Perception vs Reality: an EHR look at data

Perception vs Reality: an EHR look at data

As a practicing pediatrician who is very time conscious (ask anyone who knows me, I hate to be late), I think my office runs like a well-oiled machine. But since I am always moving, I wasn’t sure if that was true of my office as a whole. As part of my NCQA-Medical Home application project, I was forced to look at this objectively.

We started with office goals. What is a reasonable wait in a pediatrician’s office? We collectively decided that we wanted to shoot for the following:
  • 5 minutes or less wait in the waiting room
  • 10 minutes or less wait in the exam room for a sick visit (from the time the nurse puts them there until the physician comes in)
  • 15 minutes or less wait in the exam room for a well visit (allowing time for patient preparation including measurements, hearing/vision, etc.)
We decided that we would give ourselves a benchmark of hitting those targets 90% of the time. We wanted to account for the inevitable unforeseen circumstances that happen in a pediatric office (the tag-a-long, the patient who vomits all over the floor, the simple earache that turns into a complex social situation, the true emergency.)
Since our EHR can collect data about stages of a patient visit (sign in, move to a room with a nurse, doctor starts their part of the visit), we could analyze the data. At first it was difficult to get staff motivated to remember to stage the visit, but by the end of the week, everyone wanted to know how we are doing! Well, it turns out we did indeed hit our target 95% of the time.

We also found out that 95% of the time our patients arrive within 5 minutes of their scheduled appointment time! We are on time, so they are on time! (It also probably helps that we ask them to reschedule for non-urgent visits if they are more than 15 minutes late. They only do this once or twice.)

So how does the EHR help us do this?
  • First of all, our “extra time” patients are labeled such in the EHR. This is for those children who have complex medical problems, or their mom always has 20 extra questions. Office Practicum lets you set a default visit length for sick and well appointments for each patient. Some of the complex patients get 10 minutes extra for all appointments. Some of the patients whose parents come with a typed list of questions for well visits only require extra time for preventative visits. (Yes, I find a reason to code this differently so I will get paid for the extra time!)
  • Secondly, Office Practicum allows you to build reason or symptom driven templates that can have an assigned time allotment. For example, I have two symptom visit templates for abdominal pain. An “abdominal pain 2+ weeks duration” is a 20 minute appointment and an “abdominal pain less than 2 weeks” is a 10 minute appointment. Ear pain is 10 minutes, ear recheck might be 5 minutes and fatigue…definitely 20 minutes.
  • And what happens if there is a conflict between a patient level default time and a template default time? The system asks you which you want to use! (The longer time, please!!!)
What’s coming in the not too distant future? On the rare occasion when my schedule falls apart, the ability to text patients to inform them I am running late. So far no plans to see patients in their car. (Although my staff did administer a flu vaccine to a distraught child while buckled in his car seat this fall!)