T-sheet Efficience

[Groove]

Hey guys, I'm doing some moonlighting and using T-sheet paper charting for the first time and need some tips of how you guys go about maximizing your efficiency in documentation and just general approach. I'm doing single coverage and am used to a completely computer based EMR system where I can type out a chart much easier than trying to scribble on a T-sheet. Here's my questions..

1)Do you typically see the pt, order what you need, come back and fill out the T-sheet?
2)Do you do the above but stack 2-3 back at a time and then catch up?
3)Where you find the room to document excess stuff? There's just not enough white space for me to add my thought process or differentials or just random stuff that I might think is important. I feel barren and susceptible to lawyers by just writing very little and doing nothing but checking and slashing with minimal scribbling.

I'm getting the hang of it but I find the T system slows me down. I can't imagine seeing 2-3PPH using a T-system alone and staying caught up on the charts. Do you generally have several to finish filling out after a shift? I'm having mine done by the end of my shift but it's slowing down my throughput. Again though, part of it is just getting used to it so I was curious if you guys had any tips. I almost thought of just opening up a word document and typing really fast whatever else I wanted to say/addendum and slapping a sticker on it and sticking it with the t-sheet. I've been drawing arrows out the whazoo into margin lines and at the bottom to write what I want to say and don't even think I'm writing that much. There's no frackin white space on these things. It's like a system that wants to turn me completely into a check/slash nazi and I feel like we should document more to protect medicolegally.

Tips? Advice? Maybe I'll just get faster with it as I practice...

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[Apollyon]

I don't have any tips because I have more than enough time to fill in the T-sheets. That said, I think they mondo suck. At minimum, my colleagues have abysmal handwriting; combine that with being scanned, and you have a recreation of that scene from "The Jerk" when Navin Johnson is reading the letter while in the bathtub. Moreover, yes, they are just check and backslash - (sarcasm) just lovely for recalling who was the patient or what was up with them at the time.

 

[EM_Rebuilder]

It's like a system that wants to turn me completely into a check/slash nazi and I feel like we should document more to protect medicolegally.

I am not going to say I agree with it, but the T Sheet is 'supposed' to be circles and slashes with little to no additional information. They maximize billing, but most will agree that minimize legal protection....

I take the approach that if its a super low acuity (as many of the people when you moonlight are), then mine are mostly circles and slashes. When they are more complex or I am a bit worried about something, I write in the margins and such. They say you get sued over a patient you never would have thought you would get sued over...but I at least feel better when I do as above.

I always filled them out after patient encounters. It probably slowed me down a bit, but I am not getting RVU pay, and I promise you are already faster than the other folks who usually work wherever you are working. I think sitting in the room filling out paperwork makes the patient feel you are not as interested in them.

Paper T Sheets were one thing I did not want at my perm job, and we do not have them. We do have the electronic version. I actually really like it as I can click anywhere and type three pages of info if I want, yet they are fast to fill out when needed (we actually have scribes, thats another topic, but I find scribes to be a godsend!)... There is a place I still sometimes moonlight at and they are paper T sheets and I just do as I mentioned above...

Before you use blank typed up sheets, talk to the med director as he or the billing company may have some issue with it?

 

[Arcan57]

I don't batch my t-sheet charting because I find it difficult to remember all the specifics if I've seen more than 2 people in between charting, and also because it takes about 1 min to complete. Make sure you're backslashing through the [Impression/Diagonosis] items as that is part of the medical decision making (backslashing through Pulmonary Embolism means you've considered and dismissed it). If you are using a appropriate complaint specific t-sheet, then they're actually pretty sound medico-legally. If you're using the generic complaint t-sheet, then you should be writing a bunch as it's woefully inadequate.

 

[NinerNiner999]

There should also be an "addendum" T sheet, which is a big blank T-sheet for extra documentation. You can type a word document and set the margins to fit the space in that sheet. When you're done, just print it out and sign it - its part of your chart.

