Ivy Shanice Muli

This week in Family Medicine felt like stepping into the center of a web—where every strand represented a different layer of care. I spent most of my time observing patient interviews, medication and appointment check-ins. The environment was buzzing but grounded, held together by a team of nurses, doctors, behavioral health staff, and social workers all working in rhythm.

What stood out most was how care delivery had to adapt to the realities of the patient population—many of whom are enrolled in Medicaid or Medicare and  experiencing housing insecurity. Diagnoses ranged from chronic illnesses like diabetes and hypertension to more acute needs in substance use disorder (SUD) and autoimmune conditions.

To make sense of what I was observing, I began organizing them through the AEIOU framework—Activities, Environments, Interactions, Objects, and Users.

A: 
The core activities centered on direct patient care and coordination. I observed detailed patient interviews, medication check-ins, and warm hand-offs from physicians to social workers or behavioral health providers. Charting was constant—happening in-room and post-visit, usually through Epic, MyChart. I noticed how much time was spent on scheduling and managing follow-ups, as well as on navigating addiction medicine protocols and prior authorizations. These weren’t isolated tasks—they were interwoven in the patient flow and essential to successful care delivery.

E: Environments
The clinic was a series of tightly connected environments. Provider amd patient spaces included waiting rooms, exam rooms, office and the pharmacy. The design of these spaces allowed for a sense of continuity, even when staff were juggling multiple responsibilities. There was an openness to collaboration—spaces weren’t siloed but shared, which kept communication fluid.

I: Interactions
The system of interactions was one of the most revealing parts of the immersion. Everything revolved around the patient, but they weren’t navigating it alone. Patients are constantly interacting with nurses, physicians and social workers. These interactions expand outward toward support staff, referral sites, external services like transport and housing, and family members. Some relationships were direct, like between nurses and patients. Others were more logistical, like between scheduling and referral coordination. The system is dynamic, and the arrows go both ways—indicating the shared responsibility across users.

O: Objects
Several objects stood out as central to care. On the tech side: Epic for charting, UpToDate for clinical decision support, Care Everywhere for record sharing, and CoverMyMeds for managing prior authorizations. Patients used tools like MyChart for messaging and appointments, and many were issued at-home devices like Narcan spray. These tools helped extend care into patients’ homes, which was critical given how many patients faced transportation or housing barriers.

U: Users
Users spanned every level of the care ecosystem. Physicians, nurses, med techs, CNAs, administrators, social workers, behavioral health specialists, and pharmacists all had specific, interconnected roles. Patients were, of course, at the center—but they often came with family members or support people who helped manage appointments or translate medical instructions. Everyone was a user of the system—actively participating in care, documentation, coordination, or recovery.

Peer Reviewed Paper

Title: Telemedicine to Improve Access to Medications for Opioid Use Disorder in Illinois, 2022–2024

Authors: Kimberly Gressick, Maria Fiorillo, Sarah Richardson, Maria Bruni, Stacey Brenner, Miao Hua, Nik Prachand, Nicole Gastala

Summary:
This study evaluates the effectiveness of a statewide telemedicine-based program, MAR NOW, in improving access to medications for opioid use disorder (OUD) in Illinois. Following pandemic-era federal policy changes that permitted audio-only prescribing and waived the initial in-person exam, Illinois implemented a telemedicine referral system through its state helpline. This connected individuals with opioid use disorder to buprenorphine and methadone treatment with minimal barriers, regardless of insurance or immigration status. Of the 1698 individuals eligible for treatment, 89.2% successfully initiated buprenorphine or methadone—primarily through telemedicine. The program’s success was attributed to extended provider availability, transportation assistance, and intensive follow-up.The findings are particularly relevant to safety-net clinics like MSHC, which serve low-income patients who often lack consistent access to care. The high uptake of treatment in this program underscores the importance of reducing structural barriers and offering flexible, accessible models of care. Given that over 50% of patients at MSHC live below the poverty line, integrating or advocating for similar telehealth-based access to OUD medications could address both logistical and financial barriers to treatment.

