Team Based Primary Care - Part 1 : Why Team Based makes sense

Patient healthcare in a Primary Care model is owned by the Primary Care Physicians (PCP) as they receive all notes, labs and refill requests for their patients. Patients select their PCPs who then become responsible for every aspect of their healthcare. The workload on a PCP is measured in terms of the "panel size", defined as the number of unique patients under the PCP care. Generally, this count is based on the last 18 months, though occasionally a 12 month period is used. the 12 month period may result in under estimation as not every patient visits their PCP in a given 12 month period.

An ideal panel size under the traditional Primary Care model is about 1000. The US national average panel size for PCPs is about above 2000. The reason for such large panel sizes is the number of PCPs available for the patient population, which is at 1 PCP available for every 1500 patients, and this includes those physicians who are not working full-time.

The demand and supply differential causes variation in panel sizes. Demand is the number of patients seeking primary healthcare services and supply is the number of available appointment slots. Ideal situation is when Demand equals Supply.

Demand = number of unique patients seen by PCP in the last 18 months X visits per patient per year.
Supply = Appointment slots available per day X Provider days per year.

In the current situation with less number of PCPs available and more patients seeking primary care, the demand supply balance is tilted heavily towards demand, and the supply side has to overload themselves to keep it balanced.

One way to balance the panel size is to increase the supply, meaning increase the number of PCPs, which is only possible by a long time concerted and consistent effort and depends  upon more physician willing to join the PCP ranks.

Another option is to offload the PCPs by adding Nurse Practitioners and Physician Assistants to provide primary care by maintaining their own panels. This can be augmented by delegating those services that do not require clinician level training, to non-primary care personnel and to technology. Primary candidates for such delegated services are preventive and chronic care. Hence, it becomes a team based model where a team of care professionals and technology combine to share the load thereby offsetting the imbalance between demand and supply. In a team based primary care model, the panel size can be maintained between 1200 and 1500 for a PCP, which actually corresponds to the current supply of PCPs in the US. 

Additional costs incurred for implementing a team based model are training and technology. Exact numbers would vary depending upon the patient population age and health spread.

Implementing a team based primary care model requires a cultural and structural change in the practice, including clinicians' mindsets, training, re-mapping of workflows and most importantly patient education. Primary Care payment system would also require modification. 

Successful team-based Primary Care healthcare services result in increase in patient satisfaction, better overall health and wellness in the patient community, and at the same time providing a reasonable work life for all members of the Primary Care Team. 

Events, Meetings and Appointments in Outlook

Outlook calendar items can be designated into one of the three categories: Event, Meeting or Appointment. The difference between the three is very simple:

Event: Something that will last the whole day, used when something will utilize the whole day like a holiday, vacation, etc. Used to avoid cluttering/blocking out individual time slots o the calendar which you can still use to add other items such as those listed below.

Meeting: A calendar item will be designated as a meeting if there are other people involved in the event besides yourself.

Appointment: These items involve only you, like a doctor's appointment, block time to work on a project, etc.

Appointment

Meeting

Phone Scan !!!

I have been using Evernote on my phone for a few years now to store images of documents that I needed to archive, and it has great features to convert these into pdf documents and convert to text (OCR). Then I cam across an App called CamScan. This remained my favorite app and I considered it to be the most useful app I had on my phone. It did, and still does a wonderful job of converting captured images of documents into perfectly pdf files, by straightening the skewed images which is a result of phone camera not being perfectly parallel to the document being photographed. However, one limitation that bothered me was that it has a subscription based licensing model for full featured app, and at some point started adding an ink mark, rather a full colored logo on the scanned document which sort of was a way to (Ahem!) force  people to go for the paid subscription. In mu quest to find an equally good free app, I started searching around the app Market Place and found quite a few similar products with a wide range of good to bad reviews. And then by chance I came across an app that pretty much every smart phone (Android) comes pre-installed with, and other platforms (iOS and Windows) also had access to it. This is the Google Drive, when you click on the New icon (a plus sign inside a circle) in the lower right corner from within the Google Drive app, you get the options to create Folders, Google Docs/Slides/Sheets and Upload. Nestled besides these options is the option for Scan. Selecting the scan option open ups your camera and you can take a photo of your document which will be auto-corrected (unskewed, brightened and rotated) as a pdf document. You can save it or redo if the results are not to your liking. Also, you can add more pages to the same file if needed. Make sure you rename the file and select the correct location to save to. Not to be left out, Microsoft added similar feature to its OneDrive app. I will write a more detailed review of the three apps (CamScan, GoogleDrive Scan and OneDrive Scan) or will ask my sons to do that for me and post them here :).

