Re: transitioning current patients to my n ew office

[Guest guest]

Hang in there, Jim. Things will get better.

>

>

>

>

>

>

> I am in a similar situation.

>

> I just left employment where I had a 7 yr old practice of approx. 2000 pts.

> I moved 10 miles and went to a new EMR from paper charts. I am now in my

> 2nd week.

>

> I now share a front desk employee with a friend and hired a CNA/ RN student

> who was with me for 3 partial days of training but didn't show up for work

> today. She called me at lunch time to say the job " wasn't for her " . She

> did provide an address for me to send her pay though.

>

> I am rapidly learning the EMR and doing all of my own patient care work and

> call backs. I am fairly overwhelmed with the volume of labs/calls/refills

> and cases of paper charts coming over from my old office of pt transfers. I

> am now up to seeing about 6-7 pts/day but it is taking me about 10-12 hrs in

> the office to do so. I bought a new laptop/notepad but the IT guy hasn't

> been able to get it to work with the EMR servor so I am running back and

> forth to an old desktop in the back of the office to do the EMR.

>

> The phone messages from pts from the old office is truly stunning. The

> data entry to transfer my pts records to the EMR is very labor intensive.

>

> I am in the process of trying to decide how to get some help. My schedule

> called for 3-4 pts per hour but I just today changed it to 2 per hour b/c

> there is no way I can do that pace as it now stands.

>

> Stress level is high, but I will hang tough and hope for improvement.

>

> In retrospect I wouldn't have opened the flood gates to all of my old pts

> right away. I am thinking of how I can " cull the flock " in a decent and

> ethical and medico-legally safe manner.

>

> Anyway, it's a dark night and I hope it gets better.

>

> Thanks to all who participate in this listserv, to its creator, and to Annie

> Skaggs who invited me to join. It's been a great help.

>

> Jim Bury

> Pleasant Prairie WI

> EMR MedInformatix

>

>

>

>

[Guest guest]

call temp agency for extra front desk help at least for now?

M

RE: transitioning current patients to my n ew office

I am in a similar situation.I just left employment where I had a 7 yr old practice of approx. 2000 pts. I moved 10 miles and went to a new EMR from paper charts. I am now in my 2nd week. I now share a front desk employee with a friend and hired a CNA/ RN student who was with me for 3 partial days of training but didn't show up for work today. She called me at lunch time to say the job "wasn't for her". She did provide an address for me to send her pay though.I am rapidly learning the EMR and doing all of my own patient care work and call backs. I am fairly overwhelmed with the volume of labs/calls/refills and cases of paper charts coming over from my old office of pt transfers. I am now up to seeing about 6-7 pts/day but it is taking me about 10-12 hrs in the office to do so. I bought a new laptop/notepad but the IT guy hasn't been able to get it to work with the EMR servor so I am running back and forth to an old desktop in the back of the office to do the EMR.The phone messages from pts from the old office is truly stunning. The data entry to transfer my pts records to the EMR is very labor intensive. I am in the process of trying to decide how to get some help. My schedule called for 3-4 pts per hour but I just today changed it to 2 per hour b/c there is no way I can do that pace as it now stands.Stress level is high, but I will hang tough and hope for improvement.In retrospect I wouldn't have opened the flood gates to all of my old pts right away. I am thinking of how I can "cull the flock" in a decent and ethical and medico-legally safe manner.Anyway, it's a dark night and I hope it gets better.Thanks to all who participate in this listserv, to its creator, and to Annie Skaggs who invited me to join. It's been a great help.Jim BuryPleasant Prairie WIEMR MedInformatix

[Guest guest]

Wow. So much for having some breathing space right now! Is there

someone you can impose upon to help with paper flow for a while? I

don't know how you fit a full hiring process in at this point. May

it slow down soon!

Haresch

>

> I am in a similar situation.

>

> I just left employment where I had a 7 yr old practice of approx.

2000 pts. I moved 10 miles and went to a new EMR from paper

charts. I am now in my 2nd week.

