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Curbside Consult with Dr. Jayne 4/7/14

April 7, 2014 Dr. Jayne 3 Comments

I renewed my battle today with Big University Medical Center in trying to get my information corrected on its patient portal. Unfortunately, my efforts were derailed by a much more sinister problem – basic office chaos.

Luckily I’m a nice, stable patient so I only have to visit Big University’s outpatient clinic once a year. They run chronically late. I’ve learned to always schedule the first appointment of the morning so I can have a chance to make it to my own office before noon. I make sure to arrive on time if not early because they tend to triple (if not quadruple) book appointments and I want to be the first of the cohort to be roomed. I also bring plenty of reading material so I don’t go out of my mind when I inevitably end up waiting.

I shared the elevator with a member of the office staff who was reviewing a printed patient appointment schedule (including names, appointment reasons, and dates of birth.) I’m not sure why anyone would need to take home a printed schedule since they have a big-time EHR system with remote access and plenty of redundancy and they definitely shouldn’t have been reviewing it openly in the elevator.

I hit the floor 15 minutes early (as instructed by my appointment reminder that came through the patient portal) only to find the doors locked and six patients standing in the hallway. The weather was decent, so bad roads or traffic weren’t a viable excuse. They finally opened the doors just a few minutes before my appointment time and all the patients hustled to the check-in desk.

Since the office doesn’t use sign-in sheets (purportedly for HIPAA purposes) they told everyone to sit down and they would call us up in appointment order. Most of the patients were retirees and began grumbling. While we were waiting, we were treated (via the open floor plan check-in desk) to one of the receptionists chatting about some birthday party she was invited to.

By now, it was past the first appointment time and we got to watch her start up her computer, stow her personal items, then walk away. 

My process improvement brain had engaged. I decided to do an impromptu time and motion study. She was gone four minutes and came back with an open cup of coffee. I know there are no OSHA requirements about coffee at a desk, but there ought to be some rules about open liquids and eating around computers. Not to mention that slurping coffee in front of patients is unprofessional. 

The first receptionist had checked in two patients and had called me up before the second one was ready to start working. The receptionist apologized about my wait. I mentioned that their reminders tell everyone to come early. She said she knew it was a problem and they’ve asked to have the message modified several times because they don’t open early. They didn’t have a printed patient information form to verify, but rather read all our demographics aloud and asked for verbal verification.

I felt bad asking her about my patient portal problem and spared her the long story. I simply asked if they had a help desk number I could try before I left the office since all the demographics are correct at the practices where I’m seen but are wrong on the portal. The only advice she could offer was to try the help feature from within the portal.

By this time, they had four patients checked in. It was 15 minutes after the first appointment time (assuming I was actually in the first slot as I had requested) and not a single patient had been called back by the clinical staff.

I was placed in an exam room with the door left open. While waiting for the patient care technician to start my visit, I was treated to conversations about other patients coming later in the day, various people walking back and forth chatting about their weekend activities, and a physician who normally doesn’t work at the satellite location who didn’t know what exam rooms he should work from or who his assistant would be. Not exactly a vote of confidence for patient privacy or engagement.

Last year my physician had used a scribe to document my visit in the EHR. I figured at least once they would try to blame the EHR for the delays. As they started my visit, I realized they wouldn’t be scapegoating the EHR – the office had gone back to paper. The tech started documenting my visit on a photocopied paper template. She did reference the electronic allergies documented in the EHR and re-documented them on paper, so score one for patient safety. She also reviewed the previous note input by the scribe as well as a “backup” paper note that apparently was documented during my last visit.

I let her know I wanted to talk about a new concern that popped up in the three months I waited for my appointment. She responded by letting me know my physician was no longer caring for “routine follow up” patients and I would have to find a new doctor if the new concern didn’t turn out to be anything serious. I’ve already been handed off multiple times within this practice, so I’m no stranger to starting over, but I thought the timing was poor.

I finally saw the physician 45 minutes after my scheduled appointment. She remembered that I’m a member of the community teaching faculty for Big University and offered to keep me as a patient even though my new concern turned out to be nothing. I should probably feel grateful to not have to change physicians again, but I think I’m going to anyway. Their office is a mess and I get aggravated every time I go. Simple things like a) cutting the personal chatter while there are multiple patients waiting; b) being vigilant about behavior when the practice has an open floor plan; and c) manifesting obvious “hustle” when you know you’re late opening would go a long way towards reducing that aggravation.

Now they’re not using EHR any more, so my data isn’t available to share with other physicians. There’s not an advantage of staying there vs. finding a physician at one of the other institutions in town. If my records are going to be in silos, it doesn’t really matter if the silos are 20 miles apart or right next door. The clinic always posts a loss and blames it on the number of Medicaid and charity patients they see, but after several years of this routine, I’m fairly convinced that poor management has as much to do with it as patient mix.

I’ve never received a patient satisfaction survey from this location, but hope I get one today. I’ve got some choice recommendations to share with them, although I don’t think it will make much of a difference. It doesn’t matter how much we spend on IT or whether the systems have outstanding usability if we can’t get back to the basics and actually manage our offices, whether they’re academic clinics, private practices, or hospital outpatient departments.

Making sure that IT functions support our mission by synchronizing automated reminder messages with actual office practice, having help desk support for patient-facing systems, and ensuring staff come in early enough to turn their computers on before they start assisting patients are a must as well. There are numerous stressors on all our healthcare systems and personnel. We have to come up with ways to fix them.

Have any creative ideas? Email me.

Email Dr. Jayne.

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Currently there are "3 comments" on this Article:

  1. Delicious anecdote. I am always appalled when I get to hang up the stethoscope and be a patient. The system inefficiencies are astonishing enough, but what’s really amazing is the utter disregard for the compliance rules that I must enforce once I take off the patient gown and resume the CMIO role.

    Last year I visited a specialist for a routine follow-up visit. Long before the physician phase of my encounter, the nurse (I checked–she had “RN” on her badge) asked me if I wanted a re-order on my medication. I figured she was going to tee it up for the provider. I figured wrong. I told her I thought I would probably be continuing the medication, so she pulls up my record in the EMR, hits “order” on the screen, enters the name of the doctor, and presses “Sign.” She announces, “It’s done; it should be waiting for you at the pharmacy.” Really? With no intervention from the doc? No write-down-read-back? Not even an informal verification with anyone licensed to prescribe? What planet had I landed on?

  2. When I reach this level of unacceptable customer service in any business I make every attempt to reach the VP of the division to share my thoughts for improvement. If you do not think that level of management does not care about your experience, definitely time to move on.

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