Impact of EMR's -- CDI & Physician Interactions
Wanted to split this observation off into a different conversation thread.
Very good observations -- does however raise the question in my mind, how much of an impact are folks feeling as more and more of the record is in a primary electronic format. Are the opportunities for face to face conversations, chances to build stronger individual relationships becoming less frequent and more difficult when an EMR is fully adopted?
What about valuable on-unit work spaces? Are some folks finding greater challenges in maintaining a physical presence 'where the action is'?
Are physicians spending less time of units? going off somewhere out of sight to do their documentation? less available?
One classic 'opportunity' to catch a physician is when you are looking for the paper chart (one of my original CDS's would deliberately hold onto a chart when she wanted to speak with a physician & when he/she came looking for it -- 'oh, I just finished with Ms Jones' chart....would you have a moment to help me understand...?)
What are other's experiences?
For my team, we are finding a lot more telephone time, and much less eye contact. I believe that is hurting our level of success & collaboration.
Don
>>> "CDI Talk" 11/16/2011 10:09 PM >>>
The point that commenters are overlooking is communicating with the physician the "old fashioned" way, that is verbal communication. CDI is not merely about episodic chasing down of diagnoses with queries; on the contrary, CDI is intended to ultimately change physician behavior patterns of clinical documentation. Quite frankly, one does not alter patterns of clinical documentation by the physician simply by leaving a query and hoping the physician responds. There is no substitute for face -to-face communication with physicians, engaging in a 2 minute conversation to clarify diagnoses and offering tidbits on the direct impact of accurate and concise clinical documentation to their practice of medicine.
Just some food for thought...
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Very good observations -- does however raise the question in my mind, how much of an impact are folks feeling as more and more of the record is in a primary electronic format. Are the opportunities for face to face conversations, chances to build stronger individual relationships becoming less frequent and more difficult when an EMR is fully adopted?
What about valuable on-unit work spaces? Are some folks finding greater challenges in maintaining a physical presence 'where the action is'?
Are physicians spending less time of units? going off somewhere out of sight to do their documentation? less available?
One classic 'opportunity' to catch a physician is when you are looking for the paper chart (one of my original CDS's would deliberately hold onto a chart when she wanted to speak with a physician & when he/she came looking for it -- 'oh, I just finished with Ms Jones' chart....would you have a moment to help me understand...?)
What are other's experiences?
For my team, we are finding a lot more telephone time, and much less eye contact. I believe that is hurting our level of success & collaboration.
Don
>>> "CDI Talk" 11/16/2011 10:09 PM >>>
The point that commenters are overlooking is communicating with the physician the "old fashioned" way, that is verbal communication. CDI is not merely about episodic chasing down of diagnoses with queries; on the contrary, CDI is intended to ultimately change physician behavior patterns of clinical documentation. Quite frankly, one does not alter patterns of clinical documentation by the physician simply by leaving a query and hoping the physician responds. There is no substitute for face -to-face communication with physicians, engaging in a 2 minute conversation to clarify diagnoses and offering tidbits on the direct impact of accurate and concise clinical documentation to their practice of medicine.
Just some food for thought...
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Comments
"I like your comment. You are exactly right. Building that relationship with the physician is what really improves the CDI response rate. Some physicians shall we say need more nurturing; but, once you have created that professional relationship it is very valuable to both you, the physician, and the hospital. I am a well seasoned (if you know what that means) RN. Over the years, I have seen a physician who is rude, uncooperative, and very disengaged turn in to someone who will search you out and at times even give you a great big hug! After all, I love what I do; but, it makes me feel even better when I have helped someone else reach a new level.
Thanks.
Gail Holt BSN, RN"
We have not worked on the floors since the inception of the program. We had a hybrid chart until April 3rd and then fully electronic. We query our physicians via the EMR (with both the hybrid and EMR) and we write our own queries (do not have templates). My response rate averages around 90%. I occasionally will head out to the floors to find a non-responder but rarely find them as I walk around, including going to their offices. Our facility runs pretty close to capacity so often times patients medical patients may be on a surgical floor or vice versa. I have spent some time on the medical floor doing reviews but with 8 different hospitalists on everyday, with patients all over the hospital it can be difficult to find them. As you also suggested after rounds they go to their offices to document. If I don't get a response I will page them and the majority of the time they will call me (I think we all have a service line, or particular MD who doesn't want to participate).
Cindy
Most of our queries are face to face.
We are 100% EMR
Hope that helps
Good Luck
Tracey
our push for regular educational meetings with the providers and residents
in attempt to compensate. It seems to be working. I have created
electronic queries and have begun attaching these queries to email
messages in the EPIC system. The reality is there, most attendings are
doing their documentation in the office or at home! I have a unique
insight into this as I was forced after the recent flooding, to live with
a friend for the last 2 months, one of our attendings! This poor guy
spends hours every night, completing office and rounding notes at home in
his office .......... the paper chart is not a valuable tool for him
anymore.
I am also in the process of creating the option of remote access for my
staff. Not that they will be home all week, but it does give them a choice
one day a week to not drive in to work. It adds to the retention aspect of
this role that we all need to be aware of.
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
email: tiffany_susan@guthrie.org
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