Big-city Care, Small-town Doctors

Over the course of 30 years practicing medicine in a primary care office, John Giannone, MD, FAAFP, has seen and treated just about everything. As a family practitioner, Dr. Giannone sees patients from newborns to elders. And even though he is chief medical officer at UHS Delaware Valley Hospital and associate medical director of UHS Medical Group, he also sees patients at a clinic in rural Deposit — and his office is the first stop for area residents for any sort of ailment or emergency, from a sore throat to an infected splinter to a coronary event.

Residents of the rural areas of the Southern Tier can truly claim their UHS clinics and physician offices are providing “primary” care. “Patients come to us for everything,” confirms Dr. Giannone, who says that the care providers in his office and the offices around the system must have broad medical knowledge along with some specific, more specialized skill sets. “For instance, Dr. Luis Rodriguez-Betancourt in Walton can set a broken arm right in the office,” says Dr. Giannone.

In the Deposit office, Dr. Giannone is aided by one other physician, a nurse practitioner and a physician assistant, and they, in turn, are ably supported by an administrative staff. As part of UHS Medical Group, the small office and others like it effectively have the resources of a much larger hospital system at their fingertips. And because all patient records are now kept in the UHS electronic medical record (EMR) system, communication among practitioners about patient care is more accurate and more efficient than ever.

A BIG GROUP IN SMALL TOWNS

“We operate as one large medical group,” says Dr. Giannone. He details how primary care physicians in the rural offices can confer with one another on the phone and conference in specialists when they are needed — all while looking at the same patient record.

If someone needs the services of a specialist, doctors have two options. “If I am seeing someone with a routine problem for, let’s say, an endocrinologist, I can get that scheduled within a few days,” says Dr. Giannone. “But if the problem is emergent — like someone with elevated blood glucose — I can call the endocrinologist to see the patient on the same or next day, or he or she can advise me about what needs to happen.”

Of course, the system also works in reverse: Patients who are seen at the UHS hospitals or by specialists can have their electronic medical records updated so that when they return to their primary care provider, all treatments and orders are accurate and up-to-date. This works well when, for instance, a patient has had lab work or other diagnostics done at one of the hospitals.

“The lab results are integrated with the EMR,” says Dr. Giannone. “And the PACS system is an X-ray software that transmits digital X-rays from our office to UHS hospitals where radiologists can read them.” Then the primary care physician can receive a digital copy of the radiologist’s notes while the patient is in the room. “A patient used to have to go to one of the larger hospitals to get an X-ray,” he continues. “But now many of our clinics have this capability to send a digital X-ray to radiologists in Binghamton or Johnson City.”

MEMBERSHIP HAS ITS BENEFITS

Area residents can also expect the other perks of UHS membership where their office visits are concerned. Dr. Giannone maintains that he and the other providers in the rural areas take pride in delivering on the UHS promise regarding same-day visits. “We have about 20 visits a day that are same-day call-ins,” he says. “If I see a patient for pre-operative exam clearance who then needs clearance from a cardiologist, we can get that scheduled within the next day or two. The patient doesn’t have to wait another week to get taken care of.”

The integration of comprehensive services works well for patients and for the doctors’ offices. For example, the Nurse Direct call system will contact many patients discharged from the hospital within two days, to check on their condition and schedule a follow-up appointment with the primary care physician within seven to 14 days.

“We have a very good provider group that provides excellent care in all of our clinics,” says Dr. Giannone. “It’s not like the old days of Doc Jones with his bag, who would treat the horses and cows and the people, too. Now I have virtually instant communication, so if you do have a broken arm, I can make arrangements for you, and we know that you’re not going to have a wasted trip to Binghamton.”