I recently started as the Clinical Nurse Educator at a busy Family Medicine clinic. The same week I started, we started EHR. The LPN's/MA's are having a really hard time getting everything done and I am trying to think of a way to help them but I'm drawing a blank. When asked, they all tell me that they did all of the same stuff before but did not have to stay over late every night like they are now. They room pts, take care of any patient needs that need done while the pt is here, they receive faxes for refills, MD consults, pt histories, you name it, and, of course, have phone calls to make about everything from reporting labs to prior auths. To me, it sounds like there's just too much for them too do in the amount of time allotted, but they assure me they did it before and got done. Any suggestions for how to help them get done???
Sep 20, '12
did they have the time management problem before you started EHR? If they were on time before this then I would give it some time for them to get used to the EHR. I have been at a family clinic for a month and this is my first experience with a clinic EHR and it has really slowed me down compared to how fast I was in my last clinic which was still paper. It is a BIG adjustment to go from paper to computer and it's a bit unnerving because I know for me I feel like it's easier to miss stuff. In reality it isnt but not having a hard copy of a file or RX RF makes me work slower for the moment because I feel like I have to triple check everything on the EHR since I am not used to it. When I was pregnant with my daughter last year my OB was switching to EHR and it slowed them waay down for a good 3 months till they got all the kinks worked out.
Dont worry it will work its self out of the next couple of months, going from paper to computer is defintely not always a smooth transition! My clinic has be online for almost two years and we still get kinks every now and then.
Sep 20, '12
Oh and one more thing are you guys getting set up to do all prior auths online? seriously cuts down on the time of having to wait on hold w/ the insurance companies forever. prior auths take me about 5 mins start to finish now, pending only takes 24-48 hours for some ins, a lot of them will tell you if it will go through or not on spot.
Nov 5, '12
Thanks for the responses! They supposedly were ok prior to EHR, but I also think it was easier for things to be slipped under the rug if they couldn't get to it (I'm not saying that everyone did stuff like that, just to clarify, I just know that we found some stuff that wasn't done when it was paper charting). We are going on 3 months of EHR now and it seems to be getting worse rather than better. Nurses/MA's are getting extremely overwhelmed and I don't know how to help them get better! I have to admit that I am getting very frustrated as well because I want to be able to help them more than I am currently able.
Nov 9, '12
Try systems analysis, instead of educating: Determine the highest-value person or job role, whether it is by salary or impact on the rest of the clinic. Sometimes fixing reception/check-in -- the lowest paid position -- has the highest effect on the entire clinic. Look at the big picture to identify bottlenecks between job roles. Find the worst bottleneck, then figure out why it is a bottleneck -- who is not doing what when, and why. After the top two or three system-wide bottlenecks are fixed, start on the individual job roles.
Work with that job role to help them identify the most time-consuming thing they do, whether it is on the EHR or something else. Figure out why it is the most time-consuming, by breaking down the steps. Then see whether any of the steps or the entire task can be changed/eliminated. Then make that change and see if it helped. Then repeat for the next most time-consuming task. Then when that job role is performing so they can keep up, do this analysis on the next job role.
I know this seems like the responsibility of the practice manager or maybe the EHR manager, but as the educator you can play a key role as the person who sees both the whole system and the details. I guarantee you if you can step outside the pure education role and fix processes, you'll have your job for life.
Nov 14, '12
Prior Auths take sooo much time and were so diffucult to squeeze into the little time I had between patients at a clinic I used to work in. Finally, they hired a part-time MA specifically to do prior auths. She worked M-W-F 8-5 and made all of our lives SO MUCH EASIER! She'd also help mail out result letters and things like that. Not sure if that's an option where you are, but it's worth considering!
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