4 Hidden Bottlenecks in Your Practice: How to Banish Them

Leigh Page

Disclosures

July 17, 2018

In This Article

Dealing With EHR Data Entry Requirements

2. EHR Work Slows Down Your Day

The bottleneck: Physicians are forced to spend too much time documenting patient information into their EHR and, as a result, are constantly falling behind with their work and their schedule.

"This situation is not sustainable," Brown says. "Doctors are taking their documentation home—and on weekends and even vacation. It's called 'work after work.'"

Solutions

Make changes in the way you manage your inbox. For example, EHRs often direct all messages to the doctor's office directly to the physician's inbox as the default destination, Brown says.

The STEPS Forward in-basket module shows practices how they can customize their EHR inbox so that specified messages are rerouted to a pool of people on staff. This may require using IT personnel to alter the defaults.[3]

Messages that don't need to go to the physician include daily progress notes for hospitalized patients; nurse visit notes for preventive care; routine physical therapy progress notes; test results ordered by consultants; previsit labs; and refill requests, according to the module.

Use nonphysician clinicians to enter information into the EHR. Physicians get bogged down with EHR work because they think they need to enter all of the information personally.

Brown says much of the work can be done by staff. "We wouldn't expect a lawyer who is trying a case to document what is happening in the courtroom," she says. "There's a court stenographer to do that."

Medical assistants and other staff will be able to enter information accurately and efficiently by using customized EHR templates written by the doctor. (Installing templates may require working with the vendor.)

"My templates each focus on a chief complaint, providing questions in dropdowns with space to fill in answers," wrote R. Scott Eden, MD, a family physician in Maryland, in an article in Family Practice Management.[4]

Consider hiring scribes. Hiring staff specifically to input information in the exam room is especially useful for physicians who are poor typists or want to deal more individually with the patient in the visit, says Laurie Morgan, a senior consultant at Capko and Co. in San Francisco, California.

Some physicians wait to enter the data after work, but it's hard to clearly remember what transpired hours earlier, Morgan says.

Scribes can speed you up. A 2013 study reported that use of scribes increased the number of patients physicians saw by 60% per hour.[5]

Include the patient in the EHR entry process. Brown says having the patient watch as she enters EHR notes can reduce errors as well as enhance patients' involvement in their care.

When she types in notes in the exam room, Brown asks the patient to sit next to her so that they can both look at the computer screen. "This way, the patient can make sure I captured the information correctly," she says. This eliminates having to make corrections later on.

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