How To Gut Your Office Of Inefficiency In ONE Move

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.

The concept is “Having everyone in the office practice to the top of their licensure.” It basically means this: docs should do doc level tasks, MAs should do MA level tasks, and clerical/phone staff should do clerical and phone intake tasks.

Or more bluntly:

• Do you really want the $100/hr physician spending 5 minutes per encounter rooming a patient (an MA level task)?

• Should the MA spend 3 minutes per chart entering lab values (a clerical level - or better yet, automatable - task)?

Many tasks that physicians now assume they need to do can be handled by staff empowered to do so, within the upper but acceptable limits of what they’re supposed to do.

Make Your MA Your Faithful Scribe

HPIs and Systems Reviews are usually taken by the physician, but often can be done just as well — and much more consistently — by the MA.

Common HPIs can be filled out by the MA as he or she rooms the patient by clicking through a template, then reviewed in seconds by the physician upon entering the room. Same for a Review of Systems during an annual physical. These two tasks alone can free up minutes per visit - and even 3 minutes per visit over 20 patients a day means an extra hour of free time.

Concerned about the defensibility of that “all normal” ROS button, or the “past medical history reviewed - unchanged” button? Not if your customary practice is to have your MA read, verbatim, each line or question, and click the appropriate box.

This isn’t about shoving the scut onto your support staff - that would be suicidal. Ultimately, it’s about improving the workflow for everybody in the office, by having them sensibly do what they’re best trained for, and not burning gears doing other folks’ busywork while their own duties get put off.

If you’re a physician and you’re updating the meds lists, or an MA and you’re abstracting paper chart info, your office needs to step back and rethink your duties.

Trim The Fat And Snap To In 3 Steps

The basic mechanism goes like this:

1) ASSUME from the beginning that each team member in the office has a finite set of doable, key tasks, that if performed well, will have the EMR enabled office running smoothly. This is actually a reasonably safe assumption to make, for a perversely inverted reason: you’re screwed if this isn’t true, so you might as well start off on a positive note.

2) EXAMINE those tasks, and group them into categories appropriate to the particular team member: physician level tasks to the docs (needing higher level decision making, training, or “the boss” factor), clinical assisting and communicating tasks to the MAs, and clerical or phone duties to the front office or phone staff. Those meds lists should be updated by the front office or the MA, not the MD.

3) AUTOMATE whenever possible to reduce each team member’s tasks to manageable levels — something that an EMR enabled office can excel at.

Not sure where your MA is going to magically find the extra time to do data entry of all those incoming lab values? Push for that interface with the lab, so the results are automatically entered electronically into the chart, for your review and approval - MA properly out of the loop, saving her hours per day.

Have access to a secure email communication portal with your patients? Run, don’t walk, to get it incorporated into your EMR. Especially if it allows boilerplate text macros for commonly given instructions or responses to frequent questions, it will save tons of time that your staff now spends on simple patient notifications.

• Example: time yourself typing the instruction to adopt a low fat diet and regular exercise in response to that most common of primary care lab abnormalities, the elevated cholesterol result.

• Then time your MA re-transcribing that, putting it in an envelope, stamping it, and putting it in the outgoing mail pile, or worse, calling a patient, finally getting the patient on the phone, having to chat about it, then documenting it.

• THEN compare that total time to 2 mouse clicks — one on the “exercise and diet” instruction button, the other on the SEND EMAIL TO PATIENT button. Multiply that by the dozens of times daily a typical PCP gets abnormal cholesterol values, and you begin to see how supposedly itty bitty efficiencies can reclaim hours of lost time.

Me Scan? I Thought You Scanned?

What about abstracting and scanning old charts — who decides what’s important, and who feeds the sheets through the scanner? This is a whole topic in and of itself, but the same rules apply:

While docs are arguably the best arbiters of key chart info, it’s not an efficient use of their time to have them abstract or scan (see $100/hr, above). Everyone needs to have a pitch-in whenever needed attitude, yes, but do the math: if you fit in just ONE extra patient per day, that’s 23 extra patients in an average month, or an extra day of income. That’s enough to hire an extra scanning staffer who can even do the abstracting, if you give clear and simple directions on pulling info from a patient chart.

And with the increased efficiencies throughout the office, you should be able to squeeze in more than one extra patient, in addition to the cumulative savings of all those other process improvements (better billing and coding, less time wasted, etc).

Share The Wealth

The examples are almost limitless where practice life can be made better all the way around — that most desirable win-win-win situation for everyone in the office including the patient.

When the EMR alerts you when patient is overdue for something like a mammogram or a diabetes lab, any of the support staff should be able to generate the order and contact the patient to do it. Empowering them to automatically do so de-pressurizes the MDs and frees them up for higher level tasks. And EMR automation can make the generating and contacting processes quicker than ever for the MA or front office staff.

Just remember to combine the proper delegation of “top licensure” with workflow changes that will make that delegation possible. Delegate down, but pull staff up, so to speak.

Okay, so maybe that’s gutting inefficiency in TWO moves.