Table 1.

Measures to improve and transform nephrology practice

Practice ChangeDescriptionExample of a Current Problem That Would Be Addressed
Previsit planning and previsit laboratory testingGoal: increase the value of the face to face clinic visit, minimize postvisit work, and give patients direct feedback in personExcessive 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 teamsGoal: better distribute the work of caring for patients and develop a team that has responsibility for managing the patientPatients 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 encounterExcessive 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 processesGoal: decrease the chaotic nature of practice through improved team work, clear roles of staffExcessive time spent reworking the system for such tasks as preauthorization for prescriptions
Reduction in unnecessary physician workGoal: maximize the time that physicians spend in direct patient careWith 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.