 

[emrox]

At our institution before implementation of EHR, we were required to fill out a T-sheet and dictate a short note re: why the patient was in the ED. Dictations were required because other services couldn't really tell what was happening in the ED when patients were seen in follow up.

So I took that opportunity to make the HPI/PE short and I expanded my diff dx and mdm in the dictation. It really sucks to document and dictate (read giant model of inefficiency), but it was required for me and that's how I got around the problem you are describing. It was helpful, particularly for critically ill patients.

 

[Apollyon]

There should also be an "addendum" T sheet, which is a big blank T-sheet for extra documentation. You can type a word document and set the margins to fit the space in that sheet. When you're done, just print it out and sign it - its part of your chart.

The paper addendum is the "progress note" and is #95 - this I know from filling out narratives. The backside of that one has diagrams, too. This is the one I use when I need to write stuff, especially for the secondary gain people.

 

[deleted109597]

I do two things.
First, I try to have a scribe fill out the T-sheet as I find them a pain.
Second, if there isn't a scribe available, I try to write in as much as possible in the margins. Comically, because I haven't quite committed them all to memory, I sometimes write in things that are there but in places that don't make sense to me.

And don't get me started on how hypertension isn't in the PMHx for all of the sheets.

 

[Groove]

Thanks for the advice. I literally hate these damn things. I had 26 pt's, 1/3 low, 1/3 medium, 1/3 higher acuity and I just could not keep up with the T-sheets, was there an extra hour (12hr shift) filling them out. We had 5 ambulances just bolus us within a 2 hour period and I felt like there were a few hours that I always had 4 pt's still to be seen. I had to stop filling out most of the T-sheet and just focus on the orders and dispo's.

The thing that irks me is that I can't write enough to justify my rationale and management approach which I think is just ridiculous. I mean, the "Progress" white box is what... 4-5 lines, max? I have to literally write in these damn margins or find a blank space. I've got arrows out the whazoo and my handwriting is terrible in the first place. Damn, I'll never complain about my home institution computer based system again. Last night sucked. I mean, it was basically 2PPH, but I still feel like the T sheet slows me down but maybe I'll just get faster with it in time.

 

[Groove]

And don't get me started on how hypertension isn't in the PMHx for all of the sheets.

I thought I was imagining things at first until I kept noticing that. Now, when I'm in a hurry, I just X through the entire thing and write my own, rather than hunt for what is there and not there in the current template. Who writes these things...

 

[gutonc]

Who writes these things...

Coders and beancounters.

 

[UnderwaterDoc]

I find it very curious that hospitals have taken so long to implement EMRs, especially in the ED.

We are always getting talks from the coders about how we are missing out on revenue for the department because our documentation is not sufficient, things like having less than 10 systems in ROS for level 5s, not documenting smoke cessation counseling, something missing from FHx/SHx/Meds, etc. This is compounded by the fact that we have a dictation/paper mix which is terrible and inefficient IMO.

I would think that EMRs would exponentially increase revenue for the hospitals since at least the stuff we bill for would increase. Not to mention our efficiency would skyrocket and we would not have to spend 2 hours after a shift dictating.

 

[GeneralVeers]

I find it very curious that hospitals have taken so long to implement EMRs, especially in the ED.

We are always getting talks from the coders about how we are missing out on revenue for the department because our documentation is not sufficient, things like having less than 10 systems in ROS for level 5s, not documenting smoke cessation counseling, something missing from FHx/SHx/Meds, etc. This is compounded by the fact that we have a dictation/paper mix which is terrible and inefficient IMO.

I would think that EMRs would exponentially increase revenue for the hospitals since at least the stuff we bill for would increase. Not to mention our efficiency would skyrocket and we would not have to spend 2 hours after a shift dictating.

The answer is that there are a lot of old-timers who still like dictation/paper charts and aren't comfortable with computers. Additionally many physicians don't have the requisite typing speed to efficiently use an electronic chart.

