I tend to just go from room to room.
unplug my tablet and go to the next room. Probably takes me 5 seconds.
I am making a workstation outside my exam rooms as a method of testing the usefulness of my theoretical PODS.
(as outlined in my "new" office layouts).
Q: is taking a 45-90 second break between patients a good idea ? ( or should I just go from room to room ? )
IMHO, it is ALWAYS a good idea.
I usually complete the note while the patient is on the way to the checkout area.
After that, in the next 45 seconds, I review the last note (or more if necessary) from the next patient. This allows me to organize how I want the visit to go. I can go in, get to the point, let the patient speak their piece, examine them, discuss the plan, and get out. If they ask me a question, like "How is my cholesterol doing" , then I have the answer at hand. (BTW, with the portal we usually skip the 'doctor answers the lab questions' part, since they got the results on the portal months ago.)
If you will spend 45 seconds looking over the chart and preparing the visit, you will save 4 - 5 minutes of room time.
You might read a great book about having efficient office visits.
http://www.amazon.com/Extreme-Clinic-Outpatient-Doctors-Perfect/dp/1560536039/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1203741180&sr=8-1
Extreme Clinic, by Thomas Laurence MD
Reddy
William "Reddy" Biggs, MD Endocrinology Amarillo, Texas
Unbiased and independent, YES!
"Live on eClinicalWorks since 2/1/2007" http://tinyurl.com/ywqd49
reddybiggs:Extreme Clinic, by Thomas Laurence MD
Wow. Next we'll have "Agile Clinic", by Thomas Laurence!
Graham http://www.synapsedirect.com/ Synapse - the EMR for smart users
>>I review the last note (or more if necessary) from the next patient.<<
Now that is good Medicine. How many digital emr docs do that? I sadly, usually don't.
Chris Wilkerson, D.C. Carson Doctors Group TabletPCs in Medicine Editor-in-Chief www.MedicalTabletPC.com Home: www.Digital-Doc.com
Interesting. I have also noticed a decreased tendency to "look back" in the record since I started using an EMR.
My hypothesis is that it is for two reasons:
1. I feel less need to look back through the chart since I changed to EMR.
When I used paper charts, my past medical, family and social histories were contained in the initial H&P and was then spread out through the record thereafter (I did not have a written health summary), which encouraged this kind of page-flipping. My present EMR keeps all that data up-front.
2. It is more difficult to look back through the chart since I changed to EMR.
In the past, I could flip back through the record (paper chart), while my input device (paper dictation template) remained available to jot notes: the interview could continue while I absently glanced through the patient's chart and took notes simultaneously. Now, looking back means clicking on a different tab, which creates a delay, and I can't enter new data while I review the old note.
As regards Reddy's excellent policy of reviewing past notes before entering the exam room, I believe the physical layout of your clinic plays a large part in encouraging or discouraging this kind of behavior:
In the past, I hardly ever reviewed the chart before I went into the room, unless I knew I was about to face a very challenging medical problem or personality.
However, this was for primarily ergonomic reasons. My clinic, like most, did not provide a space where you could open the paper chart and refresh your memory before entering the room. The chart just hung in a slot by the door. Opening a large chart without a counter could trigger a paper avalanche. Therefore, it became habitual to enter the room, rest the chart on the counter or exam table and start flipping pages.
By the same token, I wonder how many EMR clinics have a terminal set up where you can easily review the patient's past EMR notes before you enter the exam room?
Brian Cotner, M.D. - Family Practitioner First Amazing Charts Users' Conference Branson, Missouri - June 20-22, 2008
bcmd: By the same token, I wonder how many EMR clinics have a terminal set up where you can easily review the patient's past EMR notes before you enter the exam room?
Hi Brian.
I think you are talking about my secret pods ... in my picture here.
source: http://www.emrupdate.com/forums/p/11174/78893.aspx#78893
As you can see I am planning on taking a 45 seconds between patients, in fact, I am building a room for it !
I am making a new drawing today.
These mini-pods will have 1/2 width doors so I can get in and out fast. Hmmm ... getting out will be tricky.
Great words of wisdom in this thread.
bcmd: 2. It is more difficult to look back through the chart since I changed to EMR. Now, looking back means clicking on a different tab, which creates a delay, and I can't enter new data while I review the old note.
Now, looking back means clicking on a different tab, which creates a delay, and I can't enter new data while I review the old note.
All core medical information is available in a "View Anytime" Popup in synapse.
At *ANY* time, I have access (with a function key F1-F12) the following medical information:
diagnoses, medications, visit history, last prescription, Ticklers, Previous Note, Surgeries, Vitals, PDF forms, SuperBill .. etc (too many to list)
Graham has been essentially adding popups to Synaspe as users request them.
I told Graham he should open source a few popups, so endusers can make mega popups of whatever they like !
