Home Forums Discussions General Discussion Blog of a Newbie III: An Unfolding Tale

Hi all:

My last thread Blog of a Newbie II got off subject so I'm starting a new thread.

I'm reporting at the end of my very first week of using AC. WOW!
I've had ups and downs, highs and lows, but I'm happy with the speed that me and my staff are learning to allow AC into our workflow and adjusting our workflow around AC. The two mesh nicely.

I'm excited to see how quickly my staff is learning it. End of week 1, and they are pretty much all experts with it. Even my wife (office manager and office R.N.) who jokingly claims that she has "computerphobia" is catching on.

They are processing referals, calling or computer-faxing in scripts, and documenting WAY BETTER (used to use dreaded STICKY NOTES....yes, like the little paper sticky notes that drug reps give us, not high techie computer desktop sticky notes).

My staff are scanning in PILES of paper charts in their free time. They are also updating the Past/Family/Social histories and Med Lists/Flow sheets at the same time. We had some glitches with this initially, but now we are scanning with great reliability. All of my databases are on a central server with multiple backups, so I'm not so worried about losing data. We've had to discuss proper filing techniques however because there were some minor mishaps.

The PLAN of PAPER ATTACK: scan in Monday's charts on prior Friday, scan in Tuesdays charts on prior Monday, etc.... This should get scanned into our computer about 60-75% of our most active patients within 3 months. I figure this makes more sense then starting at A and working to Z (about 2,000 charts, some multiple volumes).

I'm relocating my office down the street to another building once the renovations are complete (June 2008). I want to leave ALL of the PAPER charts in a big pile that we can set afire, or shred, or maybe we'll make 5 billion paper airplanes with all that paper!

I'm also updating our new AC charts as we go, if staff can't get it all done, I'm providing a final check with each patient to make sure the information is correct. Here's my spiel: "So Mr. X, we will be required by Medicare and other private insurers to have e-charts, and I'm going to review some things with you while in this state of convertion from paper. Can you help me update...." then we review the information that I've entered into the AC chart, giving the patient opportunity to say X,Y, or Z is not quite accurate or "wow, I have that many problemss?"

Amazing!

BridgesMD asked me how it's affecting my work flow. Here's my reply. IT'S SPEEDING ME UP, even despite the fact we are updating our charts and I'm documenting in the PMFSHx, updating med lists, etc. Much like Istrouse, I am relying heavily upon templates for every field. I took a lot of time (That's right Bert, NOT alot, but A lot) in order to create custom templates for my use.

I have templates for every subject heading in the office note. I have templates for hospital admission (haven't used it yet, but eagerly awaiting the chance), I have templates for referral letter, templates for ordering lab panels, commonly ordered MRI, CT scans, and x-rays.

Here's what I've seen SO MANY AC users comment on in the threads, and it's SOOOO COOOOOOL: the fact that I have my lab orders, referral letter, demographics, imaging study orders, etc. all printed at the desk and the staff are already processing things before the patient and I walk out of the room! Heck yah, it's AWESOME!!!

I've even been computer faxing from the exam room. When I ask "do you want the rx printed out, called in, or faxed in?" Patients say "I have all those choices?" And I can print directly to my fax machine, use the address book of the fax machine to select the pharmacy, and <to use Emeril's words> BAM! It's faxed to the pharmacy.

Today a pharmacist called me to ask about a Rx that I inadvertently messed up, BEFORE the patient even got there to fill it! <<It was prednisolone 15mg/5cc, 4cc po BID x 3days, then 4cc po BID x 4 days, then stop, disp #QS, NR.>> I MEANT to write the second dose as <<4cc po QD x 3 days>>, so I used the Rx Writer and refaxed while on hold awaiting the pharmacist. I told him the error, mentioned that I was refaxig the order, and he said "oh yeah, it's right here coming through now." He confirmed the change and all was right again in his pharmacy universe.
Yours,

I had one fairly disconcerting screw up. Nothing to do with AC, everything to do with my Client-Server connection with my laptop. I got disconnected from the Server after performing some necessary updates....a ongoing Vista problem. Only issue is, you never know which Vista update will screw up the computer.

