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We have begun to rollout our population health tools, resources, and workflows to our Fort Medical Group primary care clinics. If you remember from the recent Insights population health newsletters, this rollout began with a pilot at the Integrated Family Care (IFC) clinic. In addition to IFC, we have now rolled the project out to the Cambridge and Internal Medicine clinics. We hope to roll it out to Jefferson, Johnson Creek and Lake Mills by the end of October.

The rollout consists of four workflows; chart prep by a Health Outcomes Specialist, surveillance by the clinic manager with provider and staff engagement, full use of health maintenance, and use of Invitations and other patient outreach tools. The rollout is focused on seven measures:

  1. Breast cancer screening
  2. Colorectal cancer screening
  3. Cervical cancer screening
  4. Diabetic A1C check
  5. Diabetic lipid check
  6. Diabetic foot exam
  7. Diabetic eye exam

This rollout is really only the foundation for our future population health efforts. We have the potential to use our wealth of data to make a significant impact on healthcare quality. This directly supports our mission and vision by providing measurable outcomes to our efforts.