Bert: My main front desk person takes vitals and rooms the patient. My other front office person schedules surgeries, fills out lab slips/radiology sheets, does the financial part if needed, talks to the patients about the day of surgery, etc.
Leslie: Thanks for all of that thought and energy! Holy cow. Some great ideas. I would love to have my charts done by the end of clinic. I don't know if my obsessive compulsive nature will allow it completely. I schedule new patients for 20 minutes and follow-ups for 10 minutes. So a complex new patient will obviously take longer than 20 minutes. The problem is that I absolutely am psycho about seeing patients at their schedule times. If I get behind 15-20 minutes I'm not a happy camper. There is nothing I hate worse than going to a doctor's office and sitting for hours waiting. I don't want my patients to have to do that either. I also don't want to make new patients 30 minutes just because of my EMR.
The problem is that I only have 2 employees. If I come out of a room and have one person scheduling surgery,radiology, labs, and setting up the patient, etc then the other has to be checking in new patients and can't be tied up in a room documenting PMHx, etc.
We do have most demographics front the referring docs already put it. Only if they are truly a "new patient" from off the street do we not have that info. So she's essentially just checking the demographics with the sheet we have the patient fill out to assure we have the most up-to-date info.
My templates are set just like you discussed. For a gallbladder, I can chart that in about 3 minutes. Post-op's fly with the templates and those are usually done by the end of clinic. For more unusual things like a carcinoid of the cecum or complex ulcerative colitis, there is no way I'll have a template for that and therefore it can't be quickly done in the room. In fact, it takes 10-15 minutes to type that HPI and Plan usually.
I'm going to incorporate some of this stuff and see if I can get it a touch smoother. Getting the lab and radiology ability to send it from AC to the hospital will be less paperwork for my staff.
This week I'm going to have one front office girl record every f/u patient's weight everytime and record it in AC and forward the chart to me. That way I won't forget to chart any patient who I saw.
I'm going to do baby steps on trying to get the charts done by the end of clinic. I refuse to sit in front of a computer or laptop while in the patient's room. I just lose that physician/patient interaction if I'm typing instead of listening and letting my brain work on the complicated patients.
I'm going to have the girls fill out all the history after I see the patient (in between me seeing patients). That way they can be at the front desk to check new patients in and work on the history in between. So hopefully by the end of clinic the only ones that will need me to chart on them will be the new patients. Not perfect, but I'm working on it. If AC allowed two people to work on the same note then it would be easier but I'm actually glad you can't do that for several reasons.
I've converted my staff back over to the official "Leslie" Paperport e-fax again this week. We tried it when I first started using AC and it failed miserably. But, I got sick of all the faxes coming in, scanning them into AC, and shredding the paper. We'll see how that goes as well. Our fear is the Brother e-fax program dropping out and losing faxes. We'll get over it.
