Re: Progress note and organization questions

[Guest guest]

I use a program called asutype to do majority parts of note,

The patient is in no acute distress, speaking clearly, cooperative,

friendly

HEAD: atraumatic, normocephalic

EYES: sclera white, extraocular movements intact

EARS: tympanic membranes without lesions, canal patent

CV: regular rate, rhythm, no rub, no ectopy

LUNGS: clear to auscultation, equal breath sounds bilaterally

ABD: soft, benign, non tender

EXT: no clubbing, cyanosis or edema

problem list and chart updated,see face sheet for complete list, it

may not be reflected in the note

Usual coarse for dx discussed, if changes or symptoms suggestive of

something else is to return or if seems out of the ordinary.

medication list updated

differential diagnosis discussed

prescription provided

This took 10 seconds to do. You can modify it to how your practice

medicine and what you do.

For example I type: prosynvisc

up pops

Procedure: the joint space was prepared with Betadine swabs x 3 in a

circular pattern. The medial joint space was entered after first

place a small tract of lidocaine with a tuberculin syringe. A 25

gauge needle used for synvisc. The fluid injected freely without

and extra pressure needed.

You have to program the machine once to things you do routinely.

Brent

Regarding Money , only two ways, cut overhead , and look at billing

appropriately with some additional add ons like lab , xray, ekg,

pfts, and increase volume a bit now that somebody else is answering

the phone. If you are busy it does not make sense if you are

billing out 300 plus an hour to answer the phone for this or be a

secretary.

Brent Hrabik, MD

>

> I just wanted to write in to celebrate the fact that I have

finally

> read and cleared my inbox of an extraordinary number of emails

from

> this list serv. I am too embarassed to say how many, but it was

> interesting project to read everything that has come in from

September

> to now. It has been an overwhelming several years that I won't go

> into, but reading my email is the first thing I drop when too much

is

> going on.

>

> One gets a sense of different personalities and styles of

practice. I

> would love to take a road trip and visit all of you.

>

> I am also looking for some organizational advice. I have been in

> practice with another woman, both of us working part time to cover

5

> days of the week, since May of 2002, following the low overhead,

open

> access model. We have been using the tkfp open source EMR that

> Caldwell(also on this list serv) has been creating. I can see now

that

> we bit off more than we could chew with developing an EMR in

addition

> to starting a practice and learning all the business, billing,

coding,

> etc. at one time, yet here we are, still alive and kicking. The

EMR

> has morphed into a pretty good EMR, yet needs more work in lab

> tracking, patient registry, and health maintenance protocols.

>

> I have not achieved the simplicity of lifestyle that I would like

and

> that was part of the reason that I started this project. I would

> certainly never go back to being employed by someone else though.

I no

> longer have dreams of being hours behind in my clinic schedule,

which

> occured nightly in my previous position. I think a lot more about

> money than I used, to which I am not too happy about.

>

> The bottle neck that has slowed me down since the start of the

practice

> has been the length of time that it takes me to make a note. I

don't

> think that this is due to the EMR, but more to how I am doing the

note.

> I can now take notes on the subjective portion of the visit on

the

> computer during most interviews These don't usually need much

editing

> if at all, but the remainder of the note will take from 5-40

minutes or

> more depending on the complexity of the visit. I have a

collection of

> templates that I use all the time and I can make one on the fly

fairly

> easily. My partner is also fairly slow with notes, and I think

that

> we are too detail oriented and both have ADD on top of this.

Adding an

> office manager earlier this 2005, helped me somewhat as I wasn't

then

> distracted by every phone call, the filing, billing, etc. I still

tend

> to be mad at the insurance companies most of the time for the

stupid

> things they do to try to avoid paying or slowing payment.

>

> How do others do their notes and how do the different EMRs

facilitate

> making a note quickly?

>

>

> Also due to my husband having to retire due to health problems

> recently, I need to figure out how to augment what I am now making-

> about $4000 a month. We have large insurance premiums due to his

now

> pre exisitng health condition. How does one learn more about

botox and

> sclerotherapy. I am assuming that I would need to go to

certification

> courses. Everyone and their brother are sending me junk mail on

laser

> therapy, but not on the low tech aesthetic procedures. Any

suggestions?

>

> Thanks,

> Kathy Broman MD

> Mason City, IA

>

[Guest guest]

I use a program called asutype to do majority parts of note,

The patient is in no acute distress, speaking clearly, cooperative,

friendly

HEAD: atraumatic, normocephalic

EYES: sclera white, extraocular movements intact

EARS: tympanic membranes without lesions, canal patent

CV: regular rate, rhythm, no rub, no ectopy

LUNGS: clear to auscultation, equal breath sounds bilaterally

ABD: soft, benign, non tender

EXT: no clubbing, cyanosis or edema

problem list and chart updated,see face sheet for complete list, it

may not be reflected in the note

Usual coarse for dx discussed, if changes or symptoms suggestive of

something else is to return or if seems out of the ordinary.

medication list updated

differential diagnosis discussed

prescription provided

This took 10 seconds to do. You can modify it to how your practice

medicine and what you do.

For example I type: prosynvisc

up pops

Procedure: the joint space was prepared with Betadine swabs x 3 in a

circular pattern. The medial joint space was entered after first

place a small tract of lidocaine with a tuberculin syringe. A 25

gauge needle used for synvisc. The fluid injected freely without

and extra pressure needed.

You have to program the machine once to things you do routinely.

Brent

Regarding Money , only two ways, cut overhead , and look at billing

appropriately with some additional add ons like lab , xray, ekg,

pfts, and increase volume a bit now that somebody else is answering

the phone. If you are busy it does not make sense if you are

billing out 300 plus an hour to answer the phone for this or be a

secretary.

Brent Hrabik, MD

>

> I just wanted to write in to celebrate the fact that I have

finally

> read and cleared my inbox of an extraordinary number of emails

from

> this list serv. I am too embarassed to say how many, but it was

> interesting project to read everything that has come in from

September

> to now. It has been an overwhelming several years that I won't go

> into, but reading my email is the first thing I drop when too much

is

> going on.

>

> One gets a sense of different personalities and styles of

practice. I

> would love to take a road trip and visit all of you.

>

> I am also looking for some organizational advice. I have been in

> practice with another woman, both of us working part time to cover

5

> days of the week, since May of 2002, following the low overhead,

open

> access model. We have been using the tkfp open source EMR that

> Caldwell(also on this list serv) has been creating. I can see now

that

> we bit off more than we could chew with developing an EMR in

addition

> to starting a practice and learning all the business, billing,

coding,

> etc. at one time, yet here we are, still alive and kicking. The

EMR

> has morphed into a pretty good EMR, yet needs more work in lab

> tracking, patient registry, and health maintenance protocols.

>

> I have not achieved the simplicity of lifestyle that I would like

and

> that was part of the reason that I started this project. I would

> certainly never go back to being employed by someone else though.

I no

> longer have dreams of being hours behind in my clinic schedule,

which

> occured nightly in my previous position. I think a lot more about

> money than I used, to which I am not too happy about.

>

> The bottle neck that has slowed me down since the start of the

practice

> has been the length of time that it takes me to make a note. I

don't

> think that this is due to the EMR, but more to how I am doing the

note.

> I can now take notes on the subjective portion of the visit on

the

> computer during most interviews These don't usually need much

editing

> if at all, but the remainder of the note will take from 5-40

minutes or

> more depending on the complexity of the visit. I have a

collection of

> templates that I use all the time and I can make one on the fly

fairly

> easily. My partner is also fairly slow with notes, and I think

that

> we are too detail oriented and both have ADD on top of this.

Adding an

> office manager earlier this 2005, helped me somewhat as I wasn't

then

> distracted by every phone call, the filing, billing, etc. I still

tend

> to be mad at the insurance companies most of the time for the

stupid

> things they do to try to avoid paying or slowing payment.

>

> How do others do their notes and how do the different EMRs

facilitate

> making a note quickly?

>

>

> Also due to my husband having to retire due to health problems

> recently, I need to figure out how to augment what I am now making-

> about $4000 a month. We have large insurance premiums due to his

now

> pre exisitng health condition. How does one learn more about

botox and

> sclerotherapy. I am assuming that I would need to go to

certification

> courses. Everyone and their brother are sending me junk mail on

laser

> therapy, but not on the low tech aesthetic procedures. Any

suggestions?

>

> Thanks,

> Kathy Broman MD

> Mason City, IA

>

[Guest guest]

I too have struggled with the charting thing. I've gotten faster over my

first 2 yrs, but it is still taking a lot more time than I'd like. I use

Alteer as my EMR combined with a basic note template & use of Dragon

Naturally Speaking 8.0 medical. I free text the entire HPI section &

cut/add to the PE section template as needed. I also then free text the

discussion section. I hear a lot of guys say they are done with the note

when they leave the room, but I'm a bit skeptical & envious at the same

time. I can't do that, so I do it between pts & at the end of the day/over

lunch. I'm certain I could chart faster on paper but then it would not look

as nice & it would be harder to meet all of the needed E/M bullets for

coding. By the way, I did look briefly at the As-U-Type program mentioned

but I found it very cumbersome & confusing. I can create those same " hot

links " (ie, macros) in Dragon & it is much easier. I'm still looking at how

I can be faster with Alteer, but I also share some of your concerns.

Progress note and organization questions

I just wanted to write in to celebrate the fact that I have finally

read and cleared my inbox of an extraordinary number of emails from

this list serv. I am too embarassed to say how many, but it was

interesting project to read everything that has come in from September

to now. It has been an overwhelming several years that I won't go

into, but reading my email is the first thing I drop when too much is

going on.

One gets a sense of different personalities and styles of practice. I

would love to take a road trip and visit all of you.

I am also looking for some organizational advice. I have been in

practice with another woman, both of us working part time to cover 5

days of the week, since May of 2002, following the low overhead, open

access model. We have been using the tkfp open source EMR that

Caldwell(also on this list serv) has been creating. I can see now that

we bit off more than we could chew with developing an EMR in addition

to starting a practice and learning all the business, billing, coding,

etc. at one time, yet here we are, still alive and kicking. The EMR

has morphed into a pretty good EMR, yet needs more work in lab

tracking, patient registry, and health maintenance protocols.

