Home Forums Discussions General Discussion The Emperor's new clothes

Once again, at the risk of branding myself a Luddite, I wish to pose the following:

If I look at the broad sweep of my tasks over the last few years, I find that I am using more and more of my physician time doing things that formerly were clerical. It used to be, I saw a patient, picked up a dictaphone, dictated a note, put down the chart, and while everything else was done by staff who were being paid at a much lower rate than I, went to see another patient.At the end of the day, I initialed off a dozen lab and x-ray slips and I was done. Now, fully 1/3 of my day is involved in activities that can be best described as clerk/typist. I have to deal with UpDox faxes and file them, do my own dictation and proofread it, see that prescriptions are sent to the correct pharmacy, download labs and notify patients, code the services, etc. And we are not even in a managed care environment with all that it requires.

While it can certainly be argued that AC makes these tasks EASIER, it can also be argued that it makes them NECESSARY.

Of those of you who have been in practice 5 years or more, how many can honestly say your practice is more efficient?

It is definitely taking me at least as long to get through my day with EMR than it did with paper (recognizing that time is not the only measure of EMR success or usefulness) and I am certainly doing tasks that were previously relegated to staff. I am still hopeful that my efficiency will improve as I have only been using AC now for a little over a year and practiced the same old-fashioned way for 11 years before that. I am getting Updox and I hope that it is quicker and better than Paperport. And I hope to get a lab interface which I hope is quicker and better than any fax management. We will see. I am certain that trying to track all the elements that need to be tracked now are huge consumers of time, though arguably, it is improving care.

I have been using AC gradually more & more since 2007, and I agree with David and Bill 100%...more clerical stuff that the staff did, is now done by me electronically. I have been able to reduce 2 staff positions because the filing and paper shuffling is less, but the cost of AC and other electronic gadgets and software have probably eaten up some of that.

I think the RNs went through this a decade ago, where they are now 50/50 paper-pushers/clinicians. The future kind of sucks sometimes.

I made this comment recently and Bert disagreed with me. I definitely do a ton of the stuff my staff used to do.

I have slowly tried to figure out ways that my staff can do all the things they should be doing and limit me to only dictating the HPI/PE/A/P of the consult.

I've almost got it down except for the eRx which I am having to do which is a bit of a time waster as I don't do my notes as I go so I don't have a computer in each room. I do have to fax over the H&P to the hospital and fax the note to the referring doc.

But my staff deal 100% with all incoming faxes, importing, notify patients, upload labs/imaging, billing, etc.

So after 1 year's time with AC, I believe I am doing some tasks I never did but overall I've balanced it out. Definitely less costs in my office now than a year ago with less staff, less paper/folders/toner. Clerical work sucks.

Well, I am at a huge disadvantage here, because I never understood the saying, "The Emporer's New Clothes," even after Sinead made it a hit.

But, wow, I would say AC makes my day 40% easier, and I do way less clerical work with it. Can some of you make an actual list of things you have to do with an EMR, that you didn't do before with paper?

Well, here are mine. Remember, many of these tasks rely on the speed (or lack thereof) of the computer program, printers and network, which is far from instantaneous.

I have to type or select orders, select the person to carry it out, then print the order to be sent to the hospital (select printer, print, walk down the hall...). (Previously, used pre-printed sheet, assistant did all the work).

Documenting is substantially more time consuming than picking up a microphone, identifying the patient and dictating a note. My practice does not lend itself well to templating (may too many unique problems, very few single common problems).

Fax and lab management... previously was written slip in the inbox, looked at it, initialed it, put in outbox. Now it is go to fax program, open fax, associate with patient, import and sign off, each step of which takes more or less time depending on the network speed at the time.

Prescriptions... I like e-prescribing, but selecting the pharmacy each time, finding the right one, or else selecting the printer, sending to the printer and waiting for the printer to print, then getting up and walking down the hall to the printer is much more time consuming than writing on a pad or telling my assistant to call something in.

Coding. Now it is completely up to me. We have a well trained coder in the office who now spends her time keeping computers running. We use an awful lot of codes, far too many to keep in my head. I used to just write down what the Dx was and the coder took it from there.

Each part of the charting and billing process takes longer than doing it manually. No part can be set in motion to complete itself while I go on to do some other task; multitasking is a thing of the past. Is it more precise and accurate? Probably. Is it more efficient? No.

