{"id":2108,"date":"2014-06-25T10:46:35","date_gmt":"2014-06-25T14:46:35","guid":{"rendered":"http:\/\/geiselmed.dartmouth.edu\/news\/?p=2108"},"modified":"2014-07-08T11:17:29","modified_gmt":"2014-07-08T15:17:29","slug":"mark-nunlist-tdi-10-closing-the-gap-in-primary-care","status":"publish","type":"post","link":"https:\/\/geiselmed.dartmouth.edu\/news\/2014\/mark-nunlist-tdi-10-closing-the-gap-in-primary-care\/","title":{"rendered":"Mark Nunlist, TDI ’10: Closing the Gap in Primary Care"},"content":{"rendered":"

Mark Nunlist had been a primary care physician for almost 20 years when he became increasingly aware that there was something missing at the busy and well-respected White River Junction, Vt., practice where he was a partner. While he and his colleagues did a fine job of attending to the stream of patients who presented themselves, Nunlist felt that the practice was generally more reactive than prospective in its care.<\/p>\n

\"Mark
Mark Nunlist<\/figcaption><\/figure>\n

\u201cWe weren\u2019t consistently doing the health maintenance kinds of things that a patient should expect of their primary care doc\u2014what I now refer to as the background hum of good primary care\u2014because we didn\u2019t have systems and processes that enabled that,\u201d he explains. \u201cFor example, I couldn\u2019t guarantee that the patients we were seeing regularly were current on even such a simple thing as a tetanus shot.\u201d<\/p>\n

This concern led Nunlist to The Dartmouth Institute for Health Policy and Clinical Practice (TDI) at the Geisel School of Medicine, where he enrolled as a part-time student in the master\u2019s program in 2007. \u201cTDI set me up to understand how to look at things differently. It taught me about processes, about team building, about how to measure where you are against where you want to be, and how to close the gap.\u201d<\/p>\n

Since then, White River Family Practice has initiated significant changes. Recently, the practice was honored with the prestigious 2013 Ambulatory HIMSS Davies Award of Excellence, recognizing its exemplary implementation of the electronic health record to improve patient care.<\/p>\n

\u201cThe HIMSS Davies Award is a direct outgrowth of my TDI experience,\u201d says Nunlist, who is also Vermont\u2019s 2013 Physician of the Year and an assistant professor of community and family medicine at Geisel. Staff members from across the practice have embraced the new EHR, using it to analyze existing practice and workflows and begin implementing processes that allow for greater attention to preventive care, especially for patients with chronic health conditions.<\/p>\n

Nunlist points to management of diabetes, asthma, and ischemic vascular disease, as well as smoking and alcohol cessation intervention, as some of the areas in which use of the EHR has allowed the practice to make measurable improvements.<\/p>\n

\u201cIn all of these areas, we had to measure how we were doing\u2014how many asthma action plans are there in the record for asthma patients, for example,\u201d explains Nunlist. \u201cIt\u2019s never as good as you\u2019d like it to be. Never. When you\u2019re willing to look, you find you actually have lots of room to improve.\u201d<\/p>\n

Nunlist, who plans to retire this year, is also excited about the cultural shift that engaging in this work has brought about at White River Family Practice. Where formerly the administrative staff did not think of themselves as part of the care team, now they do. \u201cThey\u2019re much more energized about our mission,\u201d says Nunlist.<\/p>\n

\u201cTDI taught me that one of the most powerful motivators for change is looking at the reality of what you\u2019re actually doing, compared to what you think you\u2019re doing. That gap is a powerful motivator,\u201d says Nunlist. \u201cThat process is part of who we are at White River Family Practice now. It\u2019s also clear that this is what a good primary care practice ought to do.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Mark Nunlist had been a primary care physician for almost 20 years when he became increasingly aware that there was something missing at the busy and well-respected White River Junction, Vt., practice where he was a partner.<\/p>\n","protected":false},"author":18,"featured_media":2185,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"aside","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[12],"tags":[310,100,45],"class_list":["post-2108","post","type-post","status-publish","format-aside","has-post-thumbnail","hentry","category-alumni","tag-mark-nunlist","tag-primary-care","tag-tdi","post_format-post-format-aside","author-18"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-content\/uploads\/sites\/2\/2014\/06\/nunlist-featured.jpg","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p4r3h1-y0","_links":{"self":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/2108","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/users\/18"}],"replies":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/comments?post=2108"}],"version-history":[{"count":8,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/2108\/revisions"}],"predecessor-version":[{"id":2243,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/2108\/revisions\/2243"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/media\/2185"}],"wp:attachment":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/media?parent=2108"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/categories?post=2108"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/tags?post=2108"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}