>

> I now share a front desk employee with a friend and hired a CNA/

RN student who was with me for 3 partial days of training but

didn't show up for work today. She called me at lunch time to say

the job " wasn't for her " . She did provide an address for me to send

her pay though.

>

> I am rapidly learning the EMR and doing all of my own patient care

work and call backs. I am fairly overwhelmed with the volume of

labs/calls/refills and cases of paper charts coming over from my old

office of pt transfers. I am now up to seeing about 6-7 pts/day but

it is taking me about 10-12 hrs in the office to do so. I bought

a new laptop/notepad but the IT guy hasn't been able to get it to

work with the EMR servor so I am running back and forth to an old

desktop in the back of the office to do the EMR.

>

> The phone messages from pts from the old office is truly

stunning. The data entry to transfer my pts records to the EMR is

very labor intensive.

>

> I am in the process of trying to decide how to get some help. My

schedule called for 3-4 pts per hour but I just today changed it to

2 per hour b/c there is no way I can do that pace as it now stands.

>

> Stress level is high, but I will hang tough and hope for

improvement.

>

> In retrospect I wouldn't have opened the flood gates to all of my

old pts right away. I am thinking of how I can " cull the flock " in

a decent and ethical and medico-legally safe manner.

>

> Anyway, it's a dark night and I hope it gets better.

>

> Thanks to all who participate in this listserv, to its creator,

and to Annie Skaggs who invited me to join. It's been a great help.

>

> Jim Bury

> Pleasant Prairie WI

> EMR MedInformatix

>

[Guest guest]

Jim

can you move all of your routine PEs into the future a few months?

You need some breathing room!

Any stable chronic people whose appointments you can move into the

future also- cull that schedule!

I think Matt Levin? doesn't extract the charts into the EMR until he

is seeing the patient in the room, this may save you some time. Don't

do it after seeing patients, just save the old charts as they come in

until you are seeing the whites of their eyes, then enter into your EMR.

Can you move your desktop into your exam room for now? Running into

the back sounds horrific.

I would in NO WAY be able to see 4 patients an hour without help.

30-40 minutes per patient (not all clinical time, some admin stuff is

really what I need for a follow up visit), try to schedule it more

that way since you are light on staff. Otherwise you will run that

way but be always behind, which is irksome.

Just a small rough spot at the beginning, think " FUTURE " .

I'm sure it will improve as you go on, it just takes some time...

Good luck, hang in there.

Lynn Ho

>

> I am in a similar situation.

>

> I just left employment where I had a 7 yr old practice of approx.

2000 pts. I moved 10 miles and went to a new EMR from paper charts.

I am now in my 2nd week.

>

> I now share a front desk employee with a friend and hired a CNA/ RN

student who was with me for 3 partial days of training but didn't

show up for work today. She called me at lunch time to say the job

" wasn't for her " . She did provide an address for me to send her pay

though.

>

> I am rapidly learning the EMR and doing all of my own patient care

work and call backs. I am fairly overwhelmed with the volume of

labs/calls/refills and cases of paper charts coming over from my old

office of pt transfers. I am now up to seeing about 6-7 pts/day but

it is taking me about 10-12 hrs in the office to do so. I bought a

new laptop/notepad but the IT guy hasn't been able to get it to work

with the EMR servor so I am running back and forth to an old desktop

in the back of the office to do the EMR.

>

> The phone messages from pts from the old office is truly stunning.

The data entry to transfer my pts records to the EMR is very labor

intensive.

>

> I am in the process of trying to decide how to get some help. My

schedule called for 3-4 pts per hour but I just today changed it to 2

per hour b/c there is no way I can do that pace as it now stands.

>

> Stress level is high, but I will hang tough and hope for improvement.

>

> In retrospect I wouldn't have opened the flood gates to all of my

old pts right away. I am thinking of how I can " cull the flock " in a

decent and ethical and medico-legally safe manner.

>

> Anyway, it's a dark night and I hope it gets better.

>

> Thanks to all who participate in this listserv, to its creator, and

to Annie Skaggs who invited me to join. It's been a great help.