The biggest difference in my office is the lack of piles and with the lack of piles, I require less help moving them around and filing them. At the end of the day my work is completely done. I don't really do anything that I didn't do before except I type instead of writing. Sometimes in the old days someone else would write my prescriptions and I'd sign them but now I either just sign them or send them electronically.

I guess it's hard to compare because of different work flows. For me:
- type in a lab (CBC) Print to my printer in the room. Hand to pateint. I have no reason to select a person to carry out an x-ray or lab.

Can't compare. Never dictated. Too costly for me.

I guess I don't know your setup. None of that applies to me. Don't see where network speed even at 10Mbs would have anything to do with it. I guess doesn't apply.

First, got to get you some HP printers for your rooms. Second, why would you need to print a script. I think your staff would see that it printed anyway and have it ready. But, ePrescribe. Unbelievable. The pharmacy saves for every patient. It takes maybe 5 seconds to find it the first time.

Coding: I would highly recommend writing down the diagnosis and let your coder take it from there. That is what you pay the coder for. I am with you on that.

Again, forgive me because I am not in your shoes. It just seems like getting better with ePrescribe, don't use AC to send stuff to your staff except referrals, and get some small printers for your rooms.

I'm still agreeing with David on this one. Although I've finally arranged a workflow in my office around AC, it was much simpler in the old days.

My nurse did a lot in the "old days". Not so much anymore. I used to see the patient and for f/u or post-ops I could quickly dictate a note in between patients in less than a minute and send a copy of the note to the referring doc all in one breath. Done. If the patient needed f/u, lab, rx, I would tell my nurse and it would get done. That's it. Things happened as quickly as I could speak and tell my nurse what to do. I jetted to the next patient while my nurse took care of the labs, rx, radiology test, f/u appts. The new pts and consults would get dictated right after lunch and I had a standard template for H&Ps so all I did was dictate changes to the standard template and dictate the HPI/Assessment/Plan. It was fast. Very fast.

So I didn't really feel I was doing any clerical work during that time except for the standard notes that all docs have to do and get delegate.

Initially with AC I was doing the rx, labs, radiology, note, referral note, reviewing and importing pathology/radiology/lab.

I now have got it down where I do the note (and fax it to the hospital through a few steps to pull up the fax machine), the referral note (and fax it to the referring doc through a few steps to produce the letter, and pull up the fax machine/address book/fax it), and all eRx is having to be done by me due to provider restrictions.

Why my nurse/M.A. can't send an eRx under AC just astounds me. I should be able to mark her security as safe for eRx. Hell, she calls in everything else in the world. Why wouldn't she be able to eRx? If I give her enough power to eRx, then when she imports stuff, AC doesn't require me to sign off of it which needs to be done. But that's another story.

Having to buy another computer and printer for every room, have space for that in every room, and route ethernet cables to every room is more than I think it's worth.

Either way. I wouldn't go back to paper. AC has its advantages. Speed is probably not one of them though.

She can ePrescribe under AC. Why can't she.

I have to ask this. Don't get mad. Why do you use AC then?

Once again, debatable. I wouldn't have it any other way.

I definitely think that AC has slowed me down a bit, and I do a lot more that staff used to do. So I agree with Travis & David.

It may come down to the patient mix, to some extent. David & I are internists. Nobody gets/changes just one prescription. Nobody knows their pharmacy, and if they do, only the phone number, not the street address that AC uses to search for the pharmacy. I am amazed that Bert prints out an order for a CBC and hands it to the patient. Only a CBC? I never order a single study; these folks all have a dozen problems. Did you remember to look up and put the Medicare certified ICD code on the lab order for every test?

Everything in the above paragraph used to be a staff task. Now they are all mine.

Wow. This is getting crazy. I think, again, this is a work flow issue. No right or wrong. I am just trying to share ideas, and it baffles me that everyone is using AC if it is that slow. Maybe we should write the ways it improves efficiency like with chart finding and legibility and NEVER getting call backs from the pharmacy for illegible scripts or from the labs due to illegible labels or reqs.

