Why You Should STILL Be Writing In The Hallway, Even With EMR

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.

Better During, Than Late Or Never

Make no mistake about it, finishing your notes right in front of the patient is a huge step up from reassembling your notes later that evening, or God forbid, a day or more later. Besides the obvious memory issue, the latter essentially doubles the length of your workday: there’s the visit itself, and then its later reconstruction in your mind and in the medical record.

Your EMR should, with a modicum of practice, enable you to do everything before you see your next patient — write prescriptions, do referrals, order labs or radiological studies, document injections, and generate the progress note.

If you’ve ever worked on charts long after your patients left, this should be your first goal.

Better Yet: Be A Bit Early

There is, however, an even faster way.

“The time you spend with your patient may be brief or long, but the attention you give them should always be intense — and your documentation speedy. Not the other way around.”

As quick and clean as EMR is, it will always take more time to use it AND interact with your patient, than to just interact with your patient. Especially at the beginning, when you are dipping into scanned documents, pulling up image files of old pages during a visit will really make the minutes stretch.

Plus, focusing your attention elsewhere while seeing a patient is an invitation for to off-topic questions (since you obviously have nothing better to do than to look down at your screen and type), or worse, missed clinical cues (again, because you’re looking at your screen and not the patient).

The time you spend with your patient may be brief or long, but the attention you give them should always be intense — and your documentation speedy — not the other way around. Here’s how:

Review what led up to the visit.

Is this a follow-up from a previous visit? Check the prior Plan page or Progress Note, to remind yourself of what was supposed to have happened between then and now. (That flashback will go a lot quicker if you’re not simultaneously greeting and interacting with the patient.) Was the patient supposed to get labs or see a specialist? Pull up those labs and consult notes now — or if possible, have your staff do that in advance, so the info is at your fingertips before you go in.

Pre-state the obvious.

Some things are already known before that door opens — go ahead and fill those out in the hallway or alcove, not during precious time with the patient. A complete physical will inevitably lead to certain standard labs; a Gyn annual will require a mammogram; and both will require follow-up visits in 12 months. Click those order and appointment buttons right off the bat.

Consider documenting “by exception.”

Think carefully before implementing this method: it requires both experience and unflagging attention to use properly. All EMR’s can insert predefined normals with a single click — a normal lung exam will read auscultation this, percussion that, and palpation so on. EMR’s can also be set to fill ALL the fields on a page as normal with that click, which you can then amend with any abnormalities you find. This is more of an “advanced” technique, but it can save mounds of time if used properly.

Better Still: “Late” Is OK, Too

At the end of the visit, once you’ve synthesized the history, exam particulars, outside test results and consultant opinions into a perfectly-fitted diagnosis and treatment plan for the patient, it’s time to put it down in electrons.

Draw the visit to a definitive close. Instruct your patient to check out, or have staff come in and walk them through the checkout. Excuse yourself, then take a few minutes to make any medication or order changes that came up during the visit, and to document any other particulars of the H&P.

Hopefully, this will result in a win-win all the way around. You will benefit from shorter visits that don’t sacrifice depth or clarity of documentation. Your patients will benefit from your undivided attention, and increased focus (having more time means being less rushed). And your other patients will benefit, since you’ll be running on-time more often.