I would love to hear how everyone is juggling the time crunch. It is still taking longer to see patients, but I have a pretty full schedule and don't want to cut back on patients. How are you handling this?
Here's what I'm doing: I'm running my normal schedule. In the morning I go over which patients I want to see on EMR, and which ones I want to use charts.
My first priorities for EMR patients were:
1- new patients (so they won't have a chart really)
2- 2 week and 2month well child visits (same reason)
Then I started expanding to other well child checks. I still haven't made my own well child templates, but I'm familiar enough with the ones that Earl and Maggie did, as well as how my routine differs from them, that I think I'm ready to dive in now. I wouldn't have been able to do that a month ago, however, and the "Tank Template" well child templates are very good. Thanks again for taking all the time to set them up!
Once I figured out how to do sick visits quickly (especially once I made some shorter exam types and my diagnosis/plan template) sick visits are actually easier for me to see.
One big problem is entering in all the past medical, family and social history. We have been working on a shorter version for Southpont (it's named Southpoint FP, toward the bottom of the categories list on the left hand side when you're in PMFSH) that will have a corresponding questionnaire to hand to patients. The idea is to have the questionnaire be identical in order to the items on the PMFSH so that an MA or a front desk person, or a provider, can quickly enter them in. We're not quite there yet, because Greenway alphabetized them, which totally changed the order. When we get that one polished, I'll share it on this blog. It will also have a Spanish questionnaire that can be transferred into the English chart.
So on some days, I've been able to crank through pretty well. Today, for instance, I saw all patients electronically (but only worked half a day due to training). I have noticed that if patients come late or if I have a complicated patient and get really behind, then I'm sunk and just switch to charts for the rest of the day.
I have also saved the box that my tablet came in to take home charts and I've finished charting some patients at home, especially so I can enter in PMFSH.
On many patients I've just entered one or two pertinent points of past history, or I've just skipped it altogether, since we still have a paper chart.
I think I"m pretty close to being able to do all electronic charts. Now watch tomorrow be a disaster:)
By the way, we had a very good training session with Nick today. We're going to work a little bit on templating tomorrow.
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3 comments:
Thanks so much for starting this blog so that we can all share our experiences. I've transitioned now to doing all of my well child visits on Greenway. I've found that my time crunch is much less significant if I have an MA working with me who is proficient at the system. When she's working with me, she has the face sheet completed, vitals entered, and my note created prior to me seeing the patient. I will them pull up the appropriate template prior to entering the room (using the tank templates based on the patient's age). I then do my best to complete the HPI section while I'm in seeing the patient. I'm slowly getting better at doing that without actually having to spend too much time looking at my tablet. After the visit I quickly work my way through the remaining screens: PE, quickly review PMFSH to make sure my MA included everything, ROS, assesment, and plan. It on average takes me about 5 minutes. While I'm in with the patient my MA does her best to enter previous immunizations into Greenway, but if she doesn't have time she does that at the end of the day. I keep a notepad at my MA station where I do my charting so I can keep a list of things I need to tweek about the templates, i.e. add order for silver nitrate cauterization to 2 week WCC template, etc.
I have yet to try to template a sick visit, but I hope to do so this week.
Have found solace in comments. I'm finding that to learn the system, you have to just grind through the program in order to learn and quickly use the navigation techniques. Biggest hang for me is looking up ICD9 codes. I wonder if the ICD9 is published on the web in a usable format? Also, it makes more sense to buy extra power cords that the docking station.
Ted Jenkins
Great point about the power cords-- my docking station never came, and I've been doing fine. Occasionally I have to plug in in the exam room, but usually I can just plug in at my workspace in between patients and during lunch.
As far as ICD-9 codes, I just do a Google search (make sure you have Greenway settings so that you can search the web from within Greenway, it's a little easier). I will type in the search window something like "limb length discrepancy ICD-9" and search-- often times wikipedia will have the codes listed. Once you have the code, it's easiest to click on the CODE dot instead of the DESCRIPTION dot, put in your code, then it should give you the code and its description and populate the left-hand window and your note.
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