How much time do you spend on entering data?

[tima]

Is this article accurate?

More than half of my ER shift was spent on entering data.

"Out of a total of 420 minutes, I calculated that I spent the following amount of time performing the following tasks:
Seeing patients: 156 minutes
Time on computer: 237 minutes"

http://www.kevinmd.com/blog/2012/11/er-shift-spent-entering-data.html

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[glorfindel]

I'd like to do a similar experiment. These numbers generally pass the sniff test, though.

The time spent on the computer includes very valuable time (looking up old med records) and wasted time.

Also, "time spent seeing patients" includes valuable and wasted (arguing with them about narc prescriptions, etc.).

 

[Birdstrike]

.

 

[EvoDevo]

*sobs*

Can you imagine a practice like that?

*sobs more*

I hate charting so much...

 

[RustedFox]

I chart so much at home, even. It kills me.

Now, they (the corporate bean-counters) want to introduce yet two more timestamps into our EMR, each of which requires me to sit and make sure I spend 5 clicks to succesfully (and correctly) document on the right patient.

It takes me 12 clicks to sign a midlevel's chart. I counted.

If they keep this nonsense up, I want a personal scribe. One to follow me around and make sure that they get all the "clicks" right exactly as I'm greeting a patient, discussing their options, choosing to admit/discharge, calling the PMD.


What-the-puck-ever.

 

[xenakis]

It takes me 12 clicks to sign a midlevel's chart. I counted

If they keep this nonsense up, I want a personal scribe.

Lol. That reminds me when I used to be a scribe in our local ED as a premed. I made a program that allowed a doc to sign charts en-mass, just as if they did by hand, with a single password sign-in

 

[docB]

I spend more than that. I use an EMR with CPOE so all my charting and ordering counts as data entry. I'd say 2/3 to 3/4 of my time.

 

[RustedFox]

I spend more than that. I use an EMR with CPOE so all my charting and ordering counts as data entry. I'd say 2/3 to 3/4 of my time.

I got the same setup. Yep. 2/3 to 3/4.

 

[Arcan57]

Same as above. Anything less means my patients are having a really bad day.

 

[deleted109597]

One day, we won't have to enter information. They'll simply record us. Too much evidence out there of us documenting things we didn't do. Instead, they'll either have someone else writing it down, or something recording it and putting it in the record.
Now, this may be decades from now, but I guarantee it will happen.

 

[BJJVP]

The numbers add up (it's Whitecoat for God's sake, of course they add up). Definitely much over 50% of physician time is spent on documentation and BS other that patient care.

People are trying to blame it on EMRs but it was just as bad with dictation, and hand written charts before that.

There's so much more time pressure now to "move the meat" and see more patients, do more surgeries, do more procedures, etc, that everyone is feeling it more.

The two biggest reasons:

1-Med mal
2-Insurance games to get paid.

(Anecdote alert!)

I knew a guy (ER) who got called up to war from the reserves, as a military doc. No worry of getting sued or need to play insurance games to get paid. He said his charts looked like this:

"Male

Sore throat

OTCs

Signature"


He could see a hundred patients per 12

In the last several years, I've seen more and more written about cash-only medical practices starting up for this reason, The doctors claim they are less stressed and have lower overheads due to the much lower documentation requirements and billing hassles. A lot of these clinics seem to be urgent care/walk-in clinics started by ER doctors.

Does anyone have first hand experience with this? Is this really a viable business model? There is a lot written about this type of practice being potentially successful but I find it hard to believe anyone would pay cash for their medical care these days. I just don't think people believe it's something they should have to purchase using their own money.

 

[docB]

One day, we won't have to enter information. They'll simply record us. Too much evidence out there of us documenting things we didn't do. Instead, they'll either have someone else writing it down, or something recording it and putting it in the record.
Now, this may be decades from now, but I guarantee it will happen.

