Designing the Ambulatory Practice of the Future

The Stoeckle Center, the Massachusetts General Physicians Organization (MGPO), and the Center for the Integration of Medicine and Innovative Technology (CIMIT) have teamed up to redesign the traditional visit to the doctor’s office. Dubbed the “Ambulatory Practice of the Future” (APF), the initiative is designed to identify, implement and evaluate innovative concepts, resources, physical environments, and models that can transform the practice of ambulatory, or outpatient, health care – AKA: the visit to the doctor’s office.

The mission of the APF is to design a practice that provides ideal care at the ideal time, with improved outcomes for the physician, staff, patient and family members alike. The APF will serve as a catalyst for exploring emerging trends, technologies, ideas and models both within and outside of health care that will transform ambulatory health care. New practice models will be developed, studied, demonstrated and shared throughout the health care system.

The APF is following a 5-phase innovation process of discovery, modeling and predicting, construction, implementation, and outcome measurement, which has proven to be successful in similar projects at the MGH. Now in the "discovery phase," four important themes are being further defined and investigated by design team sub-groups, each with its particular mission statement:

The Care Experience Mission: To explore innovative ways in which the experience of care for patients, families and practitioners can be radically improved.

We will design a practice that in every manner possible remains patient-friendly and barrier-free. We feel strongly that we can create a system that provides care efficiently and in a coordinated manner at all times. We will study the industries or corporations that have demonstrated innovation in creating a culture with a high standard of service.

Care Team Communication and Information Mission: To ensure access to and communication of the right information, services, and care that empower all members of the care team*(*"Care team" includes anyone who is involved in the delivery of care or in contact with the patient and family).

We will provide timely information to patients and families that is customized for their cultural and educational level. We will make every effort to match patients with clinicians who are comfortable with the patient's and family’s preferences and values. We believe that patients can more effectively manage their own care and improve outcomes when provided complete and timely information. We anticipate long-term studies of clinical outcomes to evaluate the efficacy of our design against traditional practice models. We will conduct site visits and interviews with industries, corporations or experts that have demonstrated innovation related to our work.

The Virtual Practice Mission: To support patient-centered communication, monitoring and education that occurs outside of the doctor's office.

We will study the use of web-based tools to facilitate communication and the delivery of care in settings outside of the traditional doctor’s office. These tools will facilitate patient and family health education, as well as involvement with clinical decision-making for all types of care. In addition, we will investigate technical innovations for ensuring the optimum flow of information among the various members of a patient’s health care team. We will conduct site visits and interviews with industries, corporations or experts that have demonstrated innovation pertinent to this work.

The Physical Practice Mission: To define the milieu that supports both the face-to-face and virtual practice.

We will design an innovative office model to allow the clinical investigation of new devices for physical exam and diagnostic evaluation. We will eliminate or redesign inefficient administrative tasks (i.e., registration, check-in, check-out) to improve the office workflow. We will conduct site visits and interviews with industries, corporations or experts that have demonstrated innovation pertinent to this work.

Impact: The APF represents a key strategic planning initiative of the MGH and MGPO. We expect the APF to set a new standard for ambulatory care delivery for patients and providers alike, resulting in increased satisfaction and improved clinical outcomes, supported by long-term studies. Additionally, the APF is expected to reduce the cost of delivering care by improving systems, reducing waste, and streamlining administrative tasks. The results will be used to advocate with local payers and the Centers for Medicare and Medicaid for new models of reimbursement for care. By design, the APF will determine its own ongoing evolution and improvement.