Once the luddites among us retire and/or die then we should be able to move forward with more electronic charts.

 

[keeping-it-real]

you need to have a blank progress note page (written addendum) that you add to the chart +/- a dictated addendum.

i agree, though, that the t-sheet system + addendum = the model of inefficiency. when the department gets busy, i find myself not filling out anything and then doing it all later. i've had 2-3 hours of charting after a shift because of this.

the t-sheet system really highlights how *****ic our billing process is, though. the elements of history, ROS, exam etc. are all fabricated documentation standards that literally have no correlation with providing a good and detailed history/exam. IMO the overwhelming majority of our documenation is a waste of time and is only done for billing and medicolegal reason... NOT for medical reasons.

 

[Groove]

Alright, so I quickly acclimated to the T-sheet system and am now churning them out like fast food burgers, but I still don't like them. I think having a dictated addendum to go along with it would be perfect. That could all be done pretty quickly.

 

[deleted65604]

you need to have a blank progress note page (written addendum) that you add to the chart +/- a dictated addendum.

i agree, though, that the t-sheet system + addendum = the model of inefficiency. when the department gets busy, i find myself not filling out anything and then doing it all later. i've had 2-3 hours of charting after a shift because of this.

the t-sheet system really highlights how *****ic our billing process is, though. the elements of history, ROS, exam etc. are all fabricated documentation standards that literally have no correlation with providing a good and detailed history/exam. IMO the overwhelming majority of our documenation is a waste of time and is only done for billing and medicolegal reason... NOT for medical reasons.

I think this sums up T-sheets perfectly. I agree that they are woefully inadequate for painting a picture of the actual history of present illness. I did them for 3 years and I'm glad to be done with them.

 

[docB]

I've been using them for 9 years. My group is really good with them. They are fast, they bill well and if you know what you're doing you can strenghten their medicolegal protection. I frequently use the written addendums, particularly for critical care, and I occasionally dictate as well. It seems like I mainly dictate for the socially complex cases rather than the medically complex ones.

We will be switching to an EMR in the spring which will devestate us. We anticipate a 30 to 50% decrease in productivity that will likely improve over time to a lasting 25% hit. I'm not looking forward to that.

 

[UnderwaterDoc]

We will be switching to an EMR in the spring which will devestate us. We anticipate a 30 to 50% decrease in productivity that will likely improve over time to a lasting 25% hit. I'm not looking forward to that.

Why switch then?

 

[docB]

Why switch then?

Forced to by the hospital company. It's not their fault, I believe CMS is forcing everyone to go with an EMR sometime in the near future. They want to be able to mine data, so we take a pay cut.

 

[deleted109597]

Why switch then?

Because Obama got the most electoral college votes and part of "saving" healthcare was forcing us to do so.

 

[UnderwaterDoc]

Maybe I'm missing something, but I would love having an EMR. To name a few positives:

-documentation in general much easier/faster
-you can immediately check on a patient's previous visits.
-billing is exponentially easier, no need for the code words when dictating anymore, just search and click.
-much easier to document medical decision making, and ensure you cover your liable butt.
-one stop shop to check labs, imaging, consults, patient board, etc.

And with time things should get even better, just imagine having that incoming ambulance beam you the patient info before arrival, no more messy radio calls.

 

[EctopicFetus]

Maybe I'm missing something, but I would love having an EMR. To name a few positives:

-documentation in general much easier/faster
-you can immediately check on a patient's previous visits.
-billing is exponentially easier, no need for the code words when dictating anymore, just search and click.
-much easier to document medical decision making, and ensure you cover your liable butt.
-one stop shop to check labs, imaging, consults, patient board, etc.

And with time things should get even better, just imagine having that incoming ambulance beam you the patient info before arrival, no more messy radio calls.

I presume you havent worked with one. Our group started last summer when things are slow for us. We upstaffed and were running waits so bad it wasnt even funny. Productivity for the 1st few months was down no joke like 50% and people were busting their balls.

