Guest guest Posted May 2, 2010 Report Share Posted May 2, 2010 Did you see fewer patients? ( economic climate ) Are your notes more comprehensive now? And for eye contact .. see http://www.thehealthcareblog.com/the_health_care_blog/2010/04/ehr-etiquette.html > Hi group. I need you again! > > I am very frustrated and need to vent and get your advice. > > I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation). I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart " front sheet " . > > My frustrations are: > 1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever > 2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day. > 3. I have collected 25% less than for the same period last year. > > Does this get better? Any insights on what I can do? Please help! > > Alla > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2010 Report Share Posted May 2, 2010 Here are a few suggestions: 1. Can your secretary scan in the old records instead of manually entering the PMH? Could be just as time consuming, but you have more info there. 2. I have complete EMR, but I don't bring a laptop/computer in the exam room. I find it too distracting. Instead, I review pertinent history, results before appointment and then jot down important stuff on paper which gets entered into EMR immediately after patient leaves and before seeing next patient. The stuff on the paper gets shredded. 3. I found it more time consuming to enter stuff on computer because patients would get distracted and making eye contact is very important to preserving the flow of discussion between patient and doctor. 4. If you can integrate your labs to have them sent electronically, that's one less thing you/secretary have to scan. 5. Make a list of what is affecting your efficiency. Examples are: Are you seeing patients on time? Are they showing up on time? Are you allocating enough time to seeing patients, finishing their chart before moving on to next patient? What more could your secretary be doing (scanning, etc.) to help you? 6. Is there a way you can track where you are making less money or perhaps spending more time in areas that are not as profitable? Are you billing properly for those visits that take more time? It's a frustrating process, but hang in there. Soma To: Sent: Sun, May 2, 2010 4:21:32 PMSubject: EMR. Again! Hi group. I need you again!I am very frustrated and need to vent and get your advice.I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation) . I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart "front sheet". My frustrations are:1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day.3. I have collected 25% less than for the same period last year. Does this get better? Any insights on what I can do? Please help!Alla Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2010 Report Share Posted May 3, 2010 It's incredibly frustrating no matter what system/PMS/EMR you use....taking care of patients is not the time-burner, but it's the documentation to " prove " we did something that is the bane of most of our existences! To help same myself some time, I use textexpander (www.smileonmymac.com) on the " Mac " side and http://www.phraseexpress.com/ on the Windows side for the things I commonly enter repetitively but for which an adequate template cannot be created Jack Forbush, DOOsteopathic Center for Family Medicine603 Main Road NorthHampden, ME 04444www.ocfm.comtwitter: www.twitter.com/ocfm Hi group. I need you again! I am very frustrated and need to vent and get your advice. I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation). I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart " front sheet " . My frustrations are: 1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever 2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day. 3. I have collected 25% less than for the same period last year. Does this get better? Any insights on what I can do? Please help! Alla Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2010 Report Share Posted May 3, 2010 How quickly do screens update in Practice Fusion? Is the internet slow? Even a second or two of delay adds up fast and makes for a pretty poor product. Do you have convenient templates? You may have just discovered the downside of not getting an integrated EMR. Given that practice Fusion is an evolving product it may get better. And it may be a long time in coming. This is a good time to reevaluate your exit strategy. My EMR made me slightly less productive the first couple of weeks. I would expect a 10-15% improvement in productivity if it’s a good EMR and you have the workflow issues worked out. Neighbors, MD Huntsville, AL Solo using FlexMedical EMR/Billing From: [mailto: ] On Behalf Of Alla Sent: Sunday, May 02, 2010 3:22 PM To: Subject: EMR. Again! Hi group. I need you again! I am very frustrated and need to vent and get your advice. I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation). I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart " front sheet " . My frustrations are: 1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever 2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day. 3. I have collected 25% less than for the same period last year. Does this get better? Any insights on what I can do? Please help! Alla Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2010 Report Share Posted May 3, 2010 Hi ALla I am sorry you are frustrated I am personally extremely god at frustration- one of the things I do bestCoOnsider your work day and your work flow -how yo do your work. and make the computer do as much of it in a way that suits you as you can Perhpas the longer length of visit is used to: have a normal visit then the patietn leaves and you finish or tune up the note--much but not all of whiich you did when they were there Giveing yourslef a longer visit time to accomdate for the computer