December 15, 2008
New encounter forms streamline patient care
by Michael Faubion, Public Relations
Over the past year, YKHC's hospital outpatient clinics and subregional clinics have begun using a new version of an old standby-the patient exam form.
The PCC, or Patient Care Component, form has been in use at at Indian Health Service and Tribal hospitals for a long time. It used to come pre-printed from the United States Government with three carbon copies attached. After each patient visit, employees would manually enter the information written on the form by providers into a computer database system called RPMS-Resource and Patient Management System-also managed by the IHS.
YKHC has long since customized the old paper form to suit our own needs, and created many varieties for the different clinics and departments. These forms have been an improvement for gathering patient information at each visit, but weren't very helpful in getting existing information-patient identification information as well as notes from previous visits-out of the database and onto the form.
The new version of the PCC form, called PCC+, actually does accomplish this.
Now, when a patient registers for his/her appointment, instead of just getting a sticker to put on a pre-printed form, an individualized pcc+ form is created then and there, specifically for that visit. For those familiar with word processing, it's similar to a "mail merge" in which a template document accesses an individual computer record and fills in the "blanks" to personalize a letter or address envelopes.
"Each patient has the date and time and name printed on their form, along with their account number and insurance information," says Dr. Elizabeth Roll, outpatient services chief at the Bethel hospital, and the team leader for getting the PCC+ form up and running. "Even more important, it has each patient's active problems on it and what their last weight and blood pressure and other vital signs were-right on the form. On the second page it prints out what immunizations are due and if the patient needs any additional exams-a pelvic or breast exam for instance. On the third page, all of the patient's recent medications print out right on the form. This really improves medication accuracy and saves the providers time."
It's not only an improvement for the providers. Medical Records Manager Iona Sallison says, "Medical Records staff used to stamp the triplicate forms by hand for every patient appointment. Now, basically, all we do in regards to patient appointments is pull the charts and screen the records when they come back."
Athough the PCC+ form comes with information pre-printed, it's still a paper form and new observations, notes, updates, medication changes and vital signs have to be manually entered into RPMS for the record. But it does help streamline the process overall.
"PCC+ is still mainly the same Family Medicine or Pediatrics form, but it now is patient specific," said Dr. Roll. Previously, "providers would have to look through a second document-the health summary-to find out what active problems a patient had and what immunizations were due."
PCC+ also makes it easier to make corrections and manage changes in a patient's health record.
"We are working very hard to update the patient's problem list-so the providers who care for the patient have very accurate information about what the patient's problems are," Roll said.
The Indian Health Service introduced PCC+ in 2001, realizing the change would require more than just printing out a different form-clinic hospital and business practices would likely have to adapt, technology departments would have to be involved, along with billing, medical records, registration clerks and, of course, the medical providers.
The IHS Information Technology Support Center holds training sessions and provides ongoing support for facilities adopting PCC+. They also provided template forms in Microsoft Word. Having already customized the old carbon-copy PCC forms, YKHC also preferred to adapt these stock templates to meet local needs and provider preferences.
Implementing PCC+ at YKHC has had challenges beyond those foreseen by the IHS, mainly due to our vast area, scattered villages and evolving technology infrastructure. But Hubert Angaiak, Clinical System Specialist with YKHC's Technology Services Dept., says "As long as the connections to the villages improve, the villages can also use this in their clinics."
PCC+ is now in use in the Outpatient clinics and Specialty Clinics at the Bethel Hospital, as well as the subregional clinics. A version is being developed now for use in the village clinics.
It has been a coordinated effort among many departments. A PCC+ Committee, started three years ago with YKHC Medical Director Dr. Joe Klejka and Dr. Dan Smith, has been meeting regularly, with a hard push over the past two years to make PCC+ a reality for YKHC.
Dr. Roll acknowledges the challenges of coordinating so many departments, working with so many sites, and training the providers and staff to use the form. "Many people have worked together to get this form working," said Dr. Roll. "Hubert Angaiak, Kimi Gosney, Karen Sidell, Iona Sallison, Lianna Brown, Melanie Gibson, Janey Arnzen, Anne Willard and Nikko McCabe. Thanks to these people for meeting every Tuesday morning for years to help move us towards more accurate documentation. This PCC+ system has been a wonderful example of how positive people working together across departmental lines can accomplish anything!"
Hubert Angaiak likewise credits coordination and cooperation for its success. "This project would have never gotten off the ground without the support and involvement of the Hospital Departments and it's an on-going process to continue to improve it. The credit to its success belongs to them."
