Use patient data to inform and plan proactive patient care

Panel management is a process of proactively managing a defined population of patients, using EMR data to identify and respond to patient’s chronic and preventative care needs.

Panel management is a key step for a practice to take to establish a patient medical home.

Panel management enables family doctors to understand both the patients they are taking care of, and what those patients need. The concept is simple: better information about patients leads to better care for patients.

By using EMR data to proactively manage patient panels, doctors and their practice teams can:

  • Organize services and team members appropriately to best serve patients.
  • Provide proactive and preventative care for all patients they see, including those who have not actively engaged the family practice through recent visits.
  • Plan and streamline care and supports for prevalent health conditions among patients. 
  • Advocate for appropriate resources to meet patients’ needs, such as allied care providers and community services for vulnerable patients.
  • Along with other physicians, use aggregated data to plan patient supports and services in the community as a whole.

Having an accurate and optimized patient panel is a key step in a practice’s transition to a patient medical home, and enables GPs to participate in teams and networks that effectively support their patients’ needs.

For patients

Patients get more preventative and proactive care, and appropriate supports.

For doctors

With a managed panel, doctors can:

  • Use accurate panel information to make the most of their time and resources.
  • Improve preventative and proactive care.
  • Organize team members to best serve patients.

Get involved

A three-phase approach to panel management guides doctors and their teams to use tools and workflow processes that enable data-informed, proactive care:

  1. Empanelment: Develop an accurate list of active patients by confirming the patient-provider relationship and most responsible provider. 
  2. Panel Clean-up: Develop accurate and up-to-date clinical registries for three to five chosen disease indicators.
  3. Panel Optimization: Develop accurate and up-to-date clinical registries for 10 to 15 disease indicators to provide planned, proactive care.

For more information about panel management, please contact the GPSC’s Practice Support Program.

Supports