Friday, August 22, 2008

Vacation: on being redundant

I took a fair amount of time off this summer, some at the cottage (no internet access) and some travelling with my husband. I think it is good for everyone to re-charge their batteries, and there is no better time than summer to do this.

Of course, a drawback in our connected world is the flood of emails awaiting you when you return.

Patient care still needs to be managed while a physician is away: we have agreed to cover for each other in my practice, and both my partners are now on EMR. Incoming labs and scanned documents are reviewed electronically by a physician, daily. The covering physician who reviews the document will put "R" (for reviewed), their initials, and a note if needed in Comments. The labs and documents are left in the electronic in-box, and the physician on vacation does a final review and files them away when they return. My partners also saw a few patients in my absence.

I logged in once a week while away; this seemed reasonable. I also spent several hours on the EMR at home on the day prior to my return to the office; this was to review and clear all messages and incoming materials. I returned to the office with a fairly clean slate; there were a few paper-based insurance forms to complete, but that was about it. The office was much busier before and after my vacation, but that is the same with and without EMR.

Being away does not mean that no work was being done for my group. The difference this year is that most of our work flows are already set-up, and are being supervised by our FHN administrator (making me mostly redundant). The data entry was done by summer students, just like last year. The new programs for FOB screening and Diabetes were set up earlier in the spring.

Here is the email I recently sent to my group:

"As the summer comes to a close (too soon), I would like to briefly review the work done this year on chronic diseases and preventive services in our FHN. This was expanded from last year's initial program.

The FOB review and mail out program is completed; the letters are ready to mail for all the overdue patients. Your staff may have patients dropping in to pick up FOB kits, please make sure that they put a lab requisition with "FOB" ticked off in each kit a patient picks up. [We audited the electronic charts of all patients between the age of 50 and 75; eligible patients who had not had a Fecal Occult Blood screening test for 2 years or more were mailed a letter asking them to pick up a kit at the office--my secretary tells me that we had 10 to 15 patients drop by this week, and a couple of patients showed me the letter while seeing me for another reason].

Patients who are overdue for FOB have a reminder button in their Summary page. Please bill $6.86 when FOB results come in for these patients. [in Ontario, we have a fee that applies when a patient is reminded about a preventive service, and subsequently receives the service].

The next preventive services reminder letter (paps, mammos, kids vaccines) will be sent before the end of August, for all overdue patients who have received 0 or 1 letters. All patients who have already received 2 letters have been called over the summer, and this is recorded in the EMR.

Our Diabetes program (flowsheets, four reminders to look at the flowsheets, and pre-programmed lab reqs) was completed earlier this summer. Please click the reminder button when you review a diabetic, and bill the applicable fee. We have a diabetic registry for the FHN, and the yearly management fee was billed for all diabetics earlier this summer. If you have new diabetics or diabetics no longer in your practice, please let me know so that the registry can be kept up to date and your billing sheet for the Diabetic Management Fee can be updated for next year.

The total cost for this year so far is $3,900 for our FHN, which includes wages for the students over the summer ($2,700), and cost of envelopes, stamps and supplies. This is much less than last year, as most of the cost was in starting the preventive program up."

In addition to all this, the students also entered the data for these program for three physicians who have joined our group and have now started EMR (my two practice partners and another physician). We are now looking after these services for 12 physicians.

I kind of liked being redundant this summer!