October 3, 2003

VUMC for primary care encouraged, medical record confidentiality ensured

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The Internal Medicine clinic is one of three campus locations of the Adult Primary Care Center, which sees approximately 75,000 visits per year. Dana Johnson

VUMC for primary care encouraged, medical record confidentiality ensured

Vanderbilt leaders would like those employees who go elsewhere for health care to consider the quality, convenience and service that await them here at VUMC.

Among the most vocal leaders on this score is Dr. Jim Jirjis, assistant professor of Medicine and medical director of the Adult Primary Care Center. For next year, the health insurance benefits package offered to employees again includes financial incentives to seek care here at VUMC, and with the employee benefits open enrollment period continuing through Oct. 17, Jirjis is talking with staff and faculty to make the case for coming to Vanderbilt for primary care.

Among those employees who are reluctant to come to VUMC for care, “The top reason for that reluctance is a worry that other employees will look at their chart,” Jirjis said.

To help further protect patient privacy, and in particular to allay the concerns of employees who are prospective patients, Jirjis recently initiated a project with the VUMC Privacy Office to conduct random audits to determine who is accessing electronic medical records of Vanderbilt employees who are also primary care patients.

Anyone without an obvious reason for having accessed a given record may be contacted by the Privacy Office and asked to clarify the reason for looking at the record. Any inappropriate access will be investigated and anyone found in violation will be subject to penalties including termination.

Jirjis notes that, because paper records can slip through access controls more easily than electronic records can, and because medical records at Vanderbilt are increasingly electronic, access to records is much more traceable here at Vanderbilt than at most other medical centers.

Medical records maintained by campus primary care clinics are exclusively electronic. Beyond the random audits, patients who suspect a breach of their privacy can request a similar audit of their record.

Jirjis hopes that, instead of focusing on privacy, employees who are prospective patients can give more consideration to the clinical quality and service that distinguish VUMC adult primary care.

Jirjis stressed the quality of primary care attending physicians at VUMC. “All were trained at major academic centers and many have been chief residents,” he said. “In addition to helping educate new generations of physicians, our faculty is helping to advance knowledge, pursuing a range of biomedical research interests. … Here in primary care we’re part of a leading academic medical center in which patient care is allied with education and research. There is a considerable advantage in having multiple minds reviewing your case, reducing the chance of anything slipping through the cracks.”

Among Vanderbilt’s most significant distinctions is its achievement in the application of computers in health care delivery and day-to-day clinical decision-making. On the outpatient side, this achievement is perhaps brought to bear most critically in primary care, where clinicians confront the gamut of patient problems. Patients are benefiting in spades.

Using the StarPanel medical records application, physicians and their teams create and maintain dynamic patient lists, called panels, which generate automated work queues based on demographics and scheduling information. A feature called StarTracker adds the ability to create yet finer patient panels and work queues based on diagnosis codes and lab values, allowing identification and monitoring of chronic disease groups.

This new feature is already keeping primary care teams apprised of which of their coronary disease patients are due for cholesterol testing and which of their diabetic patients are due for blood glucose testing.

“Few practices around the country are able to track chronic disease in this way,” Jirjis said.

When he refers patients for specialty care here at VUMC, Jirjis can stay apprised of the work of the specialist via the electronic record; this immediate, secure access to patient information allows an extra measure of safety not found at other medical centers, he said.

The upshot of all this work with computers is that primary care patients will have better outcomes and will enjoy the added assurance that follows from more intensive management of their chronic condition.

Vanderbilt primary care patient satisfaction is on the rise, said Patient Care Services Manager Pat Covington. At the internal medicine clinic, phone access was the leading complaint, but changes made in recent years have brought the call abandonment rate way down. Covington has now begun listening in on calls to monitor service, and meets periodically with patient services coordinators to review phone performance. “We treat this as an opportunity to give feedback and we make it a positive thing,” she said. “The staff embrace this, it’s not seen as punitive at all.”

The difficult realities of health care finance have recently led to the shifting of the adult TennCare population to other providers, and Jirjis mentioned that this has opened considerable primary care capacity among residents who practice in the internal medicine clinic under the comprehensive review and supervision of attending physicians.To establish care with a VUMC primary care physician, call the new line set up for this purpose, 936-MyMD (936-6963).