Commercial Solution

MAR NOW Telemedicine Program :
The MAR NOW program represents a real-world application of telemedicine as a commercial and public health solution for opioid use disorder (OUD). Operated by Family Guidance Centers in collaboration with the Chicago Department of Public Health and the Illinois Department of Human Services, MAR NOW uses telemedicine infrastructure to prescribe buprenorphine and connect patients to methadone and other treatments. The program is a model for how healthcare systems can deploy technology to overcome traditional barriers to OUD treatment, such as lack of providers, transportation difficulties, and stigma.While MAR NOW itself is state-funded, it reflects a scalable commercial model that private telehealth companies or digital health startups could adopt: combining provider networks, electronic prescribing, and 24/7 access to care coordinators. Its success—achieving a 95% treatment connection rate and 89.2% medication initiation—demonstrates that telemedicine platforms designed with integrated support (e.g., follow-up calls, transportation assistance, flexible hours) can be both clinically effective and operationally viable.For clinics like Mile Square Health Center, partnering with or replicating such telemedicine infrastructure can improve MOUD access, particularly for uninsured or underinsured populations.

IDEO Model

This concept is highly desirable—clinicians in safety-net clinics urgently need smarter scheduling that supports wellbeing. It’s also feasible, as AI-powered scheduling and EHR integration are technically achievable with current tools. However, the viability needs refinement. While the TAM is estimated at $7 million, this assumes full market uptake and doesn’t account for real-world barriers like limited clinic budgets, EHR integration costs, and administrative resistance. The value of reduced burnout and improved retention is significant but harder to quantify. To strengthen viability, alternative revenue models (e.g., EHR partnerships, grants, or value-based incentives) should be explored.

Desirability

Primary observations were centered around the clinic’s scheduling processes and overall workflow. This Family Medicine clinic operates within a high-demand environment, with clinicians actively navigating patient care while administrative staff coordinate appointments. Key elements in this system include the EPIC electronic health record, appointment schedules, clinic spaces, seating arrangements, and computers. Users within this ecosystem comprise clinical staff and patients.

Secondary observations revealed significant stressors faced by providers. Clinicians often experience physical fatigue due to prolonged standing and psychological pressure resulting from tightly packed appointment templates. Delays in patient throughput create a cascade of frustration for both patients and providers. Literature consistently shows that provider burnout is strongly associated with extended working hours, limited break periods, and escalating workload complexity. Many current scheduling tools do not adapt in real-time to patient acuity or visit complexity, rendering them insufficient for safety-net clinics that frequently manage multifaceted cases. These conditions highlight a critical need for workflow systems that incorporate flexible scheduling, protected provider breaks, and real-time load balancing.

Need Statement

Clinicians in high-volume safety-net clinics need a workflow and scheduling system that dynamically accommodates complex patient cases while integrating provider break times to support clinician wellbeing—without compromising care quality.

Feasibility

Presently, the clinic uses static appointment templates that lack the flexibility to respond to varying patient needs or provider strain. A feasible solution would require integration with existing EHR systems such as Epic or Cerner to ensure seamless adoption. Recent advances in health informatics make it technically viable to develop AI-powered algorithms capable of analyzing patient data, assessing case complexity, and optimizing scheduling in real-time. However, barriers include institutional approval processes, securing clinician buy-in, and implementing comprehensive training programs. Given the limited budgets of federally qualified health centers (FQHCs), any solution must be both cost-effective and scalable.

Viability

The convergence of high patient volume and rising clinician burnout underscores the urgent demand for intelligent scheduling solutions in safety-net environments. Across the United States, approximately 1,400 FQHCs serve over 30 million patients (HRSA, 2024). With an average of 10 clinicians per center, this represents an estimated 14,000 clinicians who could benefit from improved scheduling systems. Assuming each clinician pays $500 annually for software access, the total addressable market (TAM) is:

TAM = 14,000 clinicians × $500/year = $7,000,000/year

With growing attention to clinician wellness and patient care continuity, both payers and providers are incentivized to invest in such innovations. A subscription or licensing model—particularly one bundled with EHR platforms—can offer sustainable revenue while lowering institutional barriers to entry. Although initial investments in software development and deployment are necessary, these costs could be offset by increased operational efficiency and reduced turnover from burnout.

The story board illustrates the challenges of medication tapering for patients with substance use disorders in family medicine. Patients often struggle with understanding tapering instructions, especially due to complex labeling and limited literacy. This can lead to dosing errors, withdrawal symptoms, and serious medical or relapse-related events. Clearer, more accessible tapering processes are needed to improve safety and treatment retention.