Measures to improve and transform nephrology practice
| Practice Change | Description | Example of a Current Problem That Would Be Addressed |
| Previsit planning and previsit laboratory testing | Goal: increase the value of the face to face clinic visit, minimize postvisit work, and give patients direct feedback in person | Excessive time-managing results and postvisit phone calls/documentation |
| Nephrology practices define what laboratory work is needed before consult visit | ||
| Development of multidisciplinary care teams with expanded roles and responsibilities of nurses, medical assistants, and other staff. Roles and responsibilities are clearly delineated. Physician extenders (PAs and NPs), for some practices, are critical in these teams | Goal: better distribute the work of caring for patients and develop a team that has responsibility for managing the patient | Patients have ongoing needs for care coordination, prescription drug management, health care coaching, and education (such as ESRD education). This is especially important for patients with advanced CKD who have multiple care needs |
| Minimize documentation and time on regulatory requirements through the use of scribes and better use of EMR tools (standardized text and order sets) | Goal: decrease the burden of EMR documentation by using tools and scribes to ensure that all documentation is completed during the patient encounter | Excessive time devoted to EMR use, which adds little value to patient care and impinges on personal time out of the office |
| Nephrology practice sites should harmonize EMR use and operability | ||
| Development of improved office work flow with standardized processes | Goal: decrease the chaotic nature of practice through improved team work, clear roles of staff | Excessive time spent reworking the system for such tasks as preauthorization for prescriptions |
| Reduction in unnecessary physician work | Goal: maximize the time that physicians spend in direct patient care | With EMR implementation, tasks that had, in the past, been performed by receptionists, nurses, and pharmacists have been relegated to physicians. Nephrology practices can better define workflows and responsibilities within the care team |
PA, physician assistant; NP, nurse practitioner; EMR, electronic medical record.