>

> Jim Bury

> Pleasant Prairie WI

> EMR MedInformatix

>

[Guest guest]

One of the fastest ways to decrease your patient load is to not participate in as many insurance plans. Eliminate the lower paying & higher hassle plans. If you really have way too many patients consider becoming cash only where the patient pays you and you give the patient a bill that the patient can submit to their insurance company. I have heard that when you go  to cash only you lose about 70% of your patients. Since you also moved you would probably lose even more. By eliminating billing you decrease your workload and improve your cash flow.Starting with an employee can be a great help in some circumstances. I started with a smart hard working, reliable medical assistant that I had worked with for 3 years prior to starting my own practice. She was a great help in setting up my practice. It is very helpful to have someone to discuss things with. We used to spend over 1 hour per day for the first few months just discussing how the day went and how we could improve things.( I changed practices suddenly with very little planning so we had a lot of things to work out.) Having staff definitely increases costs a lot. I had a part time job working 12 hours a week at a residency to help pay the bills the first year . Knowing the person you hire is key to having an employee at start up. Usually someone at your old office who you know is reliable but just as important is flexible and good at change is a good person to consider. Someone with experience and knowledge with running a medical office helps a lot but if they just want to do things the old fashioned high cost way they hurt more than they will help. I agree with Gordon that if you are not comfortable or skilled at managing staff that you should wait until the office settles down a lot before hiring staff if you ever do. Larry Lindeman MDLarry Lindeman MD Titrate the patient flow.  I know these are not "new" patients, but you can only handle so many at a time.  Just as you realized that 3-4 pts per hour was unrealistic, it is also unrealistic to continue your current patient of bringing "new" patients into your practice.When faced with a supply/demand gap - too much demand for the supply you bring to the table - you have three options and can explore each.1:  Decrease demand - this strategy has been used with great success by a number of IMPs in start up - temporarily clamp off "new" patients for a week, a month, a few months.2:  Improve your work flow to improve your capacity:  you're doing this by climbing the learning curve.  Problem is that if you're always putting out fires you never get to step back, analyze your processes and create new and better approaches.  Read Lynn Ho's piece in FPM:http://www.aafp.org/fpm/20070900/27seve.html3: Increase supply: temporarily work longer and harder to keep up with the work while climbing the learning curve (sounds like you're already doing that), consider hiring temp help (as someone already suggested).  Risk of hiring temp help is also what you already experienced: you have to train them to new processes that are not yet settled (you're not even sure what they are yet), and they may bail just as you get started (as already happened).None of these come without cost, but I've seen on this listserv several examples of burning out on this issue and/or hiring staff to support the work and finding in a year that you're right back in your old practice (working to meet overhead).Options 1 & 2 have been used with greater success than 3 by IMPs.  I don't mean to say that having staff is anathema to our model, it's just that in startup mode you don't have a stable platform for training a new person.  If you can figure out what a support person can do and can train them quickly to do it and know that the volume of work will support the salary and the support person and you can communicate with ease and clarity, having that support to meet the demand makes all the sense in the world.If you are uncertain on the key variables of working with staff (not confident the volume will support the salary, not sure of the role/tasks, not sure of the individual, not great at delegation and communication), then I recommend you use strategies 1 & 2 until these issues are clear.GordonAt 12:26 AM 10/24/2007, you wrote:I am in a similar situation.I just left employment where I had a 7 yr old practice of approx. 2000 pts.  I moved 10 miles and went to a  new EMR  from paper charts.  I am now in my 2nd week.  I now share a front desk employee with a friend and hired a CNA/ RN  student who was with me for 3  partial days of training but didn't show up for work today.  She called me at lunch time to say the job "wasn't for her".  She did provide an address for me to send her pay though.I am rapidly learning the EMR and doing all of my own patient care work and call backs.  I am fairly overwhelmed with the volume of labs/calls/refills and cases of paper charts coming over from my old office of pt transfers.  I am now up to seeing about 6-7 pts/day but it is taking me about 10-12 hrs in the office to do so.     I bought a new laptop/notepad but the IT guy hasn't been able to get it to work with the EMR servor so I am running back and forth to an old desktop in the back of the office to do the EMR.The  phone messages from pts from the old office is  truly stunning.   The data entry to transfer my pts records to the EMR is very labor intensive. I am in the process of trying to decide how to get some help.  My schedule called for 3-4 pts per hour but I just today changed it to 2 per hour b/c there is no way I can do that pace as it now stands.Stress level is high, but I will hang tough and hope for improvement.In retrospect I wouldn't have opened the flood gates to all of my old pts  right away.  I am thinking of how I can "cull the flock" in a decent and ethical and medico-legally safe manner.Anyway, it's a dark night and I hope it gets better.Thanks to all who participate in this listserv, to its creator, and to Annie Skaggs who invited me to join.  It's been a great help.Jim BuryPleasant Prairie WIEMR MedInformatix 

