Implementing the APEX (Awesome Patient Experience) model of care at University of Colorado Hospital’s AF Williams Family Medicine Clinic required months of groundwork before the official go live last February. But the launch of APEX meant the work had only begun.
Every clinic provider has dealt with adjusting to the new care delivery model (see related story). Medical assistants (MAs) have had perhaps the biggest change to their roles and responsibilities.
Sarah Herrman, MA, a senior medical assistant at AF Williams, said the clinic is not a workplace for everyone. She said she relishes the additional contact with patients and providers that APEX requires. But she adds that some of her colleagues departed for other clinics when they learned what APEX would demand of them. Herrman said she lets new MAs know what to expect at the clinic.
“I tell them to put their running shoes on,” she said. “There is so much more than you’ll do at a private practice.” In addition to expanded responsibilities for gathering patient information, Herrman and other MAs are expected to help free up providers from other tasks, such as arranging home health care, setting up durable medical equipment orders, completing paperwork, handling prescription refills, and so on.
“We have had employees who wouldn’t fit in well with the culture here,” Herrman said. “We are asked to do more and to interact more with the providers. It takes strong personalities who are not afraid to voice their opinions and want to help.”
Heavier load. A glance at the breadth of information MAs gather during a patient visit explains the importance of properly training people for the position. The APEX workflow for MAs includes identifying the patient; collecting “snapshot” information, such pharmacy preference and emergency contacts; taking height and weight; and identifying the chief complaint. All of this precedes opening Epic “X files,” which guide the MA in asking questions and taking notes based on the patient’s condition or symptoms.
With the notes complete, the MAs ask another series of questions that cover allergies, medications, advance directives, and more than a dozen queries about the patient’s history, including screenings for risk of falls and depression. If patients need medications, labs, screenings, or other basic care, the MAs initiate and pend the orders for physician approval.
The lengthy process can be a struggle for new MAs, particularly when pressure mounts during times the clinic is short staffed, said Herrman, who serves as a preceptor and mentor. She encourages MAs to adhere to the workflow consistently, so they understand and remember it. With time and experience, each MA can develop his or her individual style, Herrman said.
“There isn’t a day that I haven’t changed the process to make it work better,” she said.
Perhaps the biggest supporters of APEX have been the clinic’s patients, who may not know the acronym, but notice the difference in care, Lyon and others noted. Practice Director Karl Sudfeld said free-text comments from patient “Pulse” surveys have included specific mentions of MAs’ names and favorable remarks about the increased length of time providers spend with them.
“Even without full staffing, we’re definitely seeing good things,” added Jack Spittler, MD, a physician who spends the majority of his clinical time at AF Williams. “Patients feel more satisfied because they are spending less time doing nothing. I’ve heard fewer complaints about ‘Where’s the physician?’ Now I hear more about how much they liked the MAs, and they remember them by name.”
As one who has accepted the heavier workload and greater responsibility, APEX has been a satisfier professionally, Herrman added.
“I’ve learned more because of it,” she said. “I can now relate information to physicians about the patient.”
Herrman also believes patients have grown closer to MAs and willing to confide in them. “We have become the voice of the patient,” she said.