Documentation setup

[thecentral09]

Hey friends,
New private practice 4 months in. Extremely busy and growing exponentially. Receiving 15 to 40 new referrals per week.
I want to build a very efficient process. Currently using laptops with dragon to document, and taking a lot of my documentation home with me as I am currently seeing around 15 new patients per day ( plus everything else). I know that I won’t be seeing 15 new patients every day indefinitely, but in getting started I have been very fortunate, have advertised well, and marketed in a way that has led to the success. However, I am new to the best ways/set up to document which is extremely important in playing the volume game going forward. I was thinking two screens with a desktop and dragon, but have you guys found anything that seems to work significantly better than another way?
Scribes?

---

Members don't see this ad.

 

[lobelsteve]

Transcriptionist. Auto corrects and deletes swearing.

 

[au bon pain]

Hey friends,
New private practice 4 months in. Extremely busy and growing exponentially. Receiving 15 to 40 new referrals per week.
I want to build a very efficient process. Currently using laptops with dragon to document, and taking a lot of my documentation home with me as I am currently seeing around 15 new patients per day ( plus everything else). I know that I won’t be seeing 15 new patients every day indefinitely, but in getting started I have been very fortunate, have advertised well, and marketed in a way that has led to the success. However, I am new to the best ways/set up to document which is extremely important in playing the volume game going forward. I was thinking two screens with a desktop and dragon, but have you guys found anything that seems to work significantly better than another way?
Scribes?

Scribes can be a blessing or a burden. You need to train them to your style/practice patterns, and if they're not FT and don't stay for more than a year or two they may not be worth the trouble. Can also be pricey. Scribes aren't an option where I'm at now, but if they were I may consider one of the virtual scribe companies like hellorache.com (not an endorsement of this specific company)

 

[RoloTomassi]

I think templates are faster than dictating

 

[lobelsteve]

I think templates are faster than dictating

Put more often than not the notes are template a junk.

 

[RoloTomassi]

Put more often than not the notes are template a junk.

Yep. I didn't make the rules, just playing within the boundaries

 

[unchockey21]

We have our MAs scribe and 2 MAs per doc. One is doing intake on a patient while the other MA is in the room with another patient and me. Works great and very efficient. My last new patient is at 3:30 and I’m out the door by 4-4:15 and all notes are done. I never bring work home. That being said, we’re going to trial a company called Robin in the next month to see if we can decrease our staffing. It’s a virtual scribe. From what I’ve been told, it’s an Amazon echo looking thing that sits in the room and then med students transcribe the notes. We’ll see how that goes.

 

[callmeanesthesia]

We have our MAs scribe and 2 MAs per doc. One is doing intake on a patient while the other MA is in the room with another patient and me. Works great and very efficient. My last new patient is at 3:30 and I’m out the door by 4-4:15 and all notes are done. I never bring work home. That being said, we’re going to trial a company called Robin in the next month to see if we can decrease our staffing. It’s a virtual scribe. From what I’ve been told, it’s an Amazon echo looking thing that sits in the room and then med students transcribe the notes. We’ll see how that goes.

Dragon has a similar service. One of my partners uses it and likes it. You have to enter your own orders though.

 

[unchockey21]

Dragon has a similar service. One of my partners uses it and likes it. You have to enter your own orders though.

Thanks! I’ll have to take a look into that so we have a comparison. We have a doctor’s assistant model so they’d likely take over the order entry. I’ve made it this far not knowing how to do it. I can’t go back now!

 

[GlowInTheDark]

Dragon has DAX, it uses AI to build the note from the ambient audio it picks up. Some of the guys in the group see 30-40 patients a day and never touch a note anymore, just skim over what the dictation spits out.