[Guest guest]

Jim,

At the urgent care where I work (which has an emr), we have 1 filing cabinet

for the paper charts of new patients coming from other practices. If the

need arises to check some vital info, e.g. Why was the patient placed on warfarin

5 years ago and is still on it or what was the result of the lumbar MRI 12

months ago; you’ll know where the information is. I think

you’ll hardly ever have to use it as most of these patients are you old

patients anyway. You may want to have people fill out new medical history

summaries that are easy to insert into your emr as they should probably

be updated yearly anyway. Consider using the tools described by Lynn Ho

in her Sept FPM article. Good luck. I guess there may be some

advantages to starting with a clean slate, as I will have to do.

Straz

[Guest guest]

RE extraction of chart material

Yes, I put old records in the "paper" chart, and then pull out the parts that I need at the time of the visit.

Am transitioning into scanning all incoming info; by the way, the Doucmate 510 model now available in the office supply places for $299 works just fine!

Once my stuff is scanned in (and I also do NOT send for old records UNTIL I see pt FIRST TIME), then I'll "cull out" the usable stuff to have ready for the visit.

Matt Levin, MD

Solo since Dec 2004

In FM medical practice since 1988

Re: transitioning current patients to my n ew office

Jimcan you move all of your routine PEs into the future a few months? You need some breathing room!Any stable chronic people whose appointments you can move into thefuture also- cull that schedule!I think Matt Levin? doesn't extract the charts into the EMR until heis seeing the patient in the room, this may save you some time. Don'tdo it after seeing patients, just save the old charts as they come inuntil you are seeing the whites of their eyes, then enter into your EMR.Can you move your desktop into your exam room for now? Running intothe back sounds horrific.I would in NO WAY be able to see 4 patients an hour without help.30-40 minutes per patient (not all clinical time, some admin stuff isreally what I need for a follow up visit), try to schedule it morethat way since you are light on staff. Otherwise you will run thatway but be always behind, which is irksome.Just a small rough spot at the beginning, think "FUTURE".I'm sure it will improve as you go on, it just takes some time...Good luck, hang in there.Lynn Ho>> I am in a similar situation.> > I just left employment where I had a 7 yr old practice of approx.2000 pts. I moved 10 miles and went to a new EMR from paper charts.I am now in my 2nd week. > > I now share a front desk employee with a friend and hired a CNA/ RNstudent who was with me for 3 partial days of training but didn'tshow up for work today. She called me at lunch time to say the job"wasn't for her". She did provide an address for me to send her paythough.> > I am rapidly learning the EMR and doing all of my own patient carework and call backs. I am fairly overwhelmed with the volume oflabs/calls/refills and cases of paper charts coming over from my oldoffice of pt transfers. I am now up to seeing about 6-7 pts/day butit is taking me about 10-12 hrs in the office to do so. I bought anew laptop/notepad but the IT guy hasn't been able to get it to workwith the EMR servor so I am running back and forth to an old desktopin the back of the office to do the EMR.> > The phone messages from pts from the old office is truly stunning.The data entry to transfer my pts records to the EMR is very laborintensive. > > I am in the process of trying to decide how to get some help. Myschedule called for 3-4 pts per hour but I just today changed it to 2per hour b/c there is no way I can do that pace as it now stands.> > Stress level is high, but I will hang tough and hope for improvement.> > In retrospect I wouldn't have opened the flood gates to all of myold pts right away. I am thinking of how I can "cull the flock" in adecent and ethical and medico-legally safe manner.> > Anyway, it's a dark night and I hope it gets better.> > Thanks to all who participate in this listserv, to its creator, andto Annie Skaggs who invited me to join. It's been a great help.> > Jim Bury> Pleasant Prairie WI> EMR MedInformatix>

