Notes

[jrapa86]

How do you feel about this?

 

Outpatient setting primary care office, advertised online as an alternate to emergency room - no appointment necessary:

• must complete note in patient room with patient still present
  
• must not do your note anywhere else but in the room
  
• this is because when the patient goes to the front to pay, they are provided their SOAP note H&P note, every time.
  

For myself it feels uncomfortable. I'm unsure if this is common practice though. Id love to hear your thoughts.

[Acebecker]

It would save me a lot of work... Cause I'd see 5-10 fewer Pts/day. I don't think it would work well for our UC efficiency.

[ToppDog]

The clinic I work in now does something similar, only the provider doesn't have to stay in the same room with the patient until finished. They can go to another computer in a dictation area or office etc. Everything is complete before the patient is allowed to leave though. I believe this is part of the new Medicare requirements being mandatory in October, where all patients are to be given a clinical summary of their visit.

[jmj11]

I will comment that I've decided to do my note myself in front of my patient. I do this for a few reasons but my reasons may not apply to everyone.

 

1) I save money for the practice by not hiring a transcriptionist or service. We have a proper demand for our medical service right now. If our demand when through the roof, it might be more economical to see more patients per day and outsource my dictation. But intractable pain patients are hard and I'm not sure I want to see more than 12 per day.

2) As part of my PR and service to the referring provider is that I want to furnish notes in real time (it as being faxed from my laptop as the patient is walking out of my exam room.

3) Part of the EHR incentive is allowing patients access to their medical records. I have the record done in front of them. Now, I don't say the things I use to say in an note, but I'm candid when the facts are clear ( "I suspect that the patient has an opioid addiction because they have four providers prescribing them up to 150 Vicodin per month" but not, "I suspect he is an alcoholic because he smelled of alcohol today."

4) I bill by time because the bulk of my interaction is about counseling and coordinating of care. I can not bill for time that isn't face to face, but when I type my note in front of the patient and allowing the patient to discuss the note points in real time, then I get the credit (payment) for the energy/thoughts/time I used to generate the note.

[physasst]

I will comment that I've decided to do my note myself in front of my patient. I do this for a few reasons but my reasons may not apply to everyone.

 

1) I save money for the practice by not hiring a transcriptionist or service. We have a proper demand for our medical service right now. If our demand when through the roof, it might be more economical to see more patients per day and outsource my dictation. But intractable pain patients are hard and I'm not sure I want to see more than 12 per day.

2) As part of my PR and service to the referring provider is that I want to furnish notes in real time (it as being faxed from my laptop as the patient is walking out of my exam room.

3) Part of the EHR incentive is allowing patients access to their medical records. I have the record done in front of them. Now, I don't say the things I use to say in an note, but I'm candid when the facts are clear ( "I suspect that the patient has an opioid addiction because they have four providers prescribing them up to 150 Vicodin per month" but not, "I suspect he is an alcoholic because he smelled of alcohol today."

4) I bill by time because the bulk of my interaction is about counseling and coordinating of care. I can not bill for time that isn't face to face, but when I type my note in front of the patient and allowing the patient to discuss the note points in real time, then I get the credit (payment) for the energy/thoughts/time I used to generate the note.

 

I do this as well Mike.

 

Not for a billing reason, although that makes sense, but also so that the patient can hear me dictate while they are in the room. I always tell them..."Now, I'm going to do your note, and I want you to listen and tell me if I get anything wrong".

 

Most patients really appreciate that.

[greenmood]

The clinic I work in now does something similar, only the provider doesn't have to stay in the same room with the patient until finished. They can go to another computer in a dictation area or office etc. Everything is complete before the patient is allowed to leave though. I believe this is part of the new Medicare requirements being mandatory in October, where all patients are to be given a clinical summary of their visit.

Several of my clinical sites as well as my own PCP provide "after-visit summaries" to patients. It's a friendly summary of the visit that includes the diagnosis (and an explanation of the diagnosis), recommendations, prescriptions, follow-up care, etc. We've had patients on my family medicine and pediatrics rotations come in for follow-ups from ER visits carrying similar pages. I presume this is in compliance with the Medicare requirement.

 

If that is the case I really don't know why an office would give out the actual SOAP to the patient instead. Seems like it would lead to the inappropriate softening of language in the note, either for the sake of the patient's comprehension or in order to avoid conflict over the content.

[ToppDog]

I don't know either. My guess would be that some EMR systems are not yet able to formulate a clinical summary, so they use the actual dictation instead, as it most likely also meets the new Medicare requirements. It seems to be a huge issue at the hospital I work at, & we are trying to get in the groove before the mandatory deadline comes up. It's a work in progress though, as many patients still try to sneak off before getting it, or some of the providers let them leave because they are in a hurry, etc. The one drawback I've seen is that it holds up exam rooms before the next patients can be brought back, which can back things up quite a bit.