As a hospitalist, I often blog about the incredible inefficiencies built into the ridiculous rules and regulations of evaluation and management (E/M) coding. I often say if I could document like a surgeon and still get paid for the work I perform, I could double or triple the number of patients I see.
Besides abolishing E/M all together, I've discovered another way to rapidly improve my efficiency as a hospitalist: Implement the use of wireless mobile devices such as the iPhone or iPad for rounding.
I recently upgraded to an iPhone 4 and purchased an iPad for the sole purpose of improving my efficiency as a hospitalist. It's only been two days and the results are shocking, far beyond even my wildest dreams. While I haven't yet rounded with an iPad, I can only imagine it will make my experience even better.
Using my iPhone 4, yesterday, I was able to round on 14 patients and admit two critical care patients in less than 4 1/2 hours. Since we are coming off a holiday weekend and not a single nursing home in town staffs to accept any hospital discharges on a holiday weekend, I had a service full of patients waiting to discharge today.
How did I do today rounding with my iPhone 4 mobile platform with an app that allowed me to review all patient lab, x-ray reports and medications without ever leaving the patients front door?
I was able to round on all 16 patients and discharge 13 of them in less than 4 1/2 hours. I no longer have to walk back and forth between patient rooms and nursing stations. I can just drink my coffee at the bedside. I don't have to fight with other doctors and nurses to log into a paucity of computers that are often way too slow and way too unpredictable. I just sinc my iPhone with the patient data base app on my iPhone screen and I'm up and running with a real time update of all my patient's information.
And soon, I will be able to round on my patients with a voice activated real time dictation system that will allow me to transcribe my notes in real time and automatically populate them into my EMR and get printed and placed as a hard copy in the chart for all to see. Not that anybody cares, because nobody reads them except insurance companies and the folks from the utilization review.
Plus, soon, I will hopefully be able to take advantage of a new IT system that some doctors are currently trialing that would allow me to populate my daily progress notes automatically with whatever data I tell it to (lab results, x-ray reports, vital signs). I'll never have to write another lab value again. I'll even be able to bring forward my history and physical examination, 12 point review of systems or unobtainable ROS, and assessment from the previous day's note. And I'll be able to populate my discharge summary with any and all information I wish to on an ongoing basis.
Someday I might even be able to automatically have it sent by secure connection to the primary care doctor's office who will get my discharge summary even before the nurses get my discharge orders.
These are exciting times in a hospital IT revolution. A lot of doctors complain about the transition, but if done well, it will make all our lives much easier and patient's lives much safer. My hospitalist existence is filled everyday with time wasting duplication of documentation necessary to get paid and not be accused of fraud. Automating the process will save me hundreds of hours a year and allow me to see more patients more efficiently.
Someday I might even be able to automatically have it sent by secure connection to the primary care doctor's office who will get my discharge summary even before the nurses get my discharge orders.
These are exciting times in a hospital IT revolution. A lot of doctors complain about the transition, but if done well, it will make all our lives much easier and patient's lives much safer. My hospitalist existence is filled everyday with time wasting duplication of documentation necessary to get paid and not be accused of fraud. Automating the process will save me hundreds of hours a year and allow me to see more patients more efficiently.
This is my Holy Grail of hospitalist rounding. This is real time, wireless, mobile technology on the Apple platform that I am excited to integrate into my practice style. And instead of me spending countless hours every day populating my notes, I can simply dictate my thoughts and plan for the day and move on to the next patient.
That's how you increase the efficiency of rounding in a hospital. With bundled care and large revenue penalties for Medicare patients bouncing back starting in 2013, I can assure you physicians will do everything in their power to maintain their income with volume. And you do that by becoming more efficient with fewer doctors seeing the same number of patients. Within the next week or so, I will have my iPad up and running and will transform my daily rounding experience from one of frequent IT frustration to one of peace and tranquility.
People say there is a doctor shortage in this country. That's bull. We have an efficiency shortage. And that's all courtesy of the rules and regulations of the Medicare National Bank. It's time we took control of our practices and used the rules to our advantage.
addendum: Here's my post about how I improved hospital rounding efficiency with my iPad.
People say there is a doctor shortage in this country. That's bull. We have an efficiency shortage. And that's all courtesy of the rules and regulations of the Medicare National Bank. It's time we took control of our practices and used the rules to our advantage.
addendum: Here's my post about how I improved hospital rounding efficiency with my iPad.