I have not achieved the simplicity of lifestyle that I would like and

that was part of the reason that I started this project. I would

certainly never go back to being employed by someone else though. I no

longer have dreams of being hours behind in my clinic schedule, which

occured nightly in my previous position. I think a lot more about

money than I used, to which I am not too happy about.

The bottle neck that has slowed me down since the start of the practice

has been the length of time that it takes me to make a note. I don't

think that this is due to the EMR, but more to how I am doing the note.

I can now take notes on the subjective portion of the visit on the

computer during most interviews These don't usually need much editing

if at all, but the remainder of the note will take from 5-40 minutes or

more depending on the complexity of the visit. I have a collection of

templates that I use all the time and I can make one on the fly fairly

easily. My partner is also fairly slow with notes, and I think that

we are too detail oriented and both have ADD on top of this. Adding an

office manager earlier this 2005, helped me somewhat as I wasn't then

distracted by every phone call, the filing, billing, etc. I still tend

to be mad at the insurance companies most of the time for the stupid

things they do to try to avoid paying or slowing payment.

How do others do their notes and how do the different EMRs facilitate

making a note quickly?

Also due to my husband having to retire due to health problems

recently, I need to figure out how to augment what I am now making-

about $4000 a month. We have large insurance premiums due to his now

pre exisitng health condition. How does one learn more about botox and

sclerotherapy. I am assuming that I would need to go to certification

courses. Everyone and their brother are sending me junk mail on laser

therapy, but not on the low tech aesthetic procedures. Any suggestions?

Thanks,

Kathy Broman MD

Mason City, IA

[Guest guest]

I too have struggled with the charting thing. I've gotten faster over my

first 2 yrs, but it is still taking a lot more time than I'd like. I use

Alteer as my EMR combined with a basic note template & use of Dragon

Naturally Speaking 8.0 medical. I free text the entire HPI section &

cut/add to the PE section template as needed. I also then free text the

discussion section. I hear a lot of guys say they are done with the note

when they leave the room, but I'm a bit skeptical & envious at the same

time. I can't do that, so I do it between pts & at the end of the day/over

lunch. I'm certain I could chart faster on paper but then it would not look

as nice & it would be harder to meet all of the needed E/M bullets for

coding. By the way, I did look briefly at the As-U-Type program mentioned

but I found it very cumbersome & confusing. I can create those same " hot

links " (ie, macros) in Dragon & it is much easier. I'm still looking at how

I can be faster with Alteer, but I also share some of your concerns.

Progress note and organization questions

I just wanted to write in to celebrate the fact that I have finally

read and cleared my inbox of an extraordinary number of emails from

this list serv. I am too embarassed to say how many, but it was

interesting project to read everything that has come in from September

to now. It has been an overwhelming several years that I won't go

into, but reading my email is the first thing I drop when too much is

going on.

One gets a sense of different personalities and styles of practice. I

would love to take a road trip and visit all of you.

I am also looking for some organizational advice. I have been in

practice with another woman, both of us working part time to cover 5

days of the week, since May of 2002, following the low overhead, open

access model. We have been using the tkfp open source EMR that

Caldwell(also on this list serv) has been creating. I can see now that

we bit off more than we could chew with developing an EMR in addition

to starting a practice and learning all the business, billing, coding,

etc. at one time, yet here we are, still alive and kicking. The EMR

has morphed into a pretty good EMR, yet needs more work in lab

tracking, patient registry, and health maintenance protocols.

I have not achieved the simplicity of lifestyle that I would like and

that was part of the reason that I started this project. I would

certainly never go back to being employed by someone else though. I no

longer have dreams of being hours behind in my clinic schedule, which

occured nightly in my previous position. I think a lot more about

money than I used, to which I am not too happy about.

The bottle neck that has slowed me down since the start of the practice

has been the length of time that it takes me to make a note. I don't

think that this is due to the EMR, but more to how I am doing the note.

I can now take notes on the subjective portion of the visit on the

computer during most interviews These don't usually need much editing

if at all, but the remainder of the note will take from 5-40 minutes or

more depending on the complexity of the visit. I have a collection of

templates that I use all the time and I can make one on the fly fairly

easily. My partner is also fairly slow with notes, and I think that

we are too detail oriented and both have ADD on top of this. Adding an

office manager earlier this 2005, helped me somewhat as I wasn't then

distracted by every phone call, the filing, billing, etc. I still tend

to be mad at the insurance companies most of the time for the stupid

things they do to try to avoid paying or slowing payment.

How do others do their notes and how do the different EMRs facilitate

making a note quickly?

Also due to my husband having to retire due to health problems

recently, I need to figure out how to augment what I am now making-

about $4000 a month. We have large insurance premiums due to his now

pre exisitng health condition. How does one learn more about botox and

sclerotherapy. I am assuming that I would need to go to certification

courses. Everyone and their brother are sending me junk mail on laser

therapy, but not on the low tech aesthetic procedures. Any suggestions?

Thanks,

Kathy Broman MD

Mason City, IA

[Guest guest]

Kathy: How are you funding your health insurance premiums? What is your corporate structure? Depending on your husbands pre-existing health condition and cost of medications? Certain insurance from the AMA can save money, while setting up a health reimbursement account through Base105 can make all your health expenses can be reimbursed through your corporation tax free no matter what health plan you have. This helps with prescriptions and other expenses often not covered by insurance at all. PS I tap through my notes on eMDs templates. I have thought about Dragon but do not have the time to learn right now. Also, if you could be seeing another patient transcription service for your lengthy note could be worth while.Kathy Broman

wrote: I just wanted to write in to celebrate the fact that I have finally read and cleared my inbox of an extraordinary number of emails from this list serv. I am too embarassed to say how many, but it was interesting project to read everything that has come in from September to now. It has been an overwhelming several years that I won't go into, but reading my email is the first thing I drop when too much is going on.One gets a sense of different personalities and styles of practice. I would love to take a road trip and visit all of you.I am also looking for some organizational advice. I have been in practice with another woman, both of us working part time to cover 5 days of the week, since May of 2002, following the low overhead, open access model. We have been using the tkfp open

source EMR that Caldwell(also on this list serv) has been creating. I can see now that we bit off more than we could chew with developing an EMR in addition to starting a practice and learning all the business, billing, coding, etc. at one time, yet here we are, still alive and kicking. The EMR has morphed into a pretty good EMR, yet needs more work in lab tracking, patient registry, and health maintenance protocols.I have not achieved the simplicity of lifestyle that I would like and that was part of the reason that I started this project. I would certainly never go back to being employed by someone else though. I no longer have dreams of being hours behind in my clinic schedule, which occured nightly in my previous position. I think a lot more about money than I used, to which I am not too happy about.The bottle neck that has slowed me down since the start of the practice has

been the length of time that it takes me to make a note. I don't think that this is due to the EMR, but more to how I am doing the note. I can now take notes on the subjective portion of the visit on the computer during most interviews These don't usually need much editing if at all, but the remainder of the note will take from 5-40 minutes or more depending on the complexity of the visit. I have a collection of templates that I use all the time and I can make one on the fly fairly easily. My partner is also fairly slow with notes, and I think that we are too detail oriented and both have ADD on top of this. Adding an office manager earlier this 2005, helped me somewhat as I wasn't then distracted by every phone call, the filing, billing, etc. I still tend to be mad at the insurance companies most of the time for the stupid things they do to try to avoid paying or slowing

payment.How do others do their notes and how do the different EMRs facilitate making a note quickly?Also due to my husband having to retire due to health problems recently, I need to figure out how to augment what I am now making- about $4000 a month. We have large insurance premiums due to his now pre exisitng health condition. How does one learn more about botox and sclerotherapy. I am assuming that I would need to go to certification courses. Everyone and their brother are sending me junk mail on laser therapy, but not on the low tech aesthetic procedures. Any suggestions?Thanks,Kathy Broman MDMason City, IA

Yahoo! Mail Use Photomail to share photos without annoying attachments.

[Guest guest]

Kathy: How are you funding your health insurance premiums? What is your corporate structure? Depending on your husbands pre-existing health condition and cost of medications? Certain insurance from the AMA can save money, while setting up a health reimbursement account through Base105 can make all your health expenses can be reimbursed through your corporation tax free no matter what health plan you have. This helps with prescriptions and other expenses often not covered by insurance at all. PS I tap through my notes on eMDs templates. I have thought about Dragon but do not have the time to learn right now. Also, if you could be seeing another patient transcription service for your lengthy note could be worth while.Kathy Broman

wrote: I just wanted to write in to celebrate the fact that I have finally read and cleared my inbox of an extraordinary number of emails from this list serv. I am too embarassed to say how many, but it was interesting project to read everything that has come in from September to now. It has been an overwhelming several years that I won't go into, but reading my email is the first thing I drop when too much is going on.One gets a sense of different personalities and styles of practice. I would love to take a road trip and visit all of you.I am also looking for some organizational advice. I have been in practice with another woman, both of us working part time to cover 5 days of the week, since May of 2002, following the low overhead, open access model. We have been using the tkfp open

source EMR that Caldwell(also on this list serv) has been creating. I can see now that we bit off more than we could chew with developing an EMR in addition to starting a practice and learning all the business, billing, coding, etc. at one time, yet here we are, still alive and kicking. The EMR has morphed into a pretty good EMR, yet needs more work in lab tracking, patient registry, and health maintenance protocols.I have not achieved the simplicity of lifestyle that I would like and that was part of the reason that I started this project. I would certainly never go back to being employed by someone else though. I no longer have dreams of being hours behind in my clinic schedule, which occured nightly in my previous position. I think a lot more about money than I used, to which I am not too happy about.The bottle neck that has slowed me down since the start of the practice has

been the length of time that it takes me to make a note. I don't think that this is due to the EMR, but more to how I am doing the note. I can now take notes on the subjective portion of the visit on the computer during most interviews These don't usually need much editing if at all, but the remainder of the note will take from 5-40 minutes or more depending on the complexity of the visit. I have a collection of templates that I use all the time and I can make one on the fly fairly easily. My partner is also fairly slow with notes, and I think that we are too detail oriented and both have ADD on top of this. Adding an office manager earlier this 2005, helped me somewhat as I wasn't then distracted by every phone call, the filing, billing, etc. I still tend to be mad at the insurance companies most of the time for the stupid things they do to try to avoid paying or slowing

payment.How do others do their notes and how do the different EMRs facilitate making a note quickly?Also due to my husband having to retire due to health problems recently, I need to figure out how to augment what I am now making- about $4000 a month. We have large insurance premiums due to his now pre exisitng health condition. How does one learn more about botox and sclerotherapy. I am assuming that I would need to go to certification courses. Everyone and their brother are sending me junk mail on laser therapy, but not on the low tech aesthetic procedures. Any suggestions?Thanks,Kathy Broman MDMason City, IA

Yahoo! Mail Use Photomail to share photos without annoying attachments.

