Building the Oncology Medical Home
Trainings and Certifications
February 21, 2015
Wes Chapman, Aaron Lyss, Gina Todisco, Carolyn Craig
Building a Medical Home: It takes a trained team
Our team set out just over a year ago to build a prototype patient centered medical home in one of the 32 clinics in our practice, Tennessee Oncology. One of the first considerations that we undertook as a team was – what did we need to know/learn to actually do this job properly? Based on our collective experience, key knowledge and learning falls into 6 categories: 1) Quality and process improvement, 2) IT management, 3) Clinical knowledge (oncology related), 4) Safety and culture, 5) Project Management, and 6) Specialized clinical knowledge – particularly palliative care.
We agreed to three things up front: 1) If we were going to get further education, it was going to involve getting a certification that involved taking at least one test – no passes given to simple attendance, 2) We were all going to get the expertise to understand the entire job – meaning getting certified in all 6 areas, and 3) Training had to be cost effective, and was an after-hours undertaking – we still had jobs to do during the day.
We are only part way through the medical home, and part way through the training, but we found certain trainings to be particularly valuable:
- Quality & Process Improvement: In this area we have relied on black belt and green belt certifications, and have not yet settled on a single vendor of choice. In the past we have used the online programs through ASQ for green belt, and we are currently soliciting bids for training larger numbers of our team resident in the clinics. We have had some of our team members do specialized healthcare lean courses at local universities, but in general we have not found a clinically focused LSS vendor with attractive prices. Lean and six sigma are really quite different, and were really only brought together in a cohesive and effective whole by Toyota in the Toyota production system (TPS). We will be taking a hard look at the Virginia Mason program, as they are really based on the original TPS, and include the entire fundamentals of safety and Just Culture as noted in point 4 below. This is an area of knowledge that is important enough that we are pushing hard for training throughout our system, but we are generally disappointed with the lack of consistency and QC related to the certification itself.One quality oriented certification that we have found to be of great value is the Certified Professional for Healthcare Quality (CPHQ) through NAHQ. This is a fast and healthcare focused certification, which incorporates most of the necessary process improvement tools and techniques for clinical applications. It is indirectly sponsored by The Joint Commission, and is therefore directly tied to the accreditation used in most hospitals. This is a great accreditation to start with for team members dedicated to building a medical home.
- IT Management: This has proven to be an area of tremendous importance to the project, and we have been very happy with the curriculum for the CPHIMS certification. This certification is focused on project management in the IT arena, and has been of tremendous value. HIMSS has been a tremendous organization for us, with good regional shows (saves on travel), and access to a variety of best practice tools which have proven to be very beneficial.
- Clinical Knowledge: In this arena we have relied on The Oncology Nursing Society (ONS), NCCN and to a lesser extent ASCO (which maintains an affiliation with ONS). The ONS courses and certifications are a tremendous resource, and are useful and available to non-nurses – which has been a blessing. In general these courses are well structured, with clear and coherent lessons – and it’s all online. All of the courses and certifications require 80% or better on a comprehensive exam to pass. The prices for the courses are reasonable, and represent tremendous value for the money. NCCN has a number of free online seminars, which are really targeted at practicing oncologists. Our team took and passed at least 20 of these, but they are really aimed at a different target than us. Finally, we engaged in a few ASCO courses, but really found them to be targeted at practicing oncologists, and had very little value for us.
- Safety & Culture: Safety is a critical issue in any medical environment, and particularly in medical oncology. We focused on and engaged in courses through the National Patient Safety Foundation (NPSF) and the Institute for Healthcare Improvement (IHI). While we have used IHI for many years, we found the NPSF courses to be particularly focused and effective – really well suited to our needs. We are moving to adopt a broadly based Just Culture throughout our practice, and the integration of culture and safety in the NPSF was compelling for us.
- Project Management: The Project Management Institute does a tremendous job with project management certification and training, and we are just wrapping up with our first PMP certifications on our team. This is an industry standard, and is worth the effort. Building a Medical Home is really just an integrated series of related projects, and is most easily managed as such.
- Palliative Care: This is a specialized area in clinical care which is important in all medical oncology cases – at its core palliation is all about symptom management, and is a universal requirement for us. Palliation is frequently confused with hospice care, and we felt that our team needed to have a bit of real knowledge in this area if we were to be effective in building an effective medical home. We found the Hospice and Palliative Nurses Association to be a great resource. They offer courses for both administrative types and clinical, and certifications for both. Their courses are particularly straightforward, and are based on the same 80% requirement for passing that is used by the ONS.
CMS promulgated the initial version of its Oncology Care Model on February 12th, which promises to radically transform how oncology care is paid for and delivered in the US. It is instructive to look at the 6 fundamental principles around which the OCM is based relative to our trainings and certifications:
- Provide the core functions of patient navigation;
- Document a care plan that contains the 13 components in the Institute of Medicine Care Management Plan outlined in the Institute of Medicine report, “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis”;
- Provide 24 hours a day, 7 days a week patient access to an appropriate clinician who has real-time access to practice’s medical records;
- Treat patients with therapies consistent with nationally recognized clinical guidelines;
- Use data to drive continuous quality improvement; and
- Use an ONC-certified electronic health record and attest to Stage 2 of meaningful use by the end of the third model performance year.
Based on these fundamental requirements we feel that out curriculum is pretty much spot on. The overarching requirements are focused on the modern IT systems and clinical best practices to manage patient care, in a continuous improvement environment. On balance we have probably focused more than the requirements indicate regarding palliation and safety – but we’re OK with that – these are areas of critical importance for us, and really define why we are doing this.
Moving forward we are being drawn deeper into the operation of a medical home – extending well beyond the boundaries of our own clinics – and the comprehensive management of patient cases. Accordingly we are first looking into Certified Case Manager accreditation for our care coordinators and triage nurses. As we move deeper into risk oriented arrangements, we will take a deeper look at the URAC supported Medical Home Auditor Certification. This accreditation is aligned with the MGMA medical home model, and would therefore require rethinking the certification of our medical home.
Finally, we are taking a hard look at ISO 9001 certification as a Quality Management System for integrating all of the functions of our medical home. It has been our experience that the internal audit functions, management review and corrective action/preventive action functions are uniquely valuable in managing complex medical environments.