may only prolong the time in the room-- then you have less visits less revenue and got no where. Think of the visits as still the same length If you say certain thigns frequently like lungs clear even with forced expiration, or ht rrr etc turn that into a macro that types out when your type lc or cor for example I think that nost emrs are failry primitive and it is a shame we havw hundreds of thousand of MDs and DOS toiling away with hundreds of these non-systems Give yourslef a break The most useful thing in the long run is to analyze what work you do and how the computer can do it for you- if you see well child visits all day put the whole thing into a template the exam and all and then you have only to change it if ther e is a negative or abnormal, plus add any concerns- which may be free text eg typing , but can contain lot of shortcuts for common words In a soap note you may free text the hPI but using macros and typing in at least an outline while in the room , work s ; then they leave and 5min finshes the note and you are onto the next Let us know how you do Hi group. I need you again! I am very frustrated and need to vent and get your advice. I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation). I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart " front sheet " . My frustrations are: 1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever 2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day. 3. I have collected 25% less than for the same period last year. Does this get better? Any insights on what I can do? Please help! Alla -- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!) Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2010 Report Share Posted May 3, 2010 Is it easy to make macros/templates with practice fusion?Lonna Hi group. I need you again! I am very frustrated and need to vent and get your advice. I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation) . I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart "front sheet". My frustrations are: 1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever 2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day. 3. I have collected 25% less than for the same period last year. Does this get better? Any insights on what I can do? Please help! Alla -- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!) Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2010 Report Share Posted May 3, 2010 I do it all in the room with the patient. Being DONE when the visit is over is priceless. I have found that I need 1 1/4 - 1 1/2 hrs for new patients and 30-60 minutes for returning. I have gotten good at typing and can generally type without looking at the computer, so maintaining eye contact is not such an issue as it was at first. Of course, when there is really sensitive material being discussed, I give the patient my undivided attention then go back and type. I almost always do this before the patient leaves though. I use Amazing charts and can't give a superbill until my note is done. I hated this at first, but it has forced me to get my notes done before the patient leaves. I have a cash practice, so I have people pay me before they leave and give them the superbill. On occasion I will finish my note later. In those instances I will either email the receipt/superbill or mail it by post. LonnaSubject: Re: EMR. Again!To: Date: Sunday, May 2, 2010, 1:32 PM Here are a few suggestions: 1. Can your secretary scan in the old records instead of manually entering the PMH? Could be just as time consuming, but you have more info there. 2. I have complete EMR, but I don't bring a laptop/computer in the exam room. I find it too distracting. Instead, I review pertinent history, results before appointment and then jot down important stuff on paper which gets entered into EMR immediately after patient leaves and before seeing next patient. The stuff on the paper gets shredded. 3. I found it more time consuming to enter stuff on computer because patients would get distracted and making eye contact is very important to preserving the flow of discussion between patient and doctor. 4. If you can integrate your labs to have them sent electronically, that's one less thing you/secretary have to scan. 5. Make a list of what is affecting your efficiency. Examples are: Are you seeing patients on time? Are they showing up on time? Are you allocating enough time to seeing patients, finishing their chart before moving on to next patient? What more could your secretary be doing (scanning, etc.) to help you? 6. Is there a way you can track where you are making less money or perhaps spending more time in areas that are not as profitable? Are you billing properly for those visits that take more time? It's a frustrating process, but hang in there. Soma From: Alla <allakirschyahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Sun, May 2, 2010 4:21:32 PMSubject: [Practiceimprovemen t1] EMR. Again! Hi group. I need you again!I am very frustrated and need to vent and get your advice.I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation) . I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart "front sheet". My frustrations are:1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day.3. I have collected 25% less than for the same period last year. Does this get better? Any insights on what I can do? Please help!Alla Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2010 Report Share Posted May 3, 2010 Oh and I hope uses spell checker, she certainly doesn't use it on email ;-)!!!! Re: EMR. Again! Hi ALla I am sorry you are frustrated I am personally extremely god at frustration- one of the things I do bestCoOnsider your work day and your work flow -how yo do your work. and make the computer do as much of it in a way that suits you as you canPerhpas the longer length of visit is used to: have a normal