DogLovingPA Posted February 9, 2017 Share Posted February 9, 2017 I work at a high volume UC - depending on location we average 60-80 pts / 12 hours for 2 providers. Up until now we've had a beautiful system of paper charts that were easy to take into the room with me. A couple days later a transcriber would then put them in EMR where I'd proofread and sign off. We are now being forced to fully go electronic (new owners). Mar 1 we go live with epic and there are now computers in every pt room on large cumbersome arms that pull down and swivel. For those of you in similar situations, are you documenting the history in the pt room while talking to the pt? Pulling the computer down from the wall to use it frankly just gets in the way. But waiting until I leave the room to document the history seems like it will slow the process even more. Either way, I see our wait times going to a molasses like speed. Thanks. Link to comment Share on other sites More sharing options...
Febrifuge Posted February 9, 2017 Share Posted February 9, 2017 I've been through the Epic conversion (from other systems) a few times, and as a student I worked in an office with paper charts. I never had a romanticized view of "the old way," because paper charts have a lot of drawbacks. It sounds like your current setup is kind of the best of both worlds, with the quickness of paper and the reliability and search-ability of EMR. Bummer that you have to switch. To answer your question, I always jotted down notes in pen while in the room, and then did my note later. I'd get history stuff, write any ABnormal exam findings, and I had really good templates pre-made so I knew which ones applied. It wasn't "efficient" if you define that as fast, but I always felt it was worth it. When I'm the patient, I absolutely hate when the clinician is looking at the screen and not me, and if they're typing I assume they aren't listening. But overall, I like electronic records, and it works okay to click boxes for the billing stuff and write actual sentences for the history and intangibles. In 6 years of UC, I never compromised on writing at least good history and MDM sections, because for some of those patients, it was their first and last contact with our health system for years. All the above kind of goes out the window if you're not paid for the extra time at the end of the shift cleaning up and signing notes. I was lucky, and nobody gave me any grief if my time-card had an extra hour. I also had to learn how to keep moving and capture the most important stuff so I could fill in the rest later on, or even the next day. My notes would have stuff at the top like "striped sweater, cool glasses" or "baseball cap, hoarse voice" so I could call up a mental image of each patient when doing the good parts of the note, later. Link to comment Share on other sites More sharing options...
mmiller3 Posted February 9, 2017 Share Posted February 9, 2017 Just like Febrifuge alluded to: Templates and jotting notes on paper if you need them to remember. I worked in a high-volume immediate care seeing 35-55 PPD solo, and it went smoothly using that formula. Link to comment Share on other sites More sharing options...
beattie228 Posted February 9, 2017 Share Posted February 9, 2017 The Urgent Care I work at isn't quite as busy as you are, but I agree that charting in the room gets in the way for me as well. My approach is to type quick notes under the HPI when I'm getting the history as well as any pertinent exam findings and then I'll go back in to clean it up and finish the rest of my ROS/Exam, etc. I find this tactic to be the easiest as I don't have to fully complete the note in the room but I have a good background to fill in the blanks. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 9, 2017 Share Posted February 9, 2017 I take in a stenographer tablet if I have a two-fer just to keep the histories correct. I just use the ages and gender markings (harder to keep up with nowadays) to separate the histories. I don't move on to another exam room until I've completed my patient chart. In Cerner, using autofills, it only takes a couple of minutes. I can see 25 or 26 over what amounts to seven hours. Link to comment Share on other sites More sharing options...
DogLovingPA Posted February 9, 2017 Author Share Posted February 9, 2017 Thanks for the tips. I also think I'm going to avoid charting in the room. Especially early on, I'll probably find myself struggling with the program rather than listening the patient which is not what I want to do. There have also been some good tips on other threads about including MDM in an electronic note which I will incorporate as well. Luckily, I am hourly and paid for any extra time it takes to finish charts. Link to comment Share on other sites More sharing options...
camoman1234 Posted February 9, 2017 Share Posted February 9, 2017 I have used EPIC since 2009 and we had the computers attached to the walls (in family medicine) and COWs (computer on wheels) or WOWs (workstation on wheels) in UC. I charted in the room and had 90% of my note completed with orders before I even walked out of the room (i.e. strep, UA, bronchitis, etc). I would have 60-70% of the chart done with all other cases (non-emergent). EPIC is very user friendly. I have also trained/used Cerner and a couple of other ones I do not remember, but EPIC was my favorite. Now I am back to paper charting which I love (rural health clinic)! :) Link to comment Share on other sites More sharing options...
quietmedic Posted February 10, 2017 Share Posted February 10, 2017 I worked in a high-volume immediate care seeing 35-55 PPD solo, and it went smoothly using that formula. 55 patients in a 12 hour shift???? That's insane...the busiest Ive ever had is give or take 30 patients in 8 hours, which I suppose extrapolates to 45 in 12, and that is absolute chaos if there is anything more complex than a URI...one or two procedures, and forget it. How on Earth do you see that many (unless the MAs are doing the bulk of the work for you)? Link to comment Share on other sites More sharing options...
