Primary Care is Where Its At !
When you pull your car into the parking lot next to Dr. Lynn Ho’s office in North Kingston, Rhode Island, the large white building looks like other suburban medical offices. But enter the waiting room of Dr. Ho's practice and you'll get the feeling that you are not in your usual doctor's office.
“Hello,” says a forty-something woman with black-rimmed glasses, comfortable clothes, and a warm smile. “You’re right on time.” Most people would be shocked to receive a greeting upon entering their doctor’s office. Especially from their doctor. For Dr. Ho, though, there’s something very wrong with the “normal” interaction between a patient and her doctor, and she offers a radically different alternative.
It begins when a prospective patient books an appointment. Rather than playing phone tag with a receptionist after being given a time slot that either works or not, people can reserve a time online or call her directly, at home or at the office (she checks her answering machine between patients). Her calendar is viewable online, and because of a technique called “open access” scheduling, patients can get appointments the same day they call, often at 10 AM on a Saturday. “Some days I see three patients, some days I see fifteen,” notes Ho.
Ho has no receptionist or other staff members, so immediately after greeting a patient, the two enter into a conversation about the patient’s health, a physical examination, and discussion of next steps. The relatively small size of Ho’s practice allows her to spend a relatively large amount of time with each patient: at least an hour for a first visit and a half hour or “as long as it takes” for subsequent visits. As the visit draws to a close, the doctor handles all of the administrative details, including billing and scheduling the next appointment, herself. The results of focusing so much on her patients are clear: although Ho estimates that she’s forced to spend more than 60% of her time on administrative tasks, she has over 600 patients, and will soon have to close her practice to new patients that are not family members of existing patients.
Much of this experience that Ho creates for her patients is enabled by her expertise with technology, which she has acquired through her do-it-yourself work ethic. “If you ever need someone to install a computer network, let me know” she jokes. All of her patient records are stored in computers, using an electronic medical records program called Amazing Charts, which was developed by a fellow primary care doctor in Rhode Island. Her fax machine is connected to a computer, allowing lab, x-ray and consultant reports to be read on a screen. She’s even thinking of installing a kiosk that will let patients input their medical histories directly into a database when they first visit her. It seems that the only things standing between her and a paperless office are the Health Insurance Portability and Accountability Act (HIPAA) forms, which stubbornly sit in a filing cabinet.
Importantly, Ho has selected the technologies that she uses as she has developed her operational model, rather than adjusting her practice to fit available technologies. “Technology is what allows me to function in this micropractice,” but computerized records and handheld computers are a means, not an end.
Of course, going small doesn’t mean going alone. Ho is a member of the Ideal Micropractices (IMP) cohort, a group of family doctors led by Dr. L. Gordon Moore that seeks to make solo practices a realistic care option for more Americans. “Without their input, expertise, empathy, support and experience to guide me, I think I may have succumbed to a status quo practice,” she notes.
At the end of the day, the reason why she’s a family doctor with a micropractice is self-evident: “Primary care is where it’s at!”
Posted November 15, 2006 02:23 PM by Allan Tear | Permalink