I get that Internists tend to have more chronic and sick patients. But, that makes prescribing the same meds over and over rather easy. I think I make up for it with multiple acutes. I have no idea what the names of your pharmacies are, but it is completely the opposite here. Everyone knows if their pharmacy is Walgreen's or Rite Aid or whatever. No one knows what the phone number is. I wish I had a dollar for each patient who called me on call for a medication and didn't know their phone number. And, every patient knows Hannaford on Union Street, Shaw's on Main Street. It must be much older patients. ePrescribe allows you to search by zip code which is by default, city, street, name. Generally, if you can get the city, they can choose a pharmacy.

Don't be amazed. First of all, for my example, why should I choose seven tests? It was an example. I happen to print out as many tests as I need. I am a pediatrician so I don't have Medicare, but if I did, I would associate the ICD-9 codes with each lab in a template. But, I have never had to do that. Didn't know you had to or even could. I put an ICD-9 code where it is supposed to go that is the reason I am ordering the labs.

Well, Bert, you are 100% spot on it is a work flow issue. If there had been a magic button for this, then the "walk right in and start using it.. it's that intuitive" statement would have applied to us. I guess I would not care, except I burn up so much time waiting for tasks to get done that previously would have been done by others while I was on to using my physician skills elsewhere.

The more I think of it, the more I see the issue as that doing things electronically takes much more time than expected, and does not allow multitasking. You have an image in your head that you are going to be able to hit the "enter" button and.. zap... it is done, but in reality there are delays at every step. If I could select CBC/Chem Profile/Lipids/Hepatitis profile, hit "go" and segue immediately to writing a prescription mix of controlled/uncontrolled substances, then immediately to ordering an ultrasound without waiting for tasks to finish that would be one thing. In One database I work with, these would be done as separate "processes" that work independently. But, each step in each multi-step process in AC takes a few to perhaps 15 seconds if there is congestion, and they add up without releasing you to go to the next step. We have multiple printers, but putting one in each room would further strain the network, as they would have to be wireless and there are 7 exam rooms, and really don't solve the central issue that a lot of doctor time is eaten up waiting for the printer to spool.

We have the same number of employees as before. They just do different tasks.

On a frustrating day, like last Thursday when the system crashed and all servers and workstations had to be rebooted (did you ever time just how long that actually takes? It was more than one patient visit time slot) we really do wonder if going electronic was worth it. I keep hoping for the epiphany that makes it all worthwhile.

Good points, David. But, why did you have to reboot the workstations?

Heaven only knows. One of the myriad mysterious things that happens in the computer world that requires sacrificing a goat to the gods of the silicon chip. Everything locked up, we restarted, things started working. Wasted 20 minutes.

She can eRx but if she does, the program does not require anything that she imports to be signed off by me because she is listed as a "high level provider". As we have talked about, she would have to have to different identities and assure that she is under the correct one whether she is eRx or importing documents.

I use AC because it's less paper/toner, easier to sit in my office an pull up a patient (I always hated trying to track down a paper chart if it wasn't on the shelf), and it creates a nice electronic trail. It's also the way of the future so I thought I better jump on the wagon earlier rather than late. Maybe I'll see some government eRx money or HiTech money.

But it doesn't speed me up or make me more efficient.

If my MA had to use two different identities, I would either have her on a WIN7 or XP Pro fast user switching. But, the best way to go would be with a virtual machine. The VM could be minimized with AC running under the other name. You could simply think of the VM as ePrescribe machine. Even name it that. This takes as long as any program to maximize and the program would be ready and able to go. I use virtual machines, and frankly, they are a ton of fun. Plus, you can add another OS or three or thirty. You can use the other OS to play with to try things out.

Of course, you can get free VMs or pay for better ones. The key is you still have to use licensed OS.

These are 3 tasks that happen with every encounter:
--Undoubtably the staff had to deal with the pharmacy name/location issue in the past. But again, that's the point -- now I have to.
--I'm sure the staff doesn't mind never having to look for chart, or file them, etc. But that doesn't reduce any tasks for me.
--As far as the ICD codes, I may have the correct code on their order, or maybe not, if it is a new problem for this visit. But again, I checked a box on the lab form prior to AC, and my staff made sure the codes for the labs were the right one. Now I do.

Maybe you should go back to paper. And I have never once had one patient not know the name and street of their pharmacy.