Some of the younger folks quickly figured it out but the older guys struggled and some even now (18 months + into it still struggle). Our PAs productivity never came back. Our Doc productivity is right about where we were BUT we now have scribes cutting into our income.

I would advise anyone going to the EMR to use scribes. I spent a ton of time making macros, doing the training etc and have learned to really like it. I dragon (when I dont have a scribe), and when I do have a scrive I only have to do my MDM.

long story short we had no real spending limit on our EMR and we picked the one we thought was best irrespective of cost. It still isnt great and there are still those who bitch and moan.

Simply, my take after using Powerchart, Epic, Picis, Sunrise is that none of these are ready for prime time but they are being used in prime time. On top of that a person making $150/hr (or more) is a pretty expensive for someone to do data entry. Scribes have improved our physician satisfaction in a major way.

 

[UnderwaterDoc]

I presume you havent worked with one. Our group started last summer when things are slow for us. We upstaffed and were running waits so bad it wasnt even funny. Productivity for the 1st few months was down no joke like 50% and people were busting their balls.

Some of the younger folks quickly figured it out but the older guys struggled and some even now (18 months + into it still struggle). Our PAs productivity never came back. Our Doc productivity is right about where we were BUT we now have scribes cutting into our income.

I would advise anyone going to the EMR to use scribes. I spent a ton of time making macros, doing the training etc and have learned to really like it. I dragon (when I dont have a scribe), and when I do have a scrive I only have to do my MDM.

long story short we had no real spending limit on our EMR and we picked the one we thought was best irrespective of cost. It still isnt great and there are still those who bitch and moan.

Simply, my take after using Powerchart, Epic, Picis, Sunrise is that none of these are ready for prime time but they are being used in prime time. On top of that a person making $150/hr (or more) is a pretty expensive for someone to do data entry. Scribes have improved our physician satisfaction in a major way.

Actually we had epic during medschool and I loved it. During my EM rotations I used it just like the residents did and I thought it was great. You could click through your entire H&P if you wanted to, with the option to free-text anywhere. Our program is getting epic this coming march so maybe my opinion will change now that I will be looking at it from a different perspective.

I do agree that for the older EPs it will be a nightmare, but our current system of paper/dictation sucks big time, so we had to upgrade. It is my understanding that dictation will remain an option so hopefully that will make the transition easier.

It really sucks that in real life efficiency is taking such huge hits. I wonder what will happen here. Hopefully with time the software catches up.

 

[Groove]

Personally, I think EMR systems are the way of the future and paper charting needs to go away. I think it's naive to assume that a computer based charting method cannot be tweaked, and users trained/acclimated well enough to chart just as fast. Technology is moving at such a rapid pace that there are even more new user interfaces on the horizon. I can even remember interviewing at a hospital way back before residency who used a tablet based "T-sheet" system that was all computer based and tied in electronically with essentially EHR database.

Here's the fundamental issue... The current state of medicine and the future of medicine is evidence based. Having the ability to data mine vast patient record repositories with EHR systems that can "talk" to each other will provide limitless studies that could be performed that we simply can't do right now with many current proprietary systems. Even a proprietary system that spanned several hospitals could allow you to run "virtual" studies on pt populations that potentially provide new evidence based approaches to pt management.

I think we need to start looking beyond the simple "what maximizes the RVU's for my group" and look at the greater benefit. Plus, I really don't believe that electronic charting has to be detrimental to physician efficiency or group/hospital revenue. You simply have to pick the right system. Anytime something changes, you're going to lose efficiency and there will be a learning curve but that can be overcome. Again though.. there are bad systems out there and just because you pick a bad one doesn't mean all EMR/EHR is "bad".

I'm a bit biased though since medical informatics is an interest of mine.

I think what keeps paper charting ingrained is that smaller hospitals simply can't afford comprehensive computer charting systems or hospital administrating will not budget for it. I used to work in IT and when you go with budget requirements for a new technology solution, proving ROI has always been historically difficult in that field. You have to be a bit creative.