visit then the patietn leaves and you finish or tune up the note--much but not all of whiich you did when they were there Giveing yourslef a longer visit time to accomdate for the computer may only prolong the time in the room-- then you have less visits less revenue and got no where. Think of the visits as still the same length If you say certain thigns frequently like lungs clear even with forced expiration, or ht rrr etc turn that into a macro that types out when your type lc or cor for example I think that nost emrs are failry primitive and it is a shame we havw hundreds of thousand of MDs and DOS toiling away with hundreds of these non-systemsGive yourslef a break The most useful thing in the long run is to analyze what work you do and how the computer can do it for you- if you see well child visits all day put the whole thing into a template the exam and all and then you have only to change it if ther e is a negative or abnormal, plus add any concerns- which may be free text eg typing , but can contain lot of shortcuts for common words In a soap note you may free text the hPI but using macros and typing in at least an outline while in the room , work s ; then they leave and 5min finshes the note and you are onto the next Let us know how you do On Sun, May 2, 2010 at 4:21 PM, Alla <allakirsch> wrote: Hi group. I need you again!I am very frustrated and need to vent and get your advice.I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation). I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart "front sheet". My frustrations are:1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day.3. I have collected 25% less than for the same period last year. Does this get better? Any insights on what I can do? Please help!Alla -- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2010 Report Share Posted May 3, 2010 AC, use totally create your own templates, attend ACUC in late June in Providence RI as Jon, (I would gather), Dr Bert (Major AC Guru and all around great guy from Brewer Maine) will all be there along with many more. I plan to get Myself and out there if at all possible for this one. I heard the last user conference was a big mash. We could not attend the last one because of conflicts with NYS end of school conflicts, which worked out for the best in the end. It's the reason we attended IMP Camp an hour from home in Rochester instead and got to know all you great folks here. From there that is why Wayne is here like I am watching out for his sister's best interests... Sometimes ya just can never tell what might not work out for the best in the end. That was one of those big disappointments that turned out to have a great second choice we would learn by the end of the weekend. Anyway, with AC you can create almost any template you want in every section so as to write your charts in your very own words, just like a chart really should be instead of a lot of meaningless, CCHITy drop down, data collecting for bigh brother and the carriers programs. Honestly I have no real knowledge of your program and it could be the best thing out there. I just know when it comes to ease of use, learning and templating stuff in your own words, nothing probably beats AC. And now that we have combined it with Bert 's File Assist Pro, FAP which is a stand alone, but connected to the patient demographics of AC document managment system, so one is not tabbing back and forth in a single chart to go from charting to reviewing docs, and with a full copy of standard Adobe is "E" faxing both in and out, ala a Brother 7840 B & W laser AIO with Paperport, signing orders, typing in needed print of forms, stamping them and all the other wonderful stuff these programs allow all while never printing them.... It is truly awesome... fax comes in, sign off on PT orders or Rx refilll request, save the updated version to FAP as a properly named, dated and timed PDF, and done... What a major ink and forest saver, no less time and money in general, plus time is money when only the doc can generate revenue... Right? For a free 90 day trial period, $995 per provider, $500 per provider support and updates every year... Who could ask for almost anything more? It's great... Oh and Bert and his right hand man Ed spent 4 1/2 hours with my personally on the phone, connected to my main computer via the go to my PC's go to my support access system flying my computer, copying and pasting instruction files back and forth between CNY and Maine, because somehow our old version of FAP didn't properly update and needed to do so correctly to update our database to work with the newest version of the program we never took or needed for years, because we were late in coming to the newer SQL version of AC for quite some time... Anyway, FAP works great now, just like she always did, and I just have to get her installed on all the peers, (much easier task now) around the office now that the main machine and the databases are all smooth and cooperative as they should be... Good luck.... To: Sent: Sun, May 2, 2010 4:21:32 PMSubject: EMR. Again! Hi group. I need you again!I am very frustrated and need to vent and get your advice.I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation) . I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart "front sheet". My frustrations are:1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day.3. I have collected 25% less than for the same period last year. Does this get better? Any insights on what I can do? Please help!Alla Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2010 Report Share Posted May 3, 2010 1. I would devote something like 30 mins at the end of each day to your templates that can make you more efficient the next time you see the same problem.2. Patients understand there will be less eye contact if your'e creating the note as they speak, they are rapidly adapting