I don't mean that in a sarcastic way. I apologize if it does. I just don't know where this thread came from. I guess for me 80% of out comes from the fact that I type 90 words a minute and it is legible. I write Rr 30 words a minute and you can't read it. Of course of you dictate, then that's even garter but doesn't that cost money?

Bert, this is where it came from:

The switch from paper to electronic is not a match made in heaven for many practice types. Not everyone that reads these posts, it seems, is all a-gaga about being able to template everything and having every encounter look identical, as my patients are not peas in a pod but individuals and I feel it is important that my records reflect that. I have no interest in trying to impress an auditor that I have 7 or 77 or 777 bullet points in my history if they are of no value. Given that I, at least, do not realize any time savings from that portion of the program, do not type 90 words a minute, and find I have assumed a bunch of new burdens, I wanted to see if there were others who had found the experience similar. Apparently there are. It is disappointing to find that going electronic did not do for my practice what Quicken did for my checkbook, or Word did for my letters. The question now stands as to whether having found it to be so, there are ways to minimize that burden. I am hoping others can provide guidance.

Electronic chart with no templates and all customized.
Paper chart with no templates and all customized.

Why not use paper requisitions for labs and AC for most other things?

I've been using AC for about 8 years, I have been practicing about 25. The practice of medicine has changed more than AC over that time.

There are more details that you need to both document and follow in the chart.

We did not have to be the patient's parent and remind them of appointments and referrals and track them down if they did not complete the "assignment" that we are expected to do now.

"Bullet points" did not exist 25 years ago, although the foundations for them were in place.

Some of this is also a PCP vs Specialist issue. PCP's have been expected to do more with PMH, SH,FH and ROS than many specialists for a long time. There is generally a broader more holistic approach (again, this varies by the specialist but is predominately true IMHO.) AC makes that easier to track.

You can still dicate with dragon or hire a scribe to put your pearls of wisdom into the computer, but it has become more expensive over the years, and there is less support from hospitals and such.

We are now expected to do prescription checking and drug interactions where this was not the case only a few years ago.

Yes, we are much more "secretarial" than we used to be. Typing is totally expected of all residents now, and you better learn to be quick. That was not the case only a few years ago. We need to be able to traverse the world of computers if we are to be the "captain of the shiP" that the provider in theory should hold. This then, would mean that we can accomplish all the tasks of everyone in our offices.

I have been using AC for so long I cannot comment on whether it slows me down. What I can say is that my notes are infinately more accurate, neat and useful than they used to be. I can type well, albeit not at Bert's 90 WPM but still faster than writing.

I can see 30 patient in a day and not leave charts unfinished. I was not that good 15 years ago. How much is practice and how much is it due to AC? I don't know, but feel that AC has improved my practice of medicine. But then again, I would be considered an evangelist.

Wendell, your points are good.

Maybe my expectations were too high or incorrect. I have always dictated notes (for 35 years) as my handwriting is illegible. My notes have always reflected not just what I did, but what I was thinking at the time and an outline of what my broad future plan was for the patient most of whom have chronic illness. So, I never went through the stage of the brief handwritten note that went "UTI x 4d. Rx Bactrim X 1 week" that I have seen in records from elsewhere. Thus, I can't really say that my notes are significantly better or more useful, and when printed out leave the valuable portion slightly buried under the detritus of PH, ROS, etc. that are not germane, so are somewhat less useful to a consultant.

I will acknowledge that there are new tasks, but disagree that they all need to be done by a physician. I don't think 11 years of higher education is necessary to see that an appointment is made or a fax filed. I want to see how much of this I can shed.

I have been with Ac for voer a year now.
My practice has definetly become more effecient and manageable since I switched to an EMR
Here are the reasons
1. My staff and I do not have to go looking for paper charts
2. All forms that come in are filled and signed via Adobe Acrobat - so no more printing of paper and that has been a big saving for me.
3. All correspondence and faxes come in via PDF files and dealt with as in # 2
4. All pharmacy requests for refills are completed in the same way except for Narcotics which require my signature are printed as they will not accept electronic prescriptions
5. The message features of AC helps my staff and me communicate without interruption, of course unless there is an Emergency call .
6. When I am on vacation even for a few days all labs , correspondence are completed via the message system between me and my staff and I do not have to come back to a pile of waiting correspondenc, labs xrays as they are dealt with on a daily basis.
I use my remote Desktop to acess AC which is on my server
7.As far as templates are concerend I use them a lot but have to change some things that are difefrent that i find depending on my exam.
8. I use the Summary Section to track down all my preventive exams including Pap,Mammogram, Colonoscopies, Hemmocults,Labs- which keeps the lawyers away
9 I have learnt to delegate to my MA's and give them more responsibility as they have learnt the system.
10 All templates,Folders for Labs, Correrspondence, radiology, consultant reports etc are on a seperate shared drive as I have found out that the Import section of AC will not allow me to Stack files and slows me down
Initially I was doiing more but i find myself doing a bit less as I have begun to delegate.
Just some thoughts I thought I would share about my experience with AC.
Grenville

