So far, so good.
When Gondo comes in, he too sits at the computer and enters information into the EMR. At the end of the visit, he sends prescriptions to the printer at the front desk. So what’s left to be done that can’t be accomplished in the few minutes that Pearcey is rooming the next patient?
His Own Worst Enemy
When pressed for an answer, Gondo says he’s fine-tuning templates for retrieved information, replacing abbreviations, and fixing spelling errors. Bertman is blunt: “He may be being too anal retentive about his notes,” he says. Spelling accurately and avoiding abbreviations are obviously crucial when writing prescriptions, but Bertman’s own experience suggests that with “less documenting and more quick assessment, I can write a note I’m proud of.”
And what about those templates? If you have to scroll through your computer screen to view all the templates on your list, chances are you have too many. Bertman advises keeping templates broad enough to allow for quick modification during a visit. Don’t use gender-specific pronouns, and try to make each template generic so it can be used for a number of conditions. And avoid redundancies. For example, rather than typing out, “discussed sore throat and need to call me if symptoms don’t go as planned” — written in a template for sore throats — simply type “discussed the diagnosis … ”
Taped to the door of Gondo’s private office is an upward-trending graph that tracks how many patient records are awaiting completion. Rather than wasting time charting exactly how far behind he is, Gondo needs to get down to business. A glance at those cardboard boxes in the hallway ought to be a detailed enough reminder of the work that needs to be done.
“If I have any spare time, I work on the charts at home,” says Gondo. How much progress he makes there is debatable. With two young children — ages 2 and 4 — extra minutes are no doubt extremely difficult to come by. Weekends and holidays hold the promise of more time, but that time tends to be eaten up as other domestic tasks arise.
Angela Gondo thinks her husband should simply take two or three weeks off from his work at the prison and psychiatric hospital. They’ve even discussed bringing in a locum tenens physician once a week or so to allow Gondo more time to work on completing his notes.
But both of these fixes would be temporary at best — like paying off your credit cards with a home equity loan and then falling right back into debt — unless Gondo is able to bring himself to complete his patient notes during actual patient visits.
If it proves impossible for Gondo to complete notes during or immediately after a patient visit, he can always use the “fourth exam room” concept to catch up after every few appointments. Using this model, after each third patient encounter, Gondo would “schedule” an appointment with his charts, giving himself 15 minutes or so to finish up charting the patients he just saw, and then move on to the next patient visit. Or Gondo could do his paperwork at the end of the day, remembering that any chart left unfinished at that point will cost him, and once again he’ll fall back to spending his time organizing his workload rather than doing it.
How does Gondo fare in charting patients he sees at the prison and psychiatric hospital? Brilliantly, according to his wife; she says he finishes those charts almost immediately — because his employers require it. It’s as if he feels more of a responsibility to these other care settings than to his own practice.
Although Gondo originally took on these additional jobs because, as he says, “You gotta hustle to make it in solo practice,” it’s no longer clear that such moonlighting makes financial sense. Focusing more on his own practice and seeing more patients there may be a better bet.
Technologically Impaired
Under-using his EMR isn’t the only tech issue bogging down Gondo’s practice. But as in other areas, this physician’s approach toward enlisting help is piecemeal. At least two consultants and a series of technology experts of varying stripes have spent time in the practice over the past few years. One advocated more robust billing by integrating the office’s practice management and billing systems. Sound advice — and Gondo knows it — but he hasn’t acted on it.
Instead, he’s been trying to get his e-fax system up and running for the past six months.