[Guest guest]

Thanks Straz...those are good tips. I am sure that the level of detail that I have accumulated in my past med history sections has been a bit of over-kill and that may be a factor in slowing me down. I have not been happy though with patient-provided medical history info as it always seems to be so sketchy and imprecise.Thanks again--Jim F Strazzullo wrote: Jim, At the urgent care where I work (which has an emr), we have 1 filing cabinet for the paper charts of new patients coming from other practices. If the need arises to check some vital info, e.g. Why was the patient placed on warfarin 5 years ago and is still on it or what was the result of the lumbar MRI 12 months ago; you’ll know where the information is. I think you’ll hardly ever have to use it as most of these patients are you old patients anyway. You may want to have people fill out new medical history summaries that are easy to insert into your emr as they should probably

be updated yearly anyway. Consider using the tools described by Lynn Ho in her Sept FPM article. Good luck. I guess there may be some advantages to starting with a clean slate, as I will have to do. Straz

[Guest guest]

Hire a bright college bound High School student. (probably as smart as the rest of us.)

Preferably 11th grader.

Should be smart enough to enter demographic data first week (even if they dont add the insurance info)

Second week do some scanning and filing charts and paper.

The 3rd week - sort mail.

4th week scheduling appointments and take messages.

Etc.

Add only one new task per week maximum.

Don't overwhelm student with lots of tasks in the beginning, and should grow on job and become a star.

Cost will be minimum - $8-10 per hr., for one to two hours after school, several days per week.

There will be no long term overhead since the student should be leaving town in a couple of years.

The student will be potential great source of help in future when your future employee, if you have one, wants to take two weeks off in the summer.

Just my .02

Mike Safran

>

> I am in a similar situation.

>

> I just left employment where I had a 7 yr old practice of approx.

2000 pts. I moved 10 miles and went to a new EMR from paper charts.

I am now in my 2nd week.

>

> I now share a front desk employee with a friend and hired a CNA/ RN

student who was with me for 3 partial days of training but didn't

show up for work today. She called me at lunch time to say the job

"wasn't for her". She did provide an address for me to send her pay

though.

>

> I am rapidly learning the EMR and doing all of my own patient care

work and call backs. I am fairly overwhelmed with the volume of

labs/calls/refills and cases of paper charts coming over from my old

office of pt transfers. I am now up to seeing about 6-7 pts/day but

it is taking me about 10-12 hrs in the office to do so. I bought a

new laptop/notepad but the IT guy hasn't been able to get it to work

with the EMR servor so I am running back and forth to an old desktop

in the back of the office to do the EMR.

>

> The phone messages from pts from the old office is truly stunning.

The data entry to transfer my pts records to the EMR is very labor

intensive.

>

> I am in the process of trying to decide how to get some help. My

schedule called for 3-4 pts per hour but I just today changed it to 2

per hour b/c there is no way I can do that pace as it now stands.

>

> Stress level is high, but I will hang tough and hope for improvement.

>

> In retrospect I wouldn't have opened the flood gates to all of my

old pts right away. I am thinking of how I can "cull the flock" in a

decent and ethical and medico-legally safe manner.

>

> Anyway, it's a dark night and I hope it gets better.

>

> Thanks to all who participate in this listserv, to its creator, and

to Annie Skaggs who invited me to join. It's been a great help.

>

> Jim Bury

> Pleasant Prairie WI

> EMR MedInformatix

>

Email and AIM finally together. You've gotta check out free AOL Mail!

