You’re halfway home. Part 1 discussed Tests 1-4, for picking physician-friendly EHR features — and avoiding those that would incite a riot.

5. Pare With Care

Eventually, you’ll feel tempted to carve away what seem like excesses — don’t do it! Not without checking at least three times!

Scut step reduction always gets a PASS, if by “scut” you mean “multiple steps that are invariably done in a sequence that can’t go otherwise.”

So if you ALWAYS sign-off a lab value by

1. removing it from your lab listing
2. tasking a staffer to notify the patient
3. instructing the staffer on what new action the patient must take

then it makes sense to carve away 2 of those steps, and to have a single button that does all 3.

If at any point, however, something else might happen — like you’d want to keep a lab value in your listing once in a while, or an office colleague might notify the patient instead of the staffer — then prepare for howls of protest if you take away those other options.

Sometimes those other options might not make sense. The need for them may occur incredibly rarely. But, if you don’t thoroughly investigate these branching pathways before you cut them, I can guarantee that you’ll take out weight-bearing walls for certain practices.

6. Always Customize By Provider, If You Have The Option

This does NOT mean to build a secret garden for each and every doctor; it means, given the option to provide adjustable settings at the enterprise vs. practice vs. provider level, it’s hard to go wrong with the lowest level.

If the system will allow it, let each doctor make and save their own customized lists, plans, macros, etc. Physician variance is legendary; consensus, like the kindness of strangers, is less of a sure bet.

7. If Something Works, Copy It Shamelessly

Life is short, and medical office workflows are complicated.

If there’s a doctor-approved example of something that works and is popular, why ignore that and start from scratch (especially from scratch without clinician input)?

When you hear comments like, “Oh, I always use the XYZ system” from every specialist you talk to, or “When the fur is flying and there’s nobody to help me, especially the comatose patient, I can always rely on ABC to get me out of a tight spot,” those are the X-marks on the tattered map that tell you “Here Be Treasure.”

Physicians can come up with some pretty imaginative and roundabout ways of doing things, but they instantly know a good thing when they see it. A good engineer knows the value of starting from a solid, working model whenever possible. The key is to acknowledge that “solid,” and “working” are concepts best vetted by physicians, when it comes to healthcare IT.

Are there any litmus tests that you’ve found valuable for separating the gold from the lead? Please put it in the Comments section below!

Imagine participating in an EHR advisory group for your area.

Every month or so, you meet to hammer out and vett new directions that your medical record will take. Which mods to bring in, when to do major and minor upgrades, how to educate physicians and staff about the transitions, and so on.

And every month, you’re surprised with what folks rate a PASS or a FAIL. Every single time.

I’ve been in these fun little shoes. It’s embarrassing if you’re the “physician champion,” and one of your duties is to minimize organizational surprises from doctor pushback. Being surprised keeps life interesting, but entertainment value is limited when it means going back to the drawing board.

Sooo…I’ve distilled a list of 7 Key Tests — filters — to grade new features before they get too far down the development pathway. Looking back on our Group’s meetings minutes, I think they work pretty well.

Part 1 deals with the first four tests.

1. Any Information To Be Filed Must Have Doctor Approval Or Awareness

This is a biggie for medicolegal reasons. As an IT advisor or the practicing physician, you want to be real careful about bringing anything into the chart without some kind of signoff process — the data must pass doctor eyeballs before it gets filed away in the digital bowels of the chart. The physician is ultimately on the hook for info in the chart, and docs hate it when they’re tagged for abnormal results that apparently they never saw, and thus couldn’t have acted upon.

Protocols for colleagues and assistants fall under this. A mid level or colleague may be empowered to refill certain meds without consulting with the original doctor, for instance — but only because the protocol to do so has already been worked out in advance. The doctor has already “laid eyes” on this workflow, and approved it.

Nothing gets filed without a doctor being flagged on it. It doesn’t have to be a big hairy approval deal, but physicians need a chance to maybe do something, if warranted.

2. External Resources To Take Care Of Scut In A Cheap, Dedicated Fashion = PASS

As noted in a previous post, doctors are super busy. Taking care of “scut” — in this case, repetitive tasks that could be handled just as well by someone below the physician’s level of licensure — frees up mountains of resources. And there’s always plenty of scut.

The doctor could grind through it. The office staff could grind through it for less than the doctor being tied up. And if possible, and external agency, like a practice management group, IPA, or even a private company, could grind through it in an expert, hyper efficient fashion for even less.