 

[docB]

Maybe I'm missing something, but I would love having an EMR. To name a few positives:

-documentation in general much easier/faster
-you can immediately check on a patient's previous visits.
-billing is exponentially easier, no need for the code words when dictating anymore, just search and click.
-much easier to document medical decision making, and ensure you cover your liable butt.
-one stop shop to check labs, imaging, consults, patient board, etc.

And with time things should get even better, just imagine having that incoming ambulance beam you the patient info before arrival, no more messy radio calls.

Those of us who are used to paper T-sheets can document a simple visit in <2 minutes. Going through the necessary page loads, clicks, soft stop pop ups, interaction warnings etc. on an EMR takes > 12 minutes. We will also be required to do physician order entry adding an extra 5 + minutes.

I can look at a patient's previous visits now. We have all the labs, rads and dictations in one system and the paper stuff in an imaging system. The imaging system is slow but the lab, etc. system is fast.

Why is it easier to type my MDM into a computer than to hand write it? The main difference is I will have to be at my desk, logged in to do it rather than on the go.

It is kinda a one stop shop for patient board, etc., if you have time to come out of the chart and let the page load for the board or whatever else you want to look at.

The "things will get better as technology advances" argument is sorta true. But now that EMRs are required by the government there's no longer an incentive to make a better mousetrap. You just need to market better than the competition. The hospitals have to pick one of you. And once that system is bought and paid for will they be upgraded for free? Unlikely.

The technology for electronic ambulance telemetry is already here. But in my area the ambulance compnay would have to buy a $3500 server of some kind to make it work and get the hosptial IT guys to let them through the firewall, so needless to say, we don't have it.

 

[docB]

I presume you havent worked with one. Our group started last summer when things are slow for us. We upstaffed and were running waits so bad it wasnt even funny. Productivity for the 1st few months was down no joke like 50% and people were busting their balls.

Some of the younger folks quickly figured it out but the older guys struggled and some even now (18 months + into it still struggle). Our PAs productivity never came back. Our Doc productivity is right about where we were BUT we now have scribes cutting into our income.

I would advise anyone going to the EMR to use scribes. I spent a ton of time making macros, doing the training etc and have learned to really like it. I dragon (when I dont have a scribe), and when I do have a scrive I only have to do my MDM.

long story short we had no real spending limit on our EMR and we picked the one we thought was best irrespective of cost. It still isnt great and there are still those who bitch and moan.

Simply, my take after using Powerchart, Epic, Picis, Sunrise is that none of these are ready for prime time but they are being used in prime time. On top of that a person making $150/hr (or more) is a pretty expensive for someone to do data entry. Scribes have improved our physician satisfaction in a major way.

We are considering getting scribes. I am really against it but I know some really like them.

How do you manage what gets into the chart? Do you have to overread everything and edit them or do you just trust what the scribes put in?

When does the scribe do the chart? I assume they follow you into the room for the exam. Do they then go back to a desk to do the chart or do they use cows or tablets? Do you have to wait on them to move on to the next patient?

How reliable are they? We keep hearing that they are paid ~ twice minimum but at that do they frequently no show or call out? Do you increase doc staffing if there's no scribe? Do you staff a scribe for each doc or is there only one at a time?

We are all scared to death about this because there is a possibility we will take a 50% pay cut. We tried to use Ibex (which is now Picis) several years ago and it was a disaster.

 

[EM_Rebuilder]

We are considering getting scribes. I am really against it but I know some really like them.

How do you manage what gets into the chart? Do you have to overread everything and edit them or do you just trust what the scribes put in?

When does the scribe do the chart? I assume they follow you into the room for the exam. Do they then go back to a desk to do the chart or do they use cows or tablets? Do you have to wait on them to move on to the next patient?