On Tuesday, day #2 of Go-Live week, my lap top was out of commission. So I took paper notes, worked only til noon (thank God), gave a deposition (it was brain-beating), then came back in the evening to see more patients. But I got the connection to Server restored, entered in all the backed up office visits (suprisingly quickly), and got home rather late that night because I had 4 inpatient to top it off.

Oh yeah, my Small Business Server feature Volume ShadowCopy Service was down, so I had no automated backups using BackUp Assist for 3 days. But I got that fixed thanks to Bert (THANKS BERT), revised all my backups, and was back in top form.

One quick suggestion. We simply entered patients or families of patients on the first visit after our start date. That also saved the the issue of adding a few folks who sort of "used us" because we were a new practice. They sort of just came and went after a few visits. Either they were deductable skippers (use the new doc in town at the begining of the year to hit your deductable, and then never show up after the first visit or two, nice right?) or doc hoppers and the like and they didn't need a chart in our new system. That way we simply entered them as we went and they returned. We never had too many patients to enter on any given day. It didn't take too long to have most of our regulars in the new system. Now if you and your staff can move faster and get more in then more power to ya. But that was the way we did it.

Oh and I guess I'm a little sorry for "jacking your thread" with the Quest Lab stuff, but seeing that it was also first time encounter like stuff I thought it sort of fit. Keep up the great work and glad AC is working so well for you and your practice.

Paul

What all are you scanning, Adam, and how are you scanning it? (scanner, file format). How are you dividing it up, and organizing it, and how do you review it in the room?

I have come across a doctor who was eagerly awaiting a hospital admission.

Can't be A LOT of doctors who do...

Brian,
I am scanning in ALL of our existing paper charts.
A BIG F%@#'ing project!! I believe this will take us 3-6 months.
But I seen the whole point of using AC is to be paperless. Therefore I want to really be paperless.

So here's the process:
1)break down the paper chart
2) organize into sections (this is the biggest part of the job because I do not have tabbed/sectioned paper charts, everything was added sequentially into one big giant MESS)....so the organization makes ALL the difference.
3) Scan individual sections (office notes, radiology studies, labs, consults, hospital admissions, ER reports, insurance info, HIPPA releases, et al.)
4) Drag the sections into AC under Imported Items for the individual patient.
5) Right click-->edit, place EVERY OLD CHART into folder "Batched Import Items." This is the important distinction which identifies everything as the old chart for our office.
6) finally, label the .PDF file into it's corresponding name (radiology, labs, etc.)
7) I set up a temporary high privileged account (username SCAN)for the sole purpose of scanning in these old records. I don't want all that information going to my desktop, as it was creating a HUGE issue in clearing out my inbox. I've reviewed this information once and don't need to do it again. Once done, I'll delete the high privileged account.

Therefore, I can access all the old information via the imported items tab when needed, right from the room.

Sound like a lot of work? IT IS!!

Some would say, why not just keep all the old records somewhere? refence them if you need to.....well that defeats the ideological point of being paperless, so I'm willing to pay my staff to do this. Plus I don't have room in my new office location (moving in June) for these old records.

Plus, here's my long term plan (of which my staff is not yet aware); we will eventually cut down the size of my practice and release all of my staff except the biller and office manager. 30/60 min visits, I would put patients into rooms myslef. I could schedule visits from my exam room, allowing the office manager to manage the phones, file all incoming faxes via Fax to PC, deal with refills, etc. I want to reduce overhead as much as possible, and the ultimate paperless/computerized office would not need many (or any) staff.

Furthermore, checkout OneBox

I'm using this PBX system for my pager-->routes incoming calls to my cell phone....ie NO PAGER NEEDED!! yippee!! Onebox is an email account, a fax account, a telephone account. You can set it to call you at any number(s) you designate. Only $50/month, compared to the $200-250/month I was paying a operator driven paging company. PLUS, patients have the option of leaving NON-emergent information on a voicemail OR they can page you directly for EMERGENCY conditions. By giving them the option to either leave a message or page you, they will ALWAYS leave a message for the prescription refills and other stuff that requires assistance from the office staff rather than the physician. Nothing bugs me more than patients calling the paging company to notify the doctor that they need a medication called into the pharmacy. That is for staff to do, not me. So these phone calls have stopped entirely.