Examples of this include signing patients up for secure portal (email-like) communications, and gathering results and consultant notes prior to the next follow-up appointment.

The business proposition is to maximize the doctor’s time. Doctors work best, bringing their observational and decision making skills to bear, not running around calling for test results, or waiting around for callbacks.

3. Get Doctor Signoff Before Proceeding With System Changes — Repeatedly

You’d think it’d be enough to show ask someone once if they like a new feature. But it ain’t necessarily so.

Doctors evolve, like anyone else. Especially if any proposed modifications will take time to develop and implement, they are going to continue to change and mature during the development process. When the IT group turns around with the final product, the doctors may have advanced out from under it, and say, “Who the heck came up with that bright idea?”

Doctors need to be shown, repeatedly and explicitly — not just conceptually — how major mods are taking shape.

4. 1-Click Is Best, 2-Clicks Is Status Quo, Anything Else…Not So Good

This is a tough one; it lies almost entirely in the realm of the vendor, or an external group creating modifications.

But doctors are busy folk. They do repetitive tasks with almost every patient.

Whether looking up info or taking action, key repetitive tasks should be 1, maybe 2 levels tops, away from where they are on-screen.

Physicians will eventually complain if these take more than 2 steps — and will immediately be grateful if a 9-step process gets pared to 4. Or 1.

..but in case you weren’t paying attention to President Obama’s address to the AMA, you had better be getting thee hence to an EHR system.

This is no longer a matter of electronic records being an interesting but problematic alternative to paper charting. That hasn’t been the case for some time, by the way.

The President of These United States has laid it out, repeatedly and often:

• Change is coming
• Beans will be counted
• Incentives will be aligned with desired outcomes

The federal government is setting the stage to make it so, and everything else is going to follow from there. “Lesser” entities, like insurance companies, are taking note.

So should you.

What He Said (Italics Mine)

1. We can’t keep going on like this, and we won’t:

Make no mistake: the cost of our health care is a threat to our economy. It is an escalating burden on our families and businesses. It is a ticking time-bomb for the federal budget. And it is unsustainable for the United States of America…When it comes to the cost of our health care, then, the status quo is unsustainable. Reform is not a luxury, but a necessity.

2. We kinda oughta be ashamed of ourselves:

Today, we are spending over $2 trillion a year on health care – almost 50 percent more per person than the next most costly nation. And yet, for all this spending, more of our citizens are uninsured; the quality of our care is often lower; and we aren’t any healthier. In fact, citizens in some countries that spend less than we do are actually living longer than we do.

3. Health care reform is the NUMERO UNO domestic priority:

To say it as plainly as I can, health care reform is the single most important thing we can do for America’s long-term fiscal health. That is a fact.

How It’s Going To Go Down

Step 1: ELECTRONIC RECORDS!!!

First, we need to upgrade our medical records by switching from a paper to an electronic system of record keeping. And we have already begun to do this with an investment we made as part of our Recovery Act.

Step 2: Re-focus on preventive care, and personal responsibility:

The second step that we can all agree on is to invest more in preventive care so that we can avoid illness and disease in the first place…Building a health care system that promotes prevention rather than just managing diseases will require all of us to do our part…Our federal government also has to step up its efforts to advance the cause of healthy living…with an investment we are making in prevention and wellness programs.

Step 3: Reward different types of care:

That starts with reforming the way we compensate our doctors and hospitals. We need to bundle payments so you aren’t paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease. We need to create incentives for physicians to team up – because we know that when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes – so that we are not promoting just more treatment, but better care.

Step 4: Study what truly works, and pass it around, quickly:

Less than one percent of our health care spending goes to examining what treatments are most effective… we need to do is figure out what works, and encourage rapid implementation of what works into your practices. That’s why we are making a major investment in research to identify the best treatments for a variety of ailments and conditions.

Translation: Kick The Tire And Light The Fire, Already

If you’ve been paying attention to this blog, none of this will really be news. What’s newsworthy — and a trifle scary — is hearing the most powerful man on earth say pretty much the same thing.

To recap:

1. electronic records
2. preventive care
3. successful, not costly care
4. EFFECTIVE treatments

Sift through this and you’ll see the underlying thread — quantify, compare and measure, then pilot into the uncertain future based on the facts. Not fuzzy theories, wishful thinking, or old time inertia. What really works, bottom line? Because that’s going to form the basis for who gets paid.

