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?
It didn’t. This is a classic example of a workflow problem, not an EMR one, though EMR can make it more obvious. While EMR can enable you to do wonderful things, enabling can have a negative side, as well.
Don’t Be The Source Of The Problem, Be Part Of The Solution
The idyllic setting — where everyone greets you with the smile, asks about your family, and treats you with deference — is a setup for snowballing problems in EMR.
Offices are like feedback loops in system science: they tend to function best when there are checks and balances all the way around. If you are literally “out of the loop,” i.e. not subject to normalizing influences and constructive critiques, it’s extremely easy and natural for your behavior to “drift,” and make more work for your office than you realize.
Did a colleague send you an ambiguous consultation note? You can fire off an in-house message in less than 10 seconds for your assistant or phone staff to call for a clarification. Your insurer need a special authorization for a same-day referral? Ditto. Not sure if a certain medication is covered under a patient’s insurance? 5 seconds to dash off a note to get it looked into.
In under 30 seconds, you’ve just generated nearly an hour’s worth of staff playing phone tag, on 3 tasks. That’s an awful lot of regular 30-60 second tasks that didn’t get done, while your staff was also rooming patients, checking them out, answering phone calls, etc. And stressing all the while.
Eat Your Share Of Humble Pie — Everyone Else Is
Consider adopting a basic self-checking mechanism: arrange regular review sessions with your staff and office manager, with the goal of smoothing out the corners for everyone.
What’s a “corner”? It’s whenever there’s a backlog when there could be a steady flow. It’s easy for you to dash off an memo to call the specialist’s office for a clarification, but for your MA, there’s the lag of the other office putting her on hold, their pulling of the chart, the call-back-later delay because the doctor wasn’t in the office, or was with patients, the keeping it on a not-yet-done list because that office didn’t call back for days, then the documentation of their answer and sending it to you. Yikes.
Instead of waiting for your MA to come to you with an ulcer after a few months of this, catch it within days or weeks with the following:
- Set up weekly staff meetings for EMR review, with you as one of the staff.
Once things are agreed to be truly smooth, you can ratchet this down to once or twice a month, but never less than that. - The target isn’t smiles all around, it’s where’s-the-bottleneck?
From deferential staff, you’ll get a lot of “OK-fine” reflex answers to the “Everything OK?” question (doctor colleagues are another story) — try not to believe them, for their sake. Ask specifically about those 10, 20, 40 minutes each tasks, which are in there somewhere, guaranteed. There should be very, very few of those, and those that must be kept, you’d better be awfully certain about, after a LOT of thought. - If your staff needs more than 2 minutes for a task, rethink it.
Delegation of work can extend your reach as a provider — until you generate so much that your office grinds to a halt. Commit to it now: for every task you routinely redirect elsewhere (so you can do more provider-level tasks, or the same number of tasks better), conceive of a way for your staff to do that task efficiently, using their input.
Sometimes, the most efficient use of time for the entire practice is for you to do the task, like you calling the specialist, being immediately put through, and getting your answer straight from the horse’s mouth in under a minute.
And sometimes, the task takes care of itself, no action needed, period. A same-day referral, properly submitted through same-day channels, will likely be approved without further nursemaiding — call the specialist for 90 seconds to get their OK, and if an approval problem still arises, instruct the patient to call you or an empowered office manager to clear it up. This saves your staff 20-30 minutes on the phone with the insurer each time.
Your time is valuable, but so is your support staff’s, when they’re ultimately supporting YOU. Which is a better use of their time: 1 task done over twenty frustrating minutes, or 30 clean, well-conceived, low stress tasks done in the same time, while rooming 2 patients and keeping you on-time?
