Eating Your Own Dog Food

Eating Your Own Dog Food

[If just joining us, read the previous article first. That way this one will make more sense.]

I’m not really a morning person. (Brief pause for family and friends to chuckle knowingly.) But duty — and those 150 dead soldiers lying in state in the fridge — called, so there I was with a cup of coffee in the reception area of Kressly Pediatrics bright and early at 8:00am this morning. Based on the panic-laden cable news reports, I half expected a line to have begun forming in advance of our scheduled 8:30 start. But no: only Colleen and Jane greeted us upon arrival. We fired up the computers and took our positions.

The plan was that Sue and I would greet the patients in alternating fashion. We would confirm names, open encounters, ask the flu ROS questions to affirm readiness, and add seasonal flu to the order upon patient request. (We had prepared a list of patients already in today’s schedule who were due for seasonal, so we could offer the dose. We also had question lists hanging in the waiting room so patients could read ahead.) The patient would proceed to the next available nurse in an exam room, who would take and record a temperature on the Vital Signs screen, then administer and document the vaccine. Since we only have one lot in inventory, everything on the Vaccine Entry screen — manufacturer, lot #, expiration date, VIS, route, vaccinator — would be pre-populated, except the body site.

The first patient showed up at 8:12. We quickly learned why some practices use scribes. In very high volumes, it turned out that the best approach was for Sue to do just medical work (take temps, ask ROS questions, propose adding the seasonal) while I recorded it. The nurses thus took back patients who were fully vetted and ready to roll up their sleeves or slide down their pants.

Not only did we run on time, we were always ahead. Sue’s patients are well attuned to the practice’s “fine German engineering” and they showed up early. Everyone seemed grateful that our litle practice has maintained its dignity and composure in the face of the “Greatest Public Health Threat Since The Founding Of The Republic!! Details At 11!”

Of the 120 patients scheduled, 2 were no-shows and 10 cancelled for a variety of reasons (sickness overnight, fear of thimerosal, etc). A few showed up who weren’t in the schedule and got squeezed in. Ultimately we gave 112 H1N1s and 28 seasonals, a total of 140 fully documented vaccinations in 4 hours. We easily could have wedged in 50 more throughout the morning without breaking a sweat. We’ll keep that in mind when scheduling next weekend’s clinic.

The last patient was vaccinated at 12:26. I had been keeping up with the superbills during my “down time,” so I transferred everything to the claims queue and sent it out the door at 12:38. We turned out the lights and locked the back door at 12:43. I’m typing this from home, and we’re done. And when I say “done,” I mean “DONE.” All of the encounter documentation is complete, all of the claims have been filed, and all of the vaccine records are resting comfortably on the PA SIIS server in Harrisburg. (We both report and pull down immunization records in real time. Thanks, Frank Caniglia!)

For the next few weeks, whenever a prospect asks me whether there is really any ROI (return on investment) to be gained by installing an EMR, I will ask them to estimate how long it would take their office to:

– manage inventory (10 minutes)
– identify and contact patients (30 minutes)
– book appointments (20 minutes to setup/test)
– confirm and follow up insurance (20 minutes)
– check-in/check-out (2 people, two hours each)
– document encounters (2 people, two hours each)
– load syringes (2 nurses, 20 minutes each)
– administer vaccines (2 nurses, four hours each)
– create claims (1 check-in person, no extra time)
– report to the state registry (0 minutes)

for 140 flu shots. Our answer: 18 hours of total staff time — an average of less than 8 minutes per patient for ALL activities combined. If anyone can beat that, I’ll buy their next EMR.

The bad news is, I was good enough at my job to be invited back to next Saturday’s clinic. “The things we do for love…”


(PS: “Eating your own dog food” is a phrase computer geeks use to describe the situation when we have to use our own programs to do real work. Surviving that experience is considered the acid test of whether the software is ready to deliver to others.)

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