And for you to figure that out — “you” meaning you the provider, the federal government, and the entire healthcare edifice — you need an infrastructure that measures outcomes, specifically and precisely, then compares them. With the ultimate goal of choosing between them, or those who provide them.

Do you see why electronic records were mentioned as item #1?

If you’re still resisting this trend, you are no longer bucking tech vendors, trying to sell you their high falutin’ records systems. You won’t be up against vendors, or hospital administrators, or IPA’s, or insurance companies, or the AMA.

The entire healthcare field is being redirected, like the biggest ocean liner ever built, into a digital direction — and a digital direction with lots and lots of critical, staring eyes.

And the President, the government, and pretty much everyone else — the ocean, if you will — is singing the same tune.

We’re no longer just talking about EHR adoption, here. That’s now an absolute given, if you want to play in this space. If you want to be ahead of the curve, you’ve already adopted, and are practicing your own data mining and comparing your numbers to everyone else’s.

You’re getting adept at running reports on your own patients, and seeing how many of them meet the national or local guidelines for quality care. You’re seeing how at first, your numbers really suck, but you know that’s OK, so do everyone else’s. You’re ahead of the game because pretty much no one else knows how important it is just to be looking.

When the rest of the pack gets around to figuring out what data mining means, you’ll be way down the road, having already improved your numbers 2 standard deviations beyond anyone else’s.

Or not.

It’s not too late, if you haven’t taken the EHR plunge. But it almost is.

That faint, high pitched train whistle isn’t the digital revolution coming. It’s the sound of the locomotive, far down the tracks, pulling away from you.

Actually, pretty much everybody who’s been on EHR for a while talks about it. Sometimes loudly, to anyone who will listen.

F-R-A-U-D.

As in, “Your documentation says you did that, but you didn’t really.”

Did you?

You Didn’t Mean To, Honest

We know.

And hopefully, you’re not even guilty — yet.

But it’s an occupational hazard that you must be aware of in order to guard against: stating in your documentation that you did much more than you actually did, or reasonably could have. And perversely, the more adept you get at your record keeping, the more likely you are to fall into this trap.

It starts with one of the foundational tenets of patient encounter workflows: documenting by exception.

Most systems are based — have to be based — on some version of this. You can always document each and every aspect of a patient visit, button click by button click, checkbox by checkbox, word by word.

That’s accurate, but excruciating. And the vast majority of visits, unless they are completely novel, are based on clustered common data elements, that can be pre-populated in the chart to save you time.

For example, the common cold usually gives patients some collection of the following:

• nasal congestion
• rhinitis
• mild dry or slightly productive cough
• mild to moderate sore throat
• no high fever or shaking chills

The exact details, like whom the patient caught it from, and how many days they’ve had symptoms before presenting to the office, will vary from person to person, and these can be added individually, as well as particular elements (say, if a particular patient actually had a 101 degree fever).

Documenting by exception (DBE) takes advantage of this data clustering tendency of most conditions, diagnoses, and syndromes, to insert the cluster as a block into the medical record with one button click. This enables you to concentrate on the few corrections — the exceptions — that make the visit unique.

Whether you use it for the history, physical exam, systems review, or plan, DBE can save you major time when dealing with problems that closely fit the expected description. You can “correct the mold” when things don’t fit, or go into unique, totally-from-scratch documenting at any time (”A 135 y.o. Tibetan monk got off the plane and slipped on foil Doritos bag, straining his left orbicularis oculi muscle and causing an apparent subungual hematoma on his right 2nd toe”).

So What’s The Problem?

One problem is, even if the DBE-generated documentation is 100% spot on, nobody believes it.

That may be a bit of an overstatement, but face it: if you’ve seen one auto-generated description of a head cold, you’ve seen them all.

Working with EHR’s, even the most pro-tech admit that reading their own notes can be like reading someone else’s auto parts list. There’s a certain lack of identifiable individuality when you read an account like this:

The symptoms began 3 days ago. Onset from ill contact. Symptoms are rated as mild. Symptoms are gradually worsening. Exacerbating factors include laying down and cold air. Pertinent positives include dry cough, sore throat, rhinitis. Pertinent negatives include fever, chills.

As opposed to this:

Mr. Smith’s noted a dry, mild cough 3 days ago, followed immediately by a runny nose and mild sore throat on day 2. Recalls coming back from Denver on a commuter flight last week, “everybody was coughing in the cabin.” Denies fever or chills; but cough does worsen at night, especially when laying down. The ST and rhinitis are gone as of yesterday.