to that.3. If you're still falling behind, consider a tablet with Microsoft OneNote or Windows Journal- you can jot down notes and construct the note at the end of the half day.Subject: EMR. Again!To: Date: Sunday, May 2, 2010, 1:21 PM Hi group. I need you again! I am very frustrated and need to vent and get your advice. I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation) . I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart "front sheet". My frustrations are: 1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever 2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day. 3. I have collected 25% less than for the same period last year. Does this get better? Any insights on what I can do? Please help! Alla Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2010 Report Share Posted May 3, 2010 I don't know your program but am very happy with AC. I touch type and don't have to look at keys and rarely use templates that I just find too frustrating chasing points to click. With my laptop on my lap I see patients and not so much decreased eye contact and they love having the A/P as they walk out the door to remember what we covered. IdeallyI do the physical before seeing the next patient (these do have templates) and all that's left at a later time is the coding. Sometimes it's just takes time to get used to your new program I think I heard 4-12 months for it to smooth out and efficiency to be back to normal? Good luck. To: Sent: Sun, May 2, 2010 8:33:03 PMSubject: Re: EMR. Again! AC, use totally create your own templates, attend ACUC in late June in Providence RI as Jon, (I would gather), Dr Bert (Major AC Guru and all around great guy from Brewer Maine) will all be there along with many more. I plan to get Myself and out there if at all possible for this one. I heard the last user conference was a big mash. We could not attend the last one because of conflicts with NYS end of school conflicts, which worked out for the best in the end. It's the reason we attended IMP Camp an hour from home in Rochester instead and got to know all you great folks here. From there that is why Wayne is here like I am watching out for his sister's best interests... Sometimes ya just can never tell what might not work out for the best in the end. That was one of those big disappointments that turned out to have a great second choice we would learn by the end of the weekend. Anyway, with AC you can create almost any template you want in every section so as to write your charts in your very own words, just like a chart really should be instead of a lot of meaningless, CCHITy drop down, data collecting for bigh brother and the carriers programs. Honestly I have no real knowledge of your program and it could be the best thing out there. I just know when it comes to ease of use, learning and templating stuff in your own words, nothing probably beats AC. And now that we have combined it with Bert 's File Assist Pro, FAP which is a stand alone, but connected to the patient demographics of AC document managment system, so one is not tabbing back and forth in a single chart to go from charting to reviewing docs, and with a full copy of standard Adobe is "E" faxing both in and out, ala a Brother 7840 B & W laser AIO with Paperport, signing orders, typing in needed print of forms, stamping them and all the other wonderful stuff these programs allow all while never printing them.... It is truly awesome... fax comes in, sign off on PT orders or Rx refilll request, save the updated version to FAP as a properly named, dated and timed PDF, and done... What a major ink and forest saver, no less time and money in general, plus time is money when only the doc can generate revenue... Right? For a free 90 day trial period, $995 per provider, $500 per provider support and updates every year... Who could ask for almost anything more? It's great... Oh and Bert and his right hand man Ed spent 4 1/2 hours with my personally on the phone, connected to my main computer via the go to my PC's go to my support access system flying my computer, copying and pasting instruction files back and forth between CNY and Maine, because somehow our old version of FAP didn't properly update and needed to do so correctly to update our database to work with the newest version of the program we never took or needed for years, because we were late in coming to the newer SQL version of AC for quite some time... Anyway, FAP works great now, just like she always did, and I just have to get her installed on all the peers, (much easier task now) around the office now that the main machine and the databases are all smooth and cooperative as they should be... Good luck.... From: Alla <allakirschyahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Sun, May 2, 2010 4:21:32 PMSubject: [Practiceimprovemen t1] EMR. Again! Hi group. I need you again!I am very frustrated and need to vent and get your advice.I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation) . I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart "front sheet". My frustrations are:1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day.3. I have collected 25% less than for the same period last year. Does this get better? Any insights on what I can do? Please help!Alla Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2010 Report Share Posted May 3, 2010 Alla do not despairthere is typically a 6-18 month - to 2 year lag between starting an EMR and then getting back to productivity. This would be the normA few weeks would be very very short.yes, gets better.agree with everyone else with1)templates 2) macros 3) placement of computer patient and you in a triangleor get the ultimate documenter (thousands of words per minute, compared to dragon which might be 120 wpm or typing which is 60 wpm) (good for counting up the points but not as perfect as you clinically) Instant Medical History, where the patients do the work of "documenting" .LynnTo: From: allakirsch@...Date: Sun, 2 May 2010 20:21:32 +0000Subject: EMR. Again! Hi group. I need you again! I am very frustrated and need to vent and get your advice. I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation). I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart "front sheet". My frustrations are: 1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever 2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day. 3. I have collected 25% less than for the same period last year. Does this get better? Any insights on what I can do? Please help! Alla The New Busy think 9 to 5 is a cute idea. Combine multiple calendars with Hotmail. Get busy. