Tweaking Clinic Systems
I am finding that while I started out with the basics of the IR, chairs, charts, etc. the fine details of my work routine and even clinic lay out are constantly being tweaked. My overall goal is better service to patients.
The IR started out on a round glass table just outside my office so that I could roll my desk chair back a bit and see if someone was there. I can also hear the envelopes and schedule book pages whispering so I am alerted. Later I had a volunteer receptionist so I bought a reception desk with a matching one drawer file cabinet. I already had a chair for this desk. I put the desk in the same place as the glass table for the same reasons. When I don’t have a volunteer, this is the IR. I smile when I think of the chair occupied by one of those ppl from WCA with the hats.
I started out with paper charts. I had no problem keeping them in the office file cabinets when doing BA. Since I’ve been doing CA for nearly 3 years, charts are a problem. At first I took the really old ones home and stored them in a plastic bin in the locked garage. This reminded me of working at the U of Iowa hospital in the 70‘s where we would sometimes have to wait for charts to be retrieved “from the barn.” The next tweak was moving things around in my file drawers. I had one that was storage for various things. I rearranged my tall storage cabinet to accommodate those things. I was out of those type of solutions and also looking to cut expenses. So, I’m now computer charting.
In thinking of doing computer charting I realized I wouldn’t be able to take the “charts” to the chair side as I have done. My memory for detail isn’t the best so I was a bit leery of this. For a few days, I left the charts in my office and went empty handed to the chair. That felt very different at first. While I actually talk a little longer with the patient now, I found that I do remember and that I connect better/longer with them. A student who was observing the other day said the time with the pt was intense and short. I have a few ppl who have a list of things they are having me work on. For them, I take a small notepad to write down the 5-6 complaints, how much better they are and what they rate them on a 0-10.
I had been keeping the IR envelopes in the charts. Now, since I don’t use the paper charts, I have made some hanging files for the envelopes. I went to first and last names on the envelopes as they are in the schedule book. Patients like that better, too, as by now, there are repeats of the first and last names and sometimes they both/all come on the same day. HIPAA is about the medical information, not names.
So all of these things have allowed me to be more present, more efficient and more organized which results in better service to patients.These days, I’m always looking for ways to make things work more smoothly. It makes us all happier 🙂
Author: annmongeau
I've been a member of CAN since the beginning. It just makes sense to me to offer acupuncture at affordable prices. Then, because it's so much fun to do community acupuncture and it's so useful to people, I got active in spreading the word.
Hi Ann,
Do I understand you
Hi Ann,
Do I understand you correctly that it is not a violation of HIPAA to use patients’ first and last names on envelopes, etc., at the IR desk?
That’s my understanding
Here’s a few links. If these aren’t to the point, they get you to the web site that should contain this info somewhere.
https://www.cms.hhs.gov/hipaageninfo/06_areyouacoveredentity.asp
https://www.cms.hhs.gov/HIPAAGenInfo/01_Overview.asp
https://www.cms.hhs.gov/HIPAAGenInfo/Downloads/CoveredEntitycharts.pdf
Can you share more detail
Can you share more detail about the computer charts? My practice is less than a year, and I am shocked at the number of charts I have already. Thank you.
Thanks Ann.
Thanks Ann.
Check this out
https://www.communityacupuncturenetwork.org/node/1654
I am using a Mac program called Pages (word processing). I scan in the initial intakes (on my HP 3 in 1 printer/scanner/copier purchased at Office Depot) & consent forms that the patients filled out and then chart on a 3 column table(Date, SOAP, Points, etc.). I investigated a lot of the programs you can buy but they all had more than I needed and cost more than I wanted to pay.
I secure the computer with a password and take it home every night. Eventually I will get another computer at home and lock up the password protected laptop at the office and then transfer files between them.
I have a very secure very encrypted on line back up service that restored all my data when my hard drive died last week. I back this up daily. They are at https://reliablelifesaver.com/home.html. These folks are located in the Twin Cities and are very helpful.
This company https://ginkgosoftware.com/index.html has the most promising product IMHO. They are just releasing V 4.0 and tell me the next version will have an audit trail which is desirable.
Even with the learning curve, I like the computer charting better than paper. 🙂
Instead of sitting down and filling in chart notes after
taking care of a batch (fill the chairs and tables) of patients, you sit down at your laptop and type in the points used for each one, and possible questions from them and recommendations from you?
2nd question: what do you do with the paper intake forms that new patients filled in? File them or shred them?
I use SOAP notes
So after settling the pts, I go to the office and sit at the laptop and type the date in the first column, a SOAP note (Subjective, Objective, Assessment, Plan) in the second column and the points & use of a heat lamp, e stim, etc and my initials in the third column. I’m referring to a 3 column table like you would make in Word. I find it easier to see what points I used last time by putting them in a separate column.
Subjective is the jist of what the pt said – their description of the complaint. Objective is things I observed (pulse, palption, smells, things I saw, etc.) Assessment is usually something like qi stagnation or pain on the L forearm between Lu 9 and 7 and Plan is anything recommended (apply heat daily, try exercise to reduce stress, etc) and what the plan is for when they return to clinic (RTC 3 times this week).
I have kept the paper intakes at home in a file drawer. Since my hard drive crashed a few weeks after I started the computer charting, I was very glad I did this. My intention is to shred them at some point. When the coputer crashed, I took the intakes back to the office and made charts with them.
There are risks with computer charting. It took 5 days for the repairs and to restore data. Ideally I would have a computer at work and one at home, both with the charts on them. Chances of both computers quitting at one time are slim. I also have faithfully backed up the computer daily with the on line service I mentioned since I started computer charting. Saved my _____!
Reviewing prior tx’s
So am I understanding that you don’t reference the computer chart before the patient comes in? That is, you might not necessarily review what points they’ve received in the last few treatments and how they responded? Are you just treating what you see in the moment, regardless of what protocol you used last time?
Or, are you pulling the computerized file before each patient walks in and then also charting after setting the needles?
I review the previous visits & CC prior
to seeing the patient, just as would with the paper chart. If I need to, I pull the paper chart to look farther back or to look at the initial history, meds, etc. Since I have the paper charts in the office, I haven’t scanned the entire past record of patients I’ve been seeing for a while. For some return patients, I have scaned in the last one or two treatment sheets which can cover 10-20 treatments. With new patients, I scan in all the intake paperwork and the chart builds on the computer.
When I get done seeing the pt, I chart my SOAP note and the points, heat lamp, etc. Sometimes I have to chart several at once if I’ve been busy, just like what happens with paper charts. If I need to, I jot down a few things on a note pad at my desk for later charting.
The only thing different is that my charts are on the computer now, instead of paper. And since I type faster than I write it takes less time to chart and is much more legible. 🙂