You’d be hard pressed to recall the visit based on account #1; you could probably visualize Mr. Smith’s face and the entire visit just by reading account #2.

Back in the day when artificial intelligence and expert systems were in the realm of science fiction, the Turing Test was pretty commonly quoted. If you couldn’t tell the output on a computer screen between a human typing in another room, and computer replying to your questions, then the AI had reached a stage where the difference in thinking ability/intelligence was moot.

With electronic medical records, we’re kind of stepping backwards if our human output is being compared to a machine’s. And the perceived difference isn’t a question of intelligence; it’s potentially a much more serious matter of calling into question your professional integrity.

Problem #2: There’s Just No Way, Dude

You can make a good case that, exciting prose be darned, you documented exactly how things went with Mr. Smith, even though you clicked the “head cold” history button to get 95% there. Medico-legally, you’re obligated to document accurately and thoroughly, not melodramatically. Dry is OK.

A potentially more serious problem is when you get a little fast and loose with the button clicks.

Whipping around that mouse cursor, clicking everything in sight as being broadly normal, in other words.

Now really, when Mr. Smith came in with his probable head cold, did you really do a systems review that included the following?

• Neurological: negative for headaches, dizziness, seizures, loss of consciousness

Did you really ask him if he got dizzy or had headaches with his common cold? Much less if he fainted or seized on the trip?

Did you document what amounts to a complete annual physical for a 6 minute urgent care visit?

So What’s A Conscientious Person To Do?

First, you’ve got to familiarize yourself with the DBE premises and get comfortable with its limitations.

There’s no way around it — you will need to use it to get through your day. And if you think about it, you’ll admit to using it in your ol’ pen and paper days, too: does “nl” followed by a vertical line going down the length of the PE section, plus the few non-normal details scribbled here and there sound familiar?

DBE isn’t an artifact of EHR’s, it’s an artifact of busy human beings.

The simplest fix is to carefully read what those normal checkboxes put into the chart, and to make sure you ask or examine to match that documentation. If you don’t routinely percuss the lung borders, maybe it’s time you should.

If your system allows you to reword the verbiage assigned to those buttons and checkboxes, the next level fix is to pick words that accurately match the questions and examinations that you actually perform.

Next, consider individualizing where it counts the most: the HPI and the Plan.

Does it really matter that you percuss lung borders using the 3-fingered South Bend technique? Probably not. But a reader (or auditor) will naturally want to “hear the story” in the History section, and how you’re planning to resolve it in the Plan. That’s where the individual touches will be missed the most — especially when it comes to clarifying your thought processes for concluding what you did, and taking the actions that you did.

Free text is AOK here.

There’s an eternal argument that will rage until the sun burns out, between the “I hate those busy pages with all those buttons next to signs and symptoms” camp, and the “I love those buttons, I can click a lot faster than you can possibly type” camp. You can join in the fun at any time in your medical career, depending on your control issues or lack thereof.

This isn’t about that. The folks arguing that matter are by definition not at real risk of fraudulent documentation — both sides are being hyper conscientious, in their own way.

You’re at risk if you’re using needed shortcuts, but not paying periodic attention to what is being cut. You will drift, as all complex systems do, unless you look down at the road and correct your course, once in a while.

This is part 3 of a 3-part series: EMR 101.

Along with Step 4, Step 5 starts to open the door into EMR 201: Getting Really Good.

If EMR 101 is about surviving the day, EMR 201 is about getting efficient, which enables you to think widely and deeply about patient care, as well as proactively.

Step 5a: Abstract

Abstracting refers to distilling old chart or patient record info directly into your EMR. It differs from scanning those other records, in the same way that data is different from information – one is raw potential, the other is immediately useful.

• A scanned chart, or hospital discharge summary, is just a snapshot, an image in your medical record reference files. It can be accessed and read, and key info extracted, but until someone actively accesses, reads, and extracts that information, it stays “hidden” in that stored picture.
• An abstracted record, on the other hand, has those key elements already extracted and transferred into your EMR where it can be quickly accessed.

More important than speed, that abstracted information can spring into action in your electronic medical record.

“Will no one rid me of this meddlesome transcription?”

So the date of  a colonoscopy report can trigger an alert when the patient’s next one is due. The date of a flu shot can trigger a reminder to give them another one this winter.

Abstracting jump starts a patient’s chart; without it, you’re missing critical information you need to treat patients on the spot. The key is to streamline that initial process.

