When he launched his solo family practice in 1995, Roy Gondo knew that to stay afloat he’d have to have to work long, hard hours and look for ways to save money. It’s hardly surprising, then, that he enlisted help from his wife, Angela, to handle much of the practice’s administrative functions as well as play a role in marketing and building a patient base.

Nearly nine years later, Angela Gondo is still (unhappily) the practice’s de facto office manager, and both Gondos are up to their elbows in backlogged patient charts and billing. Angela has begun to wonder whether it wouldn’t be better if her husband took a full-time position in another clinic. An office where he’d have a steady salary would be nice. And regular vacation time. “We used to go to Hawaii,” she says wistfully, but the Gondos haven’t been able to take a break from their practice in Yakima, Wash., in five years.

As for Dr. Gondo, he isn’t ready to give up on his practice just yet, but he does worry. “I enjoy solo practice, but I don’t know how long I can do this without it being taken away,” he says, citing the increasing burdens of regulation, pay-for-performance, and the like. A series of disastrous staffing decisions — one of which resulted in a draining legal battle over unemployment benefits — compounds the questionable long-term viability of this practice.

The Gondos needed help. Fast.

When Physicians Practice brought The Great Practice Makeover to Gondo’s aid, we found burnout looming. In addition to putting in packed days at his own clinic, Gondo serves as medical director for a prison and chief medical consultant in a psychiatric hospital. Angela Gondo routinely works until at least midnight six or seven days a week. Rhea Peralta, a medical assistant who worked in the practice from 2000 to 2003, suspects Angela sometimes spends the night there.

Both Gondos feel completely responsible for every detail of the practice’s operations. That’s understandable. It is, after all, their business. Still, Dr. Gondo is going to have to be willing to cede some control to avoid total burnout.

With a good referral base in the area and their modified open-access schedule filling up daily, it’s time for the Gondos to take a step back from the minutiae of everyday business operations. Some significant tasks have languished far too long while Gondo’s attention has been scattered over a myriad of concerns.

Charts, Charts, and More Charts

They’re piled on nearly every available surface throughout the back rooms of the practice. Yet Gondo’s office is well stocked with computers, printers, and all of the other technical accoutrements of a modern, digitized practice. In fact, Gondo has a fully functioning EMR. Yet he is drowning in paper.

The solo doc installed his EMR six years ago but didn’t fully begin the process of implementing it into his workflow until last year. That’s like buying a car and leaving it in the garage while you procrastinate learning how to drive. This five-year lag provides an insight into the practice’s overall ineffectual implementation and planning processes — and how easily Gondo’s focus is diverted by other concerns. Gondo says he’s happy with his Amazing Charts EMR, and he praises the openness and accessibility of company founder Jon Bertman.

So why are nearly 200 charts (almost one-tenth of the practice’s patient panel) occupying cardboard boxes that line the hallways and lie stacked on multiple desks? Because Gondo sees roughly 20 patients a day, but then completes only three charts. That backlog has quickly become a huge problem for the practice in terms of work flow, space, and billing.

The chart backlog also creates redundancies. When a specialist to whom Gondo has made a referral calls the practice with findings, staff members often have to search through the stacks for the patient’s chart. Occasionally a patient arrives for a follow-up appointment before the note from his or her initial visit has been completed.

We discussed Gondo’s chart backlog with Bertman; if anyone could explain why the practice isn’t taking full advantage of its EMR, we figured the EMR vendor’s founder could. Bertman told us that a learning curve and subsequent backlog and catch-up period at the beginning stages of an EMR’s implementation are to be expected. But it’s clear that at the bottom of Gondo’s sea of charts is his inability to complete a note during — or even relatively close to — a patient encounter. “It’s painful sometimes,” Bertman says, but the key to getting a handle on those records will be having the discipline to complete as much of each patient note as possible (ideally all of it) immediately after each visit or while the patient is still physically in the exam room. Patients may have to wait a little longer for their appointments, but it’s in the name of better service and documentation.

Gondo is a competent typist, so Bertman sees no reason he shouldn’t be completing encounter notes on the spot. Part of the problem is the physician’s own perfectionism.

When a patient arrives, Brenda Pearcey, the practice’s current medical assistant, pulls up that patient’s record on the exam room’s desktop screen. She overwrites the previous history and plan, checking on any needed lab work and making notes to give Gondo details on the reason for the visit.