[Guest guest]

Thanks Lynn. Your words are well taken. It is good to hear that I am not unreasonable in trying to scale back the demand and allow more time per pt.I have got my laptop running the EMR and that will help a lot. I was thinking of buying roller skates for a while there...I have tried to postpone non-critical appts but then I have to do the med refills and with the EMR that seems to take a fair amount of time to do as well, unless I "wing it " w/o documenting, which I am not comfortable doing.I have learned a lot from your articles and your talk in Chicago. Thank you--Jim lynnhri wrote: Jim can you move all of your routine PEs into the future a few months? You need some breathing room! Any stable chronic people whose appointments you can move into the future also- cull that schedule! I think Matt Levin? doesn't extract the charts into the EMR until he is seeing the patient in the room, this may save you some time. Don't do it after seeing patients, just save the old charts as they come in until you are seeing the whites of their eyes, then enter into your EMR. Can you move your desktop into your exam room for now? Running into the back sounds horrific. I would in NO WAY be able to see 4 patients an hour without help. 30-40 minutes per patient (not all clinical time, some admin stuff is really what I need for a follow up visit), try to schedule it more that way since

you are light on staff. Otherwise you will run that way but be always behind, which is irksome. Just a small rough spot at the beginning, think "FUTURE". I'm sure it will improve as you go on, it just takes some time... Good luck, hang in there. Lynn Ho > > I am in a similar situation. > > I just left employment where I had a 7 yr old practice of approx. 2000 pts. I moved 10 miles and went to a new EMR from paper charts. I am now in my 2nd week. > > I now share a front desk employee with a friend and hired a CNA/ RN student who was with me for 3 partial days of training but didn't show up for work today. She called me at lunch time to say the job "wasn't for her". She did provide an address for me to send her pay

though. > > I am rapidly learning the EMR and doing all of my own patient care work and call backs. I am fairly overwhelmed with the volume of labs/calls/refills and cases of paper charts coming over from my old office of pt transfers. I am now up to seeing about 6-7 pts/day but it is taking me about 10-12 hrs in the office to do so. I bought a new laptop/notepad but the IT guy hasn't been able to get it to work with the EMR servor so I am running back and forth to an old desktop in the back of the office to do the EMR. > > The phone messages from pts from the old office is truly stunning. The data entry to transfer my pts records to the EMR is very labor intensive. > > I am in the process of trying to decide how to get some help. My schedule called for 3-4 pts per hour but I just today changed it to 2 per hour b/c there is no way I can do that pace as it now stands.

> > Stress level is high, but I will hang tough and hope for improvement. > > In retrospect I wouldn't have opened the flood gates to all of my old pts right away. I am thinking of how I can "cull the flock" in a decent and ethical and medico-legally safe manner. > > Anyway, it's a dark night and I hope it gets better. > > Thanks to all who participate in this listserv, to its creator, and to Annie Skaggs who invited me to join. It's been a great help. > > Jim Bury > Pleasant Prairie WI > EMR MedInformatix >

[Guest guest]

Yes I am fortunate enough to have my wife help but we're limited by child care issues. I think it will help though. Thanks for your input.Jim Haresch wrote: Wow. So much for having some breathing space right now! Is there someone you can impose upon to help with paper flow for a while? I don't know how you fit a full hiring process in at this point. May it slow down soon! Haresch > > I am in a similar situation. > > I just left employment where I had a 7 yr old practice of approx. 2000 pts. I moved 10 miles and went to a new EMR from paper charts. I am now in my 2nd week. > > I now share a front desk employee with a friend and hired a CNA/ RN student who was with me for 3 partial days of training but didn't show up for work today. She called me at lunch time to say the job "wasn't for her". She did provide an address for me to send her pay though. > > I am rapidly learning the EMR and doing all of my own patient care work and call backs. I am fairly overwhelmed with the volume of labs/calls/refills and cases of paper charts coming over from my old office of pt transfers. I am now up to