How about a popup with
diagnoses, medications, visit history, last prescription, Ticklers, Surgeries, Vitals,
all in one scrollable popup ?
Like a mega popup !
===
I might add, these popups are zero wait popups. They appears as fast as you can press them (no database queries).
bcmd: 2. It is more difficult to look back through the chart since I changed to EMR.
Meditab's IMS has a great feature called ChartView. It gives you a good thumbnail of the patient. It gives you Face Sheet, Documents, Notes, Rxs, Dxs, etc.
bcmd: Now, looking back means clicking on a different tab, which creates a delay, and I can't enter new data while I review the old note.
The last 3 notes are always with you in Synapse.
I don't know if this is a white supremacy issue, but non-medical people for some reason often think "white" is a form of ethnicity. Perhaps it's just ignorance.
bcmd: Interesting. I have also noticed a decreased tendency to "look back" in the record since I started using an EMR. My hypothesis is that it is for two reasons: 1. I feel less need to look back through the chart since I changed to EMR. 2. It is more difficult to look back through the chart since I changed to EMR.
I agree with the first statement completely.
With eCW, it has an excellent dashboard with the problem list, meds, allergies, and I can click a tab to get the current PMH and SH instantly.
As far as difficulty looking at previous notes, actually it is in some ways easier.
I also can get to the previous notes instantly by clicking an arrow, or jump instantly to a previous visit with a simple drop down box.
It works like a CD player, click the left button to go back one, right button (not in picture) to go forward one, or select from the drop down box to go back as far as you want. Most of the encounters are labeled with the provider's initials (an option that we use since we have 20 docs) and a visit reason.
The issue of reading old notes while simultaneously writing the current one is valid. You only have so much territory on your screen.
That's a big reason I spend the 45 seconds to read the old records first to help me organize today's visit. But if I need to, I have a 2nd or 3rd instance of eCW running, and I can jump between them with an alt-tab and in milliseconds go to an old record without losing my place on today's visit.
gchiu: I don't know if this is a white supremacy issue, but non-medical people for some reason often think "white" is a form of ethnicity. Perhaps it's just ignorance.
Evidently the young men and women in Indian and the Philipines who created the demo for me are not as racially or ethnically enlightened as you. Interestingly, they are doctors and nurses, and some of the finest people I have ever met. Perhaps the ignorance is in making such a loaded statement as you did.
T. J.
It's not at all difficult to get at my old notes; I just can't take notes at the same time, as the latest clinic note is obscured while I am doing so. This is causing me (subconsciously) to be less prone to review the old notes while I am in the room.
Having noticed this subconscious tendency, I now face a conscious decision like that of Dr. Murdoch: should I take a 45-second break between patients?
I may agree that the answer is "yes", but it is unlikely that this decision will translate into reality, unless I take action and create a "review station" or "pod" such as he has devised. I may have great intentions, but when clinic gets busy, I am not going to go out of my way to review the chart outside the exam room.
The "pod" concept makes a great deal of sense. A person who has a tablet-based EMR would seem to have a bit of advantage here; all they would need is a kind of rest station to encourage review of the record via tablet.
DrMurdoch:Hmmm ... getting out will be tricky.
Two words: pocket doors!
Teejer:Evidently the young men and women in Indian and the Philipines who created the demo for me are not as racially or ethnically enlightened as you.
It's a question of education, and I see this many a time now in demo screens from various vendors. That these things are not picked up by your local staff indicates to me a lack of precision, and attention to detail.
Evidently the young men and women in Indian and the Philipines who created the demo for me are not as racially or ethnically enlightened as you. Interestingly, they are doctors and nurses,
Everyone knows that the best Phillipine trained docs have moved to the states to work lol. Ask Roger
bcmd: It's not at all difficult to get at my old notes; I just can't take notes at the same time, as the latest clinic note is obscured while I am doing so. This is causing me (subconsciously) to be less prone to review the old notes while I am in the room. Having noticed this subconscious tendency, I now face a conscious decision like that of Dr. Murdoch: should I take a 45-second break between patients? I may agree that the answer is "yes", but it is unlikely that this decision will translate into reality, unless I take action and create a "review station" or "pod" such as he has devised. I may have great intentions, but when clinic gets busy, I am not going to go out of my way to review the chart outside the exam room. The "pod" concept makes a great deal of sense. A person who has a tablet-based EMR would seem to have a bit of advantage here; all they would need is a kind of rest station to encourage review of the record via tablet. DrMurdoch:Hmmm ... getting out will be tricky. Two words: pocket doors!
I use a tablet, thus I have not been hampered by the lack of any 'pods'.
As far as pocket doors, they do save space.
I haven't had a single one that hasn't malfunctioned, jammed, or lost internal parts in an area only accessible by removing sheetrock.
For that reason, I am really sour on pocket doors.