Paper Does Still Exist in Our Practice
Since you are reading this post, there is a good chance you have spent a great deal of time and money into the implementation of your NextGen EMR system. There is also a good chance that you assumed paper would be eliminated from your practice after the implementation. While healthcare technology continues to improve at a rapid pace, the reality is that many practices continue to deal with paper on a daily basis. Until we have completely integrated systems and are truly able to eliminate paper from your practice, there are several best practice recommendations for managing the paper.
What is Your Preferred Chart Organizational “Style”?
I worked for many years in physician practices as a Medical Assistant before I transitioned my career to Healthcare IT. During that period, I cannot even begin to tell you how much paper I chased on a daily basis. I have seen many organization “styles” in physician practices.
- All documents stacked on top of each other in chronological order regardless of the type of document.
- Dividers/Tabs in the chart that would tell us where to find things. There would be sections for things like Notes,Lab Reports,X-rays and the ever ambiguous “Misc” written on them.
- Some combination of tabs and chronological order that involved the most recent document being placed under the correct tab
- Other random organizational styles based on provider or manager preferences
While I prefer to have things divided into tabs and nicely ordered (to my exact specification, no control issues here), others may like the chronological approach to organization (someone really prefers this…..). The great thing about the NextGen EMR is we can customize areas to meet our practice’s organizational style, even if they differ from my preferred style.
Managing Incoming Paper
As an example, your practice has a follow-up patient with a foot fracture. The patient had x-rays done outside of your office 2 weeks prior to determine the fracture. There was another x-ray done yesterday to see how the fracture is healing. Both reports were delivered to your office in paper form for review. They may have been faxed, mailed or in some instances hand delivered to your practice. How does the provider quickly get a copy of the most recent foot x-ray?
There are several ways to get the paper into the system once the reports come into the office:
- Paper is scanned immediately into your EMR and routed electronically as per office protocol
- Paper is delivered to staff member to determine urgency. It is then routed to scanning and/or the provider for review
- Paper is delivered to provider who then reviews, writes directions and hands to staff for scanning
All of these are viable options and have pros and cons to the workflow.
Using Document Manager within NextGen EMR
Getting the paper into your EHR is really only the beginning of the workflow and not the most important step. If things are not organized in a way that is meaningful to your practice (yes similar to that old paper chart), your providers and staff may not be able to quickly find important documents. In the above example, the patient had 2 x-rays of the foot. When searching for the x-ray report, if things aren’t labeled correctly the users will also have to sort through lots of other documents to find the x-ray. Each second that is wasted adds up to real provider time and productivity!
The first level of sorting in your chart is similar to the “tabs” that used to be in the paper chart. The great thing in an electronic chart is that we can create these easily and use them to automatically do some organization for us. To get the most out of your system you should customize these Categories to your business needs.
Review not only your paper documents but also what is generated electronically. What do providers most need to look for when treating a patient? Below are some common samples:
- Office Note
- Consults or Referral Notes
- Lab Reports
- Imaging Reports
To continue in our example, the patient’s foot x-ray may have been scanned to the Imaging Reports category.
Additional Sorting Is an Option
There is also an additional sort feature available within the NextGen EMR. The first sorting option is the Category as listed above. Once the Category is selected, the scanning person could also enter important information into a free text box that could assist in finding the correct document quickly. This would make your search much easier and save a great deal of time from clicking on each one until you find the one you are looking for today.
To finish our example above: The foot x-ray could have been scanned to the Category of Imaging Reports and include a detailed summary of “Left Foot X-ray”. The provider could then quickly identify this report in the patient chart.
There are many areas within the NextGen File Maintenance which allows us to really optimize the system for our practice. We can edit the document management fields as an example. When editing this area, you will have the capability to decide what is required by your staff when scanning a document. What would you like to see:
- Scan date
- Test date
- Provider name
- Test specifics
In File Maintenance you also can do the same process with any document that is generated in the NextGen EMR. You can set it up so that every time you run a Master document (for example) that it would also file under your document management as such with the date of today’s encounter. This will also save you time from going into each encounter to review these documents.