Entries Tagged 'workflow' ↓

Any New Year’s resolutions, yet?

We’ve got a good one floating around the office these days: becoming more adept with the EMR.

“For goodness sakes,” said our nurse practitioner after being shown a keystroke shortcut. “What a time saver!”

“THAT’S the kind of thing we need to share with each other — shortcuts and tips it’d take forever to find on our own.”

What a concept: taking advantage of community wisdom. Something you can’t get out of your system’s instruction manual.

Something only you and your fellow users can make happen, once you get some momentum going.

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Another nifty tip from the NextGen Users Group Meeting.

Dr. Cephus Allin spoke in some detail about it, as did at least one other presenter; I’m pretty sure this is passing into the NextGen cannon of “Successful Practices Do THIS — So Should You.”

It sounds so simple, but I can attest to its profound effects on reclaimed time — and best of all, it works regardless of your EMR platform. And with a sensible use of technology, it will work regardless of your office size.

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I’ve never read anything by Joseph Stalin, but I gather he’d be much in demand for implementing EMR’s. From the management side, not the physicians.’

Dr. Cephus Allin’s presentation today, which referenced the late Soviet dictator, was titled How To Go From Paper To An EMR. It totally rocked; I wish I’d attended his other session, Why Everyone Needs An EMR. But that’s what happens when you have awesome content hidden behind modest titles.

Major take home points:

• shunt work more efficiently away from physicians onto support staff when possible
• less MD time/task = more patients scheduled/day
• abstracting the chart is much more important than scanning it
• limit the abstracting to absolutely necessary items (like problem list w/ICD-9’s, allergies, meds)
• limit the scanning to 10 pages per physician pass, and 3 passes, max, before bye-bye chart (ekg, last CPE, critical study reports/consults)
• when staff are limited and already multitasked-out, extend the go-live timeline, and adopt more incrementally and slowly

And that, indubitably, there are practices that just ain’t suited for EMR.

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I’m here at the annual NextGen Users Group Meeting, in Orlando, FL. While I hope to get the skinny on making my group’s NextGen EMR sit up, beg, and perform like a lonely Australian Sheepdog, my main mission is more generalized: to learn how better to assist new MD’s in successfully adopting this, or any, EMR system.

And if South Orange County California is anything like the rest of America, that means focusing on small group practices of three or fewer physicians.

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There’s a pretty hot topic on the EMR boards right now, and that’s which EMR is right for small practices — or whether EMR is feasible for small practices at all.

The arguments go something like this: EMR’s are too expensive for the little guys, especially coming from the big vendors. The common ASP setup, where your patient data and software run on someone else’s servers, is putting an awful lot of faith in someone else’s business model. Or most frequently, EMR is just too cumbersome, my volumes are down, I’m losing money, I’m not getting enough help modding the system to my needs, I’ve had it, I’m outta here.

Well, I have my own thoughts on this thorny matter, from both the clinician and the EMR troubleshooter points of view.

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There’s a time to scramble, and a time to sit down and get deliberate.

When I first started working in a non-academic, community based practice, my medical director advised me to handle “tasks” on the fly: between each patient seen in the clinic, take care of 2 things, like a med refill, patient callback, or lab result.

For the first several years before EMR, this worked well enough — I didn’t have huge piles of paper to contend with — but there were still times I walked to the car at 7 PM.

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One of the beauties of EMR is that you can finish all of your documenting during a patient visit, if you so choose. You can type or click on the fly, and walk out of the exam room with your note completed; no more crib notes to fill-out at some fantasy time when you have more leisure.

But sometimes, documenting outside of the room may be preferable. And as you gain more experience with your system, this may become the norm for you rather than the exception.

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Getting your EMR implementation up to speed should be your primary focus for the first several months of use. But sometimes, the fastest way to fix your EMR is to turn the spotlight on the rest of your office first.

Case in point: working smarter with your office workflow, not harder.

Let’s say your practice runs fairly smoothly. Your front and back office staff get along well, and smiles are the order of the day. No one is surly or plays passive-aggressive games, and everyone is deferential to you, the central axis of the office.

You get your EMR up and running, and everyone, including yourself, gets surprisingly adept at it. You especially love how you can fire off a series of tasks to staff in mere seconds, and track how well they’re carried out, for the good of your patients and the practice.

But after a while, your staff shows signs of strain. Eventually, you have to call a meeting, when it becomes clear that there’s a LOT of extra work and backlog happening, and your staff has been sweating and fighting the good fight for months.

And this is a best case scenario! How did EMR let you down?
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Nobody wants to crash and burn their EMR.

It’s supposed to be pretty hard to do that, thanks to the built-in redundancy of most large scale systems. Your patient data isn’t going anywhere — in NextGen, for example, it’s backed up automatically on multiple servers. And while I’m more a fan of the nearly crashproof Unix-based operating system, 98% of the software industry finds Windows solid enough to design their EMR’s around. Short of a meteor strike or Armageddon, your EMR should function just fine, if used as designed.

What you do to it, however, is another matter entirely.

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There are 4 critical themes that underlie effective EMR use, regardless of your hardware, software, or practice setup.

Understand them well, and you will save heaps of time, protect yourself better medico-legally, and use your EMR to its fullest — to the benefit of yourself, your practice, and most importantly, your patients.

Ignore them, and…well, you’ll be reading this article again!

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