1. 5 th Annual Young Physicians Forum The Practice of the Future Mark S. DeFrancesco, MD, MBA, FACOG Chief Medical Officer Women’s Health Connecticut, Inc. CHICAGO MAY 5, 2009 (Your face here)

2. Disclaimers No commercial conflicts of interest No off-label use discussed And a word of warning…

3. Disclaimers A long time ago, Far, far away…

4. Disclaimers I too was once a Young Physician, but…

5. …sadly, all good things come to an end!!! Not a Young Physician

6. Learning Objectives To compare the “standard” office practice of today with the “new and improved” model of the future. To Recognize that the “future” can be now!

7. Current Practice: “Labor” intensive: Manual Labor begins with the phone call: Patient calls to make an appointment Negotiates date and time with scheduler (who is NOT answering other calls while doing this.) Other calls that interrupt the work flow: Rx refills, lab results, clinical questions Directions to the office, etc.

8. Labor intensive office: Work done by the doctor and the staff –Taking histories, CCs and HPIs –Writing out forms, prescriptions, lab orders, etc. –Filling out “super bills” and watch the coding! Charts going back and forth all day long –Triage nurse –Billing Clerk, etc. –Prenatal forms copied for hospital –Tremendous waste of time and resources

9. Labor intensive office: Designed Evolved over past 100 years 24/7 doctor (male) Full-time only Some rationalization came in with groups BUT: –Still stuck in the mid 20th century –Interchangeable parts –Not allowing for diversity of gender or generation –More difficulty playing well together in groups

10. The Practice of the Future: Learn from Business ATMs: –Reduced need for tellers or even going into a bank Hotels: –Make your own reservations, choose rooms, etc. Airlines: –Book not only the flight, but choose your seat! Save your time and your staff time

11. The Practice of the Future: Diverse Practitioners: Collaborative providers – Team approach Part-timers More “specialized” (Ob only, GYN only, office only, etc.) Hospitalists / Laborists No call / Reduced call / Only call We will have to allow for all these options! And compensate accordingly!

12. The Practice of the Future: Office with e-connectivity Patient Portal: –Patients can pre-fill office forms and even an EHR –Make their own appointments / or request one –Request their own refills –Secure messaging for: –Lab results –Non-urgent clinical questions/consultations –“call the office” messages to patients, etc

13. The Practice of the Future: EMR Allows multiple persons simultaneous access Saves storage space Saves pulling and filing time/effort Easier tasking and triaging Almost certainly safer when guidelines are embedded, etc Required in the future!

14. How do we get there? Inertia is a difficult thing to overcome EMRs are very costly, and It’s very hard to redesign office workflow There are very economical systems right now e-Prescribing Web based prenatal records Secure messaging, appointment reminders

15. How do we get there? How do we ever get anywhere?

16. How do we get there? How do we ever get anywhere? We look to YOU, our young people, to lead the way! Be the champions… Go back to your practices and apply the technology that most of us use every day for everything else we do!

17. How do we get there? Thank you very much!