mmiller3 Posted February 10, 2017 Share Posted February 10, 2017 55 patients in a 12 hour shift???? That's insane...the busiest Ive ever had is give or take 30 patients in 8 hours, which I suppose extrapolates to 45 in 12, and that is absolute chaos if there is anything more complex than a URI...one or two procedures, and forget it. How on Earth do you see that many (unless the MAs are doing the bulk of the work for you)? It sucked, plain and simple. It was not common to see more than 35 patients in a 13-hour day, but around flu season, it happens. The MAs room, but I still had to chart via EMR, and my nurse would give any injections. It is a lot of running back and forth, especially if I had sutures or a CP/SOB/syncopal patient pain to deal with. It burned me out, which is why I left for the relative ease of family practice. They have gone through 6 different providers since I left 2.5 years ago. Link to comment Share on other sites More sharing options...
Katera Posted February 10, 2017 Share Posted February 10, 2017 I never chart in the room. Pt's hate it and I don't blame them. I see the pt, walk out go to the computer and chart what I call pertinent positives...then move on and finish the chart when I can. A lot of how it goes depends on the EMR you are using. I use Eclinical works now and it is just Ok. Docutap for Urgent Care was awesome. NextGen is the worst. And yea, anything over 40 pts a day starts to become unsafe unless you have a scribe and a few techs helping you. It's a good way to miss something and get tagged. Link to comment Share on other sites More sharing options...
DogLovingPA Posted February 10, 2017 Author Share Posted February 10, 2017 I never chart in the room. Pt's hate it and I don't blame them. I see the pt, walk out go to the computer and chart what I call pertinent positives...then move on and finish the chart when I can. A lot of how it goes depends on the EMR you are using. I use Eclinical works now and it is just Ok. Docutap for Urgent Care was awesome. NextGen is the worst. And yea, anything over 40 pts a day starts to become unsafe unless you have a scribe and a few techs helping you. It's a good way to miss something and get tagged. Agreed, from what I have seen at other places and at my previous part time job - patients do not like it when you chart in the room. Right now, I do take our paper chart (man, I'm going to miss those) in with me and I will often jot down some things - especially if it is a somewhat complicated hx. If I am silent for more than a few seconds I simply tell the patient "Sorry, I want to make sure I write this all down while you are telling me so I don't miss anything" - haven't had any complaints yet. But going in a room, pulling a computer off a wall which is going to be in the way of me moving around the exam room seems like a poor idea. And in some of the rooms, the placement of the computer puts the patient between me and the door - no thanks. NextGen still gives me nightmares to this day. My favorite so far has been athena but that was in a strictly outpatient environment. I feel UC has it's own challenges in designing an effective EMR system. Our busiest days are definitely frazzling (of course depending on the doc I'm with and the clinical staff I have sometimes anything over 10 patients can be frazzling! Lol) but in an UC I don't know how you staff to find a happy medium between the slow days and the crazy days. Sure, some days we know will be busy - Mondays, holidays, day after holidays but otherwise - do you always staff for the worst? I feel that is a money losing proposition. My busiest day ever with 2 providers was just over 100 patients - but it was all run of the mill URI/flu with no procedures. My busiest days are not always my worst days in terms of stress/complicated patients. But I definitely will not be staying in this environment forever - so far it's been a good job though. Overall decent docs, good autonomy, good learning environment and for my area, good pay. Link to comment Share on other sites More sharing options...
DogLovingPA Posted February 10, 2017 Author Share Posted February 10, 2017 I take in a stenographer tablet if I have a two-fer just to keep the histories correct. I just use the ages and gender markings (harder to keep up with nowadays) to separate the histories. I don't move on to another exam room until I've completed my patient chart. In Cerner, using autofills, it only takes a couple of minutes. I can see 25 or 26 over what amounts to seven hours. Yes, I will definitely have to jot down some notes in room for the two-fers, or three or four or fivers! One of our clinics is much more predominantly medicaid and we often have entire families pile into one room. 25 pts/7 hours is quite a lot, that gives me hope. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 10, 2017 Moderator Share Posted February 10, 2017 I also have worked at places seeing 50-60 pts/12 hr shift. not fun. don't do that anymore. the way to do it is templates for everything that you just plug 1-2 things into and they are done. these were VERY low acuity pts. uncomplicated uti, uri, dental pain, benign low back pain, etc. figured it was time to leave when I had a shift that I saw 56 and the doc saw 8...same acuity, same chart rack.... Link to comment Share on other sites More sharing options...
roger777 Posted February 11, 2017 Share Posted February 11, 2017 What about dictation? The ER group I worked with on my ER rotation did all their notes with dragon speak. It seemed like a really good setup and less tedious than typing/clicking. Anybody here use something like that? Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 11, 2017 Share Posted February 11, 2017 Ahh, the good ol' days of dictating faster than a speeding bullet, jumping tall buildings in a single bound, and getting a call from medical records asking me to please slow my speech down. Now THAT was efficient healthcare. Link to comment Share on other sites More sharing options...
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