I completely agree with you. Imagine a system where every staff member has an RFID chip in their badge and every patient has one in their band. Every time a patient interaction occurs the system starts recording. Billers will watch the recordings at 2x or 4x speed and code the visits. We will do exams while calling out our findings to the eye in the sky. "Your abdomen is soft and nontender." We will do our MDM and HCAHPS mandated explanation at the same time. "You have pneumonia based on your chest xray and your labs. Your oxygen level is too low so I'm going to admit you to the hospital." The patient hears it and the billers get it on the tape.

There are big, but not insurmountable, medico legal issues of course.

AMR has been looking at recording everything in their ambulances and had a concept rig with the capability a few years back.

I think it's coming.

 

[EctopicFetus]

Scribes.???? I dont think i would work without them anymore. Makes a shift more productive and way easier. all for 10-15 bucks per hour.. Would make it up seeing 1 more patient per shift.

 

[Arcan57]

In the last several years, I've seen more and more written about cash-only medical practices starting up for this reason, The doctors claim they are less stressed and have lower overheads due to the much lower documentation requirements and billing hassles. A lot of these clinics seem to be urgent care/walk-in clinics started by ER doctors.

Does anyone have first hand experience with this? Is this really a viable business model? There is a lot written about this type of practice being potentially successful but I find it hard to believe anyone would pay cash for their medical care these days. I just don't think people believe it's something they should have to purchase using their own money.

The shortened documentation mentioned above is the product of both financial and medicolegal freedoms that do not exist in the civilian world. Without both, you still need to document as you normally would since even with sovereign immunity you still need to get paid, and even if you're not going to be paid you need to defend yourself.

 

[docB]

Scribes.???? I dont think i would work without them anymore. Makes a shift more productive and way easier. all for 10-15 bucks per hour.. Would make it up seeing 1 more patient per shift.

We have looked at scribes at decided against them. Several of of have worked with them or do currently in other jobs.

Scribe pros:
They speed you up.
They make your shift easier, working conditions better, happier doctors
Some hospitals pay for them

Scribe cons:
We would have to employ them ourselves (employ=pay+benefits+overhead)
We would have to train them ourselves
We would have to review their charts for accuracy
We would either have to pay enough for quality, reliable people or would have to put up with poor quality, unreliable lower paid people

We have gotten fast enough with the new system that they just wouldn't make sense for us.

 

[Arcan57]

We have looked at scribes at decided against them. Several of of have worked with them or do currently in other jobs.

Scribe pros:
They speed you up.
They make your shift easier, working conditions better, happier doctors
Some hospitals pay for them

Scribe cons:
We would have to employ them ourselves (employ=pay+benefits+overhead)
We would have to train them ourselves
We would have to review their charts for accuracy
We would either have to pay enough for quality, reliable people or would have to put up with poor quality, unreliable lower paid people

We have gotten fast enough with the new system that they just wouldn't make sense for us.

I have no experience with them, but there are a decent number of national companies that do the hiring, employing, and training for you.

 

[eadysx]

I had your same concerns with scribes at first. But having had them for a year, I could not go back. My patients per hour went up as did my RVU's.

Our volume drops off at night and the overnight shift does not justify a scribe. When I work that shift now the pain seem to be multiplied. Up all night and doing all the typing..... Weak.

The biggest issue we have is turnover. All our scribes seem fixated on throwing their life away in the medical profession, so they out grow us.

If it is something your group can afford, I strongly recommend it.

E-

 

[docB]

I have no experience with them, but there are a decent number of national companies that do the hiring, employing, and training for you.

Very true although they charge for those services.

I had your same concerns with scribes at first. But having had them for a year, I could not go back. My patients per hour went up as did my RVU's.

Our volume drops off at night and the overnight shift does not justify a scribe. When I work that shift now the pain seem to be multiplied. Up all night and doing all the typing..... Weak.

The biggest issue we have is turnover. All our scribes seem fixated on throwing their life away in the medical profession, so they out grow us.