seeing about 6-7 pts/day but it is taking me about 10-12 hrs in the office to do so. I bought a new laptop/notepad but the IT guy hasn't been able to get it to work with the EMR servor so I am running back and forth to an old desktop in the back of the office to do the EMR. > > The phone messages from pts from the old office is truly stunning. The data entry to transfer my pts records to the EMR is very labor intensive. > > I am in the process of trying to decide how to get some help. My schedule called for 3-4 pts per hour but I just today changed it to 2 per hour b/c there is no way I can do that pace as it now stands. > > Stress level is high, but I will hang tough and hope for improvement. > > In retrospect I wouldn't have opened the flood gates to all of my old pts right away. I am thinking of how I can "cull the flock" in a decent and

ethical and medico-legally safe manner. > > Anyway, it's a dark night and I hope it gets better. > > Thanks to all who participate in this listserv, to its creator, and to Annie Skaggs who invited me to join. It's been a great help. > > Jim Bury > Pleasant Prairie WI > EMR MedInformatix >

[Guest guest]

Thank you Gordon for your thoughts and help. This is very cogent, and helps me to see my situation more objectively and clearly. The comment on not having a stable platform upon which to train a new person rings quite true with me. I will try to decrease demand and follow the learning curve as quickly as I can, but will try to not merely fight the fires but analyze the processes as well. Again I thank you for your help.BTW the 9/07 FPM is on my desk in front of me. Good stuff.Jim"L. Gordon " wrote: Titrate the patient flow. I know these are not "new" patients, but you can only handle so many at a time. Just as you realized that 3-4 pts per hour was unrealistic, it is also unrealistic to continue your current patient of bringing "new" patients into your practice. When faced with a supply/demand gap - too much demand for the supply you bring to the table - you have three options and can explore each. 1: Decrease demand - this strategy has been used with great success by a number of IMPs in start up - temporarily clamp off "new" patients for a week, a month, a few months. 2: Improve your work flow to improve your capacity: you're doing this by climbing the learning curve. Problem is that if you're always putting out fires you never get to step back, analyze your processes and create new and better approaches. Read Lynn Ho's piece

in FPM: http://www.aafp.org/fpm/20070900/27seve.html 3: Increase supply: temporarily work longer and harder to keep up with the work while climbing the learning curve (sounds like you're already doing that), consider hiring temp help (as someone already suggested). Risk of hiring temp help is also what you already experienced: you have to train them to new processes that are not yet settled (you're not even sure what they are yet), and they may bail just as you get started (as already happened). None of these come without cost, but I've seen on this listserv several examples of burning out on this issue and/or hiring staff to support the work and finding in a year that you're right back in your old practice (working to meet overhead). Options 1 & 2 have been used with greater success than 3 by IMPs. I don't mean to say that having staff is

anathema to our model, it's just that in startup mode you don't have a stable platform for training a new person. If you can figure out what a support person can do and can train them quickly to do it and know that the volume of work will support the salary and the support person and you can communicate with ease and clarity, having that support to meet the demand makes all the sense in the world. If you are uncertain on the key variables of working with staff (not confident the volume will support the salary, not sure of the role/tasks, not sure of the individual, not great at delegation and communication), then I recommend you use strategies 1 & 2 until these issues are clear. Gordon At 12:26 AM 10/24/2007, you wrote: I am in a similar situation. I just left employment where I had a 7 yr old practice of approx. 2000 pts. I moved 10 miles and went to a new

EMR from paper charts. I am now in my 2nd week. I now share a front desk employee with a friend and hired a CNA/ RN student who was with me for 3 partial days of training but didn't show up for work today. She called me at lunch time to say the job "wasn't for her". She did provide an address for me to send her pay though. I am rapidly learning the EMR and doing all of my own patient care work and call backs. I am fairly overwhelmed with the volume of labs/calls/refills and cases of paper charts coming over from my old office of pt transfers. I am now up to seeing about 6-7 pts/day but it is taking me about 10-12 hrs in the office to do so. I bought a new laptop/notepad but the IT guy hasn't been able to get it to work with the EMR servor so I am running back and forth to an old desktop in the back of the office to do the EMR. The phone messages from pts from the

