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Oncologist Blazes Trail Toward Bundling

Jacqueline Fellows, for HealthLeaders Media, February 6, 2014

In the beginning, he says the goal was to minimize "clinically irrelevant" physician activity. For example, instead of having a patient tell both a nurse and a physician what their symptoms are, thereby repeating information and wasting time, Sprandio began having an oncology nurse grade a patients' symptoms based on toxicity.

One Team
That information was put into a progress note template so that the physician could be accountable for addressing the symptoms the patient articulated. Additionally, the management of those symptoms was also standardized because the protocols were agreed upon by the whole practice.

"It is one team," says Sprandio, explaining that even though there are eight physicians at his practice, they function as one entity. "The team works the same. There's no variation. There's no, 'Doctor so-and-so likes the nurses to do this and not do that,' we wanted standardization."

By instituting a robust EMR system with a custom software overlay to mirror the physician work environment, Sprandio was able to reduce the variation of many aspects of physicians' interactions, but it's not something he glosses over or cites as a determining factor in the success of where CMOH is today in terms of efficiency. Documentation is important, but it's "just one part" of consistent patient care. The real key, he says, is a physician-led care team committed to the same goal.

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