[Guest guest]

When it is slower I try to use templates and typing to improve my typing skills but when I'm busy I use voice recognition to make notes in a couple of minutes. Especially if you have templates set up such as saying normal gyne exam to fill in the entire usual physical . I use via voice because I'm a mac based system but for PC's dragon is the way to go. I would recommend the medical dictionary even though it adds expense but it saves a lot of time teaching the system your usual words. I haven't dictated in the room but I have heard that patients like it. I tend to like a few minutes after the visit to put my thoughts together before I dictate.Larry Lindeman  I just wanted to write in to celebrate the fact that I have finally read and cleared my inbox of an extraordinary number of emails from this list serv.  I am too embarassed to say how many, but it was interesting project to read everything that has come in from September to now.  It has been an overwhelming several years that I won't go into, but reading my email is the first thing I drop when too much is going on. One gets a sense of different personalities and styles of practice.  I would love to take a road trip and visit all of you. I am also looking for some organizational advice.  I have been in practice with another woman, both of us working part time to cover 5 days of the week, since May of 2002, following the low overhead, open access model.  We have been using the tkfp open source EMR that Caldwell(also on this list serv) has been creating.  I can see now that we bit off more than we could chew with developing an EMR in addition to starting a practice and learning all the business, billing, coding, etc. at one time, yet here we are, still alive and kicking.  The EMR has morphed into a pretty good EMR, yet needs more work in lab tracking, patient registry, and health maintenance protocols. I have not achieved the simplicity of lifestyle that I would like and that  was part of the reason that I started this project.  I would certainly never go back to being employed by someone else though.  I no longer have dreams of being hours behind in my clinic schedule, which occured nightly in my previous position.  I think a lot more about money than I used, to which I am not too happy about. The bottle neck that has slowed me down since the start of the practice has been the length of time that it takes me to make a note.  I don't think that this is due to the EMR, but more to how I am doing the note.   I can now take notes on the subjective portion of the visit on the computer during most interviews These  don't usually need much editing if at all, but the remainder of the note will take from 5-40 minutes or more depending on the complexity of the visit.  I have a collection of templates that I use all the time and I can make one on the fly fairly easily.   My partner is also fairly slow with notes, and I think that we are too detail oriented and both have ADD on top of this.  Adding an office manager earlier this 2005, helped me somewhat as I wasn't then distracted by every phone call, the filing, billing, etc.  I still tend to be mad at the insurance companies most of the time for the stupid things they do to try to avoid paying or slowing payment. How do others do their notes and how do the different EMRs facilitate making a note quickly? Also due to my husband having to retire due to health problems recently, I need to figure out how to augment what I am now making- about $4000 a month.  We have large insurance premiums due to his now pre exisitng health condition.  How does one learn more about botox and sclerotherapy.  I am assuming that I would need to go to certification courses.  Everyone and their brother are sending me junk mail on laser therapy, but not on the low tech aesthetic procedures.  Any suggestions? Thanks, Kathy Broman MD Mason City, IA

[Guest guest]

When it is slower I try to use templates and typing to improve my typing skills but when I'm busy I use voice recognition to make notes in a couple of minutes. Especially if you have templates set up such as saying normal gyne exam to fill in the entire usual physical . I use via voice because I'm a mac based system but for PC's dragon is the way to go. I would recommend the medical dictionary even though it adds expense but it saves a lot of time teaching the system your usual words. I haven't dictated in the room but I have heard that patients like it. I tend to like a few minutes after the visit to put my thoughts together before I dictate.Larry Lindeman  I just wanted to write in to celebrate the fact that I have finally read and cleared my inbox of an extraordinary number of emails from this list serv.  I am too embarassed to say how many, but it was interesting project to read everything that has come in from September to now.  It has been an overwhelming several years that I won't go into, but reading my email is the first thing I drop when too much is going on. One gets a sense of different personalities and styles of practice.  I would love to take a road trip and visit all of you. I am also looking for some organizational advice.  I have been in practice with another woman, both of us working part time to cover 5 days of the week, since May of 2002, following the low overhead, open access model.  We have been using the tkfp open source EMR that Caldwell(also on this list serv) has been creating.  I can see now that we bit off more than we could chew with developing an EMR in addition to starting a practice and learning all the business, billing, coding, etc. at one time, yet here we are, still alive and kicking.  The EMR has morphed into a pretty good EMR, yet needs more work in lab tracking, patient registry, and health maintenance protocols. I have not achieved the simplicity of lifestyle that I would like and that  was part of the reason that I started this project.  I would certainly never go back to being employed by someone else though.  I no longer have dreams of being hours behind in my clinic schedule, which occured nightly in my previous position.  I think a lot more about money than I used, to which I am not too happy about. The bottle neck that has slowed me down since the start of the practice has been the length of time that it takes me to make a note.  I don't think that this is due to the EMR, but more to how I am doing the note.   I can now take notes on the subjective portion of the visit on the computer during most interviews These  don't usually need much editing if at all, but the remainder of the note will take from 5-40 minutes or more depending on the complexity of the visit.  I have a collection of templates that I use all the time and I can make one on the fly fairly easily.   My partner is also fairly slow with notes, and I think that we are too detail oriented and both have ADD on top of this.  Adding an office manager earlier this 2005, helped me somewhat as I wasn't then distracted by every phone call, the filing, billing, etc.  I still tend to be mad at the insurance companies most of the time for the stupid things they do to try to avoid paying or slowing payment. How do others do their notes and how do the different EMRs facilitate making a note quickly? Also due to my husband having to retire due to health problems recently, I need to figure out how to augment what I am now making- about $4000 a month.  We have large insurance premiums due to his now pre exisitng health condition.  How does one learn more about botox and sclerotherapy.  I am assuming that I would need to go to certification courses.  Everyone and their brother are sending me junk mail on laser therapy, but not on the low tech aesthetic procedures.  Any suggestions? Thanks, Kathy Broman MD Mason City, IA

[Guest guest]

, Larry, and , Thanks for ideas.

We have enough health costs, with premiums, prescriptions etc. and CT

scans that we can deduct them on our joint tax returns, they

essentially come out of pretax. I am in a partnership and pay taxes on

my joint individual return. I am not paying too many taxes these days

with my current income.

Regarding templates, for quick visits, it doesn't take me very long.

It is the multiple problem ones, which are most of my patients. I can

type nearly as fast as I can talk, so I am not sure if the Dragon

Naturally Speaking would be helpful. I should say that I can type that

fast when I am organized and focused. If I am not focused then the

whole day is a loss and I am way behind. I am not sure if I could

dictate any better when not focused. if I am focused then i can do the

HPI and the ROS while talking with the patient. I can insert allergies,

medications with a single click. I can insert major portions of the

exam with just several clicks, just making simple adjustments for the

specific exam. Then it depends on how verbose I am with the plan. I

certainly am not done with a note at the end of a visit though.

What takes a lot of time is placing orders for the labs etc.. I have

to hand fill out the form with all the patients demographics and then

hand fax it, as the hospital doesn't have the order system computerized

yet. The same goes for all xrays, referrals, filling out PAP forms

and labeling. We have the capability of faxing all of this from the

computer, but they don't like our individual forms over their own

forms. We don't have much clout to get them to accept something

different from one little office. I can fax referral letters from the

computer and easily attach part of my note. There seems to be more and

more paperwork for each patient. We are working on developing a

tracking system that hopes to put in a sql database format. I

need all the help I can get to remember things. I am one of those

people that used to have a really good memory and thus never developed

any good system for remembering things.

It is probably easy to see from the above letter why it takes me so

long to finish my notes.

Kathy Broman

Mason City, IA 50401

On Tuesday, February 21, 2006, at 06:00 PM, Egly wrote:

> Kathy:

>  

> How are you funding your health insurance premiums? 

>  

> What is your corporate structure?

>  

> Depending on your husbands pre-existing health condition and cost of

> medications?  Certain insurance from the AMA can save money, while

> setting up a health reimbursement account through Base105 can make all

> your health expenses can be reimbursed through your corporation tax

> free no matter what health plan you have.  This helps with

> prescriptions and other expenses often not covered by insurance at > all.

>  

>

>  

> PS  I tap through my notes on eMDs templates.  I have thought about

> Dragon but do not have the time to learn right now.  Also, if you

> could be seeing another patient transcription service for your lengthy

> note could be worth while.

>

> Kathy Broman wrote:

>

> I just wanted to write in to celebrate the fact that I have finally

> read and cleared my inbox of an extraordinary number of emails from

> this list serv.  I am too embarassed to say how many, but it was

> interesting project to read everything that has come in from September

> to now.  It has been an overwhelming several years that I won't go

> into, but reading my email is the first thing I drop when too much is

> going on.

>

> One gets a sense of different personalities and styles of practice.  I

> would love to take a road trip and visit all of you.

>

> I am also looking for some organizational advice.  I have been in

> practice with another woman, both of us working part time to cover 5

> days of the week, since May of 2002, following the low overhead, open

> access model.  We have been using the tkfp open source EMR that

> Caldwell(also on this list serv) has been creating.  I can see now that

> we bit off more than we could chew with developing an EMR in addition

> to starting a practice and learning all the business, billing, coding,

> etc. at one time, yet here we are, still alive and kicking.  The EMR

> has morphed into a pretty good EMR, yet needs more work in lab

> tracking, patient registry, and health maintenance protocols.