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 Hi guys, You are truly amazing! Thank you so much for all the help I immediately got on my whiny post. Here is what I learned and implemented based on YOUR help: I was intentionally seeing fewer patients because even the ones I was scheduling were waiting too long for me. I was working much harder, spending 2-3 hours per day longer finishing up charts. I did collect 25% less in the first 4 months of the year for fewer patients and more hours worked. I am using a wrong system! Practice Fusion is slow. The worst is looking at downloaded documents. It would be suicidal to try to scan even parts of my old charts. There are also too many clicks to get places. I looked at Amazing Charts. There is a reason that so many of IMPs are using AC. It has so much to offer and it is FAST! To make things better as I am ready to exit, I am going into the pt rooms with a printed out last note. This has speeded me up a lot. I am no longer typing most of the visit but am taking quick notes on the printed out last note. I document after I leave the room when I am not interrupted by patients. I am trying to keep the pt, the computer and me in a triangle and offer pts to see what I type. Good response from patients. The patients, my nurse and I are happier. I am going to switch to AC and this is my exit strategy. NOW A FEW QUICK QUESTIONS ABOUT AC: Does anyone using AC have concerns about breach of info? Are web based EMR's more secure as I am told by Practice Fusion? I have in-house billing. Is E-Z Claim the easiest? Can I talk to someone who is using AC and does own billing? Is it cheaper to pay 5% and let a company do all the work? THANK YOU ALL AGAIN FOR THE INCREADIBLE HELP!!!!!!!!!!! You made me feel so much better! Alla >> Hi group. I need you again!> > I am very frustrated and need to vent and get your advice.> > I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation). I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart "front sheet". > > My frustrations are:> 1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever> 2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day.> 3. I have collected 25% less than for the same period last year. > > Does this get better? Any insights on what I can do? Please help!> > Alla> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 Yes I was the one who suggested taking "notes" on paper for the CC, HPI. But try to use the EMR for the "repetitive" areas, as these are the most important to have legible and typed, try to do these at the point of care: 1) Assessment (Dx, and with the EMR that I use, I sketch out why I'm doing what I'm doing). 2) Plan -- testing, inc X-rays, Labs, EKG, Spiro, immunizations. You should set these up as some type of macro, and "check off (delete unused ones)" the ones you need. 3) Medications 4) Follow up Your internet connection may be too slow for PracticeFusion. See if you can upgrade it before "ditching" your system. You put a lot of work into it, so would be best to try to preserve it, even so later lookups will be faster. Try to use your old notes as templates for new ones. Consider "trial versions" of popular single version EMRs like Amazing Chart (since many use well here, another is SOAPware which I and others use) but don't go live -- just work on them at home. Finally, if you have room in the exam room, even under a desk, see if you can stash a printer. Nothing moves things along as handing medication scripts, orders to pts on the way out the door. I used to use a network printer, but printing in room (laser cheaper, really) is much more efficient. If not, put the printer at the checkout desk and print to there. Remember, many of us have been using EMRs for years (10+ for me). Much of this is workflow, and you won't get that efficiency right away. Much of my efficiency is "back office" meaning less bother when support staff can't read my notes, faxing them to consultants when pts need to see them, etc. You'll get there, just think process by process. And BILLING COMES FIRST!! Feel free to contact me off list if you have other questions. Matt in Western PA matlev@... Re: EMR. Again! Hi guys, You are truly amazing! Thank you so much for all the help I immediately got on my whiny post. Here is what I learned and implemented based on YOUR help: I was intentionally seeing fewer patients because even the ones I was scheduling were waiting too long for me. I was working much harder, spending 2-3 hours per day longer finishing up charts. I did collect 25% less in the first 4 months of the year for fewer patients and more hours worked. I am using a wrong system! Practice Fusion is slow. The worst is looking at downloaded documents. It would be suicidal to try to scan even parts of my old charts. There are also too many clicks to get places. I looked at Amazing Charts. There is a reason that so many of IMPs are using AC. It has so much to offer and it is FAST! To make things better as I am ready to exit, I am going into the pt rooms with a printed out last note. This has speeded me up a lot. I am no longer typing most of the visit but am taking quick notes on the printed out last note. I document after I leave the room when I am not interrupted by patients. I am trying to keep the pt, the computer and me in a triangle and offer pts to see what I type. Good response from patients. The patients, my nurse and I are happier. I am going to switch to AC and this is my exit strategy. NOW A FEW QUICK QUESTIONS ABOUT AC: Does anyone using AC have concerns about breach of info? Are web based EMR's more secure as I am told by Practice Fusion? I have in-house billing. Is E-Z Claim the easiest? Can I talk to someone who is using AC and does own billing? Is it cheaper to pay 5% and let a company do all the work? THANK YOU ALL AGAIN FOR THE INCREADIBLE HELP!!!!!!!!!!! You made me feel so much better! Alla >> Hi group. I need you again!