If it is something your group can afford, I strongly recommend it.

E-

How do you compensate the night doc with no scribe to make him even with the day guy whose numbers are better because he has a scribe? We were looking at this and felt we wouldn't need scribes during low volume times but the economics of paying the uncovered guy additional money commensurate with the cost of the scribe was daunting.

 

[EctopicFetus]

We have looked at scribes at decided against them. Several of of have worked with them or do currently in other jobs.

Scribe pros:
They speed you up.
They make your shift easier, working conditions better, happier doctors
Some hospitals pay for them

Scribe cons:
We would have to employ them ourselves (employ=pay+benefits+overhead)
We would have to train them ourselves
We would have to review their charts for accuracy
We would either have to pay enough for quality, reliable people or would have to put up with poor quality, unreliable lower paid people

We have gotten fast enough with the new system that they just wouldn't make sense for us.

We started our own program from scratch. They do cost money but not as much as you think and honestly if you can get them to put in orders, they make you more efficient and your charting is better since it is real time. We have a "head scribe" who reviews their charts. It takes about 2 years to get the program on autopilot.

I am all for it and I think our group has benefited from them significantly.

 

[eadysx]

How do you compensate the night doc with no scribe to make him even with the day guy whose numbers are better because he has a scribe? We were looking at this and felt we wouldn't need scribes during low volume times but the economics of paying the uncovered guy additional money commensurate with the cost of the scribe was daunting.

The day folks are on production, and the our Monday-Thursday "night guy" is on a strait salary. We value his willingness to do nights, and did not want to see his income change. For us, production and scribes happened at the same time, so the night guy just never went on it, he kept his old salary. We share the weekend nights amoungst the rest of the group and it works out about right.

Cheers,
E-

 

[spyderdoc]

Scribe cons:
We would have to employ them ourselves (employ=pay+benefits+overhead)
We would have to train them ourselves
We would have to review their charts for accuracy
We would either have to pay enough for quality, reliable people or would have to put up with poor quality, unreliable lower paid people.

We've been using them about a year. We are a partnership and can not have employees, so we use a scribe service. They hire, train, and pay the scribes. It is very nice. They are all recruited from the local colleges, and are mostly pre-med or pre-health, so they are quite reliable. There has been turnover as expected since they are using this job for experience....I would say that my work flow has not changed a ton, but it is nice to have most of my documentation done shortly after I leave the room. It is entered in a more "real time" fashion. Before scribes, I'd do most of my charting at home, spending 2-4 hours after a shift depending on how complicated the cases were....Now I spend 0-1 hour charting at home. That is so worth it to me.

One downside is sometimes they enter stuff you don't really want on the chart, and sometimes they don't enter things you want...So you have to pay attention to the entries they make. Over time with experience, they tend to get better and know what you like and don't like, so this is where the turnover factor comes into play. They get good, then they leave to go off and become a doctor or something like that. Good for them, but now I got to break in another scribe.....

 

[PikminOC]

We have looked at scribes at decided against them. Several of of have worked with them or do currently in other jobs.

Scribe pros:
They speed you up.
They make your shift easier, working conditions better, happier doctors
Some hospitals pay for them

Scribe cons:
We would have to employ them ourselves (employ=pay+benefits+overhead)
We would have to train them ourselves
We would have to review their charts for accuracy
We would either have to pay enough for quality, reliable people or would have to put up with poor quality, unreliable lower paid people

We have gotten fast enough with the new system that they just wouldn't make sense for us.

Have you heard of this? IKS Scribble | IKS Health. Have you guys been using this?

 

[xaelia]

Wow ... what a necrobump.

Look at all those young versions of us debating whether we ought to have our own loyal Jonathans.

 

[wareagle726]

I didn't realize it was a bump until you said that. It's funny, I WAS a scribe when this convo was happening. Welp, 2023 documentation guidelines are here and I fired my scribe coverage.