OK, well your flow is like mine in many ways with a few major differences. I also use a pre-printed superbill from my PM program.
Consider this:
As soon as you get the referral from your referring doc, ask them if they would fax all the demographics/insurance info and any other info they might have, such as their last office note, to you (We do this routinely and, as we already have everything in AC it is very easy for us to comply).
Then, have your front office person enter all of the demographics into AC and your PM before the patient ever arrives (if they do not show, simply inactivate them). She can also go ahead and import the labs or xrays that may have been sent by the referring M.D. She can also import the referring doc's note into, say, "Incoming Correspondence". Their superbill is then ready to be printed out the day of their appointment. Perhaps this is work that could be done while you are in surgery and not in the office.
When the patient arrives, have them sign their superbill (allowing you to bill their insurance), have the front office person confirm their demographic and insurance info, collect their copay,marking it on the superbill, scan their driver's license and insurance cards, ask them to complete your history form and hand the superbill to the back office person.
That person then rooms the patient, taking their history sheet with her. She opens their chart, collects vitals, completes the Chief Complaint (e.g. Evaluate Gallbladder, referred by...) and then, using the history form that the patient completed, enters current meds, allergies, PMH, etc. I have templates made for PMH, SH so that it is easy for my staff to simply enter the information where indicated. They then forward the chart to you. All of this is going on while you are in another room seeing another patient.
You enter the room, see the Chief Complaint, and open a template such as "Gallbladder, NEW"
in the History section, add or delete pertinent info, then review the info entered by your MA/nurse/person off the street trained by you.
Then go to Physical Exam and open your template (Normal Exam?) and add or delete info where needed. Then to Assessment where your codes are selected.
Then, under "Plan", open a template for Gallbladder which delineates the fact you have reviewed the labs and xrays, discussed options with the patient, and devised a plan, e.g. schedule for cholecystectomy at what ever hospital.
Fax any scripts or adjust any meds you want to give now.
If you have more orders, do them now so they show up in your plan. Tell, don't ask, your hospital that this is the way they will be receiving lab and xray orders from you. If they do not like it you will refer your patients elsewhere as you are not going to keep track of separate forms for every lab in town. If they need triplicates, they can copy them there. I developed lab templates which include the CPT codes for each test or panel(which I took from existing lab forms from the hospital). You can either print out these orders for the patient(as I do) or go ahead and fax them wherever.
Then, sign and save this note...YOU ARE ALMOST FINISHED!! Forward back to the front desk. Staff then get the note, know what to schedule before the patient ever leaves the room.
Next, finish the superbill which is in the room with you, take the patient to the front desk, tell the scheduler to schedule a cholecystectomy...blah, blah, blah.
The front person then schedules the surgery (or other xrays/studies), prints out an instruction sheet (which is stored on her desktop or somewhere. In my case, it is stored in Paperport. They duplicate it, put in the name,date,time, etc) and hands it to the patient. She then puts the patient in the AC schedule denoting the date/time/hospital/surgery and the patient leaves. She then faxes your note along with a standardized cover sheet saying something like, Dear Dr. So and So. I had the privilege of seeing your patient, Rotten Gallbladder, on this date. My assessment follows. Thank you for your generous referral.
Sincerely,
Dr. Travis
She then forwards the chart back to you.
Then at the end of the day, perhaps you make an Addendum with the heading "Hospital Orders", open a hospital orders template, fill in anything unique, such as "Notify Dr. So and So", and save. Then open the letter writer, delete the "Dear" heading, put in your note to serve as your H&P, delete the "Sincerely" and fax both to the hospital, save and YOU ARE FINISHED!!!
For the most part, I will have completed all my hospital work before I leave the room with the patient. But, most of my hospital admission go straight from my office to the hospital. And, as I use a hospitalist, the orders need to be there when the patient arrives.
Now, as far as follow ups, this is easy as you already have everything mostly already in place. Staff rooms the patient, puts in Chief Complaint "FOLLOW UP CHOLECYSTECTOMY", you open your "Post Cholecystectomy" template, add/delete info, open Physical Exam Template (The wounds are healing nicely without any redness or purulence. Sutures were removed blah, blah...)
Put in your Assessment, Go to Plan and open your template "Post Cholecystectomy" (The patient was given ongoing wound instructions and was asked to call us if any redness, purulence or other problems arise...blah, blah...I will be happy to see the patient back if needed in the future.) Fax with coversheet to referring doc and you are done.
Anyway, just some thoughts. I wish you could experiment with your work flow and see if you cannot complete your notes while in the rooms. If you can manage to spend some time up front developing templates, this will help you a lot on the back end.
