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Would you recommend charting from home?


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Just started shadowing a family practice PA. Office hours are 7:30-6:30 (most days). She said most days she goes home and charts for another hour or two which helps her spend more time with her family. The other 2 PAs I shadowed said that either coming in early or staying late for charting is more time efficient; it allows them to go home and actually focus on their family. Just wandering what your thoughts on this are. Thanks. 

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I never take patients' charts home, now that I work in a practice that has no EMR. When I did and had VPN access, I would either come into the office or do a bit of work from home to catch up.  Now, I work on the clock to chart at work, and am much enjoying the improved quality of life.  Perhaps once a quarter I will need to come in early or stay significantly late to chart.

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I try to avoid charting at home. I use 3 different EMRs (Codonix, eClinical, and Cerner) which all have some good macros you can setup in there. I use my lunch breaks to chart and I'm usually in the office for 30 minutes tops after my last patient for charting (because I have to pick up my kids). I usually get in the office 30 minutes before my first patient comes in which is usually enough time to tie up loose ends from the day before and to prep for my morning load of patients. That being said, there are some days where it was just tough and I'll spend maybe an hour after the kids go to bed to finish up my charts. Then again I'm only seeing about 28-32 patients a day.

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NO NO and NO

 

Not unless you are paid productivity (and paid VERY well) or are an owner...

 

 

Otherwise you are merely giving your time energy and $$ to the owner - no other profession would demand you work at home, and neightbor should ours....

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I cannot say NO loudly enough or enough times.

 

NO NO NO NO NO NO NO NO NO NO

 

It is a bad habit - it will harm you personally and your family. It sets a precedent and destroys the line between home and work.

 

If it is bad enough that you cannot finish at work - there is a system problem:

 

Bad EHR

Bad schedule

Too many patients

Too many extraneous activities and obligations in the office

BAD EHR - usually wins

 

Figure out whatever it takes within reason for a human being and do not start doing crap from home. It will eat you alive.

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I never take patients' charts home, now that I work in a practice that has no EMR. When I did and had VPN access, I would either come into the office or do a bit of work from home to catch up.  Now, I work on the clock to chart at work, and am much enjoying the improved quality of life.  Perhaps once a quarter I will need to come in early or stay significantly late to chart.

 

So I understand a little bit of this but what about not having EMRs makes charting easier? Also, how common is it for a practice not to have EMRs? I thought that was pretty common nowadays

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http://www.healthcareitnews.com/news/more-80-percent-docs-use-ehrs

 

If I am not mistaken, any clinic that receives any type of federal funding or wants to meet Meaningful Use (or whatever it is called now) - they have to use EHR.

 

EHR can have Dragon dictation, hand typing, box clicking or inserted old fashioned dictation into the EHR templates.

 

The method of data entry and output dictates how much time one will spend making it work. We view and respond to labs in EHR, we send almost all Rx's - except controls. We get imaging results and outside records are scanned. We have immunization records in the EHR. It is pretty all inclusive - BUT - if it goes down - we are screwed. No info - flying blind.

 

I have an EHR with some box clicking (the bane of my existence) and I use Dragon Medical to dictate into the headings - HPI, PMHx, etc. My doc clicks a very few boxes and dictates to an actual human transcriptionist. We aren't big on Meaningful Use yet but are trying to catch up to Phase II.

 

He is a maniac and sees up to 28 per day - a lot of OMT. I see tops 21-23 and a lot of complicated multi system issues. We have to finish before we leave at night. His rule. He doesn't want piles of backlogged charts like his predecessors did. 

 

It is a way of life and isn't going away. It has its benefits and handwriting isn't an issue anymore. If used creatively, one can still make a clinic note that paints a picture of the patient rather than a bland bunch of checked boxes that could be anybody including my shoe.

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If I am not mistaken, any clinic that receives any type of federal funding or wants to meet Meaningful Use (or whatever it is called now) - they have to use EHR.

Yep.  We're a one-doc, 4-APP clinic, and business is booming as the people on commercial insurance search for something other than providers who stare at screens and ignore them.  No computers in the exam rooms, but I type all my notes, with the aid of dragon, and a poor man's dotphrase library that I trained MS Word Autocorrect to use.

