Internal Medicine Center Team Resources

A Summa-Based Resource for the community
The Internal Medicine Center serves as a critical resource for the community by providing patients of all backgrounds and needs the primary care they need to pursue their own best health.
What is happening now in imc?
There are a multiple projects happening in the IMC as we seek to improve efficiency, value and chronic disease care for our patients. You can access key things to know as you see patients using the buttons on this page.
Health Promotions Calendar
The IMC Change Team has established a rotating schedule on a monthly basis so that we can gain expertise as a clinic in addressing populations of patients we already see. A Health Promotion focus lets us standardize  aspects of our care using evidence based medicine and best practices. Click through to check this month's special focus and access any special tools you need to use to help us improve our care.
Health Promotions IMC
Patient Centered Home Care Model
We are in our third round of certifying our clinic as a NCQA PCMH. This model requires progressive elements of care that have been shown to improve outcomes, patient satisfaction and physician satisfaction as well. Learn more using the link.
Patient Centered Home

IMC Refresh

Quick Start IMC Month

Click on resources to get you up and running for your IMC month.
How many patients will I be scheduled to see in a half day?

For your first few sessions in the IMC as an intern, you will likely only have 1-2 patients to see. Slowly over time, this number will increase to a max as 6 as an intern and 8 as a senior (Categorical IM). You can expect 2-6 patients scheduled per half day, depending on your year of residency.

Can patients be added to my schedule?

Patients can be added to your schedule if there is a cancellation, no show or a same day visit. These are generally for acute complaints, but other issues may be apparent after they are seen. We try to avoid overload for any one clinician, but the goal is to provide access to care if we can. If you are getting behind and faculty are not already aware, please let them know and they will look for a solution with you.

Do I have to be in the clinic all day?

If you are scheduled to see patients for the half day, arrive by 8 AM for the morning and 1 PM for the afternoons. Check in with your assigned faculty member when you see them. If you don't have any patients scheduled until later on in the half day (common if you are on med team), you may be given permission to come back at a certain time.

What if I am running late due to weather, car trouble or some other unexpected event?

If you are running late and it will effect patient care, call or text the chief resident through Perfect Serve. The team will work to adjust your schedule if necessary.
Didactics

You should plan to attend all didactics, which run from 8-8:30 on Tuesday, Wednesday and Thursday mornings.
Didactics are scripted learning cases that introduce you to 12 different patient conditions using embedded links to diagnostic and treatment guidelines. Prepare by reading through the case and using the links to answer questions. You will be expected to prepare for each didactic. If you are assigned to Present or Back Up Present, start the session at 8 AM. Read the case aloud and ask participants to offer answers to the questions before providing the answer. Finish promptly at 8:30 AM to allow time for the IMC Huddle.

For more information on Didactics, and this month's schedule use the button link.

Didactics
PCMH and Chronic Disease Training (Transform-CD)

On the second or fourth Tuesday, your AM schedule will be open to participate in the Patient Centered Medical Home Training. This is a brief didactic (usually held in DOM Conference Room B) followed by seeing patients as a member of the Diabetic Planned Visit or High Risk Patient Team. All Categorical, TY and Preliminary residents are scheduled to participate. This training includes learning business skills needed to lead clinical teams and obtain high clinical outcomes, no matter what your future career plans include.

Interdisciplinary Team Meeting

During one lunch hour you will be assigned to attend the Interdisciplinary Team Meeting. You are welcome to bring your lunch to this meeting. An endocrinologist, social worker and APN will problem solve with you forgone of your patients with diabetes who is a challenge. Be prepared to give an informal 1-2 minute case summary to the team and then invite their in put on solutions to help you get your patient to goal.

This learning experience explores the benefit of leveraging an interprofessional care team for you challenging patients.

Change Team Meeting

The Change Team is a interprofessional design team that is implementing the patient centered home model at our office. This care has been shown to improve quality and outcomes in the IMC. The team, which includes residents, faculty and staff, designs and conducts rapid tests of change to expand and improve our care. This learning experience helps residents begin to develop skills they will need to lead clinical improvement teams.

Population Medicine Self Study

This self guided workbook experience takes place in one half day on your schedule (Categorical IM residents only). Follow the instructions in the Population Health Workbook in the IMC to complete this learning experience.

SAMS Clinic

You will be assigned a half day in the Summa Anticoagulation Management clinic. This learning experience will familiarize you with evidence-based protocols that are used by hospital pharmacy staff to ensure safe levels of anticoagulation for patients with a broad selection of conditions. Check to be sure you know the location of the clinic and report there for your half day. There is also a didactic session that will reinforce the safety and selection of anticoagulation protocols.