OK, so help me here..


Form filling. This remains a significant issue that seems more complex than previously. Filling forms in UpDox, at least, seems pretty cumbersome and is one of the "time sinks" mentioned. It can be done, looks "cool" but seems more of a gimmick than just "X" in a few boxes on a paper form. Longer forms were typically filled out by staff previously, checked and signed by me. How is this a time saver for you personally?

Yes, staff used to have to go searching for charts, but this did not involve physician time. They seem to be busy doing different tasks now, but are still busy.

Messages and vacations, I agree. I can keep up with a lot of stuff by remote control, less of a nightmare when I come home.

Please elaborate on the virtue of having templates, etc. on the shared drive? What is meant by "stacking?"

On several physician forums (like Sermo) you will find thread after thread, the gist of which is "I don't want an EMR; they just make our lives worse". (Sorry, David, but compared to most, you are no Luddite...you are an "early adopter"). I would love to see the EClinical, NextGen, or Epic boards; my bet would be that the sentiment there is much the same. With AC, I think we get more positives, but I don't sugarcoat it; with the good comes some bad.

I believe that we have no choice about it; an EMR is a necessity; if not now, then very soon. So to some extent the question of "better with it or without it?" is moot. I think the point made by David (and Bill and John and Travis) is that when you transition to an EMR, especially AC, the default is to give the physician more of the clerical work. AC would be great for a "micro practice" (one with NO employees). Sometimes I find it kind of relaxing to reformat faxes, send refills, mark up lab reports with my electronic pen...but that is NOT the most efficient way for me to run my practice. I agree that I do more non-physician work than I did; part of the ongoing struggle of EMR adoption is to look for ways to delegate. I am happy to talk about ways to do so, and I think we should.

Not to beat my old, nearly dead horse, but while implementation of AC may be easier than most EMR's, making it work efficiently is complicated. More attention has got to be paid to helping people set it up and find efficient work flows in their practices. This will be especially true as thousands of EMR skeptics begin to use it.

1. Forms are filled and signed with Acrobat Reader9 pro -ODT drivers physical, Well child Physical forms,Disabilty forms, FMLA forms etc-
I have one of my MA fill in the essential part of the form Name of provider,address of the provider and the patient and whatever they can fill in.
When I have filled in the rest it is printed to the ADOBE printer and saved to the MA's folder for them to fax it out.
It is then saved to the respective folders for future retrieval or refilling of the form.
When you retrieve the form in the future or fill in the next year for eg FMLA or ODT, Yearly sports physical you then highlight and delete the section you need to change and there you have it...
2. When you import stuff into AC under a patients name it will save it one file at a time . Let's say you import labs on 9/12 and the next day on 9/13 --it shows up as 2 different PDF files and when you try to combine them/ stack them it will not allow you to do that.
I have a 1 TB hard drive on one of my worksation computers that I have "shared" so that it is visible to all other workstations including the server.
I have made folders for every possible thing I can think of to make my life and my staff's life easier when we need to search for any file - Corrrespondence, Consultant letters, Labs, Pathology, Pap, Radiology, CT scans, US... A-H, I-P, Q-Z
Using Adobe Acrobat you can combine/stack, unstack,delete while still saving the original file if you wish.
3. As far as Templates are concerned - I have templates for Immunizations,Narcotics, PTINR on my shared hard drive that I explained earlier, using Microsoft Word
I have several Templates created in AC that I have created for each section of the record - History,Physical exam, orders etc for the most common problems I encounter. I just change a few things that are different for each visit.
I hope this helps.
Grenville

Thanks Grenville,

Just two questions:

Why on the workstation and not on the server. I am guessing because of the TB.
We don't import either. But, FAP, would probably make your life a whole lot easier. If you are a solo practice.