How reliable are they? We keep hearing that they are paid ~ twice minimum but at that do they frequently no show or call out? Do you increase doc staffing if there's no scribe? Do you staff a scribe for each doc or is there only one at a time?

We are all scared to death about this because there is a possibility we will take a 50% pay cut. We tried to use Ibex (which is now Picis) several years ago and it was a disaster.

My new (since Aug) perm job has scribes. I was VERY apprehensive at first as I always was a very particular yet speedy charter during residency and my moonlighting experiences..

Since coming to the new job and having several months under my belt, I simply LOVE scribes! They make our job so much easier.. I will try to answer some of your questions.

1.) The scribes have been educated to put everything we ask into the chart and often 'then some'. As in physicial exam, the exam is considered normal unless we direct an abnormal finding to them.

2.) As far as what gets in the chart.. Do I read 100% of every chart with detail..no... Its a bit pick and choose and some scribes you trust slightly more than others. They are also taught to keep it neutral and not put 'severe abd pain, or severe HA, etc'. I can tell you that my MSIV and intern (we have rotators from outside) charts need read and altered MUCH more than my scribes. I will personally look closer at the chest painer chart I send out, undifferented abd pain that I send out, the non chronic HAs that send out... I consider those higher risk and I make certain the documentation is to my likening.

3.) They do the chart when we get back to the physicians area. I probably see at most 3 patients at once. We go back, while I am putting in orders, following up on prior labs, etc.. they knock out the charts.

4.) Our scribes have been rather faithful. I do not know of anyone 'not' showing up. Ours are generally college students so they do sometimes have a class they need to go for and we are forgiving for that. Staffing does not change if no scribes. We have at least two of our fulltime guys that choose to not use scribes. We have two dedciated night scribes so nights can be hit or miss sometimes; occasionally one of the other scribes might work part of the night.

My overall take is Scribes make my job so much easier. I have worked probably 3-4 shifts since August where I did not have a scribe and I was slower those days plus having to do my own charts just sort of sucked.. its a bit spoiling. The other huge advantage is the personal secretary aspect. They page my consults, bird dog xrays/reads/labs.. go ask something I forgot to ask, touch base back with consultants on dispositions... they also get us lunch or dinner about every day...

Financially.. I have no idea the history of how that changed here as they have been using scribes for several years here; I am not certain if the docs pay were deducted for them or what happened? I do know that nothing comes directly out of my check. Our scribes are an 'on site' system; we have a scribe manager who is the med directors scribe and does the managment of them. New scribes work with old scribes for a while before going independent. I have only worked with one 'brand new' scribe and they caught on pretty quikcly I though...


I've had conversations with my old resident colleagues about scribes since I have become such 'pro scribe'.. how much would I personally be willing to 'pay' for the service. As in, if I went to a new job and scribes were an option but cost X/hr dollars.. how much would I be willing to pay. My day is incredibly less stressful by not having to do the charts and having someone birddog those little things for me. I think that value is different for everyone, but that is what you would essentially be purchasing..

 

[deleted109597]

How do you manage what gets into the chart? Do you have to overread everything and edit them or do you just trust what the scribes put in?

Since they also write on T sheets at my shop, I can usually glance over their writing and make sure it is accurate.

When does the scribe do the chart? I assume they follow you into the room for the exam. Do they then go back to a desk to do the chart or do they use cows or tablets? Do you have to wait on them to move on to the next patient?

Mine write as I'm in the room. I just announce odd physical exam findings (murmurs, masses, etc). The hardest part is describing the rashes. My scribe is trying to get into medical school, so he's pretty savvy, but just like a 1st year medical student he doesn't know a whole lot of actual medicine.

How reliable are they? We keep hearing that they are paid ~ twice minimum but at that do they frequently no show or call out? Do you increase doc staffing if there's no scribe? Do you staff a scribe for each doc or is there only one at a time?

As reliable as you can make them. Mine lets me know if he's going to not be there a few days in advance. I can live without them, but don't want to for the most part. We do not increase physician staffing if scribes don't show.