 

We only tolerate medicare as Walk-ins or commercial patients who age into medicare.  We take state workers' comp, but not Sedgwick, and NO medicaid in any form.  Clinic makes a reasonable profit, as I understand it, that would be COMPLETELY wiped out by EHR just based on the installation and maintenance costs, let alone the productivity loss.

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We are a 35 yr old practice with well over 10000 patients. Privately owned. No interest in corporate ownership.

2 docs retired.

One doc left.

2 PAs.

We take a lot of stuff - Medicare is probably 35% and they keep aging in. We have dropped out of several of the more heinous plans and lost a few patients. We encourage them to find the better plans that don't require intense paperwork and prior auth's for everything including breathing. 

We take several state medicaid plans and many many private plans and Tricare.

 

The older 2 docs had to retire before we could get going on EHR seriously and be able to work toward better reimbursement. They simply refused to have anything to do with a computer. 

So, we are plugging along to try and catch up with the current expectations and then they will change again.

 

I never had to deal with this when I graduated and feel for new grads - EHRs take away from the absolute personalization of a clinic note and truly painting a picture of the patient for specialists and others to read. We are so worried about the smoking status and these stupid reminders about "did you discuss this...." that we can forget why the patient is actually there.

 

I do not take my computer into the room. I take hand notes in real ink on the demographics, vitals face sheet. I make eye contact and use plastic anatomy models and all that old fashioned stuff. It still works.

 

I then step out and print anything needed or give lab orders to the MA who goes back in to check the patient out.

 

Hopefully, the patients get a reasonable experience and resolution of why they are there without to much hyper-tech.

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I seriously think we need to go back to just voice to print in a soap format - abreviated - with A/P in one paragraph

 

forget all this other garbage that insurance companies want - who gives a crude how may +- ROS and what # of systems - we are providers and this system stinks....

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Ventana - I am with you.

 

Yesterday, I was looking at opening a doggy day care and training center ---- or a coffee hut (and I don't drink coffee).

 

Yesterday was a Burger King day and I got frustrated and had a hard time seeing the cause.

 

First patient went to UC the minute they opened next door - told he might be having a stroke or TIA and to go to ER. NOPE, he walks right next door and says he wants to be seen in our clinic and then argues about going to the ER. Deep Sigh

 

Next, phone message. 50ish woman - "my throat is red and I don't feel good and my insurance won't cover an office visit. I want a zpak". NOPE, not ethical to treat over the phone and I just saw you 3 weeks ago and somehow got paid. Here's your sign........................

 

80 something woman last seen over a year ago and somehow still getting insulin - freaked out on the phone with a sugar of 377 but didn't want to come in. Her son dragged her in and she proceeded to yell at both of us. Stupid kids. Huge Deep Sigh

 

Not rewarding yesterday especially when faced with system issues about documenting and all that crap. Just one of those days when I didn't feel particularly useful or like I was making a difference - just drive through and do what you want......

 

Deep Sigh - starting again this morning - new day - maybe a new outlook

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When I started I charted a few at home, but now I've stopped. I try to finish charting before seeing the next patient. Occasionally I will to stay an hour behind to finish charting. Our EMR sucks, but I've learned to become quicker with it.  When I'm home, I'm there to relax and spend time with family. I need that balance. One of my coworkers like to stay charting until 8-9PM, however, but she writes very detailed charts. The docs write 1-3 sentence HPIs usually! I tend to write a paragraph.

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I work at a privately owned urgent care center. There are four physicians and two PAs, and all of us take charts home to work on them. However, we have recently been told by our Board of Directors that taking charts home is a potential HIPPA violation and could end up costing our company as much as $2 to $3 million in penalties if a HIPPA violation were to occur. So no more charts going home, which actually makes me feel happy. I either stay late or come in early to finish charts. My days off feel much better now, but I still hate all the EMR bull****. We have Dragon for voice dictation but it is so bad that only 1 provider uses it. I am trying to learn how to chart efficiently without writing the great American novel for future attorneys to enjoy.

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