI activity, which prohibited further spread of this intervention to other sites in the organization.
- Written with significant input from Dr. Panzer.
- Panzer J. Ordering Labs as a Team. Ann Fam Med. 2018;16(2):176-176. doi:10.1370/afm.2207
- Iora Health Looks to “Kick the Industry in the Behind” | HealthLeaders Media. https://www.healthleadersmedia.com/clinical-care/iora-health-looks-kick-industry-behind. Accessed February 1, 2019.
- Iora Health hopes to expand with $100M raise. Boston Business Journal. https://www.bizjournals.com/boston/news/2018/05/21/iora-health-hopes-to-expand-primary-care-model.html. Accessed February 1, 2019.
- Our Model. Iora Health. https://www.iorahealth.com/model/. Accessed February 8, 2019.
- Jeffrey Panzer, MD, MS
- Marisa Moret, BS
Chicago, ILTalk to the Innovators