> > I am very frustrated and need to vent and get your advice.> > I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation). I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart "front sheet". > > My frustrations are:> 1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever> 2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day.> 3. I have collected 25% less than for the same period last year. > > Does this get better? Any insights on what I can do? Please help!> > Alla> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 I was at a previous practice when they converted from paper to A4 HealthSystems (which is now Allscripts). Here's my experience: - Spent 1-3 hours/day converting tomorrow's patients to electrons (PMHx, last A1c, Rx, Allergies). Scanned docs eat memory and take time to come up so we avoided scanning. Hiring a college student for data entry helps. - Took 2 months to see as many patients as previous but was going home very late. - Started going home on time about 6-8 months into it. - At 18 months, was going home sooner and seeing more patients than before. How we got there: - Templates/Customization/Adapt systems. - Templates/Customization/Adapt systems. - Templates/Customization/Adapt systems. - Most important is I changed my process to fit the program. I created 4 physical exam templates that covered 95% of my patients. I tried to do one of those exams on everyone. So instead of modifying a template, I modified my exam. For example, if my template include an ear exam but I didn't think I needed to look in the ears, I did it anyway. It was faster to look in the ears than modify the note. Same thing for ROS. I had 3 ROS's that covered about everything. HPI took customization. The practice owner spend a ton of time creating about 50 good HPI templates. So my notes were FAST. HPI: boom, in there. ROS, boom, in there. PE, boom, in there. All done with about 10-20 words added for clarification or additions. A4 has a great A/P section. Once a pt had a dx on the " chart " , we pulled the plan from a template of choices and modified the comments specific to the dx and boom, done. - Ergonomics: Laptops with touchscreens are the only way to go in my mind. Desktops hinder the pt:provider interaction. Put the laptop in your lap and treat it like a note pad. With touch screen and a pen, I developed muscle memory. After a while, I could almost hit any spot on the screen without looking down. Printer in the room is a must. One should never have to leave the room once you go it. If you do, change your system. - Data: " 0 " and " 1 " are king. Scanned docs are cumbersome as they take too long to load and can not be used in data relationships (e.g. creating graphs of results vs time). Everything that can be changed to 0s and 1s (e.g. lab data) should be entered as such. - Don't spend too much time converting an old chart to electrons. After about five EMR visits with a patient, you'll almost never need to refer back to older visits in the paper chart. Save things like last C-scope, last specialist note, etc. We had a rule that after five visits, the paper chart got archieved. I, also, would be happy to dicuss more off- or on-line. I'm thinking of going PracticeFusion with the new practice. If I do, I'm getting a robust (fast) touchscreen laptop and may pay the money for fiberoptic to the computer. I'm fortunate in that the office I'm about to lease has fiberoptic cable into the building. Cheers, Craig > > > > Hi group. I need you again! > > > > I am very frustrated and need to vent and get your advice. > > > > I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation). I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart " front sheet " . > > > > My frustrations are: > > 1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever > > 2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day. > > 3. I have collected 25% less than for the same period last year. > > > > Does this get better? Any insights on what I can do? Please help! > > > > Alla > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 AllaI am using EZClaim and doing my billing (I don't know how successfully though)happy to communicate off list, just email me and we can set up call.thanksLynn HoTo: From: allakirsch@...Date: Thu, 6 May 2010 02:57:40 +0000Subject: Re: EMR. Again! Hi guys, You are truly amazing! Thank you so much for all the help I immediately got on my whiny post. Here is what I learned and implemented based on YOUR help: I was intentionally seeing fewer patients because even the ones I was scheduling were waiting too long for me. I was working much harder, spending 2-3 hours per day longer finishing up charts. I did collect 25% less in the first 4 months of the year for fewer patients and more hours worked. I am using a wrong system! Practice Fusion is slow. The worst is looking at downloaded documents. It would be suicidal to try to scan even parts of my old charts. There are also too many clicks to get places. I looked at Amazing Charts. There is a reason that so many of IMPs are