Monday, August 24, 2009

New office

I love my new office! We spent the weekend moving in, unpacking, hanging things on walls, and installing and testing all the IT we have. Our IT guy spent several days at the office making sure that everything works. I now have a new and very fast internet line from eHO: our IT guy, the Family Health Team's IT guy and the IT guys from eHO worked together to make sure it was ready for this week--it takes a whole village to raise an EMR. The telco company was there installing our phone and fax systems; the alarm configured their system as well. We met the lab technician next door. I went downstairs to say hello to the pharmacist in our building. Our office manager seemed to be five places at once, as she masterfully directed this symphony.

We reopen tomorrow.

This office was planned from the outset as a paperless practice. I now own a large number of redundant power bars--our old office had too few power outlets. We have a lot of grommets (the little holes in desks and countertops you put cables through); the grommet guy came by today to put more in where we wanted them.

The office really has very little paper; my partner was very good about getting rid of his at the end, and we shredded everything before leaving. We found some paper prescription pads; those were shredded, except for two pads in case of EMR outage. We are not ordering Rx pads with the new address.

Here is the basic plan for patient flow:

1. EMR schedule reviewed by MD (and RN if she is there) in the morning--the "huddle". Additional instructions for staff pre-work added if needed (example, take bp).
2. patient checks in; secretary verifies demographics. If there are alerts (example, print depression questionnaire and give to pt; give pt bottle for urine sample), she completes the requested action. Scheduler shows pt is In.
3. Pt is shown into clinical area; the initial area is the central nursing station, where the BP-tru, height, weight and waist circumference are done by a member of the front staff. There is a computer there, all vitals are entered directly into the computer
4. Pt gets put into exam room; scheduler shows which room (1 to 8)
5. MD/RN sees that pt is in room on Scheduler; loads chart, reviews notifications (example, due for FOBT), sees alerts and reviews CPP/lab/Diagnostic Imaging, loads chronic disease flowsheet as needed, then enters room and greets patient
6. After exam, pt goes back to central Nursing station, gets lab req/urine sample bottle if needed, talks to receptionist on duty in that area and books follow up appointment if needed. MD/RN can send pop-up message if a specific type of follow up is needed (example, diabetes--wt and BP--in 3 months). No little line up to talk to a busy front receptionist.
7. Pt goes back out through waiting room. Scheduler shows patient is Out.

We have a large staff room for back office work. We have two scanners, one in reception and one in the staff room. There are two fax machines; faxes come straight into a PC, but in case the PC fails, the fax machine will print the document. Outgoing faxes can be done from either machine. The secretary at the front reception will be there mainly to greet patients and manage flow; the second secretary at the side reception will be responsible for scanning/uploading, and for managing outgoing patients at the central nursing station (which is right beside the reception). There are two PCs at reception (front and side); 1 PC at Nursing station; 2 PCs in the staff room; a phone beside each PC.

There is a common consult room for the 3 physicians, and the RN has space there as well; there is some room for residents and medical students to sit and discuss cases, and they have space in the staff room to type their charts. Two of the physicians have desktop PCs in the consult room; all physicians have tablets or laptops to take into the exam rooms. The consult room has 3 additional portable computers ready to go, for the RN or other Allied Health Provider to use, or in case one of the MD's computers crashes or fails. The common room has 1 outbox for faxes/papers with action needed, and 1 outbox for scans; front staff periodically check this during the day. Each MD has an inbox on their desk. There is a shredder in the room, so that paper documents can be disposed of immediately if needed. There is a shredder in the reception area and in the staff room as well.

If a provider needs to have a private conversation, he or she can go into any exam room; rooms have phone jacks, so one of the phones can be plugged in. We have increased our phone lines to three incoming lines, 1 private line, and 1 fax line--hopefully this will reduce the number of missed calls and messages left because all lines were busy.

I'm sure this won't work out perfectly as planned, and we'll have to work out kinks over time. We've been talking about flow a lot over the past few months, and I have looked at a fair amount of literature on this. I think the basic plan is sound; I'll start to find out tomorrow.


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