Bert
I am a solo practitioner.
I do not trust my staff with the Server.
If the Server goes down -- the whole office shuts down..I am too afraid to take a chance
Besides working on AC, the rest of the work is done through the shared drive where my folders reside.
I feel more comfortable that way.
Moreover the whole setup seems extremely fast even with my wireless laptops
Never had a problem so far...touch wood!!
At the end of the day, the AC on the server and the Shared drive are backed up to two different locations.. maybe I am anal , but again I am too afraid to chance it to one back up
Grenville

No, not anal at all. I do about four backups a night. I guess I am confused about your server. Just asking. Not criticizing. Probably done enough of that on here already.

I guess what kind of server do you have? Sure, servers can be an application server, but the main idea of a lot of servers is to be a file server. I am not understanding how sharing folders from a server to users affects the server. We use permissions to keep users out of folders, but you would have the same problem with the folder on the workstation. In fact, way less security.

I am completely confused.

I have a windows 2003 server.
Security is not an issue as I programmed the ROM of my routers with a security password.
I just dont like my staff accessing the server for ther rest of my work besides AC.
I am knowlegable about Servers but not in detail.
I am just comfortable with my present setup.
I guess each one can use whatever he/ she finds works best for them
I was just throwing out some ideas which has worked best for me ,having tried most of them that have been mentioned on this board
Grenville

I understand. I also understand that do what works best for you. Don't take it personally. It just isn't dangerous at all for someone to have user rights to a folder on a server. In fact, it is safer. Oh well.

Grenville,

I'll need to puzzle on that. We bought Acrobat at the start of our AC experience, but have not yet taken it out of the box. Maybe time to fire it up and see what it does. We did do the template for INR, A1C, etc. as you suggested, and it does well.

So, I am unclear about the lab; don't you have to manually enter the labs in the system you describe? You are right that having a combined file would be great, but importing from Quest is so easy. I am hoping one day they can figure out how to let us link to their Care360 system through AC so we can get the flow sheet.

Am I right that you have a "master form" for the services you mention, then fill it in and "save as" under the patient's file? Does that individual's form then live under imported items in their patient record like the INR flow sheet?

And, I guess I don't know what the term "stacking" means in this context.

David,

I think what Grenville is calling stacking is simply combining PDFs together. Some 3rd party Acrobat programs will let you combine them. Adobe, which is what you are probably referring to since you paid for it, created Acrobat, and given its cost and the fact that it is Adobe, it can do most anything. For instance, we have Adobe on every client. I can take five or ten or 100 PDFs, lasso them, right click on them, and choose to combine them. There are many options with Adobe. You can, of course, use the program to drag files out of the program or do it in other ways.

David
You will need Acrobat pro or any Acrobat version that will give you the TYPEWRITER function in the drop down TOOL menu.
In AC I have created Templates in the HPI(history of the Physical illness)eg Cold & Flu,Well exam,etc and one template for the PHYSICAL exam section which is the most lenghty one.
All I do then is make minor changes to the template depending on the physical exam and I am done.
Only labs values that are important to me eg PSA,Hga1c,Lipids etc have values (numbers) entered in the SUMMARY section with the dates and that makes my life easier than go searching for the labs
All other labs, Radiology etc are saved when they arrive as PDF files through faxes to their respective folders if they are normal with a message sent to me through AC message system.
If they are abnormal a message is sent to me that I should look them over and advise them - these are saved in a Grenville folder. I then type my message on the report/PDF file and save it.I then send a message to my MA to instruct the patient. You can then have your MA type the message on the same file/lab/radiology report after he/she has spoken to the patient or just send a message via AC and you save the message.
The SUMMARY section is a comprehensive tool for me to know about my patient that I need about the last labs were done and also has the dates for Pap, Colonoscopy , Hemmocult, Mammogram etc
Templates made outside AC live under a seperate folder as MASTER Templates eg under PATIENT CHARTS on my SHARED DRIVE of one of my Workstation/ Client computers which has also all the SUB FOLDERS for Radiology, Pathology, US, CT scans , Mammograms etc or whatever folder you choose to make your life easier when you want to search for a file.
Every time I use the Template , it is filled out and SAVED by the pateient's name in the respective FOLDER- PTINR, NARCOTICS etc. When I need to refill Narcotics, or check PTINR which is monthly I pull out their file , fill in whats necessary and save it as a template file back to its folder(So one Template may one year of information depending on the enteries I have made.)

