How much typing of charts do you do?

[cabinbuilder]

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As I sit here after quitting my last job, I am struggling to get back to a locums location due to severe arthritis in my hands. Sure, I can type but to pound out chart notes day after day is impossible for me. I have lost the use of my hands in the past due to excessive hours of typing every day. Because of this I insist on dictation availability for me to be productive - it's getting harder to find.

So my question to my wise colleagues: how do you see 25 patients a day and get through the charting without sitting there until 9 pm and losing the use of your hands? Any suggestions would be welcome. I have tried dragon in the past but it can't keep up with how fast I talk and I ended up typing again.

Any suggestions would be most helpful,

 

[VA Hopeful Dr]

Couple possibilities...

1. My partner uses lots of what epic calls Smart Text.... you train the system that a certain typed phrase means something much longer. Example: .htnc = Pt's BP at goal at this time. Continue current treatment and recheck at next visit. It still involves typing but less of it. The problem is, you have to train the system which locums won't allow you the time to do.

2. Some EMRs (I think allscripts is one) have more check boxes and less free type available.

3. Spend more time with dragon. You have to give it time and alter your style somewhat for it. Its not ideal, but it might be better than the alternative.

4. My father in law (OB/GYN) has fallen in love with Voltaren Gel for his arthritis that was causing issues with surgery.

 

[deleted87716]

Our EHR (NextGen) uses checkboxes for a lot of the HPI, ROS, and PE elements, so typing is kept to a minimum. The key is learning to use the templates efficiently. I free-text a little bit here and there in my notes, mostly in my A&P. To help with that, I have a lot of pre-written text snippets that I paste in and modify if needed. I'm usually able to complete my notes while seeing the patients, so there's nothing left to do at the end of the day.

Some of my colleagues use Dragon, but they still seem to be a lot slower at getting their notes done.

 

[cabinbuilder]

Thanks guys.

I used Next Gen in Alaska but they had me dictate. I know the other providers there were anywhere from 80-150 charts behind.

I have used EPIC too but dictation on that as well for the body of the chart note.

You are correct, doing locums there isn't time to create templates, etc to streamline the charting as fast as dictation. Will keep on keeping on.

 

[deleted87716]

The problem with getting behind is that you tend to stay behind. I've always made it a point to do today's work today. There's always more to do tomorrow.

The main issue with dictation is that it can't be data-mined, rendering it useless for automated coding, meaningful use, PQRI, P4P, etc.

 

[cabinbuilder]

I don't think I have been anywhere that

The problem with getting behind is that you tend to stay behind. I've always made it a point to do today's work today. There's always more to do tomorrow.

The main issue with dictation is that it can't be data-mined, rendering it useless for automated coding, meaningful use, PQRI, P4P, etc.

had automated coding. I always have coded everything myself even before the note is done. I always try to get the days work done before I go home too but some days it's just not possible with crash and burn walk-in's at the end of the day.

 

[deleted87716]

I don't think I have been anywhere that had automated coding. I always have coded everything myself even before the note is done.

NextGen has a coding feature that will count "bullets" and suggest a level of service when you complete the note. Usually, it's right. Free-texting will throw it off, though. Coding based on time still has to be done manually, of course.

Other top-tier EHRs (e.g., Epic, Centricity, etc.) have similar capabilities. I'd consider it mandatory, personally. It can definitely help out with cost justification, as most docs chronically under-code.

 

[cabinbuilder]

NextGen has a coding feature that will count "bullets" and suggest a level of service when you complete the note. Usually, it's right. Free-texting will throw it off, though. Coding based on time still has to be done manually, of course.

Other top-tier EHRs (e.g., Epic, Centricity, etc.) have similar capabilities. I'd consider it mandatory, personally. It can definitely help out with cost justification, as most docs chronically under-code.

Hence our prior conversation about my last job where I was to code a level 2 for new patients. Just sickening.

 

[DIce3]

Out of curiosity, what else was wrong with the last job? I agree about the typing; my hands can hurt at the end of the day.

I agree about staying up with the charts. For me, the best situation is to keep all charts up to date real time, but doing so can really feel like working in a salt mine sometimes.

 

[cabinbuilder]

Out of curiosity, what else was wrong with the last job? I agree about the typing; my hands can hurt at the end of the day.

I agree about staying up with the charts. For me, the best situation is to keep all charts up to date real time, but doing so can really feel like working in a salt mine sometimes.

Hmm, the last job started with "do you have a manipulation table" the answer I got was "you cannot do manipulation, we don't have a code for that". Then it proceeded to you can't do injections, or trigger points, or most procedures. My question to the director was "what can I do then"? The answer: you can see the patients, write scripts, or refer to the ER. This is an urgent care clinic. One of the doctors told me that I should not do any procedures on anyone because then the patients will come to expect "extras" being done in urgent care and it would look bad on the other doctors who don't know how to do any procedures.

