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Has anyone in primary care been able to perform and document office visits faster with EMR than with paper and dictation? I can't do it. I have tried Amazing Charts (with Dragon), e-MDs with tablet computer in the room. I prefer EMR, do better care, code higher levels, keep better records, but I struggle to get done by 6:30 pm, seeing 20 patients per day. I currently use Amazing Charts, using Dragons, template macros. I think some of my problem is that I am the only person in the office using AC - the rest are on paper charts (it's a complicated practice ownership setup). I think if the MA was entering vitals in the room typing in some hx, reconciling the med list, I would have less to do. Is the key to speed completing the note in the room? If so, I would have to use a keyboard with AC, as it doesn't have good point and click templates like e-MDs. When I used e-MDs (2005), I found myelf adding significant Dragon input into the HPI, such that the point and click method offered only modest benefit, especially with multi-problem complex encounters.
Anyone using an EMR that shortens their day?
Toby Lindsay MD Cashiers, NC
That depends on whether you are asking both the paper based user and EMR user to deliver the same level of documentation.
You also need to factor in the time to retrieve the notes, especially for patients who aren't scheduled ...eg. phone calls.
I got a call while I was in clinic the other day from the resident at a hospital from another city to ask about one of my patients. She had become dehydrated, and encephalopathic probably from infection, and they had no information on her. I was able to instantly bring up her notes as I was speaking to him, and then fax all the past years results ( flow chart) as well as my last letter to her GP to him within a few minutes of hanging up. The patient's relatives called me later on to thank me for promptly responding to the request for information. Just not going to happen so quickly with paper charts.
Graham http://www.synapse-ehr.com/ Synapse - the EMR for the superior physicianhttp://www.onhealthtech.com/Health Tech Discussion Board
I can't speak for the original poster, but as a doctor I would want to get home to see my family. My costs are mostly fixed. Currently, without an EMR, I need to see about 15-16 patients per day, just to cover those fixed costs. I only earn money based on those patients after 15-16. So, if I see 20 patients, I am not doing all that well. If I see 25, I doing OK. Seeing this EMR user barely manage to see 20 patients is very discouraging, epecially since an EMR only increases my fixed costs.
The purpose of the chart is to communicate into the future what was done and why during that patient interaction. We routinely see EMR notes that include all sorts of extraneous details, such as "no postmenopausal bleeding" mentioned in the ROS on a pharyngitis visit. More documentation is not necessarily better.
I have a long history as a computer nerd, but I don't want to severely impact patient flow (and income) just to use computers. This doctor's plea turns me cold.
martalli: I have a long history as a computer nerd, but I don't want to severely impact patient flow (and income) just to use computers. This doctor's plea turns me cold.
I see patients from 9:00 to 4:00, with 30 min for lunch. EMR doesn't impact my flow - I use my computer in my office only (no patient there). I see patients first, and chart mostly at the end of the day. That is my question: Is it more efficient to "chart as you go" with EMR, and has anyone actually proved that it is faster to do this with EMR, than with paper/dictation? If so, how does one do that using Dragon for most of data input? I have considered wireless blue-tooth headset with computers in the exam rooms, or a moving laptop, but I think that would impact patient flow, or just look geeky.
I think the first few months it is slower. Thereafter it is the same within the first year. Now I noticed I am able to see more and document faster. But my baseline before all these was I tend to dictate long notes. Usually are redundant. To shorten the note I undercoded.
If you have a system and assuming the EMR you have is flexible and mirrors your systematic trend of thought and also the 3rd party payors trend of thought an emr can be a secret weapon and makes a difference between thriving and surviving. Sadly some actually fail which I define as relegating now to administrators and being employed on a system. What is interesting is that eventually these independent groups that sell out eventually use an EMR and seem to feelit is working for them - strange.
I have discussed this ad nauseum and and use the term LONGITUDINAL DOCUMENTATION and I am glad Lowell is also using this term, is the key and such evolution of individual cases especially in Primary care should be efficiently be deposited in one area of an EMR - called PATIENT SPECIFIC INFORMATION in my EMR and can easily re use, re build/reorganize such information. The pundits call it medical home I called it all these years my ROAD MAP. Stating REVIEWED is a nightmare, as when I admit for the traditional MD's like the above posters that uses paper, I end up tracking the whole chart, all 2 to 5 volumes, only to find a lot of things lost in translation. A CVA rule out became CVA, an MI rule out was not an MI. These information are critical.
Now I can work non stop as the beauty of all these is that all the noises are taken off my shoulder and can concentrate on the patients needs, while I also meet the useless bullets established by 3rd party payors.
In addition to saving me time and appropriately coding I can expound on BY THE WAY issues, like a complicated case of Diabetics, with CAHD, HTN, Hyperlipidemia, Hypothyroid etc, that tells me also needs a preoperative clearance.