 

[paintrain]

Hey friends,
New private practice 4 months in. Extremely busy and growing exponentially. Receiving 15 to 40 new referrals per week.
I want to build a very efficient process. Currently using laptops with dragon to document, and taking a lot of my documentation home with me as I am currently seeing around 15 new patients per day ( plus everything else). I know that I won’t be seeing 15 new patients every day indefinitely, but in getting started I have been very fortunate, have advertised well, and marketed in a way that has led to the success. However, I am new to the best ways/set up to document which is extremely important in playing the volume game going forward. I was thinking two screens with a desktop and dragon, but have you guys found anything that seems to work significantly better than another way?
Scribes?

Wow amazing. Congrats. On a side note, can I ask what area you're in and how you are generating so many new patient referrals? Can chat via DM if you prefer. Also saw your thread about legal work. I can give some guidance there too.

 

[Pain Applicant1]

I just use templates for the initial visit. I created my own and then copy the note from the previous visit for follow-up visits. I type while speaking with the patient to update the note with each visit. My notes are typically done when I walk out of the room. I also enter the claim and submit it prior to leaving the room. New pts and fluoro procedures are 30 min, f/u's and room procedures are 10 min.

This takes a bit of finesse as you don't want the pt to feel that you're just typing and not paying attention to them. That's where the art of medicine comes in. Some tricks for this are to always sit down, never make the pt feel that you're rushing, and always let them speak their piece. If they go off on a tangent gently bring them back but don't do it rudely. Associate whatever they're saying back to the reason for the office visit.

For instance, if a family member has recently died they'll often go on about it which is understandable. I'll just say something like I'm really sorry about this, please always let us know if there is anything we can do for you. Is this situation worsening your pain at all or will it trigger you to relapse, etc.

I also almost always end the conversation with something like, do you understand our plan moving forward, do you have any questions for me, etc.

 

[Analgesia108]

agree with Pain Applicant1 - my note & coding are done before the patient reaches check out - otherwise, it used to be a nightmare trying to complete notes after work

however, my f/Ups are 15 mins each so there is enough time to review MRI images (if any) and correlate with the spine model that I offer patients to hold while we discuss their condition and treatment options..

I created several templates ( totally worth the pain creating them) for PE that can be edited quickly and I dictate the plan after discussing with the patient, making every encounter unique -

Procedure templates are the quickest - sometimes a few seconds if there is nothing to edit..

 

[Pain Applicant1]

my note & coding are done before the patient reaches check out - otherwise, it used to be a nightmare trying to complete notes after work

I can't agree more.

The best policy I made for myself was that notes and billing had to be done before leaving the room or at the latest before leaving the office. When I first started, I was up until midnight every night catching up on these things.

 

[agolden1]

Dragon has DAX, it uses AI to build the note from the ambient audio it picks up. Some of the guys in the group see 30-40 patients a day and never touch a note anymore, just skim over what the dictation spits out.

What kind of group do you and @unchockey21 work in (i.e. pain only, orthopedic, HOPD, other) where the group is willing to shell out for these systems?

 

[kstarm]

I have a combination of dragon/scribe/and typing depending on the day. Also lots of templates. I find they all have their pluses and minuses. I find dragon makes just enough mistakes to annoy me, similar with the scribe, though better with me directly dictating. With the billing changes there is so much less needed and so my follow-ups in particular are a very brief subjective. Exactly what I did for PE. And then I get into what I think is going on, and plan of care, as well as any insurance mobojumbo that is needed. It helps so much not having all the extraneous info and I think it conveys much more easily to others (and later to myself when I see the patient again) what I was thinking, why, and what the plan is.

 

[unchockey21]

What kind of group do you and @unchockey21 work in (i.e. pain only, orthopedic, HOPD, other) where the group is willing to shell out for these systems?

Ortho/pain. 16 Ortho, 5 pain docs

 

[redchyvak]

That’s very interesting to hear about your experience with dragon AI. I briefly looked at it but wasn’t sure it was worth a three-year contract at $1800 per month. I am struggling keeping up with notes though, and spend a lot of time after work catching up…just may be worth it.