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Your time is in short supply and high demand. One way to manage: A smooth and flawless workflow. Here's one physician's successful process.
Our time is in short supply and great demand. We all are feeling the increased pressure to see more patients at a time when reimbursements are falling. Managing our time remains one of the pervasive challenges facing us. We need to improve our office efficiency more than ever to be able to deliver quality care to our patients.
Because a physician's time is of utmost importance to the productivity and profitability of a practice, we need to make our systems as efficient as possible to see the necessary number of patients to make a decent living. I believe efficiency embodies creating a smooth and flawless workflow. And one of the most important goals of this workflow is to allow more direct patient time, thereby improving the quality of the patient visit and likely outcomes of treatment.
In my practice, we have instituted a seven-step process that has improved my productivity by approximately 25%. The use of an electronic health record (EHR) system has been an invaluable asset in my ability to improve productivity and profitability.
This system is equally effective om a primary care practice or emergency setting:
The patient enters the practice and registers with the front-office staff.
The front-office staff members begin the process of verifying the information supplied by each patient. This verification process includes a review and update of all demographic information, insurance, identity, preferred pharmacy information for e-prescribing, and collection of the co-pay.
This step is very important because it also begins the process to ensure data accuracy. We ask for photo identification to confirm a patient's identity. We have found that conducting this step in the office rather than on the telephone, while scheduling an appointment, helps us catch and correct inaccurate and outdated information.
3: Obtain vitals
When a patient first enters the clinical area of the practice, the nursing staff begins to gather data for the examination including a patient's vital signs: weight, height, temperature, blood pressure, and pulse.
4: Data entry
Once a nurse enters the exam room, he or she opens up a new note within the EHR to document the patient's chief complaint, history of present illness and his or her past medical history, including surgical and social histories, review of medications, allergies, and immunizations. At this stage, my nurse also will check on the status of existing prescriptions. If a refill on a prescription is needed, the nurse will begin the process so the e-prescribing step is ready before I begin the patient's assessment.
Throughout this process, my nursing staff and front-desk communicate with me via instant messaging (IM), which has dramatically improved our efficiency as a healthcare team. I can move from patient to patient. I don't have to leave the room to pick up my messages throughout the day. I don't have to have a nurse or front-desk staff member knock on my door and disrupt the patient flow. I may receive an IM asking for my guidance on a patient calling in with chest pain. Or I might get an IM from my nursing staff about a patient's question/concern before the examination. This improvement also helps us manage the volume of questions that occur each day without interfering with this patient flow.
5: Physician examination/assessment
The patient is next moved to an examination room for the direct patient/physician contact. During this phase of the appointment, I interview the patient and use this step to re-verify, through an EHR, all of the data that have been collected, including the chief complaint and history of present illness. It gives me the opportunity to review lab work, medication histories, complete the review of systems and physical examination, and build a treatment regimen. I take this time to evaluate the patient’s response to certain medications, and it’s also a time to educate the patient about particular diseases such as diabetes, hypertension, or obesity.
Medical issues can surface during this phase of the examination simply because the patient doesn’t feel comfortable talking about the problem/complaint with the nurse. I can easily update the EHR with this new information and talk further about his or her medical concern.
Having so much of this patient’s information gathered before the examination/assessment has dramatically improved the bottlenecks that can typically occur within the workflow of a busy practice. Even more importantly, these changes have improved the quality of time I spend with patients.
Once the patient leaves the examination room, discharge instructions, orders for lab work and other diagnostic studies, and educational material are all printed out. Through e-prescribing, a patient's medications can be sent directly to the patient's pharmacy. In my practice, we have created a discharge-planning page in the EHR. We use it to prepare packets of educational materials for patients that might address conditions such as hypertension, hyperlipidemia, or diabetes, and assembling patient education materials used to be time-consuming process that involved the retrieval, review, and copying of all these documents. Now everything is prepared and printed out at the front-desk during discharge.
The last step of the appointment includes scheduling follow-up appointments or referrals.
As a physician in practice, I think we should all take a critical look at improving our workflow. There is no question that the evaluation and end-result has improved our system to deliver quality patient care. And that is really what it is all about.
The author practices internal medicine in Youngstown, Ohio, and is a clinical assistant professor of medicine at the Northeast Ohio Medical University, Rootstown.