FUHN Adds Expertise to Optimize Electronic Health Records across Member Clinics

Virginia Mason Institute's approach to continuous improvement

Few people start their careers as computer programmers and become family practice physicians. But that is exactly the path Dr. Dan Florey, the Medical Information Lead at the Federally Qualified Health Center Unified Health Network (FUHN), pursued. In his role, he will guide FUHN member clinics in using technology to remove barriers and improve processes for providing patient care. 

Dan knew FUHN’s Executive Director, Mary Maertens, from when he practiced medicine at Avera Medical Group Tyler; he later served as a Chief Medical Information Officer in the Avera System. While Dan worked at the Avera System, he attended a weeklong Virginia Mason Institute seminar with other providers. Dan was tasked with implementing VMI learnings at the Avera System. 

About Virginia Mason Institute and process improvement 

Virginia Mason Institute (VMI) is a nonprofit organization affiliated with Virginia Mason Medical Center and the broader Virginia Mason Health System in Seattle. Founded in 2008, VMI provides education, training, coaching, and consulting around a management and improvement system known as the Virginia Mason Production System® (VMPS). The latter is a lean management methodology based on the principles of the Toyota Production System and tailored to patient care, safety, and hospital/clinic operations. VMPS focuses on eliminating waste and inefficiency, reducing errors, improving safety, and optimizing workflows so staff spend more time on patient care. 

VMI helps healthcare organizations build a sustainable culture of continuous improvement — not just one-time fixes. For organizations under financial or resource pressure, adopting VMPS can help them maintain high-quality care while controlling costs. 

At the center of VMI’s philosophy is to “go see, ask why, show respect,” a fundamental lean mantra attributed to former Toyota Chairman Fujio Cho. For Dan, the experience with VMI changed his approach to process improvement, and he is bringing what he first learned there to the FUHN clinics. 

Improving coding at member clinics

FQHCs and community clinics often function with thin financial margins as safety-net healthcare options. Every visit, procedure, or service provided needs to be documented and coded correctly in order to be reimbursed by Medicaid, Medicare, and managed care plans. Incorrect or incomplete coding leads to lower reimbursement, and lost revenue accumulates fast. Clinics must bring in every dollar available for reimbursement to maintain clinics’ resources for staffing, equipment, and care-related and support services. 

Accurate coding means sustainable health infrastructure for the community. It also informs strategic decisions for growth and staffing, affects quality reporting and value-based payments, and ensures maximum legitimate reimbursement. Accurate coding is more than a billing issue —it’s mission-critical infrastructure.

“For me, everything is about mission,” said Dan. “When I’m looking at an efficient provider who is not struggling with documentation and who is hitting quality guidelines, I am thinking about how to keep the physician from burning out. Too often, however, we have doctors who are undercoding—and consequently underbilling and leaving money on the table for legitimate patient care delivery.”  

To simplify coding, Dan feels strongly that clinics need well-child and annual wellness visit templates in EHR systems, among other improvements. 

“You need to make the right thing to do, the easy thing to do,” Dan said. “We need to make sure that the required components of a well-child visit are marked in such a way that they are immediately clear to the doctor, as they have many things they are balancing in those visits.” 

A clinic visit experience

Dan is visiting all the FUHN member clinics to “go see, ask why, show respect.” In one of his initial visits, he was following a physician known for being the clinic’s best at working with the EHR and hitting all the quality measures. She was using “smart phrases,” typing in her notes right there, and linking orders to diagnoses quickly, all while delivering compassionate care during the 36-week obstetrics (OB) visit that Dan observed. 

Even with the high level of efficiency, Dan was still looking for opportunities to make the process work even better. He thought about how Ambient AI might be used in the bilingual setting. He also considered how it might be helpful to have a set of favorite orders for a 36-week OB clinic visit, so the provider could click on one thing and those elements would pop up automatically. During every visit that he observes, he’s looking to recommend process improvements centered around EHR efficiency. 

“Dan’s skill set is what we need right now, as he understands the pressures providers, staff, and leadership are facing today,” said Mary Maertens, FUHN’s executive director. “He brings a keen sense of efficiency and process improvement to the table.” 

To learn more about Dr. Dan Florey, read the blog, The Power of Purpose and Courage: Dr. Dan Florey joins FUHN.