>

> I have not achieved the simplicity of lifestyle that I would like and

> that  was part of the reason that I started this project.  I would

> certainly never go back to being employed by someone else though.  I no

> longer have dreams of being hours behind in my clinic schedule, which

> occured nightly in my previous position.  I think a lot more about

> money than I used, to which I am not too happy about.

>

> The bottle neck that has slowed me down since the start of the practice

> has been the length of time that it takes me to make a note.  I don't

> think that this is due to the EMR, but more to how I am doing the note.

>   I can now take notes on the subjective portion of the visit on the

> computer during most interviews These  don't usually need much editing

> if at all, but the remainder of the note will take from 5-40 minutes or

> more depending on the complexity of the visit.  I have a collection of

> templates that I use all the time and I can make one on the fly fairly

> easily.   My partner is also fairly slow with notes, and I think that

> we are too detail oriented and both have ADD on top of this.  Adding an

> office manager earlier this 2005, helped me somewhat as I wasn't then

> distracted by every phone call, the filing, billing, etc.  I still tend

> to be mad at the insurance companies most of the time for the stupid

> things they do to try to avoid paying or slowing payment.

>

> How do others do their notes and how do the different EMRs facilitate

> making a note quickly?

>

>

> Also due to my husband having to retire due to health problems

> recently, I need to figure out how to augment what I am now making-

> about $4000 a month.  We have large insurance premiums due to his now

> pre exisitng health condition.  How does one learn more about botox and

> sclerotherapy.  I am assuming that I would need to go to certification

> courses.  Everyone and their brother are sending me junk mail on laser

> therapy, but not on the low tech aesthetic procedures.  Any

> suggestions?

>

> Thanks,

> Kathy Broman MD

> Mason City, IA

>

>

>

>

<image.tiff>

>

> Yahoo! Mail

> Use Photomail to share photos without annoying attachments.

>

>

[Guest guest]

RE: Hospital accepting orders on their forms OR your typed orders.

I highly doubt the hospital has the power to insist that you MUST use their forms.

I use an EMR (SOAPware) that allows me to set up templates too. The top of the order has the demographics, and I can change anything I want on the generated report. I just hand the printout for a lab or X-ray (the nonscheduled ones that pts can walk in for) to the pt.

I print out the specials (CT scans, echos, stress tests) and my office person cuts out the typed order and puts it onto the standard hospital order form that lists all of the specific choices. I have a few pts who are data entry/check-in at the hospital-- they love these as they can actually read what I write.

We also do not have direct order entry into the hospital system, but can get results out.

I print out a note for each pt encounter including assessment, plan, meds, follow up for each visit. In my new practice of 14 months, I can get through 10-11 complex pts with little difficulty-- main issue has been a printer hookup that needs a better buffer, so printout is alittle slower than I'd like.

I also find that templating most of PE, assessment, plan, meds, follow up choices is rather straightforward, but subjective, except for some prefilled, is mostly free text, despite my best intentions.

Hope this helps.

Dr Matt Levin

FP

Pittsburgh, PA

Using SOAPWare at point of care since 1997; doing all pt care notes in system since Dec 2004.

Re: Progress note and organization questions

, Larry, and , Thanks for ideas.We have enough health costs, with premiums, prescriptions etc. and CT scans that we can deduct them on our joint tax returns, they essentially come out of pretax. I am in a partnership and pay taxes on my joint individual return. I am not paying too many taxes these days with my current income.Regarding templates, for quick visits, it doesn't take me very long. It is the multiple problem ones, which are most of my patients. I can type nearly as fast as I can talk, so I am not sure if the Dragon Naturally Speaking would be helpful. I should say that I can type that fast when I am organized and focused. If I am not focused then the whole day is a loss and I am way behind. I am not sure if I could dictate any better when not focused. if I am focused then i can do the HPI and the ROS while talking with the patient. I can insert allergies, medications with a single click. I can insert major portions of the exam with just several clicks, just making simple adjustments for the specific exam. Then it depends on how verbose I am with the plan. I certainly am not done with a note at the end of a visit though.What takes a lot of time is placing orders for the labs etc.. I have to hand fill out the form with all the patients demographics and then hand fax it, as the hospital doesn't have the order system computerized yet. The same goes for all xrays, referrals, filling out PAP forms and labeling. We have the capability of faxing all of this from the computer, but they don't like our individual forms over their own forms. We don't have much clout to get them to accept something different from one little office. I can fax referral letters from the computer and easily attach part of my note. There seems to be more and more paperwork for each patient. We are working on developing a tracking system that hopes to put in a sql database format. I need all the help I can get to remember things. I am one of those people that used to have a really good memory and thus never developed any good system for remembering things.It is probably easy to see from the above letter why it takes me so long to finish my notes.Kathy Broman Mason City, IA 50401On Tuesday, February 21, 2006, at 06:00 PM, Egly wrote:

Kathy: How are you funding your health insurance premiums? What is your corporate structure? Depending on your husbands pre-existing health condition and cost of medications? Certain insurance from the AMA can save money, while setting up a health reimbursement account through Base105 can make all your health expenses can be reimbursed through your corporation tax free no matter what health plan you have. This helps with prescriptions and other expenses often not covered by insurance at all. PS I tap through my notes on eMDs templates. I have thought about Dragon but do not have the time to learn right now. Also, if you could be seeing another patient transcription service for your lengthy note could be worth while.Kathy Broman wrote:I just wanted to write in to celebrate the fact that I have finallyread and cleared my inbox of an extraordinary number of emails fromthis list serv. I am too embarassed to say how many, but it wasinteresting project to read everything that has come in from Septemberto now. It has been an overwhelming several years that I won't gointo, but reading my email is the first thing I drop when too much isgoing on.One gets a sense of different personalities and styles of practice. Iwould love to take a road trip and visit all of you.I am also looking for some organizational advice. I have been inpractice with another woman, both of us working part time to cover 5days of the week, since May of 2002, following the low overhead, openaccess model. We have been using the tkfp open source EMR that Caldwell(also on this list serv) has been creating. I can see now thatwe bit off more than we could chew with developing an EMR in additionto starting a practice and learning all the business, billing, coding,etc. at one time, yet here we are, still alive and kicking. The EMRhas morphed into a pretty good EMR, yet needs more work in labtracking, patient registry, and health maintenance protocols.I have not achieved the simplicity of lifestyle that I would like andthat was part of the reason that I started this project. I wouldcertainly never go back to being employed by someone else though. I nolonger have dreams of being hours behind in my clinic schedule, whichoccured nightly in my previous position. I think a lot more aboutmoney than I used, to which I am not too happy about.The bottle neck that has slowed me down since the start of the practicehas been the length of time that it takes me to make a note. I don'tthink that this is due to the EMR, but more to how I am doing the note. I can now take notes on the subjective portion of the visit on thecomputer during most interviews These don't usually need much editingif at all, but the remainder of the note will take from 5-40 minutes ormore depending on the complexity of the visit. I have a collection oftemplates that I use all the time and I can make one on the fly fairlyeasily. My partner is also fairly slow with notes, and I think thatwe are too detail oriented and both have ADD on top of this. Adding anoffice manager earlier this 2005, helped me somewhat as I wasn't thendistracted by every phone call, the filing, billing, etc. I still tendto be mad at the insurance companies most of the time for the stupidthings they do to try to avoid paying or slowing payment.How do others do their notes and how do the different EMRs facilitatemaking a note quickly?Also due to my husband having to retire due to health problemsrecently, I need to figure out how to augment what I am now making-about $4000 a month. We have large insurance premiums due to his nowpre exisitng health condition. How does one learn more about botox andsclerotherapy. I am assuming that I would need to go to certificationcourses. Everyone and their brother are sending me junk mail on lasertherapy, but not on the low tech aesthetic procedures. Any suggestions?Thanks,Kathy Broman MDMason City, IA<image.tiff>

Yahoo! MailUse Photomail to share photos without annoying attachments.

[Guest guest]

RE: Hospital accepting orders on their forms OR your typed orders.

I highly doubt the hospital has the power to insist that you MUST use their forms.

I use an EMR (SOAPware) that allows me to set up templates too. The top of the order has the demographics, and I can change anything I want on the generated report. I just hand the printout for a lab or X-ray (the nonscheduled ones that pts can walk in for) to the pt.

I print out the specials (CT scans, echos, stress tests) and my office person cuts out the typed order and puts it onto the standard hospital order form that lists all of the specific choices. I have a few pts who are data entry/check-in at the hospital-- they love these as they can actually read what I write.

We also do not have direct order entry into the hospital system, but can get results out.

I print out a note for each pt encounter including assessment, plan, meds, follow up for each visit. In my new practice of 14 months, I can get through 10-11 complex pts with little difficulty-- main issue has been a printer hookup that needs a better buffer, so printout is alittle slower than I'd like.

I also find that templating most of PE, assessment, plan, meds, follow up choices is rather straightforward, but subjective, except for some prefilled, is mostly free text, despite my best intentions.

Hope this helps.

Dr Matt Levin

FP

Pittsburgh, PA

Using SOAPWare at point of care since 1997; doing all pt care notes in system since Dec 2004.

