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Telemedicine; I need ways to be more efficient

Ligament

Interventional Pain Management
15+ Year Member
Jan 9, 2002
6,168
2,705
326
  1. Attending Physician
Currently:

Patient is scheduled for telemed
I log on to the session
do my thing
End session
Email my staff the plan; orders/diagnostics/procedures. Type up history visual physicial exam, impression and plan for my scribe, who puts it in a pretty looking format.

I'm finding all this is taking too long, even if I am sending cliffs notes to my scribe.

How can I make it go faster?

How are you guys doing telemed?

I was thinking a three way telemed with my scribe on one end to document everything.

Note: I only do telemed from home currrently, so there is no staff physically in my location. Any staff work has to be done remotely.
 

SommeRiver

Membership Revoked
Removed
Account on Hold
2+ Year Member
Apr 20, 2018
2,168
1,648
126
  1. Attending Physician
Mine take the same time as a normal visit.

See the pt.
Dictate the note.
Text orders to my nurses.
Done.

My texts look like this:

"Patient AY - Zanaflex 2mg BID PRN #60 and right L4-5 TFESI."

I should add I'm quitting telemedicine probably next week. I hate it and find it completely unnecessary given my reality.
 
  • Like
Reactions: 1 user
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SSdoc33

Full Member
10+ Year Member
Apr 23, 2007
9,275
3,330
276
  1. Attending Physician
Currently:

Patient is scheduled for telemed
I log on to the session
do my thing
End session
Email my staff the plan; orders/diagnostics/procedures. Type up history visual physicial exam, impression and plan for my scribe, who puts it in a pretty looking format.

I'm finding all this is taking too long, even if I am sending cliffs notes to my scribe.

How can I make it go faster?

How are you guys doing telemed?

I was thinking a three way telemed with my scribe on one end to document everything.

Note: I only do telemed from home currrently, so there is no staff physically in my location. Any staff work has to be done remotely.

First of all, i am with you. I hate telemedicine, it slows me down, and sitting in front of a screen for 3 hours in a row is for software engineers, not doctors.

Second of all, i think i see why you are taking home a residents salary if you are paying a scribe when you really dont need to right now. Call the patient, do the note, and have your help read the note and execute the orders. It isnt perfect and i find the my physical exam is actually more important than i gave it credit for. It is poor medical care imho.

Save telehealth for mbb f/u and mri f/u if you can
 
Jan 9, 2010
7,895
3,359
276
  1. Attending Physician
Currently:

Patient is scheduled for telemed
I log on to the session
do my thing
End session
Email my staff the plan; orders/diagnostics/procedures. Type up history visual physicial exam, impression and plan for my scribe, who puts it in a pretty looking format.

I'm finding all this is taking too long, even if I am sending cliffs notes to my scribe.

How can I make it go faster?

How are you guys doing telemed?

I was thinking a three way telemed with my scribe on one end to document everything.

Note: I only do telemed from home currrently, so there is no staff physically in my location. Any staff work has to be done remotely.
It sounds like the email is a deadly time killer. It's also risky from a hipaa standpoint. Your staff needs primary access to your notes. If your EMR doesn't allow this, whatever software you're using should have some ability to share, or put in a cloud based file sharing program. Even if you're using MS word or something, you can save it in a shared drive.

I prepare a basic note before I call and write shorthand while I'm talking. I clean up the note as I'm wrapping up the convo and make a plan and add nurse as cosigner and done. I always add small/happy talk at the end of the convo for good measure.

Telemed is actually turning out to be very efficient for me. I have a half day that is exclusively focused physical exams, after full review, interview and discussion via telemed. I am spending more time doing procedures because of this efficiency.

I'm sure not all practices are like this but, despite my efforts to screen, I get so many pts that don't have current imaging, are not interested in procedures, or have not tried basic things like PT, etc. Telemed is seriously weeding this out. Pts who come in for a PE do so exclusively at my discretion.
 
  • Like
Reactions: 1 users

callmeanesthesia

Full Member
5+ Year Member
Apr 13, 2016
1,481
1,174
176
California
  1. Attending Physician
It sounds like the email is a deadly time killer. It's also risky from a hipaa standpoint. Your staff needs primary access to your notes. If your EMR doesn't allow this, whatever software you're using should have some ability to share, or put in a cloud based file sharing program. Even if you're using MS word or something, you can save it in a shared drive.

I prepare a basic note before I call and write shorthand while I'm talking. I clean up the note as I'm wrapping up the convo and make a plan and add nurse as cosigner and done. I always add small/happy talk at the end of the convo for good measure.

Telemed is actually turning out to be very efficient for me. I have a half day that is exclusively focused physical exams, after full review, interview and discussion via telemed. I am spending more time doing procedures because of this efficiency.