Needless to say I was so depressed about the whole situation that 5 days felt like 5 years. It was affecting me adversely. It was a death sentence for me. I resigned.

 

[DIce3]

Understandable. Do you think you will go into solo practice after you have traveled the world?

 

[cabinbuilder]

Understandable. Do you think you will go into solo practice after you have traveled the world?

no, not enough capitol to think about that. Too much of a free spirit. I love being the relief help with option to extend but there is always an end date. We shall see. I have 3 more years before I need to make a decision.

 

[smq123]

NextGen has a coding feature that will count "bullets" and suggest a level of service when you complete the note. Usually, it's right. Free-texting will throw it off, though. Coding based on time still has to be done manually, of course.

Other top-tier EHRs (e.g., Epic, Centricity, etc.) have similar capabilities. I'd consider it mandatory, personally. It can definitely help out with cost justification, as most docs chronically under-code.

We used NextGen as residents. We were told not to use their automated code calculator, as there was something incorrect about its algorithm. NextGen would never give us a firm answer, but that just made it seem stupid.

 

[deleted87716]

We used NextGen as residents. We were told not to use their automated code calculator, as there was something incorrect about its algorithm. NextGen would never give us a firm answer, but that just made it seem stupid.

It's usually correct, although it tends to over-code some acute single-problem visits (e.g., UTI, URI, etc.) as 99214 instead of 99213 if you document a ton of stuff in the HPI/ROS/PE and code moderate complexity (because of prescription medication). I just override those.

 

[styphon]

Hmm, the last job started with "do you have a manipulation table" the answer I got was "you cannot do manipulation, we don't have a code for that". Then it proceeded to you can't do injections, or trigger points, or most procedures. My question to the director was "what can I do then"? The answer: you can see the patients, write scripts, or refer to the ER. This is an urgent care clinic. One of the doctors told me that I should not do any procedures on anyone because then the patients will come to expect "extras" being done in urgent care and it would look bad on the other doctors who don't know how to do any procedures.

Needless to say I was so depressed about the whole situation that 5 days felt like 5 years. It was affecting me adversely. It was a death sentence for me. I resigned.

That is a horrible urgent care. And they can bill for trigger points, injections, and procedures - so why not?

I have done trigger points, I&Ds, foreign body removals from the skin, eyes, and ears at the urgent cares I work at - and no one cares. The ones that have PA's are especially procedure heavy.

I would not do joint injections, gyn procedures(endometrial biopsies, colposcopies, paps), mole/suspicious lesion removal at the urgent care as I think all require close follow up and someone to track the results.

 

[cabinbuilder]

I would not do joint injections, gyn procedures(endometrial biopsies, colposcopies, paps), mole/suspicious lesion removal at the urgent care as I think all require close follow up and someone to track the results.

I generally agree with this but there have been times that I have had folks walk in the door who are self pay who I cannot refer to anyone. Those people I will cut out, inject, bx, whatever because it's the right thing to do. I just do the f/u myself or try to work around the payment constraints.

 

[styphon]

I generally agree with this but there have been times that I have had folks walk in the door who are self pay who I cannot refer to anyone. Those people I will cut out, inject, bx, whatever because it's the right thing to do. I just do the f/u myself or try to work around the payment constraints.

I don't really care about payments - considering that when I am at urgent care I am salaried - but I work random days there, and I may not even work at the same site (there are >6 sites) for weeks and maybe I am a micromanager - but I don't expect the other providers to give the best follow up considering it is urgent care.

 

[cabinbuilder]

I don't really care about payments - considering that when I am at urgent care I am salaried - but I work random days there, and I may not even work at the same site (there are >6 sites) for weeks and maybe I am a micromanager - but I don't expect the other providers to give the best follow up considering it is urgent care.

I see, but since I do locums, I may be at a site from 3-6 months every day. That gives me opportunity to f/u when needed on certain cases since I am FP trained. My purpose of being at a site is to fill the shortage and sometimes that means adding a little FP practice into the mix.

 

[deleted87716]

I don't really care about payments - considering that when I am at urgent care I am salaried

Well, you can bet that the people who are paying your salary care about payments...

 

[Dharma]

What are the prospects for better software looking like? Hopefully some tech guru is jumping on this with some efficient, user-friendly, tablet software. (Too bad I know zilch about programming… there is definitely money to be made).

 

[septoplasty]

What are the prospects for better software looking like? Hopefully some tech guru is jumping on this with some efficient, user-friendly, tablet software. (Too bad I know zilch about programming… there is definitely money to be made).

I would say it doesn't look good. Way too much competition in the market with tons of EMR's available.

 

[cabinbuilder]

Back on the job today. Computer training for 4 hours, will see how things go.