Take time to make time

There’s lots of advice out there on how to make your clinical day more efficient, but many tips involve tasks that take time. They tend to get kicked down the road or put off for later. We spoke to physician experts and broke down a priority ranking for when to tackle efficiency-improving tasks to get the most value. Priority: ASAPCreate shortcuts, templates and alerts on your EMRStart to make your EMR work for you as soon as possible. After all, it’s part of your administrative staff, in a way.TemplatesCreate templates to minimize time while charting, advised Dr. Ernst Greyvenstein, medical director of health systems transformation (accelerating change transformation team, or ACTT) at the Alberta Medical Association and associate clinical professor at the University of Calgary’s Cummings School of Medicine. Dr. Greyvenstein is a family physician who heads up Circle medical, an 11-physician team practice in Calgary. Templates could be for referral letters or other items that you use often. Dr. Greyvenstein got his administrative staff to create the templates.MacrosAdd macros to your EMR. These allow you to insert information from elsewhere in the EMR or insert standard phrasing without having to retype it. For example, in a referral letter, you can use a keystroke to input the patient’s name. Or you could write “ne” every time you want to include text that reads “normal exam that includes general head and neck, heart, lungs, abdomen and extremities.” That last example is from a video on ACTT’s YouTube channel on how to use macros in Med Access EMR. Dr. Greyvenstein programmed his own macros.ShortcutsDr. Greyvenstein asked his EMR provider to create shortcuts for common tasks to avoid always going through a series of drop-down menus. This came in handy for sick notes and referral requests.AlertsThe provider also programmed alerts to remind physicians about routine screenings, something that not only saves time but can save people, too. One of Dr. Greyvenstein’s patients recently came in for an appointment about their ears, and an alert for a routine colon cancer screening appeared on the EMR. The results unfortunately came back positive and now the patient can be treated.AutomationThere are other ways to automate tedious processes. Dr. Tola Overduin, a plastic and reconstructive surgeon with a clinic in Kitchener, Ont., took time to prepare an electronic intake form that not only links to the patient’s chart but also automatically populates a consult letter template.Dr. Overduin said the electronic intake form gives patients time to think about the answers to the questions and leads to a more focused patient encounter. It also saves her from time-wasting copy-and-pasting from the form to the consult letter. “I estimate it saves me about 50% of time,” she said at an OntarioMD Digital Health Virtual Symposium in June. She needed a one-hour-long virtual appointment with an IT professional to set up the automation.Some intake form templates are available to download from different EMR companies, noted Dr. Vandana Ahluwalia, a community rheumatologist in Brampton, Ont., who chaired the OntarioMD symposium session. “The initial time spent on setting up the automation is sometimes quite a bit, but once it’s done, it’s a time-saver.”Online bookingDr. Overduin set up online appointment bookings. When the patient books an appointment, they’re automatically sent the electronic intake form tailored to their condition. When an appointment is booked, the message is also sent to the patient’s family physician so they know Dr. Overduin has made contact with the patient.Priority: Within a monthConsider an AI scribeSince January, Dr. Greyvenstein and his colleagues have been using an AI scribe. So far, the physicians in his clinic have said it saves an hour of charting time a day. “It improves the quality of our record-keeping and it also improves our patient engagement,” he said.There are caveats about AI scribes, which can work better for some specialties than for others. Doctors using them have to obtain patient consent and make sure the contract with the AI scribe provider is rock solid. Keeping abreast of regulatory and technical developments will take time, but initial reports suggest that time saved charting could be huge.Priority: Month twoWork on efficiency with your administrative and nursing staffYour administrative and nursing staff’s skill sets can help you become more efficient. Dr. Greyvenstein asked his staff where they thought they could reduce the amount of time wasted. He wanted to target, “things we do in a specific way for ages and we don’t even know why we’re doing it.” The suggestions were spot on.To keep working on efficiency, Dr. Greyvenstein and his team have a huddle at the start of the workday, “15 minutes of very quickly going over what worked well yesterday, what we can improve from yesterday and looking at doctors’ schedules and areas of vulnerability and whether there are certain things that physicians want to have done on their patients and alerting their staff to that.” This means that before each patient, the staff has properly prepared the rooms and has all the required documentation already filled out. It’s been of significant value, he said.When staff come to him with questions, Dr. Greyvenstein asks: “What would you do?” This way staff are more likely to take more ownership in the solution. For new staff, make sure they get thorough training, “so they know exactly what physicians want” in terms of taking history and vitals.Learn what tasks you can delegate to staff. Dr. Greyvenstein said the ACTT website has tools to help you analyze what tasks and responsibilities should be given to each staff member. Pro tip: This could be done as a quality improvement project. He also advises hiring a clinic manager if you can.One thing your staff can do is learn how to search for, and correct, billing error codes, suggested Dr. Ryan Banach, a Toronto family physician who presented at the OntarioMD symposium on behalf of the Ontario Medical Association.Of course, take time to celebrate your staff. Happy, loyal staff who feel like they’re part of a team are less likely to leave and trigger a time-consuming hiring headache.Priority: Month threeChange your behaviour to get the most out of the patient encounterIt may take a while to shift your habits, but work to make the most out of patient encounters to save time on charting and documentation later. Try to get all charting and other tasks done while you’re with that patient before moving on to the next patient.“It is important to optimize the time you have with the patient to the best of your ability and do as much as you can during that visit,” Dr. Greyvenstein said.Prepare for the appointment. Organize your clinical day so that you can check lab or test results and consult notes ahead of time so you know what to address with the patient. Make sure your staff knows what documentation is needed and how the exam room should be prepared.Dr. Greyvenstein said he uses “every single gap” in his schedule to be proactive about what he anticipates the patient needing. For example, if he thinks the patient will need a referral, he’ll create a referral request beforehand so he can go over it with the patient during their visit.Consider creating a set of standardized questions for various common conditions, one physician suggested in the Medical Post’s editorial survey. This can make you more efficient when the patient is in front of you and focus the patient encounter.When documenting the patient encounter, get into habits that will make future appointments run more smoothly. For example, include a little summary in your notes of what to do at the next appointment. Or, as you write a prescription, write a little message in the note window saying when their last test was and why it’s being prescribed. This will save you time when renewing a prescription, advised Dr. Sarah Smith, a practicing rural family physician in Edson, Alta., who runs a business called the Charting Coach. Dr. Smith spoke at the OntarioMD symposium.Priority: Within the yearFind out about community resourcesA big time-grab is patient education. See if there are community resources that could provide that information and build up a library of those resources. For example, there may be nutrition advice from a local food security group.Going out and meeting people from those groups and creating those connections helps you give a warm hand-off for your patients, Dr. Smith advised.Think about schedulingDr. Greyvenstein makes sure his staff schedules similar procedures in blocks together. This helps with staffing, efficiency in setting up procedure rooms and time spent moving from room to room.Look at busy times in your practice and schedule administrative staff accordingly, Dr. Banach said at the symposium. Consider putting more administrative staff on the phones on Monday morning, when more calls tend to come in from patients. Other efficiencies in scheduling might include not booking annual wellness visits during cold and flu season.Priority: Regular intervalsTake the time to stay healthyFinally, something to do every day is to take care of yourself. Try to stay healthy and stay active to reduce burnout, Dr. Greyvenstein said. This isn’t done during the clinical day, but is essential to efficiency, because a sick day can take a week to recover from, work-wise

Take time to make time

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