|
| * Site location name: | | | | * Name (of person completing this assessment): | | | | * Title: | | | | * Phone Number: | | | | * E-mail: | | |
|
|
|
|
General Information about your Clinic/Location |
| |
|
|
|
What type of practice do you operate at this location? |
| |
|
|
|
|
| If you selected "specialty" as a clinic/practice type, indicate specialty type: | | |
|
|
|
|
Are you affiliated with a provider organization? |
| |
|
|
|
|
How many patients does your clinic see each day? (total number of patients among ALL providers at your location) |
| |
|
|
|
|
|
How many providers are available to see patients at this location? |
| |
|
|
|
|
On average, how many patients per day does each provider see at this location? |
| |
|
|
|
|
Which type of staff members do you employ at this location? |
| |
|
|
|
|
|
How many exam rooms does the clinic/practice location have? |
| |
|
|
|
|
Are all exam rooms organized in the same manner? |
| |
|
|
|
|
Are supplies and equipment readily and consistently available in each exam room? |
| |
|
|
|
|
What type of metrics do you collect? |
| |
|
|
|
|
|
|
|
Do you track/monitor chart completion rate (either by provider or clinic-wide)? |
| |
|
|
|
|
Do you currently collect e-mail addresses from patients? |
| |
|
|
|
|
Do you ask patients if it is OK to send them text messages to remind them about upcoming appointments? |
| |
|
|
|
|
Do you provide a survey or some type of evaluation method for your patients to comment on their experience? |
| |
|
|
|
|
What type of patient feedback tool(s) do you currently use? |
| |
|
|
|
|
|
|
|
|
|
|
| Describe any tasks or activities that you engage in as a way of improving patient prepardeness (for example, ensuring patients arrive on time, requested forms are complete, Rx list, etc.)
| | |
|
|
|
|
Resources to help influence patient behavior: |
| |
|
|
|
|
|
| Describe your current prior authorization process/procedures: | | |
|
|
|
|
|
|
|
|
Do you track/monitor the time providers spend with patients (average "face time" or time providers spend in patient exam room) |
| |
|
|
|
|
Do patients routinely communicate additional reasons to be seen (beyond their original stated reason for being seen) to their provider? |
| |
|
|
|
|
| If you do track face time with provider, please indicate here: | | |
|
|
|
|
Do you track/monitor cycle time? (time from patient entering the practice at sign-in until the patient leaves the clinic) |
| |
|
|
|
|
Do you require patients to sign-out/check-out once their visit is complete? |
| |
|
|
|
|
| What activities or tasks are completed during the check-out process?
| | |
|
|
|
|
If you do track cycle time (or have done so in the past), what is your approximate cycle time? |
| |
|
|
|
|
| What is the most significant barrier to improved patient flow? | | |
|
|
|
|
| If it were possible, what two changes would you make in order to improve patient flow? | | |
|
|
|
|
| What, if any, changes have been made in the past to improve patient flow? | | |
|
|
|
|
Are the work procedures and processes standardized? (is there formal documentation and clarification relating to who does what, when they do it, and how it should be done)? |
| |
|
|
|
|
Phone and Reception Operations |
| |
|
|
|
Do you have a phone triage protocol that is formalized (written down and accessible to staff)? |
| |
|
|
|
|
If you track call volume, how many phone calls per day does the practice receive? |
| |
|
|
|
|
| Describe how your practice manages/processes requests for Rx re-fills: | | |
|
|
|
|
What type of phone-related metrics do you monitor/collect? |
| |
|
|
|
|
|
What different types of technology systems do you utilize? |
| |
|
|
|
|
|
|
|
Do you currently track chart preparation errors by type? |
| |
|
|
|
|
If you indicated that you do track chart errors, what are your most common errors? |
| |
|
|
|
|
|
| Describe some of the challenges/issues that are present related to chart prep. | | |
|
|
|
|
|
|
| If you track your appointment fill rate - what is it? | | |
|
|
|
|
| What is your current no-show rate? | | |
|
|
|
|
Do you remind patients of their appointment day/time? |
| |
|
|
|
|
How are patients contacted? |
| |
|
|
|
|
|
If you call patients to remind them about appointment time/date, how far in advance do you call? |
| |
|
|
|
|
Do you request information from patients prior to the appointment? (for example, mail out forms to patients to complete prior to visit) |
| |
|
|
|
|
| Describe any changes that have been made to better manage and/or reduce patient no shows. | | |
|
|
|
|
Do you track the percentage (or number) of cancelled appointments that are converted to an appointment in which another patient is seen? |
| |
|
|
|
|
|
|
If you use an Electronic Health Record (EHR), which EHR software do you use? |
| |
|
|
|
|
|
|
Do you use a patient portal? |
| |
|
|
|
|
If you indicated you have a patient portal, which functions are you currently using: |
| |
|
|