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Topic starter
I am looking for some tips that may help to persuade one of our providers to use the EMR more appropriately.
There is a long back story but basically we have a provider who has been with our clinic for 10 months and has not been using the EMR as expected. He basically dictates his entire note into the HPI section. Including dictating things such as vitals, meds, allergies, assessments and plans which are also being documented on the encounter forms. Thus duplicating work and making an VERY awful looking note.
This particular provider does not like EMR's and is not very receptive to change or to learning to use the EMR as it was designed to be used.
I have a meeting with him in a couple of weeks and I am open to any tips or suggestions others might offer that I could use to help open his mind to the EMR world.
Many thanks in advance.
Posted : November 27, 2018 8:16 am
When a person dictates, or simply writes, elements like BP, meds, allergies into the note, the EMR cannot effectively monitor and advise when issues arise. Also, it is impossible to determine individual compliance to requirements from MU, PCMH, etc..., as well as any private payers.
This also makes it difficult for anyone who needs to see the patients when that doctor is not available, or with an off-hours emergency. It will be very time-consuming to read through many notes in order to understand patient medications.
In this day and age, it does not seem to be a discussion of why, but rather that you MUST. No other way to deliver care in the 21st century.
Posted : November 27, 2018 9:15 am
We have had providers who just could not hack it, and ended up leaving our practice because we switched to Centricity. The ones who stayed, but did not like the new workflow had to be shown ways to save time and get things done quickly. Many of our providers did not like the stock EMR workflow, but some found that quicktext was a dream, and that persuaded them to use the EMR properly for meds, since they could save time on the note portion.
Depending on what this providers hang up is, showing that you are willing to help them make their workflow efficient may be all you need. Or they may just have to be told they have no other choice like joe said above. Either way, good luck to you!
Posted : November 27, 2018 12:42 pm
Topic starter
He will argue that dictating everything into Dragon is more efficient and serves better for patient care than clicking boxes and creating a "cookie cutter" note. He does enter meds, allergies, problems and orders into the chart appropriately. Its just that he dictates his entire note, using Dragon, on the HPI form (HPI, Histories reviewed, Meds reviewed, Allergies listed, ROS, Vitals, PE, A&P). Some of the information he dictates is also documented on other forms in the encounter thus duplicating info and making a poorly formatted note. We have had other providers mention that his notes are difficult to read. Mostly because they have an entirely different format than the other providers. I have attached a sample note to give you an idea of what he is doing.
I may just have to create a custom form for him where I could write the translation to create a cleaner note.
Posted : November 29, 2018 5:42 am
After looking at the note, it is eerily similar to some of our providers old notes. The only other thing I can think of to mention to him, is that we cannot track data with free-text notes like this. The vitals look silly since they are duplicated, but we do reports on our patient population using ROS, PE, and other checkboxes and buttons.
There were several times though, when I did make a new form for PE, or ROS, or our Medicare Visits, so that they can have the fewest clicks possible, and still have a meaningful note. Finding that balance of changing provider habits, and giving them tools to not struggle so much is pretty hard, but if you can find the biggest pain points for this provider, and fix them, he may turn into one of your most productive employees. That is what happened with us.
With PE and ROS, I am not sure if you have CCC or another form, but I would ask what his biggest struggle is with each form, and tell him what you can offer to ease the documentation process. Most of our providers want 1 page forms, without super buttons for the most common visits. Then they can tweak the note for the small percent of visits that are different.
Good luck!!! 🙂
Posted : November 30, 2018 6:32 am
Jessica,
I can relate to your struggles and you are likely fighting a losing battle. In my experience, changing a physician's behavior only happens when there is $$ at stake, or in rare occasions, when the partner physicians in the practice demand that the problem physician change his behavior. That said, I think there are ways to accommodate his method of documentation, but as you alluded, it will require a custom form that handles the text translation for him to prevent duplication. If it were me, I would schedule time to sit down with him and explain that you understand his frustrations, and you want to explore ways to accommodate his method of documentation, but also accommodate the practice's needs to capture some of the data as discrete elements. It could be that some workflow changes could alleviate some of his struggles. In our practice, the majority of the discrete data elements (vitals, ROS, medications, allergies, etc.) are collected and entered by the nurse. We have one physician that uses a scribe, because he had similar issues.
I have found that the two areas providers spend the most time documenting is the HPI and Assessment and Plan. Since both of these elements are narrative, I would try and come up with a custom form that gave him the ability to document these elements using dictation, but also review the other elements of the note without having to navigate to another form. I'm assuming he wants to see all of his documentation on one screen without having to bounce back and forth through several different forms or toggling the TEXT tab. With HTML forms, you can do some pretty creative things. I've built forms that allow providers to hover over an icon that displays the ROS and vitals in a hover box. You could also include a control that shows the entire progress note dynamically as the different components of the note are captured. My guess is that this particular provider would prefer to use Word to document his progress notes (I'm sure he would point out that it also has a spell checker that works; a side benefit of HTML forms). Since that is not going to happen, I would try and figure out how to give him a way to document all from one form, but still be able to quickly view all the relevant content/data needed to make clinical decisions. I'd be happy to connect offline sometime if you would like to see some of the forms we are developing to accommodate similar challenges in our environment. Feel free to email me if you have any interest.
Greg
Posted : December 10, 2018 2:02 am