Preferably, without you being the one doing it all, especially during the first patient visit when you should be focusing on other matters.

Step 5b: Delegate

Ideally, the electronic chart should be ready for you from the very moment you “open” it during your first patient contact.

Yeah, right.

A physician often ends up being the one inputing the “critical info set”:

• meds
• allergies
• dates of certain past tests
• diagnostic codes corresponding to diagnoses for the chronic conditions list

This results in the most accurate carryover, but at a high cost. Abstraction at this point is little more than transcribing — words from paper column A, entered into data field B. If you’re doing this regularly, congratulations on being one of the most highly paid and frustrated typists on earth.

Get good at entering the diagnosis codes, especially, and remember: this is temporary.

Delegation rears its screaming head, here — “Will no one rid me of this meddlesome transcription?” — but it actually starts long before. If your data source is legible, like from a typed hospital discharge note or a clear-clear chart summary sheet, you’re in luck. It’s possible to assign office staff (or hire personnel) to do the transfer, as closely as the day before the patient visit.

If your data is illegible, like your own handwritten notes (or where the critical data is scattered throughout), you’ve got to suck it up, plain and simple.

Get good at entering the diagnosis codes, especially, and remember: this is temporary. As the patient visits increase, the visits themselves build the necessary context for future judgments.

As long as you’re accepting new patients, the abstracting and delegating will never entirely disappear. To keep it manageable — and guard against imported data that you haven’t approved — consider the following physician/staff workflow:

1. Never allow records to be scanned without you signing off on them. The last thing you want is a damning piece of buried data that you will be responsible for, that you never saw, except at deposition.
2. Keep an inbox for documents from elsewhere, and using the previously mentioned batch processing method, work through it steadily at set times of the day.
3. Have a highlighter, or better yet, sticky pad labels (the kind that mark forms where you have to sign?), and mark the info bits you want your staff to enter into the chart, such as
   • entire EKG’s
   • dates of colonoscopies, mammograms, Pap smears, vaccines
   • any other “stick pin” items you must track or update over time
4. Pass the documents to staff in an outbox, to enter just the choice highlighted bits, then off to the general scan pile.

This way, you are not being bogged down with abstracting, your staff isn’t having to wade through and interpret an entire note for the few bits of interest, and nothing gets scanned without being cleared, first.

The next to last step to work on, on your march towards EMR mastery:

Step 4: The 80/20 Rule

Also known as “The Pareto Principle,” the 80/20 Rule is extraordinarily useful. It’s a principle of economics and management, and is most often cited today by entrepreneurs (like Tim Ferris) needing to keep vast amounts of data and responsibilities manageable. Sound familiar?

At the EMR 101 level, the 80/20 Rule goes like this:

• the vast majority of your daily patient encounters occur around a handful of clinical diagnoses

which translates into

• the vast majority of your daily documentation can be done with a handful of templates or pages.

This was alluded to in the last post, under Step 2: Get Familiar With TWO Workflows, Tops. You can go far with this one; long after you’ve graduated to speedier, more specific templates, you’ll still be able to fall back to your “old faithful” workflows whenever confronted with a condition laying outside of what your EMR was designed to handle.

But this principle extends way beyond this:

• 80% of your headaches come from 20% of your patients
• 80% of your office income comes from 20% of your health plans
• 80% of your inbound calls are about the same 20% of daily tasks (e.g. refill requests and lab reviews)
• 80% of your going home late comes from 20% of your documenting habits (e.g. doing crib notes, then going back later to reconstruct the full notes)
• and so on

Once you start seeing these trends, you can start to prioritize where to direct your attention most efficiently. In medicine, of course, you’re trying to encompass 100% as your goal; the 80/20 Rule is NOT about letting 20% of your work go undone, or missing the critical diagnosis 20% of the time!

But if you’re swimming in a morass of seemingly undifferentiated tasks, this rule can identify what to fix first to give yourself the most breathing room. Make 2 or 3 changes that lift the “crush” of your workload off of your back, and you will be much less worn down.

And “much less burnt out” means “less likely to miss critical things.”

Take That Step, You Can Do It

Think about it: take a bit of time now — when you’re floundering, I know — to regain yourself heaps of time from now on.

