send notes to patients when things like
mammograms or quarterly lab tests are
due via text or mail, through MyChart
messages, or by phone call. Nurses can
also help answer patients’ questions
via phone or MyChart and they can
authorize refills on some medications
that are taken regularly. (See p. 15 for
more information.) Medical assistants
also follow up on referrals, labs, and
X-rays to make sure patients have
gotten the care they need.
“Our goal is to make sure the
patient is getting those services, that
we got the information back in a
timely manner, and that we closed the
loop by talking to the patient again. I
hope patients recognize that their visits
are more comprehensive and more
organized,” Ms. Clark says.
Connecting patients
with their care team
Pharmacists, dieticians, and behavioral
health experts can be added to the
PCMH team when needed. At the Sun
City clinic in Georgetown, for example,
patients can make appointments with
an on-site pharmacist to help them
manage their medications and learn
about any potential interactions.
Also, patients develop relationships
with the whole care team, not just
with a physician. Ms. Clark told the
story of a husband and wife, longtime
patients at Baylor Scott & White’s Sun
City Georgetown clinic. The husband
brought his wife in to the clinic because
she was ill, but did not realize how
severely. When the medical assistant
on their care team recognized them
in the waiting room, she immediately
brought them to the exam area. The
staff rushed to give the patient the care
she needed, and called in emergency
medical technicians because the
woman’s situation was serious.
“As hard as it was, it was better
because the medical assistant was there
and the woman’s husband trusted her.
The next morning she called to check
on them first thing and make sure
their daughters had arrived. That is a
patient-centered medical home at its
best,” Ms. Clark says. n
What’s next with PCMH
at Baylor Scott & White
The next phase of PCMH recognition will be securing
that status for the obstetrics and gynecology clinics in
the Austin/Round Rock region and in College Station,
projected for 2016.
Also, Baylor Scott & White’s Central Texas clinics are
continuing to look at ways to expand care, in line with one
of the core values of patient-centered medical homes,
Ms. Clark says. In summer 2015, pilot programs began
offering electronic visits (E-Visits) to employees and their
dependents that are eligible for the service. Patients
can communicate with a provider via the web for some
common conditions like pink eye, sinus infections, flu, and
urinary tract infections. Providers can offer treatment
options, prescribe a medication, or ask patients to come
in for a clinic visit.
Another option uses live video-chat for a remote visit
between eligible patients at home and a provider at
the clinic. This was successfully piloted at McLane
Children’s Specialty Clinic and is now being used by two
of the clinic’s specialty providers for select patients.
This program will soon expand to other specialties
and regions, including psychiatry, medication therapy
management, and primary care.
sw.org | September 15 THE CATALYST
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