The Paper Chase: A Behind-the-Scenes Look at a Non-Digital Medical Practice

With all the talk about meaningful use, it’s easy to forget what used to—and still should—motivate practices to become digital in the first place: the overwhelming problems created by paper.

Paper has an enormous impact on practices, and on patients, too. I know most EMR Straight Talk readers are medical professionals, but regardless of our professions, all of us are patients, and we know how it feels to call our doctor with an important question—maybe regarding a recent test—and then have to wait a day or more to get an answer.

Why does it take so long? To respond appropriately to your call, your physician must first review key chart information before the call, and then document the conversation after the call. If your doctor works in a non-digital practice—or worse, in a satellite office of a non-digital practice—here’s what typically happens:

Your call comes in and a staff member writes your message on a piece of paper and gives it to the Medical Records staff so they can pull your chart. Of course, since you were just in yesterday, the chart has not yet been re-filed and could be in any number of places. And so the chart hunt begins, starting with the “to-be-filed” pile and continuing throughout the office, from the physician’s desk, chair, or floor to the nurse’s inbox, from the billing department through the “waiting-for-transcription” pile to pre-certification or procedure scheduling. If the chart is not found—for example, it could be in the trunk of your physician’s car—your call either has to wait for another day, or be answered without the benefit of complete medical information. If your chart finally is located, Medical Records has to note where it was found (so it can be returned later), clip the message to it, and put it in the “to-be-faxed” pile. When a staff member has time, he or she has to disassemble the chart, remove the pages that will give the doctor enough information to answer your question (hopefully!), and head for the fax machine. With luck, the fax is not in use on either end, and the message can be sent to the satellite office. (Otherwise, your call has to wait again.) The staff member then reassembles the chart and returns it to where it belongs.

In the satellite office, a staff member retrieves the fax and gives it to the physician’s nurse or secretary, who in turn gives it to the physician. When the physician has the time, he or she goes through the pile of messages and charts on the desk and tries to contact you, hoping that you are still available. If you are, then you finally get the answer you need, but the practice still has a lot of work to do. The physician has to document the discussion—if he or she does so on paper, this must be faxed back to the main office; your chart has to be located again; the note has to be inserted, and the chart has to be returned to wherever it was when your call was first received. If the physician dictates a summary of the call, an even-more-complex transcription-management process ensues.

On the other hand, consider the simplified workflow in a digital office. Your call is received, and then transferred to your physician, who brings up your chart within a few seconds. Because this is such a quick process, there’s a good chance your call can be answered right away or within a few minutes, in between patients. Afterwards, he or she can summarize the conversation by typing or using Dragon to immediately enter the note into your chart. And it’s done.

When you multiply the impact of this process by the number of patient calls received, and then extend it to the myriad of other routine workflow tasks repeated over and over on a daily basis, it is clear that the built-in inefficiencies of a paper-based office are overwhelming—especially in large, multi-office group practices. No practice can afford to maintain the paper chart status quo.

2 thoughts on “The Paper Chase: A Behind-the-Scenes Look at a Non-Digital Medical Practice

  1. Transcription is not going away with the EMR, in fact there are two parts of the EMR that cannot be used in a pull down menu and that would be the HPI (history of present illness) and the plan and assessment which are patient specific and indiviualized for the patient. For years now practices use paperless transcription and all transcribed reports are on the computer in the patient’s record. Obviously, the statement of using Dragon, which there are a couple of versions and that was not specified; is not the answer. Physicians are not going to sit at their desks and edit their dictated speech files, nor are they going to take the endless hours to get the speech to recognize their voice pattern in order for the speech to be accurate, which it is not 100% accurate and pretty much picks up all background noises and makes it a part of the dictation. Also, not mentioned is that fact that Dragon Medical powered by Nuance is a separate license, an addtional expense and has to be installed BEFORE the set up of the EMR in order to coordinate with any templates, so this does not have to be done twice.

    Transcription is a viable source for the accuracy of patient’s medical records, a machine cannot replace a human, physicians make endless mistakes that can go over looked because the human transcriptionists finds numerous mistakes on a daily basis that coupled with putting the wrong information on the pull down menu, sends a red flag about eliminating specific parts of the patient’s charge and not having a human interface for quality in patient care records.

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