Re: Progress note and organization questions

, Larry, and , Thanks for ideas.We have enough health costs, with premiums, prescriptions etc. and CT scans that we can deduct them on our joint tax returns, they essentially come out of pretax. I am in a partnership and pay taxes on my joint individual return. I am not paying too many taxes these days with my current income.Regarding templates, for quick visits, it doesn't take me very long. It is the multiple problem ones, which are most of my patients. I can type nearly as fast as I can talk, so I am not sure if the Dragon Naturally Speaking would be helpful. I should say that I can type that fast when I am organized and focused. If I am not focused then the whole day is a loss and I am way behind. I am not sure if I could dictate any better when not focused. if I am focused then i can do the HPI and the ROS while talking with the patient. I can insert allergies, medications with a single click. I can insert major portions of the exam with just several clicks, just making simple adjustments for the specific exam. Then it depends on how verbose I am with the plan. I certainly am not done with a note at the end of a visit though.What takes a lot of time is placing orders for the labs etc.. I have to hand fill out the form with all the patients demographics and then hand fax it, as the hospital doesn't have the order system computerized yet. The same goes for all xrays, referrals, filling out PAP forms and labeling. We have the capability of faxing all of this from the computer, but they don't like our individual forms over their own forms. We don't have much clout to get them to accept something different from one little office. I can fax referral letters from the computer and easily attach part of my note. There seems to be more and more paperwork for each patient. We are working on developing a tracking system that hopes to put in a sql database format. I need all the help I can get to remember things. I am one of those people that used to have a really good memory and thus never developed any good system for remembering things.It is probably easy to see from the above letter why it takes me so long to finish my notes.Kathy Broman Mason City, IA 50401On Tuesday, February 21, 2006, at 06:00 PM, Egly wrote:

Kathy: How are you funding your health insurance premiums? What is your corporate structure? Depending on your husbands pre-existing health condition and cost of medications? Certain insurance from the AMA can save money, while setting up a health reimbursement account through Base105 can make all your health expenses can be reimbursed through your corporation tax free no matter what health plan you have. This helps with prescriptions and other expenses often not covered by insurance at all. PS I tap through my notes on eMDs templates. I have thought about Dragon but do not have the time to learn right now. Also, if you could be seeing another patient transcription service for your lengthy note could be worth while.Kathy Broman wrote:I just wanted to write in to celebrate the fact that I have finallyread and cleared my inbox of an extraordinary number of emails fromthis list serv. I am too embarassed to say how many, but it wasinteresting project to read everything that has come in from Septemberto now. It has been an overwhelming several years that I won't gointo, but reading my email is the first thing I drop when too much isgoing on.One gets a sense of different personalities and styles of practice. Iwould love to take a road trip and visit all of you.I am also looking for some organizational advice. I have been inpractice with another woman, both of us working part time to cover 5days of the week, since May of 2002, following the low overhead, openaccess model. We have been using the tkfp open source EMR that Caldwell(also on this list serv) has been creating. I can see now thatwe bit off more than we could chew with developing an EMR in additionto starting a practice and learning all the business, billing, coding,etc. at one time, yet here we are, still alive and kicking. The EMRhas morphed into a pretty good EMR, yet needs more work in labtracking, patient registry, and health maintenance protocols.I have not achieved the simplicity of lifestyle that I would like andthat was part of the reason that I started this project. I wouldcertainly never go back to being employed by someone else though. I nolonger have dreams of being hours behind in my clinic schedule, whichoccured nightly in my previous position. I think a lot more aboutmoney than I used, to which I am not too happy about.The bottle neck that has slowed me down since the start of the practicehas been the length of time that it takes me to make a note. I don'tthink that this is due to the EMR, but more to how I am doing the note. I can now take notes on the subjective portion of the visit on thecomputer during most interviews These don't usually need much editingif at all, but the remainder of the note will take from 5-40 minutes ormore depending on the complexity of the visit. I have a collection oftemplates that I use all the time and I can make one on the fly fairlyeasily. My partner is also fairly slow with notes, and I think thatwe are too detail oriented and both have ADD on top of this. Adding anoffice manager earlier this 2005, helped me somewhat as I wasn't thendistracted by every phone call, the filing, billing, etc. I still tendto be mad at the insurance companies most of the time for the stupidthings they do to try to avoid paying or slowing payment.How do others do their notes and how do the different EMRs facilitatemaking a note quickly?Also due to my husband having to retire due to health problemsrecently, I need to figure out how to augment what I am now making-about $4000 a month. We have large insurance premiums due to his nowpre exisitng health condition. How does one learn more about botox andsclerotherapy. I am assuming that I would need to go to certificationcourses. Everyone and their brother are sending me junk mail on lasertherapy, but not on the low tech aesthetic procedures. Any suggestions?Thanks,Kathy Broman MDMason City, IA<image.tiff>

Yahoo! MailUse Photomail to share photos without annoying attachments.

[Guest guest]

KATHY: EVEN IF YOU HAVE DEDUCTIONS YOU PAY FICA PERSONALLY AND FROM THE BUSINESS. THIS RUNS 15.2%. MEDICAL DEDUCTIONS ONLY KICK IN AT GREATER THEN 7% OF YOUR INCOME. YOU WOULD SAVE OFF THE TOP OF YOUR TAXES 10-15% AT MINIMUM AND ADDITIONAL 15% FICA. $7OOO IN TAKE HOME COSTS YOU $3000. KEVINKathy Broman wrote: , Larry, and , Thanks for ideas.We have enough health costs, with premiums, prescriptions etc. and CT scans that we can deduct them on our joint tax returns, they essentially come out of pretax. I am in a partnership and pay taxes on my joint individual return. I am not paying too many taxes these days with my current income.Regarding templates, for quick visits, it doesn't take me very long.

It is the multiple problem ones, which are most of my patients. I can type nearly as fast as I can talk, so I am not sure if the Dragon Naturally Speaking would be helpful. I should say that I can type that fast when I am organized and focused. If I am not focused then the whole day is a loss and I am way behind. I am not sure if I could dictate any better when not focused. if I am focused then i can do the HPI and the ROS while talking with the patient. I can insert allergies, medications with a single click. I can insert major portions of the exam with just several clicks, just making simple adjustments for the specific exam. Then it depends on how verbose I am with the plan. I certainly am not done with a note at the end of a visit though.What takes a lot of time is placing orders for the labs etc.. I have to hand fill out the form with all the patients demographics and then hand fax it, as the hospital doesn't have the

order system computerized yet. The same goes for all xrays, referrals, filling out PAP forms and labeling. We have the capability of faxing all of this from the computer, but they don't like our individual forms over their own forms. We don't have much clout to get them to accept something different from one little office. I can fax referral letters from the computer and easily attach part of my note. There seems to be more and more paperwork for each patient. We are working on developing a tracking system that hopes to put in a sql database format. I need all the help I can get to remember things. I am one of those people that used to have a really good memory and thus never developed any good system for remembering things.It is probably easy to see from the above letter why it takes me so long to finish my notes.Kathy BromanMason City, IA 50401On Tuesday, February 21, 2006, at 06:00 PM, Egly

wrote:> Kathy:> > How are you funding your health insurance premiums? > > What is your corporate structure?> > Depending on your husbands pre-existing health condition and cost of > medications? Certain insurance from the AMA can save money, while > setting up a health reimbursement account through Base105 can make all > your health expenses can be reimbursed through your corporation tax > free no matter what health plan you have. This helps with > prescriptions and other expenses often not covered by insurance at > all.> > > > PS I tap through my notes on eMDs templates. I have thought about > Dragon but do not have the time to learn right now. Also, if you > could be seeing another patient transcription service for your lengthy > note could be worth while.>>

Kathy Broman wrote:>> I just wanted to write in to celebrate the fact that I have finally> read and cleared my inbox of an extraordinary number of emails from> this list serv. I am too embarassed to say how many, but it was> interesting project to read everything that has come in from September> to now. It has been an overwhelming several years that I won't go> into, but reading my email is the first thing I drop when too much is> going on.>> One gets a sense of different personalities and styles of practice. I> would love to take a road trip and visit all of you.>> I am also looking for some organizational advice. I have been in> practice with another woman, both of us working part time to cover 5> days of the week, since May of 2002, following the low overhead, open> access model. We have been using the tkfp open source EMR

that > Caldwell(also on this list serv) has been creating. I can see now that> we bit off more than we could chew with developing an EMR in addition> to starting a practice and learning all the business, billing, coding,> etc. at one time, yet here we are, still alive and kicking. The EMR> has morphed into a pretty good EMR, yet needs more work in lab> tracking, patient registry, and health maintenance protocols.>> I have not achieved the simplicity of lifestyle that I would like and> that was part of the reason that I started this project. I would> certainly never go back to being employed by someone else though. I no> longer have dreams of being hours behind in my clinic schedule, which> occured nightly in my previous position. I think a lot more about> money than I used, to which I am not too happy about.>> The bottle neck that has

slowed me down since the start of the practice> has been the length of time that it takes me to make a note. I don't> think that this is due to the EMR, but more to how I am doing the note.> I can now take notes on the subjective portion of the visit on the> computer during most interviews These don't usually need much editing> if at all, but the remainder of the note will take from 5-40 minutes or> more depending on the complexity of the visit. I have a collection of> templates that I use all the time and I can make one on the fly fairly> easily. My partner is also fairly slow with notes, and I think that> we are too detail oriented and both have ADD on top of this. Adding an> office manager earlier this 2005, helped me somewhat as I wasn't then> distracted by every phone call, the filing, billing, etc. I still tend> to be mad at the insurance

companies most of the time for the stupid> things they do to try to avoid paying or slowing payment.>> How do others do their notes and how do the different EMRs facilitate> making a note quickly?>>> Also due to my husband having to retire due to health problems> recently, I need to figure out how to augment what I am now making-> about $4000 a month. We have large insurance premiums due to his now> pre exisitng health condition. How does one learn more about botox and> sclerotherapy. I am assuming that I would need to go to certification> courses. Everyone and their brother are sending me junk mail on laser> therapy, but not on the low tech aesthetic procedures. Any > suggestions?>> Thanks,> Kathy Broman MD> Mason City, IA>>>>>> Yahoo! Mail> Use Photomail to share

photos without annoying attachments.>>

[Guest guest]

KATHY: EVEN IF YOU HAVE DEDUCTIONS YOU PAY FICA PERSONALLY AND FROM THE BUSINESS. THIS RUNS 15.2%. MEDICAL DEDUCTIONS ONLY KICK IN AT GREATER THEN 7% OF YOUR INCOME. YOU WOULD SAVE OFF THE TOP OF YOUR TAXES 10-15% AT MINIMUM AND ADDITIONAL 15% FICA. $7OOO IN TAKE HOME COSTS YOU $3000. KEVINKathy Broman wrote: , Larry, and , Thanks for ideas.We have enough health costs, with premiums, prescriptions etc. and CT scans that we can deduct them on our joint tax returns, they essentially come out of pretax. I am in a partnership and pay taxes on my joint individual return. I am not paying too many taxes these days with my current income.Regarding templates, for quick visits, it doesn't take me very long.

