Today we’re going to talk about something that some doctors say is ruining medicine. We’re going to talk about something that doctors complain about almost as much as they do medical billing. We’re going to talk about EHR encounters. Encounters are the workhorse interface of the EHR. It’s intimidating, chaotic, unintuitive, and generally unpleasant. Late-career physicians who come to ParkHealth are often the only ones at their practice still using paper, which is surprising when you consider that these physicians are often the chief executives of their organizations.
Unfortunately, by the time they come to us, they’d been accumulating stress and friction for so long that, sadly, many exhibit diagnosable anxieties. But like any other chaotic mess inherited as scientific investigators, physicians, and clinicians, we always return to the basics.
Granted, we’ve been at this a while, so we’ve developed a bit of a repertoire about working with more senior physicians and getting them online.
Well, like I mentioned. We return to the basics. We think fundamentally about what the EHR is and what the encounter is. Over the years, we’ve developed OERs specifically tailored to medical specialties that utilize metaphors and analogies that latch onto processes in respective medical fields. In pediatrics, we talk about a schedule, like the Periodicity Schedule. But instead of simply “growing,” we physicians have to direct ourselves to meet periodic developmental milestones. We have such schedules on our website, so check those out when you get a chance to. They’re OERs, so they’re published to the public domain and free to use.
In our OERs on healthcare literacy, we talk about how the best way to universally frame things at the practice is by understanding that every new system is simply a language. And the way that Americans, especially Californians, pick up Spanish, is they toe into it, with a word or two here and there—then phrases. Then eventually, clumsy fluency develops into something that resembles Spanglish. We do the same thing with late career physicians that are struggling with the EHR. We discuss priorities and having to choose or designate the most important things during the patient visit, and relate that back to the encounter. We arrange these priority concerns about the visit into workflows, and arrange the workflows in order of difficulty and importance. When we atomize things this way—by the way, please do check out our OER on healthcare systems thinking where we talk about healthcare information atomization. When we atomize things this way, we’re able to clump together workflows that are “easy wins.” Easy wins in any digital transformation process is a key to beating inertia.
With pediatrics, we usually find that we have to prioritize the parts of the encounter that are evaluated by billing first. With encounters that take up that old 1970s paradigm of SOAP, we start with the encounter’s assessment and planning notes. On our website, you’ll find examples of common workarounds to EHR templates and shortcuts. Many EHR systems for instance, require unique keyboard shortcuts be assigned to template items. But when lists have to be prioritized, this is where a common and universal system for serialization comes into play. This sort of looks like and behaves like the CPT coding system, where each subsequent digit demarcates a category and sub-category. For the learning materials mentioned and a few helpful narratives to help contextualize these things, please visit www.park.health/basics.
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