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EPtalk by Dr. Jayne 5/25/23

May 25, 2023 Dr. Jayne 2 Comments

A recent article in the American Academy of Family Physicians’ journal FPM summarized “Clinical Workflow Efficiencies to Alleviate Physician Burnout and Reduce Work After Clinic.” The first of their four suggestions was for EHR users to make use of macros and defaults in their systems so that they can easily insert content into their visit notes.

I continue to see physicians who won’t take advantage of basic system personalization. When I was in traditional primary care practice, my goal was to be able to do visits using as few clicks as possible and there’s no way I could have been as fast as I was without defaults for common physical exams and orders. It’s still difficult for me to understand the psychology where a user will waste time visit after visit, day after day, week after week, but won’t spend 90 seconds to create a default. The article even includes a link to a blog with a starter list of EHR macros for those who might have users who are reluctant to take steps to make their lives easier.

One of their other recommendations was to “consider cutting note bloat by writing in short phrases rather than full sentences and including only what is essential.” My first EHR made it easy to create notes in a format that was more akin to a bulleted list than beautiful, flowing prose. For many, reading a list like that is easier than reading a block of text, so I agree that it’s a valid strategy.

They also go on to mention that the EHR should be used as a database and not as a way to recreate the paper chart. Providers are encouraged to ask for help and to take advantage of organizational resources such as clinical informaticists, or even to get help from more efficient colleagues.

Even as a CMIO, I’m always willing to sit down with our clinicians to coach them through more efficient workflows. One of my early clinical informaticist roles involved implementing some challenging users. I miss the days when I could work with them and watch the proverbial light bulb go on when they had figured out how to breeze through their visits.

Many of the organizations I work with are big on telehealth, and I hope all organizations are making their plans to move to HIPAA-compliant telehealth technologies now that the public health emergency has ended. Organizations have had three years to move to compliant tools, but there are always going to be groups that wait until the bitter regulatory end before they do the right thing for patient privacy. The Office for Civil Rights is providing a 90-day grace period, but penalties for HIPAA violations will resume on August 10.

In the interim, organizations should look at their telehealth programs and technology, conduct a risk assessment, and confirm that they are using HIPAA-compliant tools. I suspect some purchases may be on the horizon and can imagine some vendors salivating at the organizations that left their transitions until the bitter end.

From Jimmy the Greek: “Re: marketing. Check out some of the language on this corporate website. ‘We create value by making sustainability an integral part of our vectors of superiority.’ There’s also ‘Improving lives for generations to come with irresistible superiority that is sustainable.’” Wow.” Any time I see the word “vectors,” my infectious disease brain immediately thinks of rats, flea bites, ticks, and other disease vectors. These linguistic gymnastics are found on the Procter & Gamble investor site, which is an otherwise interesting read if you’re so inclined. Given their product lines, I suggest that P&G might be better served by a tagline such as, “Assimilation through personal care, one buzzword at a time.”

Speaking of buzzwords, I’m currently disliking this one the most: omnichannel. The way I keep seeing it used, it falls squarely into the “I do not think it means what you think it means” category more often than not. I’ve also recently run into a resurgence of “circle back,” which I think should be eradicated from the business lexicon, along with “synergy,” “new normal,” and “out of the box.”

I had a visit at my primary care physician’s office this week. I scheduled it online and had my choice of a next-day visit that didn’t work for my schedule or one the following week, which I booked. Online check-in was a breeze, and the patient questionnaire related to my issue was easy to navigate.

The only blemish in the workflow was when the medical assistant had to free text every field when documenting my vaccine administration. At a minimum, I would have hoped the EHR would have had a vaccine inventory management system that would have presented things like the lot numbers and expiration dates as dropdowns or pick lists to help reduce errors and manage inventory. Even the site had to be free texted despite the fact that there are generally only six places on the human body where intramuscular injections are administered. She also had some kind of paper sheet that she was performing dual entry on, so I’m not sure what was going on with that and was afraid to ask.

When I arrived home, I was pleased to see that my patient-visible note contained an accurate History of Present Illness and that the exam matched what was actually performed, which is a big contrast to a visit I had with a specialist in the group last year. However, as I was reading my note, I realized that they never asked to collect my co-pay. Since they’re owned by my former employer, I know that collecting the co-pay at the time of service is a requirement. It’s also an industry best practice that everyone should know about. It helps avoid statement costs as well as the risk of never receiving the co-pay.

This means that I’ll get an annoying statement in the mail (I haven’t been able to turn off paper statements despite trying) and then have to go online and make a payment. Usually, I don’t receive an electronic statement notification until after the paper one has arrived, which seems to be a less than optimal way to configure your revenue cycle.

What makes you cringe when you visit a healthcare facility and see that best practices aren’t being used? Leave a comment or email me.

Email Dr. Jayne.

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Currently there are "2 comments" on this Article:

  1. I just made an interesting connection.

    What is one of the classic patient resistance problems doctors face when advising an overweight patient?

    “Help me Doc, I’ll do anything!”
    “OK, go on a diet and exercise more.”
    “I mean, anything but that!”

    It’s psychological, and self-sabotaging. Well, physicians who resist implementing workflow optimizing techniques with their EMR, are doing the same thing. It’s psychological, and self-sabotaging.

    “I hate this EMR, why does it suck so much?”
    “You could implement some macros for standard procedures and findings. It’s quick to set up and has a big payoff.”
    “Hey, look, it’s been nice talking but I have to go right now!”

  2. I want to start off by saying excellent content and to continue with that theme I feel organizations should implement as part of the Provider on boarding process, set aside time to build those macros and teach them how to create their own smart text/documentation enhancement tools. This would give them an opportunity to the benefit from the enhancement. Some new providers actually bring a word document with their preferred reporting content ready to be cut and pasted into their smart text.

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