I'm sure not all practices are like this but, despite my efforts to screen, I get so many pts that don't have current imaging, are not interested in procedures, or have not tried basic things like PT, etc. Telemed is seriously weeding this out. Pts who come in for a PE do so exclusively at my discretion.
If you see them via telemed then have them come in for PE, how do you bill for those?
fwiw I have lots of patients who haven’t been worked up or done conservative care too. I don’t mind though - I’d rather be the one to tell them their pain is because they are 50 lbs overweight, smoke, and don’t exercise, rather than their PCP telling them they have degenerative disc disease.
 

Ligament

Interventional Pain Management
15+ Year Member
Jan 9, 2002
6,168
2,705
326
  1. Attending Physician
It sounds like the email is a deadly time killer. It's also risky from a hipaa standpoint. Your staff needs primary access to your notes. If your EMR doesn't allow this, whatever software you're using should have some ability to share, or put in a cloud based file sharing program. Even if you're using MS word or something, you can save it in a shared drive.

I prepare a basic note before I call and write shorthand while I'm talking. I clean up the note as I'm wrapping up the convo and make a plan and add nurse as cosigner and done. I always add small/happy talk at the end of the convo for good measure.

Telemed is actually turning out to be very efficient for me. I have a half day that is exclusively focused physical exams, after full review, interview and discussion via telemed. I am spending more time doing procedures because of this efficiency.

I'm sure not all practices are like this but, despite my efforts to screen, I get so many pts that don't have current imaging, are not interested in procedures, or have not tried basic things like PT, etc. Telemed is seriously weeding this out. Pts who come in for a PE do so exclusively at my discretion.

Thanks for the reply. My email system is HIPAA compliant capable with two factor authentication and failsafe encryption (escrow if no TLS, etc) but all staff are on our internal email system no no HIPAA issues. I'm not emailing them via our personal email addresses. Work email system only.

My notes are in my email. For example, as I'm doing the telemed, I'm typing an email to my scribe, a rough outline of the history, visualised physical, impression and plan. My scribe fleshes out my skeleton outline into a real document for publication.

I'm seeing a shift toward more and more telemed until the insurance companies eventually outsource us all to India. So, I'm trying to make it as efficient as possible.
 
  • Like
Reactions: 1 user
Nov 21, 1998
10,834
4,883
376
Over the rainbow
  1. Attending Physician
Thanks for the reply. My email system is HIPAA compliant capable with two factor authentication and failsafe encryption (escrow if no TLS, etc) but all staff are on our internal email system no no HIPAA issues. I'm not emailing them via our personal email addresses. Work email system only.

My notes are in my email. For example, as I'm doing the telemed, I'm typing an email to my scribe, a rough outline of the history, visualised physical, impression and plan. My scribe fleshes out my skeleton outline into a real document for publication.

I'm seeing a shift toward more and more telemed until the insurance companies eventually outsource us all to India. So, I'm trying to make it as efficient as possible.

We're using virtual off-site scribes to "tee-up" the patients before announcing the presence of the doctor. The patient is online with the virtual scribe for 20 minutes and online with the doctor for 5 minutes. Working well.
 
  • Like
Reactions: 1 user

Ronin1

SDN Lifetime Donor
2+ Year Member
Dec 14, 2017
375
271
136
Sunny Florida
video visits are time based billing.

please be careful if you are only spending 5 minutes with the patient as to the actual time you are with patient or the actual billing code you use...
Actually video visits are not time billing. Telephone only visits are time based currently through July 31
 
  • Like
Reactions: 1 users
Nov 21, 1998
10,834
4,883
376
Over the rainbow
  1. Attending Physician
video visits are time based billing.

please be careful if you are only spending 5 minutes with the patient as to the actual time you are with patient or the actual billing code you use...

What is the patient's experience of the time worth?
 

Ferrismonk

Full Member
10+ Year Member
Dec 12, 2006
1,698
1,607
276
  1. Attending Physician
I thought you couldn't do telehealth from home. Maybe this is one of those COVID carve-outs, but usually telemed requires you to be in the office.

I have two computers. One is my EMR and one is my video chat. My notes are the exact same as in person except I put in a telehealth template in each note.

Here's our process:
Staff calls patient, does intake and puts relevant info into EMR, makes sure the patient is connected properly to videochat system, MA then brings me order sheet, then I connect. Meds I e-scribe, other orders are written down for MA to take care of after the visit. All HIPPA compliant and all notes stay in my EMR.
 

SommeRiver

Membership Revoked
Removed
Account on Hold
2+ Year Member
Apr 20, 2018
2,168
1,648
126
  1. Attending Physician
You can do telemed from home. Not sure about pre-COVID, but you definitely can now. We looked into that and were assured it was okay.

Patient experience - Some like it bc they don't have to leave their house to do it, others hate it bc they hate computers.

My pts seem to be more in favor than not.

Opiate pts are harder for Rx though, so we had to buy this app to Rx opiates and that turned into a mess...No more.
 
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