When it comes to care coordination, primary care physicians (PCPs) are often thought of as the quarterbacks in keeping track of patients' journey through the healthcare system. But while patient-centered medical homes provide the foundation for care coordination and population health, the specialists who treat complex patients play a role in managing patients' healthcare journey as well, according to Sandhya K. Rao, M.D., a general internist at Massachusetts General Hospital (MGH), associate medical director for quality improvement at MGH's physicians' organization, and medical director for population health at Partners Healthcare.
There are a variety of ways specialists can use technology to efficiently close gaps in care, Rao told Vital Signs, the Massachusetts Medical Society's member newsletter. Consider the following examples:
- Virtual consultations. PCP-to-specialist online consultations have helped improve the traditional "curbside consult" for physicians throughout the United States, by allowing PCPs to ask specialists brief questions on behalf of patients via an electronic platform. This approach is not only more efficient than sending patients to specialists for simple consultations, but the system also includes a framework for specialists to get reimbursed for answering PCPs' questions.
- Follow-up questionnaires. Once patients get specialty care for a problem, it's standard practice for that patient to follow-up regularly, potentially for the rest of their lives. Not all of these simple check-ins need to happen face-to-face, however. Physicians at MGH have replaced many of these visits (more than 7,000 so far) with email questionnaires, which gather patients' feedback on any illnesses they are enduring, side effects they are experiencing and vital signs they are taking at home. Specialists can then go through returned questionnaires quickly and respond with recommendations before or after clinic hours, Rao said.
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