Learn better times to complete work
Patient visits are associated with a large bulk of work, including the completion of charts or reviewing the in-basket. Physicians tackle their work in different ways, but the PWP works to help improve workflow by problem-solving pain points and coaching them through a solution to test.
“We’ve worked with a couple doctors that like to wait until the end of the clinic day to review their notes before signing off on them,” Rajcevich said. “They are often doing that late at night when their families are asleep. They rush home to spend time with their family and then plug back into work from nine to midnight, sometimes two in the morning. They’re working long hours and it’s making them unhappy. It’s not sustainable over the long run.”
Rajcevich recommends that physicians plug into different kinds of work at various parts of the day, depending on whether they need other people to be involved. For a provider who likes to review their notes at the end of the day, Rajcevich and her colleagues advise that providers do the work in the early-morning hours before clinic opens instead of burning the midnight oil.
“We’re not suggesting people change what they like to do, but maybe doing it differently can help buy some time back into their day,” Rajcevich said. “It’s coaching people through some of that and helping them see different opportunities in their current workflow with a fresh set of eyes.”
Let someone else do the typing
A pilot program was created prior to the development of the PWP that incorporated a medical assistant (MA) scribe model in a family medicine practice. This is the model described in the “Team Documentation” STEPS Forward™ module offered by the AMA, said Rajcevich.
Through this model, the MA will room the patients, pend orders and medication refills and do a quick handoff with the doctor. While the physician sees the patient, the medical assistant will scribe the visit with the doctor. At the end of the visit, the MA wraps everything up, gives the patient the after visit summary and ensures that follow-up instructions are understood.
“The doctors are finding that they are closing their charts more promptly and they are done with all their documentation at the end of the day,” said Rajcevich. “They feel like they have a better work-life balance, more efficiency and are happier in general.”
Medical assistants have also said they know more about the patient because they are there for the entire visit which allows them to answer questions and perform better follow up. Furthermore, they have acquired a holistic understanding and better appreciation for the workflow of all team members, not just their own.
“We feel it is a win across the board so far and we are continuing to work with them,” she said.
Gaining mastery of the EHR
Some physicians are exceptional in their use of the EHR—they are fast and know how to set things up so that it works well for them. Then there are physicians that don’t know what they don’t know, said Rajcevich.
“These physicians might know that something is clunky or frustrating, but they don’t know that they can make it better or how it can be better, or if there is a way to reduce the time they are spending doing something over the course of the day or week,” she said.
Epic offers a way for MHS to identify what some of the biggest opportunities are with physicians and their teams. This can include whether they are spending a lot of time in orders or in their in-basket, or their notes are two times the length of their partners and don’t need to be that long. By identifying these opportunities, Epic trainers for MHS can help physicians update preferences to reflect the care they are providing their patients while also reducing the number of clicks needed to complete tasks.
MHS has three certified Epic trainers to train new providers as part of their onboarding to MHS, shadow the provider in clinic and perform one-on-one coaching sessions. After learning how the providers work with the EHR, the trainers can offer insight about what potential opportunities are available to help, and how it might complement any recommendations developed during collaboration with the PWP practice optimization consultants.
The level of engagement or involvement provided will depend on the wants and needs of the provider. Some physicians are shadowed only once and MHS will follow up later to see how things are going.
“If they want us to really get in there with them, then we are happy to do that,” Rajcevich said. “If they want us to shadow them one time and get some feedback, then that is fine too. We follow the lead of the physicians and the teams we’re working with.”
By participating in the program, physicians can see more patients because there will be less work that falls to one person associated with each visit. With more team members sharing the workload appropriately, physicians achieve a more efficient work day and experience a better work-life balance.