old office is truly stunning. The data entry to transfer my pts records to the EMR is very labor intensive. I am in the process of trying to decide how to get some help. My schedule called for 3-4 pts per hour but I just today changed it to 2 per hour b/c there is no way I can do that pace as it now stands. Stress level is high, but I will hang tough and hope for improvement. In retrospect I wouldn't have opened the flood gates to all of my old pts right away. I am thinking of how I can "cull the flock" in a decent and ethical and medico-legally safe manner. Anyway, it's a dark night and I hope it gets better. Thanks to all who participate in this listserv, to its creator, and to Annie Skaggs who invited me to join. It's been a great help. Jim Bury Pleasant Prairie WI EMR MedInformatix

[Guest guest]

Matt- I wish I wasn't getting boxes of copied charts at this point, they are not organized and finding the one I want in that mess is a big task. Your decision not to get old chart prior to seeing the pt makes sense.Thanks again--JimDr Levin wrote: RE extraction of chart material Yes, I put old records in the "paper" chart, and then pull out the parts that I need at the time of

the visit. Am transitioning into scanning all incoming info; by the way, the Doucmate 510 model now available in the office supply places for $299 works just fine! Once my stuff is scanned in (and I also do NOT send for old records UNTIL I see pt FIRST TIME), then I'll "cull out" the usable stuff to have ready for the visit. Matt Levin, MD Solo since Dec 2004 In FM medical practice since 1988 Re: transitioning current patients to my n ew office Jimcan you move all of your routine PEs into the future a few months? You need some breathing room!Any stable chronic people whose appointments you can move into thefuture also- cull that schedule!I think Matt Levin? doesn't extract the charts into the EMR until heis seeing

the patient in the room, this may save you some time. Don'tdo it after seeing patients, just save the old charts as they come inuntil you are seeing the whites of their eyes, then enter into your EMR.Can you move your desktop into your exam room for now? Running intothe back sounds horrific.I would in NO WAY be able to see 4 patients an hour without help.30-40 minutes per patient (not all clinical time, some admin stuff isreally what I need for a follow up visit), try to schedule it morethat way since you are light on staff. Otherwise you will run thatway but be always behind, which is irksome.Just a small rough spot at the beginning, think "FUTURE".I'm sure it will improve as you go on, it just takes some time...Good luck, hang in there.Lynn Ho>> I am in a similar situation.> > I just left employment where I had a 7 yr old practice of approx.2000 pts. I moved 10 miles and went to a new EMR from paper charts.I am now in my 2nd week. > > I now share a front desk employee with a friend and hired a CNA/ RNstudent who was with me for 3 partial days of training but didn'tshow up for work today. She called me at lunch time to say the job"wasn't for her". She did provide an address for me to send her paythough.> > I am rapidly learning the EMR and doing all of my own patient carework and call backs. I am fairly overwhelmed with the volume oflabs/calls/refills and cases of paper charts coming over from my oldoffice of pt transfers. I am now up to seeing about 6-7 pts/day butit is taking me about 10-12 hrs in the office to do so. I bought anew laptop/notepad

but the IT guy hasn't been able to get it to workwith the EMR servor so I am running back and forth to an old desktopin the back of the office to do the EMR.> > The phone messages from pts from the old office is truly stunning.The data entry to transfer my pts records to the EMR is very laborintensive. > > I am in the process of trying to decide how to get some help. Myschedule called for 3-4 pts per hour but I just today changed it to 2per hour b/c there is no way I can do that pace as it now stands.> > Stress level is high, but I will hang tough and hope for improvement.> > In retrospect I wouldn't have opened the flood gates to all of myold pts right away. I am thinking of how I can "cull the flock" in adecent and ethical and medico-legally safe manner.> > Anyway, it's a dark night and I hope it gets better.> > Thanks

to all who participate in this listserv, to its creator, andto Annie Skaggs who invited me to join. It's been a great help.> > Jim Bury> Pleasant Prairie WI> EMR MedInformatix>