Maybe I'm missing something, but I would love having an EMR. To name a few positives:

-documentation in general much easier/faster
-you can immediately check on a patient's previous visits.
-billing is exponentially easier, no need for the code words when dictating anymore, just search and click.
-much easier to document medical decision making, and ensure you cover your liable butt.
-one stop shop to check labs, imaging, consults, patient board, etc.

And with time things should get even better, just imagine having that incoming ambulance beam you the patient info before arrival, no more messy radio calls.

-Easier and faster isn't always true. I have to log on every single time I go sit down at my computer. This takes time. To print discharge paperwork, I have to make at least 20 mouse clicks, including clicking OK twice for pretty much everything (as in, are you really sure you want to print?). Also, if a lab result pops up, or there is a sudden change, I can grab the T and write on it. If I have to log in to the computer, it takes time. Also, there aren't functioning computers in every room, so I can't have someone document for me while I am doing critical care if they use a computer. Remember, there's a reason code sheets exist. It isn't because using the computer is easier.
-You can check on their visits to that hospital. If you're in a town with multiple shops, it doesn't help you much.
-Billing isn't easier. Often, I don't have things I would like to put as the diagnosis as our system doesn't have all of the ICD in it. So frequently I have to put in diagnoses that aren't in the system, which makes it harder on the billers. Also, unlike paper charting, if you diagnose an ICD code in the computer, that's what you get. If you put something similar on paper, the coders can actually find the diagnosis code that pays better and fits in that role. They cannot change the computer record, so I've been told.
-MDM isn't hard with paper charting. I find it harder to try and explain myself in the computer than by simply backslashing multiple things on the T sheet.
-No argument there. But we have a computer system with those, so you don't necessarily have to chart on the computer.

Personally, I think EMR systems are the way of the future and paper charting needs to go away. I think it's naive to assume that a computer based charting method cannot be tweaked, and users trained/acclimated well enough to chart just as fast. Technology is moving at such a rapid pace that there are even more new user interfaces on the horizon. I can even remember interviewing at a hospital way back before residency who used a tablet based "T-sheet" system that was all computer based and tied in electronically with essentially EHR database.

Here's the fundamental issue... The current state of medicine and the future of medicine is evidence based. Having the ability to data mine vast patient record repositories with EHR systems that can "talk" to each other will provide limitless studies that could be performed that we simply can't do right now with many current proprietary systems. Even a proprietary system that spanned several hospitals could allow you to run "virtual" studies on pt populations that potentially provide new evidence based approaches to pt management.

I think we need to start looking beyond the simple "what maximizes the RVU's for my group" and look at the greater benefit. Plus, I really don't believe that electronic charting has to be detrimental to physician efficiency or group/hospital revenue. You simply have to pick the right system. Anytime something changes, you're going to lose efficiency and there will be a learning curve but that can be overcome. Again though.. there are bad systems out there and just because you pick a bad one doesn't mean all EMR/EHR is "bad".

I'm a bit biased though since medical informatics is an interest of mine.

I think what keeps paper charting ingrained is that smaller hospitals simply can't afford comprehensive computer charting systems or hospital administrating will not budget for it. I used to work in IT and when you go with budget requirements for a new technology solution, proving ROI has always been historically difficult in that field. You have to be a bit creative.

I don't disagree. A perfect system based on the computer would be ideal. It would have a camera and log me in by appearance as soon as I sit down. It would allow me to put macros in for common things. It would never have downtime.
Not saying we shouldn't strive for these things, but since none of them exist, computers aren't as user friendly as I would like. Forcing a bad system on people for PR isn't the answer though.

 

[EvoDevo]

We use scribes here and i can tell you that everything that EM Rebuilder says is true for us as well. In addition, I can have my scribe bird dog OSH records, etc that I need so that I can go and see more patients, f/u on labs, etc.

The new jobs is supposed to have them and if that somehow doesn't happen then I'm hiring my own.