OneDrive Scan

Google Drive Scan

CamScan

Business Intelligence - The Intro

BI Dashboard examples (Click to Enlarge)

Business Intelligence does not have a formal definition but the term is used for a variety of tools and activities used to analyze raw data and present it in a more meaningful and useful format for business analysis purposes.

The term Business Intelligence has been abbreviated to BI and is used alternatively. We will stick to using the abbreviated form BI for representing Business Intelligence in all our Articles, Blogs, Guides and Forums.

BI provides current performance status in relation to past performance and predictive  future views, and provides the target users (business leadership) the ability to modify (slice and dice) and dive deeper (drill down) or summarize (drill up) information. The data becomes even more useful when a comparison to industry specific benchmarks is incorporated.

BI helps organizational leadership to make informed decisions and take calculated risks in both operational and strategic spheres. KPI's can be established and performance can be measured against those. Performance Indicators breaching preset thresholds utilizing easy to read and at-a-glance visuals, can lead to further digging (slicing/dicing and drilling) into the data.



BI information is generally represented as Dashboards, which are collections of related visuals and reports, providing an at-a-glance . Raw data is converted into an OLAP cube. OLAP stands for Online Analytical Processing, which may be defined as a computer based technique for analyzing data and providing insights. Cube is used to define a mutli-dimensional data sets. traditionally a data set has two dimensions , rows and columns. OLAP cubes have more than two dimensions and those with more than three dimension are also sometimes refer to hypercubes. The advantage of cubes is the data is pre-processed and readily available for slicing, dicing and drilling, saving time compared to running queries in real-time against traditional relational data sets.

NULLs in SQL results Export to EXCEL

I was working on a project to export some data into a tab delimited file. Initially, we did some test files and it was simple enough to use a select query and export the results to a text file by right clicking the top left box of the results pane. However, the recipient indicated that the file had NULL columns with the text string 'NULL' in them which interfered with their processing. They requested us to remove the NULL string and instead pass on these fields as blank. I found a free tool called FnR, for Find and Replace, which replace text strings with whatever value is specified. It was all working fine till they asked us to send a full file with more than half a million records. FnR refused to work and would time out. I generated a command line command, another useful feature built into FnR, and tried that, but no joy. So i went to my trusted friend Google and asked for solutions. I found that this has been a very common issue and many people had asked for a solution, only t get lectures on what they are doing wrong and long debates of what DBAs and Analysts  deemed best practices. Some workable solutions were also discovered in the process, but when dealing with a large number of fields it becomes impractical to use REPLACE or COALESCE commands with every field to check if it contained a NULL and then replace it with blanks. While the debate lingered on from forum to forum, the person asking the question would eventually bail out due to frustration without getting a proper solution to their problem. I did however came across one suggestion that wasn't given much attention of using the query to export the results to text, rather than the right click process I was following. I decided to give it a try and, viola, no more NULL strings.  

.URL files not deleting

I was deleting a folder and it kept denying permission, everything was deleted except two files that appeared to be internet shortcuts with a .url extensions. Checked permissions and properties and looked everything but simply could not delete this folder or the files individually. Resolved this by stopping the Indexing services. The files disappeared by themselves and I was able to deleted the folder.

Newly Added External IP to ISA 2006 not available

Adding multiple external IP addresses to an ISA server is a simple task, primarily you go to the WAN adapter Properties> TCP/IP settings> Advanced... and add to the IP addresses list. The issue generally encountered is that the IP address you added is not available in the list of IP addresses on the ISA server management console. First try shutting down the ISA Management Console and restarting it (close out and open), it that doesn't work, then restart the Windows Firewall service (WARNING: that will restart RRAS as well and you will loose remote connectivity). Restarting the ISA Management Console should do the trick.