using AC. It has so much to offer and it is FAST! To make things better as I am ready to exit, I am going into the pt rooms with a printed out last note. This has speeded me up a lot. I am no longer typing most of the visit but am taking quick notes on the printed out last note. I document after I leave the room when I am not interrupted by patients. I am trying to keep the pt, the computer and me in a triangle and offer pts to see what I type. Good response from patients. The patients, my nurse and I are happier. I am going to switch to AC and this is my exit strategy. NOW A FEW QUICK QUESTIONS ABOUT AC: Does anyone using AC have concerns about breach of info? Are web based EMR's more secure as I am told by Practice Fusion? I have in-house billing. Is E-Z Claim the easiest? Can I talk to someone who is using AC and does own billing? Is it cheaper to pay 5% and let a company do all the work? THANK YOU ALL AGAIN FOR THE INCREADIBLE HELP!!!!!!!!!!! You made me feel so much better! Alla >> Hi group. I need you again!> > I am very frustrated and need to vent and get your advice.> > I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation). I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart "front sheet". > > My frustrations are:> 1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever> 2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day.> 3. I have collected 25% less than for the same period last year. > > Does this get better? Any insights on what I can do? Please help!> > Alla> Hotmail has tools for the New Busy. Search, chat and e-mail from your inbox. Learn more. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2010 Report Share Posted May 7, 2010 If you reallly want to make the best use of scanned documents in a form that will ALWAYS be yours no matter what may come, hell or high water of this EMR coming or going as the tides of medicine, the business world or the gov't making one EMR a dead player and some other bloated, paid the senators enough to make themselves the only approved system (It could happen one day, it's all politics, why do we have to pay for access to an "E" Rx system when it is most for the gov't and the super large pharmacies? but we have to chose from like two major pipelines to be hooked up to with a monthly taxi meter, access fee? Remind me again why we have to pay for this verses the gov't or the large profit pharmacies???) I recommend you find BERT, Dr Bert on the AC user board and ask him if he is still allowing new practices to beta test FAP for him... It is like an index card tab box that you get to create your own 20 tabs of subjects and inside each box are the 26 letters of the alphabet... But what makes FAP great is that each file scanned in, converted from your efax or what have you, is a real life, fully functional PDF with all the things we can all do with PDF's. And once imported via FAP (File Assist Pro) the files have been named, dated and timed as ", , 5-6-2010, 7:15 pm" or something similar. And when you do your back up they are sorted into files in the same way under the sub headings... Subject you created like Labs, or Old Charts or what have you... and then subs of each letter of the alphabet for patients last name... FAP ties into your AC database so the instant a patient is enter into AC's demographics BOOM, he or she is available to FAP for document naming and filing... so no double entry once in AC always in FAP too and not the other way around so no fear of duplicates... Now here is why being PDF's is so cool and important.. Think of all the wonderful things we can do with them like stamp them manipulate them, combine and merge them, so to halfs of a report come in your fax at two separate times, you can still merge them as PDF's with FAP... Two, they are super universal and most Document Managment systems like or prefer or even insist on them. Three, as well named PDF's god forbid Jon and AC go belly up one day (Fingers crossed but these kind of things have happened a number of times in the EMR business already.. Anything is possible.. These are well backup and logically stored PDF's and you have full access to them to copy and import to your next system if really needed and you can get to them the back way at anytime with or without FAP or AC via clicking thru the folders logically the old fashioned way.... They are always your PDF's in a format you can always access, and no license or corporate death can keep you from them. AC last I looked uses a lame file naming system that uses hidden software ties to each numbered charts imported items folder. Inside the Imported items folder associated with each chart via it chart number those files saved are only saved as some meaningless 0000000001, 00000000002, so on and so forth. One good loss of hidden tenticals and all these imported items have no idea whose chart they belong to for do they as you would manually have to extract each one one at a time and rename and create your own back door FAP like filing system to save and have access to your old "E" documents to transfer them to your next EMR.... FAP backs up separate and fairly easily from AC so you do a simple run at the end of the day and copy to your back up drives and places as always... It can save the stuff as data files or as extracted PDF's which is what I do most nights but every few nights I also do the data files. I'll do them any night I'm not running out the door to get home or to some event... Last BIG advantage over imported items in AC or any other program that would allow you to use a tied together yet separate program.. Instead of tabbing in AC back and forth between what you are charting and the letters or results you are looking at under imported items in AC instead you can leave the chart open to the section you are working in and quickly toggle back and forth between the two programs