It is the multiple problem ones, which are most of my patients. I can type nearly as fast as I can talk, so I am not sure if the Dragon Naturally Speaking would be helpful. I should say that I can type that fast when I am organized and focused. If I am not focused then the whole day is a loss and I am way behind. I am not sure if I could dictate any better when not focused. if I am focused then i can do the HPI and the ROS while talking with the patient. I can insert allergies, medications with a single click. I can insert major portions of the exam with just several clicks, just making simple adjustments for the specific exam. Then it depends on how verbose I am with the plan. I certainly am not done with a note at the end of a visit though.What takes a lot of time is placing orders for the labs etc.. I have to hand fill out the form with all the patients demographics and then hand fax it, as the hospital doesn't have the

order system computerized yet. The same goes for all xrays, referrals, filling out PAP forms and labeling. We have the capability of faxing all of this from the computer, but they don't like our individual forms over their own forms. We don't have much clout to get them to accept something different from one little office. I can fax referral letters from the computer and easily attach part of my note. There seems to be more and more paperwork for each patient. We are working on developing a tracking system that hopes to put in a sql database format. I need all the help I can get to remember things. I am one of those people that used to have a really good memory and thus never developed any good system for remembering things.It is probably easy to see from the above letter why it takes me so long to finish my notes.Kathy BromanMason City, IA 50401On Tuesday, February 21, 2006, at 06:00 PM, Egly

wrote:> Kathy:> > How are you funding your health insurance premiums? > > What is your corporate structure?> > Depending on your husbands pre-existing health condition and cost of > medications? Certain insurance from the AMA can save money, while > setting up a health reimbursement account through Base105 can make all > your health expenses can be reimbursed through your corporation tax > free no matter what health plan you have. This helps with > prescriptions and other expenses often not covered by insurance at > all.> > > > PS I tap through my notes on eMDs templates. I have thought about > Dragon but do not have the time to learn right now. Also, if you > could be seeing another patient transcription service for your lengthy > note could be worth while.>>

Kathy Broman wrote:>> I just wanted to write in to celebrate the fact that I have finally> read and cleared my inbox of an extraordinary number of emails from> this list serv. I am too embarassed to say how many, but it was> interesting project to read everything that has come in from September> to now. It has been an overwhelming several years that I won't go> into, but reading my email is the first thing I drop when too much is> going on.>> One gets a sense of different personalities and styles of practice. I> would love to take a road trip and visit all of you.>> I am also looking for some organizational advice. I have been in> practice with another woman, both of us working part time to cover 5> days of the week, since May of 2002, following the low overhead, open> access model. We have been using the tkfp open source EMR

that > Caldwell(also on this list serv) has been creating. I can see now that> we bit off more than we could chew with developing an EMR in addition> to starting a practice and learning all the business, billing, coding,> etc. at one time, yet here we are, still alive and kicking. The EMR> has morphed into a pretty good EMR, yet needs more work in lab> tracking, patient registry, and health maintenance protocols.>> I have not achieved the simplicity of lifestyle that I would like and> that was part of the reason that I started this project. I would> certainly never go back to being employed by someone else though. I no> longer have dreams of being hours behind in my clinic schedule, which> occured nightly in my previous position. I think a lot more about> money than I used, to which I am not too happy about.>> The bottle neck that has

slowed me down since the start of the practice> has been the length of time that it takes me to make a note. I don't> think that this is due to the EMR, but more to how I am doing the note.> I can now take notes on the subjective portion of the visit on the> computer during most interviews These don't usually need much editing> if at all, but the remainder of the note will take from 5-40 minutes or> more depending on the complexity of the visit. I have a collection of> templates that I use all the time and I can make one on the fly fairly> easily. My partner is also fairly slow with notes, and I think that> we are too detail oriented and both have ADD on top of this. Adding an> office manager earlier this 2005, helped me somewhat as I wasn't then> distracted by every phone call, the filing, billing, etc. I still tend> to be mad at the insurance

companies most of the time for the stupid> things they do to try to avoid paying or slowing payment.>> How do others do their notes and how do the different EMRs facilitate> making a note quickly?>>> Also due to my husband having to retire due to health problems> recently, I need to figure out how to augment what I am now making-> about $4000 a month. We have large insurance premiums due to his now> pre exisitng health condition. How does one learn more about botox and> sclerotherapy. I am assuming that I would need to go to certification> courses. Everyone and their brother are sending me junk mail on laser> therapy, but not on the low tech aesthetic procedures. Any > suggestions?>> Thanks,> Kathy Broman MD> Mason City, IA>>>>>> Yahoo! Mail> Use Photomail to share

photos without annoying attachments.>>

[Guest guest]

I agree almost every hospital will accept an order that includes a specific order and a diagnosis code. HMO"S are the exception. If your hospital does insist I suggest you look for alternatives. For lab work, even though a lot of labs have forms that want a lot of demographic data, you can ignore most of the fields if you have the blood drawn at a lab such as a hospital or quest and have insurance billed. The lab will get the demographic information from the patient. If you draw the blood at your office you are expected to fill in the forms. If this is a hassle for you send the patient to the lab. I take care of a lot of people with add. If you are having a day that you are feeling particularly distracted consider making that a light day with patients scheduled lighter than usual. WIth open access scheduling its easier to say that on this day you will only see 6 patients instead of 10. Or you will still see 10 but you can spread them out over a longer period of time. You can also tell your patients that you are sorry but on those bad days you can only deal with one most pressing problem and they will have to reschedule to deal with their less pressing problems. Most patients are very understanding if this is not a regular occurrence. I know this sounds obvious but consider adjusting your meds a little if you are having a lot of distracted days. I hope your office manager is a super organized person. This can make all the difference for a doctor with add. I know this listserve stresses the need for low overhead but a doctor with add almost always needs to be paired with someone with organizational strengths to be effective.As far as making more money the easiest way is through excellent coding. Most doctors undercode level 4's. Look at this months Family practice management. Also consider adding just 1 patient more per day if that is possible. ($80/patient x 5 days/wk x 48 wks/yr = about $20,000/year with almost no change in overhead).  If your practice is full consider dropping the lowest paying insurance company to make room for better paying companies. Larry Lindeman MDRE:  Hospital accepting orders on their forms OR your typed orders. I highly doubt the hospital has the power to insist that you MUST use their forms. I use an EMR (SOAPware) that allows me to set up templates too.  The top of the order has the demographics, and I can change anything I want on the generated report.  I just hand the printout for a lab or X-ray (the nonscheduled ones that pts can walk in for) to the pt.  I print out the specials (CT scans, echos, stress tests) and my office person cuts out the typed order and puts it onto the standard hospital order form that lists all of the specific choices.  I have a few pts who are data entry/check-in at the hospital-- they love these as they can actually read what I write. We also do not have direct order entry into the hospital system, but can get results out. I print out a note for each pt encounter including assessment, plan, meds, follow up for each visit.  In my new practice of 14 months, I can get through 10-11 complex pts with little difficulty-- main issue has been a printer hookup that needs a better buffer, so printout is alittle slower than I'd like. I also find that templating most of PE, assessment, plan, meds, follow up choices is rather straightforward, but subjective, except for some prefilled, is mostly free text, despite my best intentions. Hope this helps. Dr Matt LevinFPPittsburgh, PAUsing SOAPWare at point of care since 1997; doing all pt care notes in system since Dec 2004. Re: Progress note and organization questions, Larry, and , Thanks for ideas.We have enough health costs, with premiums, prescriptions etc. and CT scans that we can deduct them on our joint tax returns, they essentially come out of pretax. I am in a partnership and pay taxes on my joint individual return. I am not paying too many taxes these days with my current income.Regarding templates, for quick visits, it doesn't take me very long. It is the multiple problem ones, which are most of my patients. I can type nearly as fast as I can talk, so I am not sure if the Dragon Naturally Speaking would be helpful. I should say that I can type that fast when I am organized and focused. If I am not focused then the whole day is a loss and I am way behind. I am not sure if I could dictate any better when not focused. if I am focused then i can do the HPI and the ROS while talking with the patient. I can insert allergies, medications with a single click. I can insert major portions of the exam with just several clicks, just making simple adjustments for the specific exam. Then it depends on how verbose I am with the plan. I certainly am not done with a note at the end of a visit though.What takes a lot of time is placing orders for the labs etc.. I have to hand fill out the form with all the patients demographics and then hand fax it, as the hospital doesn't have the order system computerized yet. The same goes for all xrays, referrals, filling out PAP forms and labeling. We have the capability of faxing all of this from the computer, but they don't like our individual forms over their own forms. We don't have much clout to get them to accept something different from one little office. I can fax referral letters from the computer and easily attach part of my note. There seems to be more and more paperwork for each patient. We are working on developing a tracking system that hopes to put in a sql database format. I need all the help I can get to remember things. I am one of those people that used to have a really good memory and thus never developed any good system for remembering things.It is probably easy to see from the above letter why it takes me so long to finish my notes.Kathy Broman Mason City, IA 50401On Tuesday, February 21, 2006, at 06:00 PM, Egly wrote:Kathy: How are you funding your health insurance premiums?  What is your corporate structure? Depending on your husbands pre-existing health condition and cost of medications?  Certain insurance from the AMA can save money, while setting up a health reimbursement account through Base105 can make all your health expenses can be reimbursed through your corporation tax free no matter what health plan you have.  This helps with prescriptions and other expenses often not covered by insurance at all.  PS  I tap through my notes on eMDs templates.  I have thought about Dragon but do not have the time to learn right now.  Also, if you could be seeing another patient transcription service for your lengthy note could be worth while.Kathy Broman  wrote:I just wanted to write in to celebrate the fact that I have finallyread and cleared my inbox of an extraordinary number of emails fromthis list serv.  I am too embarassed to say how many, but it wasinteresting project to read everything that has come in from Septemberto now.  It has been an overwhelming several years that I won't gointo, but reading my email is the first thing I drop when too much isgoing on.One gets a sense of different personalities and styles of practice.  Iwould love to take a road trip and visit all of you.I am also looking for some organizational advice.  I have been inpractice with another woman, both of us working part time to cover 5days of the week, since May of 2002, following the low overhead, openaccess model.  We have been using the tkfp open source EMR that Caldwell(also on this list serv) has been creating.  I can see now thatwe bit off more than we could chew with developing an EMR in additionto starting a practice and learning all the business, billing, coding,etc. at one time, yet here we are, still alive and kicking.  The EMRhas morphed into a pretty good EMR, yet needs more work in labtracking, patient registry, and health maintenance protocols.I have not achieved the simplicity of lifestyle that I would like andthat  was part of the reason that I started this project.  I wouldcertainly never go back to being employed by someone else though.  I nolonger have dreams of being hours behind in my clinic schedule, whichoccured nightly in my previous position.  I think a lot more aboutmoney than I used, to which I am not too happy about.The bottle neck that has slowed me down since the start of the practicehas been the length of time that it takes me to make a note.  I don'tthink that this is due to the EMR, but more to how I am doing the note.  I can now take notes on the subjective portion of the visit on thecomputer during most interviews These  don't usually need much editingif at all, but the remainder of the note will take from 5-40 minutes ormore depending on the complexity of the visit.  I have a collection oftemplates that I use all the time and I can make one on the fly fairlyeasily.   My partner is also fairly slow with notes, and I think thatwe are too detail oriented and both have ADD on top of this.  Adding anoffice manager earlier this 2005, helped me somewhat as I wasn't thendistracted by every phone call, the filing, billing, etc.  I still tendto be mad at the insurance companies most of the time for the stupidthings they do to try to avoid paying or slowing payment.How do others do their notes and how do the different EMRs facilitatemaking a note quickly?Also due to my husband having to retire due to health problemsrecently, I need to figure out how to augment what I am now making-about $4000 a month.  We have large insurance premiums due to his nowpre exisitng health condition.  How does one learn more about botox andsclerotherapy.  I am assuming that I would need to go to certificationcourses.  Everyone and their brother are sending me junk mail on lasertherapy, but not on the low tech aesthetic procedures.  Any suggestions?Thanks,Kathy Broman MDMason City, IA<image.tiff>Yahoo! MailUse Photomail to share photos without annoying attachments.

