Curbside Consult with Dr. Jayne 4/7/25
I spent the majority of this weekend training to use a new electronic health record system and completing practice onboarding.
I’m going to be doing some per diem work at a local practice. It is busier than it wants to be, but not quite busy enough to support adding an additional physician. The practice needs additional coverage, especially before and after their physicians have scheduled vacation. Those are windows of time that usually end up overbooked, as physicians struggle to see people before they leave town or face an overloaded schedule when they return.
They are also looking for inbox coverage and possibly some acute care coverage during the vacation. It’s an ideal scenario for me because the physicians typically schedule their vacations six months in advance. That gives me plenty of lead time to build my consulting engagements around those weeks. I’ll also be doing some coverage here and there during the intervening months to become familiar with how the office runs.
The practice uses a fairly well known EHR. They signed me up to watch some online training modules first. I’ve used so many different EHRs over the years that I didn’t expect anything earth shaking as I sat down with my laptop and a nice cup of tea.
The first thing that struck me as I logged into the learning management system was that they had assigned comprehensive training to my profile, which included a broad swath of specialties that I don’t practice and won’t be covering. I called the office manager to make sure that this was intentional since family medicine uses a lot of the subspecialty templates. It wasn’t immediately clear whether that choice was made by the office or the EHR vendor.
Since I was being paid for the full time that was needed to cover all the assigned courses, I didn’t want to spend more time arguing about it. Not to mention that I figured that it would be a great way to see what vendors are developing and whether there’s anything new.
I had the practice’s training environment open while I was watching the modules. I have found that to be the easiest way to handle content, such as personalizing the physician workspace or setting up medication favorites. I learn by doing, so I was surprised that following the prescribed learning plan meant sitting through almost 90 minutes of content that didn’t contain anything that was remotely interactive. It reminded me of the old-school training I used to see when I was first doing informatics work, with a deluge of material that just droned on and on.
I’ve had enough experience working with people who are well versed in adult learning theory to know that this isn’t ideal. The voiceover for the training almost lulled me to sleep several times. I decided to switch from tea to my favorite coffee concoction, which is jokingly referred to as rocket fuel by those who have sampled it.
I have to say that this level of caffeine jolt was sorely needed. I ended up having to wade through specialty documentation with no way of fast forwarding or indexing to the part covering templates that would actually be of use to me. For example, the OB/GYN content wasn’t subdivided by template or visit type. I’m not going to be doing any obstetric visits, but do need to know what content is available for acute GYN problems.
I ended up just letting the video run its course and randomly surfing through the content that was available in the training environment, learning in a more hands-on way. I’ve done enough locum tenens and per diem work over the years that if I can document my top 15 most common visits, I’ll be good to go for at least the first day and will eventually pick up the rest of the workflows I need to know.
I was somewhat surprised when I arrived at the coding and billing part of the documentation template. It didn’t seem to be taking into account the newer coding guidelines that went into place a couple of years ago. The suggested codes were easy to override, but it gave me a bad feeling about the vendor in general, as if they weren’t keeping up with the times.
I couldn’t figure out how to see what version I was using or when the last update was, so I jotted those down as questions for my next conversation with the office manager. It also didn’t look like the Health Maintenance guidelines were totally up to par, because the recommendation for RSV vaccination for non-elderly adults wasn’t current, either. That’s a newer item, so I could see how it might be coming in a future upgrade, but not having it in the reminders would be a bit of a pain for clinicians.
Day 2 was filled with completing all the practice’s HIPAA, Conflict of Interest, Ethics, and Fraud / Waste / Abuse training. I’ve done so many of those over the years that I can just about recite them. I can also generally predict the clinical scenarios that are going to be used. As someone who has worked in so many different places, I have a dream of a training passport that would exempt people from having to do the training at every new place, but I know organizations like to put their own spin on training.
I’m always on the lookout for a module that will top the wildest one I’ve ever seen, which I had the pleasure of watching when HIPAA first came out. It was a badly acted video with mafia overtones, kind of likening the idea of violating HIPAA to a brush with organized crime. It was so bad, but so attention getting, that nothing has really topped it yet.
I also had to fill out a ridiculous amount of credentialing paperwork, which I haven’t had to do in a number of years. Fortunately, I had a copy of the last packet that I had to complete, so it was straightforward. although tedious. Once I turn that in, they’ve assured me that I will be granted access to the production EHR. Then I can see what’s really in there and start the process of making sure that I have all the shortcuts enabled that I can, such as medication favorites, quick phrases, and other preferences.
It’s always fun to get those things set up. It reminds me a bit of getting your backpack ready for that first day of school. Even though it’s not as cool as a 64-pack of brand name Crayola crayons, I’m pretty hyped about going for my first day. We’ll see whether the reality meets the expectation in a few weeks.
What’s your favorite “first day of school” memory? Leave a comment or email me.
Email Dr. Jayne.
The primary point of using the Cloud is using operating expenses vs limited capital ones and avoiding having to update…