if and when you want to and need to during a visit... It does make like a heck of a lot easier in the exam room... loves it. Oh Bert should be at the AC user conference as a presenter this coming month at the end of June in Providence and it promises to be a very informative weekend with lots of power users showing off their tricks and share tips and secrets... And Jon and some of his staff will be there to chat with all of us, teach us too, and get suggestions for the next round of ideas and improvements... We are going to try like heck to get there according to our kids silly late running NYS school year. Oh and AC is a good bit faster now because it recently changed back ends from older slower Access to a SQL server based data base engine which woke it up very nicely.. And all for $995 per doc too!!! We just recently upgraded to the new version and so far all is really good once I solved small install problem on the peers with Tech support. BIG SUGGESTION with AC: Try the best you can to use only one format of operating system within your network especially if you are doing a P2P network and not a full blown server based one (Server is totally not needed with AC for the average small solo office with about half a dozen or so machines on the network.. Don't waste the time and the money and have a simplier network that you can understand and take care of yourself as you learn about such things over your first year or so if you don't really understand them yet... It will make your life immeasurably easier and cheaper too)... AC tends to choke and throw codes on the people who won't follow this one piece of sag advice from the more in the know users on the board.... I am still all XP Pro all around the office and it was pretty stable with the old access data base and now that I think of it, since I have installed the new 5.0 SQL version the thing has not hick-uped a single time or crashed once.... It really has been that smooth... Older AC used to want to get rebooted now and again and that solved 90% of her problems most of the time, a simple reboot. That is still the companies instructions, but with the newest version and our very homogenious network for smooth and compatible communication, I'm almost afraid to jinx myself but all is quiet on the western front..... How cool is that? On this note Vista seems to have always been very ill tempered and never really wanted to play nice with it's older brother XP... Also there is an important difference in quality between XP home and XP Pro and don't bother with home. If you have a tablet, XP Tablet is a quality version of Pro so you're good there and we still have one tablet on the network now, 's exam room laptop and doing fine. My old tablet finally has a connection wire issue between the main body and the monitor and I have not attended to that since I have my new Dell and we don't really Need the extra machine right now... But I should tinker with it and see if I can find the short and repair it sometime soon.... Try all that and read lots of posts at the user board to get well aquainted with AC. You won't regret it... To: Sent: Wed, May 5, 2010 10:57:40 PMSubject: Re: EMR. Again! Hi guys, You are truly amazing! Thank you so much for all the help I immediately got on my whiny post. Here is what I learned and implemented based on YOUR help: I was intentionally seeing fewer patients because even the ones I was scheduling were waiting too long for me. I was working much harder, spending 2-3 hours per day longer finishing up charts. I did collect 25% less in the first 4 months of the year for fewer patients and more hours worked. I am using a wrong system! Practice Fusion is slow. The worst is looking at downloaded documents. It would be suicidal to try to scan even parts of my old charts. There are also too many clicks to get places. I looked at Amazing Charts. There is a reason that so many of IMPs are using AC. It has so much to offer and it is FAST! To make things better as I am ready to exit, I am going into the pt rooms with a printed out last note. This has speeded me up a lot. I am no longer typing most of the visit but am taking quick notes on the printed out last note. I document after I leave the room when I am not interrupted by patients. I am trying to keep the pt, the computer and me in a triangle and offer pts to see what I type. Good response from patients. The patients, my nurse and I are happier. I am going to switch to AC and this is my exit strategy. NOW A FEW QUICK QUESTIONS ABOUT AC: Does anyone using AC have concerns about breach of info? Are web based EMR's more secure as I am told by Practice Fusion? I have in-house billing. Is E-Z Claim the easiest? Can I talk to someone who is using AC and does own billing? Is it cheaper to pay 5% and let a company do all the work? THANK YOU ALL AGAIN FOR THE INCREADIBLE HELP!!!!!!!! !!! You made me feel so much better! Alla >> Hi group. I need you again!> > I am very frustrated and need to vent and get your advice.> > I started Practice Fusion EMR 4 months ago (thank you, Chad, for the recommendation) . I like this EMR. I am not scanning in old records but my secretary enters PMH from my paper chart "front sheet". > > My frustrations are:> 1. I am finding myself significantly less efficient. I book longer appointments to accomodate my inefficiency and yet am more behind than ever> 2. I have much less eye contact with patients. In the past, I prided myself on having good bedside manner. Now I spend so much of my time during the visit glued to the computer and yet still have a lot to chart at the end of the day.> 3. I have collected 25% less than for the same period last year. > > Does this get better? Any insights on what I can do? Please help!> > Alla> Quote Link to comment Share on other sites More sharing options...
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