In the old days, the healthcare provider would scribble a few orders, write a brief note and be done with the paperwork.
Times have changed.
When using a tracking board, CPOE, and Electronic Health Record, the healthcare provider is now burdened with inputting endless data to obtain accurate:
- Through-put times
- Door-to-balloon times
- Stroke alert data
- Time of EKG reading
- Time of consultation
- ETC., ETC., ETC. – The list is endless
This does not include the history and physical, clinical course, medical decision making, procedure notes, critical care documentation, Rx, and discharge paper work, and etc.
What kind of help is available?
- Scribes work but are expensive.
- Voice activated input like “Dragon Medical” dictation software are worth every penny
- A data gatherer who sets up record with everything except HPI and MDM (college students are inexpensive)
- You could do everything after the fact but times are inaccurate depending on the program used. This practice also burns providers out and increases the need for mental days off.
The provider is “bogged down” with endless paperwork regarding data entry which leads to lost productivity and less real-time patient contact and care. Switching to an EHR will take some adjustment time but it will help healthcare providers adjust to the role of “data jockey.”My ED uses a combination solution.
- The king pin is an EHR charting program, XpressCharts EHR, that I helped developed. The program is user friendly, has the ability to created “favorites,” is dictation software compatible, and has a minimal need for user computer knowledge. The program can also be used easily without adjuncts.
- Voice activated support that allows users to dictate in all text boxes. The EHR used, XpressCharts EHR, is set up to easily allow this which eliminates most typing.
- College students serve as “data-go-fors”.
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