Medical Practice Productivity Pitfall: Skimping on Non-urgent Projects

January 29, 2014

To operate efficiently and profitably, medical practices must devote time and attention to non-urgent, non-routine matters.

If your medical practice is busy, your office and everyone who works there is busy. That probably means that there are just enough providers and staff to do the routine work. In some cases there is extra capacity to deal with emergencies and glitches without neglecting the routine.
Very few offices, if any, have the resources to address anything that is neither urgent nor routine.

That's efficient in the short term, but it is a root cause of inefficiency, unreliability and low profitability in the long term.

Consider an example: A practice implements an EHR. No one has time to abstract and input only the patient information needed for ongoing patient care, so the practice just scans in the whole chart. Of course, it will take months to get all the active charts scanned. Every day the practice encounters patients whose charts are digitized and those whose charts are not. That means providers and staff have to work in and maintain both systems.

But wait; it gets worse. Since the goal is simply to get the charts scanned, everything in the paper chart is scanned just as it is. If the practice is very lucky, someone thinks to separate the scanned images according to the sections of the chart. Even so, providers are faced with having to "page through" the images to find what they need. That takes much more time than paging through actual paper and is a major cause of EHR dissatisfaction.

If providers get frustrated enough, they insist on having the paper chart available during each visit. That makes it difficult to keep the scanned and not scanned charts separated. Some are bound to end up in the wrong place. They are not easily found and some charts may never get scanned. The paper charts cannot be shredded or moved offsite, because the scanned files are unusable and untrustworthy.

What should have be an operational improvement, becomes an operational burden without the offsetting benefits of remote accessibility, less paper handling, and reduced storage requirements. It may eventually get better, but it may just be the new normal for the practice.

All of these negative, unintended consequences could have been avoided.

The first task in any project is to create a comprehensive definition of the desired end state. If the practice thought about how the information from the paper charts would be used in the future, it would have recognized that taking the time to decide what to scan and how to organize it was crucial. The objective was not to scan the paper; the objective was to make the information reliably and readily accessible.

To accomplish that objective the practice could have done any one of the following:
• Pulled, prepped and scanned charts for patients scheduled to come in the next day.
• Outsourced to a high volume scanning operation.
• Started with A and marched to Z (Using both paper and digitized charts for an interim period, particularly would be easier because it would always be clear where the scanning process was relative to the alphabet).

The example should make clear that planning is critical, and planning takes time and focused attention. It is often said that if you don't know where you are going, any road will get you there. The truth is that if you don't know where you are going, NO road will get you there.

If the people in a practice are already fully occupied and a new project or initiative crops up, there are only two sources for the necessary resources:

• The people in the practice work more hours, and are disciplined in devoting those hours to the task at hand.
• The practice temporarily engages outside resources to accomplish the task.

Either source can work. The important thing is for the practice to give focused attention to matters that are important but not currently urgent, so it can operate effectively, reliably, and profitably.