Should I use Pre-Charting?

Yes. If the patient has not 'Arrived' you should double click on their name on your schedule to enter the Pre-Charting area.

Pre-Charting is a great feature that allows you to start a note before the patient is being seen. This is the time to: use Chart Review to check prior encounters, visits with consultants, lab results;  add/remove items from the problem list; plan expected health maintenance; Use Up To Date to advance your knowledge on diagnosis or management of conditions that you are expecting to see that day in the IMC.  

NOTE: if the patient does not show up, the pre-charting encounter will auto-delete in 30 days. All of the work that you put into the problem list will not be lost. Your note however will be deleted. If your note contains key information that you do not want to lose, you can add it to the “specialty comments” box on the synopsis tab.

Which templates should I be using for my notes?

There are two templates that we recommend you use. It depends on whether you like to free text your assessment and plan or type it in the problem list! The two dotphrases are: IMCGENNOTEPBPAPV1 or IMCGENNOTEFTV1. You can “steal” these from faculty smartphrase lists or talk to your attending to see if they can help you get these!

What has to be done before I print the After Visit Summary (AVS)?

You should enter Visit Diagnoses, any new or future Orders, any Medication refills, any referrals (consults), any Patient Education, Patient Goal, Level of Service, Follow up information including ALL of the following: When, with which provider, & for what reason (e.g. return in 2 weeks for BP check with Dr. Smith).

What's up with Transition Notes? Why can't I close my note?

You cannot close your note because an Express Lane is added when the appointment type is selected by Scheduling and there are unsigned orders. We cannot bill these codes at this time, so you can simply remedy this situation by hitting the ‘exit’ button on the top right hand side of the express lane interface.

Billing: How do I select the proper Level of Service for a visit?

You will learn this over time. Ask your staffing attending to start out. There are several sheets posted in the bullpen that explain which level to pick. Use the Billing Tips Button to access the tip sheet that will help you. At the most basic level: if the attending goes in the room you will most often check a EL4. If the attending does not go in the room it will likely be EL3. Always confirm billing code with attending while staffing.

Billing Tips
Do I need to set Patient Goals for patients with one or more chronic disease?

Yes: Goals are a great evidence based way to engage passive patients and to understand what they need to assume some of their own self care. We are focusing on completing goals especially on all diabetics, but it is good practice to use in all your patients with any ongoing health issue. See the tip sheets under the PCMH Tab on this page to document these correctly in order to meet documentation criteria for Patient Centered Medical Home (PCMH)


Which faculty member will supervise me for my half-day session?

There is a list of faculty assignments posted on the back of the bullpen door to the nurse station.

Should I talk with the faculty supervisor before seeing patients?

Offer to do so; the individual faculty member will give you their preference. In general most attendings will want you to come to clinic prepared to give short 30 second synopsis of what you believe needs done at the visit and any questions that you have or couldn’t answer during pre-charting)

Does the faculty member have to go in the room to observe me?

During the first half of the year this is required for all interns; during the second half it’s more optional. If the visit is complex and will be billed at a level 4 or higher the attending needs to enter the room for at least a short part of the visit. This can be to go over the AVS (After Visit Summary) or any other part of the visit.

When I finish my note, how will I know which faculty member to list as my supervising physician?

Always list the faculty member who staffed the patient with you.

How will I be evaluated?

Faculty members who have worked with you will be looking for a single thing you could begin doing to improve. To make this more useful, volunteer anything you are working on (time management, preventative screening, behavioral health, etc.) with your faculty member and they will try to give you feedback specific to your learning target.)

Remember: It is a relatively short time in your professional life that you will have skilled faculty members eager to make you more efficient, more observant or more communicative with your patients. Tell them what you are working on and get them in the room to observe you and give you advice while you are still in training and have this benefit available.
How Do I use Translation Services?

Check with the MA to use the iPad on Wheels. The touch-screen prompts are self explanatory. Even though many family members will offer to translate, in some cultures they will feel a need to alter what you say to satisfy norms. For example, only the eldest son may be able to discuss a serious disease with an elder. Offer to engage a trained translator and the family member can still offer their additions or stay involved in the interview.

What are Talking Points and when should I use them?

Some conversations with patients are awkward or require special training. Talking Points include the language you should use, how to place orders and how to satisfy the Health Maintenance on multiple items. These were developed by specialists who share their tips with us. You can access all Talking Points using the Button.

PCMH-Talking Points