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.