So in summary after my long dissertation, yes I am faster with emr. I will soon use it for progress notes in the hospital. Takes much longer to dictate and write
Roger Ven Torres, M.D. http://www.wapcp.org/ Praxis user since 2000
martalli:I can't speak for the original poster, but as a doctor I would want to get home to see my family. My costs are mostly fixed. Currently, without an EMR, I need to see about 15-16 patients per day, just to cover those fixed costs. I only earn money based on those patients after 15-16. So, if I see 20
That sounds crazy.
I only need to see one follow up patient a day to cover my costs. But then I'm not supporting a receptionist, typist, nurse or landlord.
As for the original question, with an EMR you can go home and finish your documentation there if you have remote access or EMR as SaaS. Who wants to carry a bunch of notes home with them?
Guess what is interesting with respect to speed? The Database.
Chris Wilkerson, D.C. Carson Doctors Group TabletPCs in Medicine Editor-in-Chief www.MedicalTabletPC.com Home: www.Digital-Doc.com
digital-doc: Guess what is interesting with respect to speed? The Database. Heres another variable: The number of patients.
Heres another variable: The number of patients.
gchiu: That sounds crazy. I only need to see one follow up patient a day to cover my costs. But then I'm not supporting a receptionist, typist, nurse or landlord.
Do you work out of garage like Dr. Huxley on the Cosby Show? I am in a rural health clinic with three doctors and a nurse practitioner. We bought our building last year and have about 20 years of payments on the mortgage ahead of us. We also have about 13 employees. Our overhead is about 50%, which is comparable to other practices in the US.
I can see the benefits of a bare-bones practice. However, you should consider that if your are making $30/hr or $60/hour to see patients, it might be better to pay someone $12 and hour to make call backs, etc. It avoids interruptions and allows you to focus on what is actually making money. Since your profile says you are in New Zealand, you are probably practicing in a very different environment regarding how much reimbursement you get and what you are reimbursed for. We get nothing for call backs, telephone visits, or filling out paperwork (at least in general).
Whatever you think of our setup, we are a very typical American practice, or at least very typical for an American rural health clinic.
I'm not a doctor, so this is not first hand experience, but here is what I observed over the years:
In summary, I have never seen a doctor being able to see more patients because he had an EMR, but I did see folks going home at a reasonable hour with all the documentation completed for the day.It usually takes a year or more, if you are lucky, to get to this level of efficiency. Initially, you will either see less patients, work longer hours, or have lots of incomplete documentation.
If the EMR is really good, it will save you time in different ways. Things like calls to pharmacy, excuse notes, physical forms, patient letters and all sorts of administrative things you do today can be automated and delegated. But the time spent with and for each patient is not likely to decrease, no matter when you actually complete the chart.
Margalit Gur-Arie
On Healthcare TechnologyHealth Tech & Policy Bloghttp://www.onhealthtech.com/Health Tech Discussion Board
After the first month with my EMR I was seeing an average of about 4 more patients a day with no increase in staff. After nine months I decreased staffing. Now, a little over year after starting with the EMR (seven years after starting practice) I still see opportunities for more productivity. On a full day I usually see 28 to 32 patients. My EMR paid for itself the first year. I type poorly and don't use Dragon but do have a great team and a nice integrated EMR that saves time in lots of little ways. There are lots of success stories and plenty of failures with EMRs. Find an office like yours with an EMR success story and copy what they do. In my case, a local vendor provided great support and made a big difference. Failures happen for many reasons and often have little to do with software you choose. Having a staff that will work with you can be half the battle. Being totally committed is a big stumbling block for many offices. On day one, I told my staff I didn't want another piece of paper put in front of me and we went from there to a great year. To make sure it happened we scanned every page in the historical charts, etc - all without ever adding any more staff. I'm looking forward to great second year.
Great categorization! Our neurologists send reports that start with the templated hx (they use Healthmatics EMR): "The pain is dull. Occurance is constant. Relieving factors: rest, meds." Then the HPI abruptly switches to an obviously dictated (or typed) free for narrative that is a real history.
As you note is example #1, the key to completing the note in the room seems to be good point and click templates. e-MDs has the best point and click templates I have seen, especially for the HPI.
HuntsvilleDoc: Find an office like yours with an EMR success story and copy what they do. In my case, a local vendor provided great support and made a big difference.
Find an office like yours with an EMR success story and copy what they do. In my case, a local vendor provided great support and made a big difference.
HuntvsilleDoc - Could you specify what EMR you use, and who is your vendor?
martalli: Do you work out of garage like Dr. Huxley on the Cosby Show? I am in a rural health clinic with three doctors and a nurse practitioner. We bought our building last year and have about 20 years of payments on the mortgage ahead of us. We also have about 13 employees. Our overhead is about 50%, which is comparable to other practices in the US.
Funny. Since you purchased your building, you are acquiring an asset so that's not the same as a fixed lost cost.
I decided years ago I'd prefer to work fewer hours and keep the overheads down to absolute minimum.