Lisa Letourneau, MD MPH, serves as Director of Clinical Integration for MaineHealth, a nonprofit integrated healthcare delivery system. She has a wide range of clinical and administrative experience, and has a particular interest in helping to build connections between public health and clinical care. She has been involved in planning and implementing several chronic illness programs at MaineHealth, including diabetes, asthma, and heart failure.

We interviewed Lisa Letourneau, MD MPH to get answers to your questions about the Clinical Office Systems survey data.

Q: What are clinical office systems?

Many physician practices have used business office systems for some time, such as systems for scheduling patients or billing. Clinical office systems are additional types of systems or tools to make sure all the patients in the practice get good care, even when the practice is busy or hectic.

One example of a simple clinical office system is a list in the practice of all patients with asthma. The practice could use this list to send out a letter to all these patients in the fall reminding them they need to get a flu shot. Without this kind of system, a practice would probably not be able to easily identify all their patients with asthma, or know who’s overdue for a flu shot. See Drs. Albaum and Claffey’s discussion of office systems for more info.

Q: Why are we measuring who uses clinical office systems?

Many studies have shown that putting these types of systems in place can improve care, especially for people with chronic conditions. Pathways to Excellence promotes the use of clinical office systems as a way for practices to improve patient care and outcomes. By asking physician practices about their use of clinical office systems, we are hoping to make doctors and consumers more aware of the value of these systems. We have been measuring these systems since 2002.

Q: How did we measure use of these clinical office systems?

The idea of using clinical office systems to improve care in physician practices is relatively new. Up until now, there’s been no way to routinely measure the extent to which practices use these systems.

Because the Pathways to Excellence program believes these systems are important to improving care and outcomes, the physicians helping to lead the program worked together to develop a survey asking physician practices about their use of these systems. The survey was mailed to each primary care physician practice in Maine; the practice was then asked to answer the survey to describe the types of clinical office systems in place in their practice. The Pathways program then scored the survey, using a standard scoring system set up in advance.

Q: What do the scores mean?

The Pathways to Excellence clinical office systems survey consists of 7 sections. These include Clinical Electronic Information Systems; Electronic Prescribing Systems, Chronic Illness Registries; Self-Management/Patient Education, Clinical Guidelines/Evidence-Based Medicine; Care Management, and Assessing Risk Factors.

Each practice that responded to the survey received a score for each of these sections, as well as a total score equaling the sum of the 7 sections. Both the total score and the section scores reflect the extent to which practices have put clinical systems in place in their practice. For example, on the “Electronic Clinical Information Systems” section, a practice earned full points if they had a fully developed electronic medical record system in place and used it for all patients in the practice.

Q: Can I believe the results?

The Pathways program asked physician practices to answer this survey based on the clinical office systems that they had in place at the time of the survey. The scores reported here reflect what we have been told by practices. We also have a signed attestation form from the practice. We trust that physician practices answered the survey accurately and honestly. Overall, the Steering Committee is satisfied that the survey is a good tool and that it was scored fairly by the practices.

Q: Why are we reporting them?

The Pathways program recognizes that the use of clinical office systems is one important piece of achieving high quality healthcare. By measuring and reporting on the use of these systems, we are hoping to raise awareness about their importance, and encourage consumers to talk with their doctors about how these systems can be used to improve care and outcomes.

Q: What does it mean if my doctor’s practice didn’t answer and/or scored low?

Every effort was made to mail this survey to each primary care physician practice in Maine. The initial mailing was followed by several postcards and outreach by representatives from Physician Hospital Organizations across the state, as well as provider relations representatives from Anthem and CIGNA Healthcare health plans. If the results indicate that your doctor’s office didn’t answer the survey, it means that either their practice was unintentionally left out of this mailing, or that they got the survey and chose not to answer it. It is possible that some physician practices could have very good clinical office systems in place, and simply chose not to answer the survey.

Practices that answered the survey received a wide range of scores, reflecting the fact that practices around the state are at different stages of putting these systems in place. Some practices have been working on putting clinical office systems in place for several years, and have well developed systems in place resulting in high scores. Others may have started to put these systems in place more recently, or may only have been able to work on certain types of systems to date, resulting in a lower survey score. Practices will have an opportunity to update their scores in future years to reflect work that is going on today.

It is important to know that having clinical office systems in place is one part of providing good overall care in a physician practice. Good care is also influenced by many other factors, such as good communication with patients, the ability to work with patients to reach treatment goals, and good customer service. See the disclaimer.

Q: How do I use the results to work with my doctor?

The overall goal of the Pathways to Excellence program is to promote high quality healthcare and the best possible health outcomes. Getting good care and outcomes results from effective partnerships between physicians and patients. You are encouraged to work in partnership with your doctor, and to use this information to talk with your doctor about how to get the best care possible. See the disclaimer.

Q: Should I use these results if I need to choose a new doctor?

If you’re in the process of choosing a new doctor, you may want to talk with them about the importance of clinical office systems in getting good outcomes. If you have a chronic illness you can use this survey to see how different practices are doing in providing support to patients with that condition. On the overall practice profile you can also see how the practice does on providing various services to patients with that condition. This survey and the overall practice profiles could provide you with important information and questions for that discussion.

Q: Why are you (and other doctors) so interested in office systems?

Dr. Michael Albaum says: Here’s what I hope a really good office system will be able to do for me and my patients down the road:

• I have access to all my patients’ information electronically, so I can get it if I’m on call at night, or at the ER, or whenever I need it.
• I can write prescriptions and have them checked for drug interactions with the other medicines a patient takes and then have it go off to the pharmacy electronically. No more hand written prescriptions for the patient to carry.
• At every patient visit, I can check that we are working together to follow best practice care, that we are doing what research shows is best to keep the patient well.
• I get reminders about patients that are not coming in for care, so we can follow up with them.
• I have the ability to look at data on my population of patients so I can screen who is due for tests, exams, immunizations.
• Everyone in the practice has appropriate access to patient care information, so we can work as a team. And I can easily send this data to specialists outside the office.
• I can create information for patients at the push of a button, so they leave the office with clear instructions about their own self care.
• Patients can email the office with requests for appointments, medicine refills, and simple questions.