[Guest guest]

I agree almost every hospital will accept an order that includes a specific order and a diagnosis code. HMO"S are the exception. If your hospital does insist I suggest you look for alternatives. For lab work, even though a lot of labs have forms that want a lot of demographic data, you can ignore most of the fields if you have the blood drawn at a lab such as a hospital or quest and have insurance billed. The lab will get the demographic information from the patient. If you draw the blood at your office you are expected to fill in the forms. If this is a hassle for you send the patient to the lab. I take care of a lot of people with add. If you are having a day that you are feeling particularly distracted consider making that a light day with patients scheduled lighter than usual. WIth open access scheduling its easier to say that on this day you will only see 6 patients instead of 10. Or you will still see 10 but you can spread them out over a longer period of time. You can also tell your patients that you are sorry but on those bad days you can only deal with one most pressing problem and they will have to reschedule to deal with their less pressing problems. Most patients are very understanding if this is not a regular occurrence. I know this sounds obvious but consider adjusting your meds a little if you are having a lot of distracted days. I hope your office manager is a super organized person. This can make all the difference for a doctor with add. I know this listserve stresses the need for low overhead but a doctor with add almost always needs to be paired with someone with organizational strengths to be effective.As far as making more money the easiest way is through excellent coding. Most doctors undercode level 4's. Look at this months Family practice management. Also consider adding just 1 patient more per day if that is possible. ($80/patient x 5 days/wk x 48 wks/yr = about $20,000/year with almost no change in overhead).  If your practice is full consider dropping the lowest paying insurance company to make room for better paying companies. Larry Lindeman MDRE:  Hospital accepting orders on their forms OR your typed orders. I highly doubt the hospital has the power to insist that you MUST use their forms. I use an EMR (SOAPware) that allows me to set up templates too.  The top of the order has the demographics, and I can change anything I want on the generated report.  I just hand the printout for a lab or X-ray (the nonscheduled ones that pts can walk in for) to the pt.  I print out the specials (CT scans, echos, stress tests) and my office person cuts out the typed order and puts it onto the standard hospital order form that lists all of the specific choices.  I have a few pts who are data entry/check-in at the hospital-- they love these as they can actually read what I write. We also do not have direct order entry into the hospital system, but can get results out. I print out a note for each pt encounter including assessment, plan, meds, follow up for each visit.  In my new practice of 14 months, I can get through 10-11 complex pts with little difficulty-- main issue has been a printer hookup that needs a better buffer, so printout is alittle slower than I'd like. I also find that templating most of PE, assessment, plan, meds, follow up choices is rather straightforward, but subjective, except for some prefilled, is mostly free text, despite my best intentions. Hope this helps. Dr Matt LevinFPPittsburgh, PAUsing SOAPWare at point of care since 1997; doing all pt care notes in system since Dec 2004. Re: Progress note and organization questions, Larry, and , Thanks for ideas.We have enough health costs, with premiums, prescriptions etc. and CT scans that we can deduct them on our joint tax returns, they essentially come out of pretax. I am in a partnership and pay taxes on my joint individual return. I am not paying too many taxes these days with my current income.Regarding templates, for quick visits, it doesn't take me very long. It is the multiple problem ones, which are most of my patients. I can type nearly as fast as I can talk, so I am not sure if the Dragon Naturally Speaking would be helpful. I should say that I can type that fast when I am organized and focused. If I am not focused then the whole day is a loss and I am way behind. I am not sure if I could dictate any better when not focused. if I am focused then i can do the HPI and the ROS while talking with the patient. I can insert allergies, medications with a single click. I can insert major portions of the exam with just several clicks, just making simple adjustments for the specific exam. Then it depends on how verbose I am with the plan. I certainly am not done with a note at the end of a visit though.What takes a lot of time is placing orders for the labs etc.. I have to hand fill out the form with all the patients demographics and then hand fax it, as the hospital doesn't have the order system computerized yet. The same goes for all xrays, referrals, filling out PAP forms and labeling. We have the capability of faxing all of this from the computer, but they don't like our individual forms over their own forms. We don't have much clout to get them to accept something different from one little office. I can fax referral letters from the computer and easily attach part of my note. There seems to be more and more paperwork for each patient. We are working on developing a tracking system that hopes to put in a sql database format. I need all the help I can get to remember things. I am one of those people that used to have a really good memory and thus never developed any good system for remembering things.It is probably easy to see from the above letter why it takes me so long to finish my notes.Kathy Broman Mason City, IA 50401On Tuesday, February 21, 2006, at 06:00 PM, Egly wrote:Kathy: How are you funding your health insurance premiums?  What is your corporate structure? Depending on your husbands pre-existing health condition and cost of medications?  Certain insurance from the AMA can save money, while setting up a health reimbursement account through Base105 can make all your health expenses can be reimbursed through your corporation tax free no matter what health plan you have.  This helps with prescriptions and other expenses often not covered by insurance at all.  PS  I tap through my notes on eMDs templates.  I have thought about Dragon but do not have the time to learn right now.  Also, if you could be seeing another patient transcription service for your lengthy note could be worth while.Kathy Broman  wrote:I just wanted to write in to celebrate the fact that I have finallyread and cleared my inbox of an extraordinary number of emails fromthis list serv.  I am too embarassed to say how many, but it wasinteresting project to read everything that has come in from Septemberto now.  It has been an overwhelming several years that I won't gointo, but reading my email is the first thing I drop when too much isgoing on.One gets a sense of different personalities and styles of practice.  Iwould love to take a road trip and visit all of you.I am also looking for some organizational advice.  I have been inpractice with another woman, both of us working part time to cover 5days of the week, since May of 2002, following the low overhead, openaccess model.  We have been using the tkfp open source EMR that Caldwell(also on this list serv) has been creating.  I can see now thatwe bit off more than we could chew with developing an EMR in additionto starting a practice and learning all the business, billing, coding,etc. at one time, yet here we are, still alive and kicking.  The EMRhas morphed into a pretty good EMR, yet needs more work in labtracking, patient registry, and health maintenance protocols.I have not achieved the simplicity of lifestyle that I would like andthat  was part of the reason that I started this project.  I wouldcertainly never go back to being employed by someone else though.  I nolonger have dreams of being hours behind in my clinic schedule, whichoccured nightly in my previous position.  I think a lot more aboutmoney than I used, to which I am not too happy about.The bottle neck that has slowed me down since the start of the practicehas been the length of time that it takes me to make a note.  I don'tthink that this is due to the EMR, but more to how I am doing the note.  I can now take notes on the subjective portion of the visit on thecomputer during most interviews These  don't usually need much editingif at all, but the remainder of the note will take from 5-40 minutes ormore depending on the complexity of the visit.  I have a collection oftemplates that I use all the time and I can make one on the fly fairlyeasily.   My partner is also fairly slow with notes, and I think thatwe are too detail oriented and both have ADD on top of this.  Adding anoffice manager earlier this 2005, helped me somewhat as I wasn't thendistracted by every phone call, the filing, billing, etc.  I still tendto be mad at the insurance companies most of the time for the stupidthings they do to try to avoid paying or slowing payment.How do others do their notes and how do the different EMRs facilitatemaking a note quickly?Also due to my husband having to retire due to health problemsrecently, I need to figure out how to augment what I am now making-about $4000 a month.  We have large insurance premiums due to his nowpre exisitng health condition.  How does one learn more about botox andsclerotherapy.  I am assuming that I would need to go to certificationcourses.  Everyone and their brother are sending me junk mail on lasertherapy, but not on the low tech aesthetic procedures.  Any suggestions?Thanks,Kathy Broman MDMason City, IA<image.tiff>Yahoo! MailUse Photomail to share photos without annoying attachments.