Push back from your desk and find a handful of problems to fix — pick 2 to start with. I’ve had great success with the following, which ultimately enabled me to end my workdays about an hour earlier than before:

1. batch processing lab reviews or med refills for 15 minutes at noon, and 15 minutes at the end of the day (instead of sprinkled throughout the day — barring any urgent values, of course)
2. finishing notes as you go, and getting rid of the “crib notes/reassemble later” habit

See how much time and energy you get back with just those changes. Then look again, find some more “big bang for your buck” issues, and go at it again.

Reclaim your day, one swipe at a time.

Next time: EMR 101, Part 3 – The Final Chapter

As promised, what follows is a working approach to Getting Good With Your EMR.

It’s informed by something over 30,000 patient contacts, and observations of what has worked and hasn’t over many implementations, many practices, and a handful of enterprises.

If you’re not quite sure what that all means, it translates thusly:

Been there, done that, moved on, still around.

Listen up:

Step 1: Slow Down

I know I said, “Fast” in the title, but the quickest way to Get Good with your EMR is to take a deep breath and periodically step back from the spinning grindstone that is your medical practice.

Attitude adjustment, as I noted in the last post, is key. And that’s nearly impossible to attain if you’re trying to stuff a gazillion patients back into your schedule, like a ninja with his hair on fire.

When you rush, you revert to your old, proven ways of doing things. That may mean paper, or dictating for transcribers, or even a prior EMR.

But remember: you’re trying to create new habits, to fit with a new digital workflow. Switch off the autopilot, and look at the controls with fresh eyes. You’re not just trying to land this one plane; you’re trying to learn how to fly.

Step 2: Get Familiar With TWO Workflows, Tops

Here’s a proven, timeless strategy: get really familiar with a couple of basic, generalizable workflows before moving on to more condition-specific ones. Two is about all you should need, and one may be enough.

I’m a family physician in primary care medicine, and like general practice internists or pediatricians, I can see almost anything across the entire spectrum of medicine on any given day.

Yet probably 98% of the time, I use one template to start with: Master PCP, it’s called on my NextGen implementation. From there, I march through the patient’s chart in pretty much the same way, whether it’s for a quick visit like an ankle sprain or a comprehensive annual physical:

• History of present illness
• Past medical history and Review of Systems
• Physical Exam
• Assessment and Plan
• Health Maintenance review

Other physicians start with different “home page” templates, like Master IM, or Master UC (urgent care). But the principle is the same: by repeatedly using the same set of pages over a variety of patient visits, you’ll become familiar with all the button and checkbox locations, while avoiding the overload of learning new templates for every condition.

What this general, “Swiss Army Knife” approach lacks in speed, it makes up for with a comforting reliability. And sufficient documenting speed takes care of itself, as familiarity with the layouts allows you to find the buttons quicker over time — to start reaching for the right checkboxes even as you’re forming the patient questions in your mind.

Likewise this automatically takes care of another common affliction, the dreaded “I must check every box I see!” syndrome. When you’re familiar with a limited set of templates, your brain doesn’t freeze-up like a deer in the headlights each time it tries to re-orient itself to an unfamiliar layout. It “sees through” the checkboxes and buttons it knows it doesn’t need, and focuses on those it does.

If your only goal is to regularly survive the day, this may be the only workflow you’ll ever need.

Step 3: Batch Process

I’ve reviewed this at length in a previous post, please check here for details.

But basically, you will have what I call a microscopic mode (the patient in front of you) and a macroscopic mode (your entire schedule and day, including calls for refills, lab reviews, etc).

Most naturally, you switch between the two modes between patient visits. You take in the big picture by checking your schedule and completing a few tasks when you come out of a room. Head into the next one, and you cone-down your focus, again.

Batch processing points out that while this works for many things, it is much more efficient to group certain tasks together and plow through them all at once at specified times. Zooming your mental focus in and out is not only tiring; it’s slow, as well.

Notice An Underlying Theme, Here?

It’s mostly about Underlying Themes, at this stage.

Principles.

What you’re trying to achieve is a solid foundation for future work. That means avoiding a collection of quick fixes and cut corners, and basing your regular workflow on solid, proven principles.

This post could equally well have been titled “How to Get Good Enough, Fast.”

EMR 101 is about surviving the day — finishing your notes on time, no work taken home, orders and referrals done before the patients check out — and getting back up to your pre-EMR speed. Without this level of competence, you could probably care less about the really nifty things an electronic health or medical record can do for you (see start of this post, re: “ninja with his hair on fire”).

Those are topics for future posts:  EMR 201: How To Get Really Good, and EMR 301: Becoming A Recordmaster.

Next time:

EMR 101: How To Get Good, Part 2.