There is an additional dimension of this whole process that I am glimpsing and is becoming more apparent as time goes and at the risk of discussing while my ability to convey is somewhat in the gestational stage, I think, should be addressed.
The office visit, chart, desktop, Chromebook and TV terminology is rigid and what I am experiencing is malleable, expansive and fluid, and transcends these constructs.
The opened AC chart flows between the dual monitored desktop, Chromebook, and TV, and in fluid motion is not unlike a back and forth conversation or a balanced dance, that invigorates both patient and physician. I have been at this for 21 years, and I have never been able to replicate this effect with paper charting or the laptop/office desktop scenario.
I will have to do some more observing and whittling on my thought process but the office visit, with the portal takes on a similar dimension, where the office visit goes beyond the actual physical office space but includes the portal access to the patient's smart phone several days before and after the visit.
The same goes for the paradigm shift in how the office flow now occurs with secure messaging surpassing phone traffic, and messaging directly to my nurse bypassing the front office phone. I have taken on more traditional nurse roles, such as med reconciliation, and handling the prescriptions, but this allows her more time to schedule, shuffle paperwork, to do away with the traditional secretarial role.
But this malleable, fluid, expansive change of the AC chart has to be the most dramatic of all the changes I have noted since starting all of this in 2011.
I think my anger from 2011 when I felt I had no choice but to go electronic to avoid the penalties is being assuaged by these unexpected but pleasant developments in the office thanks to folks smarter than I coming up with all of these great tools. The trick is figuring out how to get the tools puzzled together to maximize one's work flow.