Grenville

Grenville,

Are you using Version 5 of AC? It seems to an initial reading that some of what you do is supposedly built in to V5, but maybe in a more clumsy fashion.

I am still on on Ver 4.0.73
I have played around with V5 doing backups from my V4.0.73 and so far I have not encountered any problems
Grenville

Thanks.

However, I just ran an experiment. After several runs to make sure I had all the moves cold, I timed how long it took to refill a prescription that came in by fax electronically. This included opening to see who the patient was, modifying it and signing it via UpDox, faxing it back to the pharmacy, and importing to into the patient chart. It took 2 minutes and 57 seconds. That compares to about 5 seconds doing it manually. I just don't see any possible way this is an improvement. What am I missing?

I guess I don't think we can help you if we don't know what your prior work flow was. When you say five seconds doing it manually. For me, it takes zero seconds, because my MA either does it through NewCrop, or she opens the fax (and sends in the script). Either way, I don't even know about it until I see it in my message box. A lot of providers on here refuse to refill any medication until the patient calls. That would be one way to fix the problem. But, here is where I need to know your work flow. Because if refills that are done based on calls by patients (which definitely takes up a staff person's time and a phone line) are done by an MA, then the can do the fax as well.

I take it you are opening the fax as you described. I am not sure why. Why aren't your staff doing that and routing obvious medication issues to your MA?

But, since I am here and my staff has gone home, and I check faxes as they come in through FAP, I will time myself.

32 seconds. That is from opening the fax, identifying the patient and the medication, finding the patient in the Patient List, right-clicking on their name and choosing Medications and ePrescribing, clicking on the medication and sending it to his or her pharmacy. I delete the fax as it is not necessary to import anywhere given there is now a record in AC.

32 seconds to send the correct medication which I can tell was prescribed 30 days ago and know that it got to the pharmacy. The medication is checked for allergies.

I guess I am confused as to how you were notified before faxes. That would help me understand and possibly help you. We have been getting faxes for a long time.

Again, not sure what manually is (calling the pharmacy?). Because writing a script doesn't do anything.

But, once again, my answer during the day is two seconds as that is how long it takes for me to open the message from my MA, approve what she prescribed (yes, after she sent it), can't remember the last time she was wrong, and send it to the chart.

Here are some of the scenes played out in my ofice as far as prescritions for meds are concerned
#1. Patients or pharmacy call in for refills. The MA's while taking the message, peek into AC to see when was the last visit and will notify them whether they need to be seen or it will be filled. Message is sent to me with all the particulars and 99% of the time it take me under 10 sec to make my decision and the message is sent back to refill or deny the request
#2. The pharmacy will send in a script by fax which arrives as a pdf file. Agains the MA's do the same as in # 1 and all parts of the script are filled out by them using the Typewriter function in Adobe Acrobat pro(20-30sec) and sent to my message folder(outside AC). It takes me under 10 sec to sign the script again using Adobe where my signature is stored and send the file back to them in their folder for them to fax it out
#3 Lastly while patients are in the examining room and request refills of their meds. I open the Rx and click on the meds from the med list on the left and fax it to the local pharmacy or save it as a PDF file by cliking the PREVIEW PRESCRITIONS button and send it to the MA's folder(outside AC) for them to fax it.
Pts can also collect their printed scripts from the check out counter as they leave which is sent to the printer while I am with them in the room.I hate to do that as it cost too much in paper and ink.($$$)
Sometimes I am forced to do that for Narcotics that I cannot send to the local pharmacy as they insist that I sign my printed electronic script.
I sincerely hope this helps you.
I hated to write scripts,being a family physician as each pt had atleast 5-10 scripts or even more and by the end of the day my hands were fatigued.I am positive that I will never go back to paper. Honestly I am virtually paperless as I am waiting for my LABCARE interface which should be completed in a few days (I have Labcare in my office and they print out all the labs )
Grenville