Trinity Health of New England aids in design of user friendly primary care office

September 1, 2017

Attractive, modern offices are mark of respect for patients


From a patient's point of view, a visit to a primary care physician often involves long delays in waiting rooms — time passed fretting about to-do lists or flipping through dog-eared magazines, followed by more time waiting in the exam room.

From a doctor's point of view, that same office can feel like a work environment where more time is devoted to filling out electronic forms than examining, diagnosing and treating patients.

Too often, for both caregiver and patient, it's a frustrating experience.

The Connecticut Institute for Primary Care Innovation hopes to change that dynamic. A collaborative enterprise between Trinity Health of New England's Saint Francis Hospital and Medical Center in Hartford, Conn., and the University of Connecticut School of Medicine, it has been studying new practice designs and technology with the potential to improve experiences in the primary care office of the future.


The primary care design institute concentrates on innovation pertaining to the Institute for Healthcare Improvement's long-running Triple Aim initiative — to improve individual experiences of care, to improve population health and to reduce per capita health care costs. "At the same time, we hope to improve training and increase recruitment and retention of primary care providers," says Dr. Adam Silverman, vice president for population health at Saint Francis Healthcare Partners and a general internist by training.

"This collaboration, which is both state and privately funded, is built on the belief that unless you intentionally focus on change, change will never happen," he adds.

"Our concept is to develop a process to walk people through a potential vision of the future and show them how to marry novel technology to novel work flows, as well as redesign office space to support both staff and patients," adds Jeri Hepworth, director of medical education at Saint Francis Hospital and Medical Center.

The Connecticut Institute for Primary Care Innovation was launched in 2010 to serve as a resource for the region and state to convene primary care stakeholders and leaders and showcase innovative practice models. It moved into its current state-of-the-art space on the Saint Francis campus in 2012, and has been focusing on improving the design of primary care practices since 2014.


Hepworth, as a co-director, and Silverman, as outreach leader, estimate they devote 10 to 20 percent of their professional time to the institute, as do other members of the organization's faculty and staff. In addition, the institute has one full-time administrator, a governing board, advisory board and primary care policy council.

Traveling exhibit
To promote its vision, the institute set up an interactive exhibit at a meeting of the Society of Teachers of Family Medicine in Dallas and an American Academy of Family Physicians conference in Orlando, Fla. The exhibit gave clinical team policy makers and others the opportunity to experience everything from innovative furniture and redesigned clinical hubs to software that facilitates virtual appointments between patients and providers.

"There is a huge interest in all this technology within the industry," says Silverman. "When we first started touring the exhibit, we would reach 400 people during a two-week stay. Now we get 4,000 visitors in two days."

Physician describes how thoughtful office design benefits patients
Dr. Ed Kim, left, a family physician, describes how thoughtful office design benefits patients to visitors to an office-of-the-future display at the 2016 national conference of the American Academy of Family Physicians in Orlando.

Some of the elements included in the office-of-the-future design like "care anywhere" are already in use. In some markets patients with minor ailments can submit a computerized questionnaire with their symptoms to a doctor and get a diagnosis and provisional treatment plan in return, without leaving their home or office.

Technology in home use now including scales, blood pressure cuffs, glucometers and so on send real-time health data to physicians whose offices monitor patients' weight, blood pressure and blood sugar levels. Smartphones track and transmit a patient's daily exercise activity data. Patient portals and telemedicine tools facilitate patient-provider communication.

Patient engagement centers
It's becoming more common for medical practices to stream educational videos on a variety of health care topics in their waiting rooms where a captive audience is primed to receive health and wellness information. The institute expects this will become standard in the primary care office of the future.

While waiting, patients may complete customizable health questionnaires that interact with electronic health records and provide actionable information to the examining clinician. And patient flows will be managed by staff so patients won't spend more time waiting for their doctor than visiting with him or her.

Go team
The innovation institute envisions offices designed as clinical team hubs, to foster ongoing, informal collaboration between office staff. That approach is at the heart of its concept for the office of the future. Furniture will be adaptable to multiple uses. For example, standing desks might be separated by dividers that can be pulled up for private space or down for active team communication.

A visitor to Office of the Future exhibit tests blood pressure report transmission technology
A visitor to the Office of the Future exhibit at the 2016 national conference of the American Academy of Family Physicians tests out blood pressure report transmission technology that facilitates virtual medical appointments.

Gone are the segregated areas for front office functions, back office billing and physicians' offices and consulting rooms, which discourage interaction and work flow. The hub, instead, promotes scheduled huddles, where physicians, medical assistants and nurses can communicate informally throughout the day.

And while the hub is a relatively small space — less than 2,500 square feet — to encourage collaboration, there will be more personal spaces around the periphery for sitting, thinking and engaging in private conversation.

To free up time for patient care, software may automate routine clinical tasks like prescription refills. There will be multiple ways to access electronic medical records, and when phone calls come in, staffers will be able to quickly locate and ask physicians for answers to questions instead of calling patients back later.

Exam rooms
The institute encourages reconfiguring examination rooms as an additional way to advance communication and collaboration and facilitate face-to-face interactions. New layouts are intended to make it easier for providers to focus their attention on patients. Videoconferencing, digital scopes and other diagnostic tools will allow the primary physician to bring specialists remotely into the office for consultations during appointments.

Brain trust
The institute's innovation program has not only impacted conventional thinking about primary care delivery, but it has also generated new ways of thinking about how to streamline communication and share resources among large health care entities including Trinity Health of New England, says Silverman.

Trinity Health of New England was formed in 2015, and it includes five acute care hospitals — Saint Francis and Mount Sinai Rehabilitation Hospital, both in Hartford; Saint Mary's Hospital in Waterbury, Conn.; Johnson Memorial Hospital in Stafford Springs, Conn.; and Mercy Medical Center in Springfield, Mass. "Each hospital has its own institutional history, but we need to learn to share knowledge and use new technology to come together to deliver the best patient care, while reducing costs and sharing operations," Silverman says.

The entire Trinity Health system, he adds, also is involved in an innovation program. It has identified three hubs in its 93 hospitals to help with transformations. In addition to Saint Francis' work in primary care, Loyola University Health System in Maywood, Ill., is focusing on technology transfers and Mercy Health Saint Mary's in Grand Rapids, Mich., is working on human-centered design.

'Little engine that could'
"We are like the small engine that could, but our focus on primary care innovation has lots of overlap within our larger company because we directly impact our mission of caring for the neediest," Hepworth says.

"When we talk to patients about our pilot programs in internal and family medicine, they say they are excited about going to places that look and feel upscale, rather than ragged. It's a mark of respect, and it changes interactions with physicians," she says. "People become more interested in self-care. That leads to better outcomes, and better caregiver satisfaction as well."



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