[Guest guest]

If radiology calls you every time a

patient shows up with one of your computer generated orders (complete with ICD9

for the diagnosis that prompted the test and CPT for the

requested test) and refuses to do the test until you fax an order with the

hospital logo on it---I call that “the power to insist”.

Our mammography center (which also does

bone densities) is better. They have

been taking my order template for 3 years, but yesterday they got a little

silly: they called to ask if “Dual Xray Absorptiometry/ Axial Skeleton” was a bone density test. (That is what my orders have always

said) Must’ve been a new

hire!

Annie

Re:

Progress note and organization questions

RE: Hospital accepting orders

on their forms OR your typed orders.

I highly doubt the hospital has the

power to insist that you MUST use their forms.

I use an EMR (SOAPware) that allows

me to set up templates too. The top of the order has the demographics,

and I can change anything I want on the generated report. I just hand the

printout for a lab or X-ray (the nonscheduled ones that pts can walk in for) to

the pt.

I print out the specials (CT scans,

echos, stress tests) and my office person cuts out the typed order and puts it

onto the standard hospital order form that lists all of the specific

choices. I have a few pts who are data entry/check-in at the hospital--

they love these as they can actually read what I write.

We also do not have direct order

entry into the hospital system, but can get results out.

I print out a note for each pt

encounter including assessment, plan, meds, follow up for each visit. In

my new practice of 14 months, I can get through 10-11 complex pts with little

difficulty-- main issue has been a printer hookup that needs a better buffer,

so printout is alittle slower than I'd like.

I also find that templating most of

PE, assessment, plan, meds, follow up choices is rather straightforward, but

subjective, except for some prefilled, is mostly free text, despite my best

intentions.

Hope this helps.

Dr Matt Levin

FP

Pittsburgh, PA

Using SOAPWare at point of care

since 1997; doing all pt care notes in system since Dec 2004.

Re:

Progress note and organization questions

, Larry, and , Thanks for ideas.

We have enough health costs, with premiums, prescriptions etc. and CT scans

that we can deduct them on our joint tax returns, they essentially come out of

pretax. I am in a partnership and pay taxes on my joint individual return. I am

not paying too many taxes these days with my current income.

Regarding templates, for quick visits, it doesn't take me very long. It is the

multiple problem ones, which are most of my patients. I can type nearly as fast

as I can talk, so I am not sure if the Dragon Naturally Speaking would be

helpful. I should say that I can type that fast when I am organized and focused.

If I am not focused then the whole day is a loss and I am way behind. I am not

sure if I could dictate any better when not focused. if I am focused then i can

do the HPI and the ROS while talking with the patient. I can insert allergies,

medications with a single click. I can insert major portions of the exam with

just several clicks, just making simple adjustments for the specific exam. Then

it depends on how verbose I am with the plan. I certainly am not done with a

note at the end of a visit though.

What takes a lot of time is placing orders for the labs etc.. I have to hand

fill out the form with all the patients demographics and then hand fax it, as

the hospital doesn't have the order system computerized yet. The same goes for

all xrays, referrals, filling out PAP forms and labeling. We have the

capability of faxing all of this from the computer, but they don't like our

individual forms over their own forms. We don't have much clout to get them to

accept something different from one little office. I can fax referral letters

from the computer and easily attach part of my note. There seems to be more and

more paperwork for each patient. We are working on developing a tracking system

that hopes to put in a sql database format. I need all the help I can get

to remember things. I am one of those people that used to have a really good

memory and thus never developed any good system for remembering things.

It is probably easy to see from the above letter why it takes me so long to

finish my notes.

Kathy Broman

Mason City, IA 50401

On Tuesday, February 21, 2006, at 06:00 PM, Egly wrote:

Kathy:

How are you funding your health insurance premiums?

What is your corporate structure?

Depending on your husbands pre-existing health condition and cost of

medications? Certain insurance from the AMA can save money, while setting

up a health reimbursement account through Base105 can make all your health

expenses can be reimbursed through your corporation tax free no matter what

health plan you have. This helps with prescriptions and other expenses

often not covered by insurance at all.

PS I tap through my notes on eMDs templates. I have thought about

Dragon but do not have the time to learn right now. Also, if you could be

seeing another patient transcription service for your lengthy note could be

worth while.

Kathy Broman

wrote:

I just wanted to write in to celebrate the fact that I

have finally

read and cleared my inbox of an extraordinary

number of emails from

this list serv. I am too embarassed to say

how many, but it was

interesting project to read everything that has

come in from September

to now. It has been an overwhelming several

years that I won't go

into, but reading my email is the first thing I

drop when too much is

going on.

One gets a sense of different personalities and

styles of practice. I

would love to take a road trip and visit all of

you.

I am also looking for some organizational

advice. I have been in

practice with another woman, both of us working

part time to cover 5

days of the week, since May of 2002, following the

low overhead, open

access model. We have been using the tkfp

open source EMR that

Caldwell(also on this list serv) has been

creating. I can see now that

we bit off more than we could chew with developing

an EMR in addition

to starting a practice and learning all the

business, billing, coding,

etc. at one time, yet here we are, still alive and

kicking. The EMR

has morphed into a pretty good EMR, yet needs more

work in lab

tracking, patient registry, and health maintenance

protocols.

I have not achieved the simplicity of lifestyle

that I would like and

that was part of the reason that I started

this project. I would

certainly never go back to being employed by

someone else though. I no

longer have dreams of being hours behind in my

clinic schedule, which

occured nightly in my previous position. I

think a lot more about

money than I used, to which I am not too happy

about.

The bottle neck that has slowed me down since the

start of the practice

has been the length of time that it takes me to

make a note. I don't

think that this is due to the EMR, but more to how

I am doing the note.

I can now take notes on the subjective

portion of the visit on the

computer during most interviews These don't

usually need much editing

if at all, but the remainder of the note will take

from 5-40 minutes or

more depending on the complexity of the

visit. I have a collection of

templates that I use all the time and I can make

one on the fly fairly

easily. My partner is also fairly slow

with notes, and I think that

we are too detail oriented and both have ADD on

top of this. Adding an

office manager earlier this 2005, helped me

somewhat as I wasn't then

distracted by every phone call, the filing,

billing, etc. I still tend

to be mad at the insurance companies most of the

time for the stupid

things they do to try to avoid paying or slowing

payment.

How do others do their notes and how do the

different EMRs facilitate

making a note quickly?

Also due to my husband having to retire due to

health problems

recently, I need to figure out how to augment what

I am now making-

about $4000 a month. We have large insurance

premiums due to his now

pre exisitng health condition. How does one

learn more about botox and

sclerotherapy. I am assuming that I would

need to go to certification

courses. Everyone and their brother are

sending me junk mail on laser

therapy, but not on the low tech aesthetic

procedures. Any suggestions?

Thanks,

Kathy Broman MD

Mason City, IA

<image.tiff>

Yahoo! Mail

Use Photomail to share photos

without annoying attachments.

[Guest guest]

we pretty much use the people layout for their forms and have the

computer fill in as many of the blanks as possible to remove the

repetition. We try to match the form as close as possible , if not

totally alike then tough.

Brent

> >

> > I just wanted to write in to celebrate the fact that I have

finally

> > read and cleared my inbox of an extraordinary number of emails

from

> > this list serv.  I am too embarassed to say how many, but it was

> > interesting project to read everything that has come in from

September

> > to now.  It has been an overwhelming several years that I won't

go

> > into, but reading my email is the first thing I drop when too

much is

> > going on.

> >

> > One gets a sense of different personalities and styles of

practice.  I

> > would love to take a road trip and visit all of you.

> >

> > I am also looking for some organizational advice.  I have been in

> > practice with another woman, both of us working part time to

cover 5

> > days of the week, since May of 2002, following the low overhead,

open

> > access model.  We have been using the tkfp open source EMR that

> > Caldwell(also on this list serv) has been creating.  I can see

now that

> > we bit off more than we could chew with developing an EMR in

addition

> > to starting a practice and learning all the business, billing,

coding,

> > etc. at one time, yet here we are, still alive and kicking.  The

EMR

> > has morphed into a pretty good EMR, yet needs more work in lab

> > tracking, patient registry, and health maintenance protocols.

> >

> > I have not achieved the simplicity of lifestyle that I would

like and

> > that  was part of the reason that I started this project.  I

would

> > certainly never go back to being employed by someone else

though.  I no

> > longer have dreams of being hours behind in my clinic schedule,

which

> > occured nightly in my previous position.  I think a lot more

about

> > money than I used, to which I am not too happy about.

> >

> > The bottle neck that has slowed me down since the start of the

practice

> > has been the length of time that it takes me to make a note.  I

don't

> > think that this is due to the EMR, but more to how I am doing

the note.

> >   I can now take notes on the subjective portion of the visit on

the

> > computer during most interviews These  don't usually need much

editing

> > if at all, but the remainder of the note will take from 5-40

minutes or

> > more depending on the complexity of the visit.  I have a

collection of

> > templates that I use all the time and I can make one on the fly

fairly

> > easily.   My partner is also fairly slow with notes, and I think

that

> > we are too detail oriented and both have ADD on top of this. 

Adding an

> > office manager earlier this 2005, helped me somewhat as I wasn't

then

> > distracted by every phone call, the filing, billing, etc.  I

still tend

> > to be mad at the insurance companies most of the time for the

stupid

> > things they do to try to avoid paying or slowing payment.

> >

> > How do others do their notes and how do the different EMRs

facilitate

> > making a note quickly?

> >

> >

> > Also due to my husband having to retire due to health problems

> > recently, I need to figure out how to augment what I am now

making-

> > about $4000 a month.  We have large insurance premiums due to

his now

> > pre exisitng health condition.  How does one learn more about

botox and

> > sclerotherapy.  I am assuming that I would need to go to

certification

> > courses.  Everyone and their brother are sending me junk mail on

laser

> > therapy, but not on the low tech aesthetic procedures.  Any

> > suggestions?

> >

> > Thanks,

> > Kathy Broman MD

> > Mason City, IA

> >

> >

> >

> >

> <image.tiff>

> >

> > Yahoo! Mail

> > Use Photomail to share photos without annoying attachments.

> >

> >