How to Get More Time Back

One of the biggest complaints that healthcare professionals constantly have is related to workplace efficiency and administrative burdens. Many clinicians, including physician assistants, are happy with their career choice but find the paperwork a nuisance. Not only is it a bit of a nuisance, but many healthcare providers report spending several hours a day outside of the clinic working on their electronic medical records. Once we get stuck in the same everyday routines and stresses, breaking this pattern can be difficult.

Building relationships and expectations with colleagues and patients, and making records more efficient are two steps to getting home on time and spending less personal time on records.

I have worked in psychiatry for the past 13 years; I consider myself very fortunate that my mentor was a natural expert on efficiency and boundaries. Since starting in this field, I have taught others what I call the Golden Rule of the workplace.

This simple rule says that you teach other people how to treat you. What that really means is consistency and clear expectations. For example, if you delegate a job or task and then do the work yourself, you’ve only taught that person that they don’t have to do it. Although it may have been easier for you to do it “this time,” you have set a standard, and once a standard is set, it’s hard to go back.

When communication is inconsistent, expectations get muddled. That doesn’t mean not helping when you need to, but being aware if and when you’re creating more work for yourself.

Team huddles

In everyday life, Team Huddles are proven to help with interprofessional communication and teamwork. You can encourage your team to ask questions, be better prepared for the day, foster healthy team-based relationships, and clarify expectations.

The Agency for Healthcare Research and Quality offers a toolkit that explains what huddles are, how they can be useful, and how to establish them

My Golden Rule of the Workplace also applies to your relationship with your patients, which you can apply right from your first encounter. At the first meeting, I always tell my patients that I will give them enough medication to come to the follow-up appointment, and then have them schedule the follow-up before the end of the telemedicine appointment or before they leave the building.

I also tell them that if they don’t make it, they must call us to let us know and ask for refills if needed. I also tell them the days I’m in the clinic, days I’m not on call, and that refills will only be topped up during my normal clinic hours. If they then miss an appointment, they were told it was up to them to reschedule and ask for refills.

When you find yourself being inundated with refill requests, unnecessary calls, or emails when you should be free, ask, “Have I taught others to have these inflated expectations of me?”

Why we create charts

So how do we spend less time charting and working from home? Let’s get back to the basics of why we create charts. There are three main reasons for doing this: first, so you know what you were thinking when you see the patient again; second, to let a colleague or other clinicians know what you were thinking and when to resume treatment if necessary; and third liability.

Using templates and dot phrases or keyboard shortcuts are the most common suggestions to help with charting efficiency, but there are other approaches that can be helpful.

When conducting research in a specialty, I note any previous medications a patient has tried and their reactions or side effects. I also make a list of medications they haven’t tried. I keep these lists in a portion of my chart that is applied to each note, so I don’t have to go back into multiple charts at each appointment just to see what was attempted. I already have a list of medications to consider based on past drug reactions.

Also, I always make a note in my plan of what I would do next time if what we did today didn’t work. This helps with pre-booking for the next appointment as well as when a colleague or other person resumes care. Wherever possible, redundancies are eliminated or at least reduced.

If a patient reports symptoms and you document this in the Medical History (HPI), do you repeat the report in the Review of Systems (ROS) in a way that it is redundant? Could you note in the ROS that “Show HPI” is displayed, or pull the information from the HPI instead of typing it all in again? This helps you be aware of how you document. If there is a more precise way to create charts using templates or other forms, use these tools.

Adhesion is really the sticking point. We never want to cut corners here; It is important to document all required information. This goes back to the old adage: what you didn’t document didn’t happen.

How to bill

You can also pre-create maps, which I strongly encourage. As of 2020, you can choose to bill based on either time or medical decision-making, per the Centers for Medicare & Medicaid Services (CMS) and American Medical Association guidelines for assessment and management coding. If you bill by time, the time you spent with the patient that day can be included in the billing time. This means pre-chart time is included. According to CMS, the time includes the work before, during and after the encounter. This can be beneficial in some specialties, but more importantly for the subject at hand, it helps the clinician to be better prepared and therefore more efficient.

Precharting takes little time and prevents you from going in unprepared. It gives you a chance to review the notes and means you can start developing a possible game plan before the patient is even seen. It also gives the provider time to review other consultation notes, labs, images, etc.

If you find yourself struggling with the IT aspect or know how to use the system, don’t hesitate to contact your administration for further training. Remember, they want you to be more efficient, and most of them won’t hesitate to make that happen.

We love what we do, but medicine is a very demanding job, whatever your role. Unfortunately, many of us wake up one day to find that we are drowning in the extra work and wonder how we got to this point. Having clear expectations and boundaries for your work team and patients, and brushing up on EHR efficiency are two options for finding more time in your personal life and enjoying your work.

Heidi A. Posey, PA-C, specializes in child, adolescent, and adult psychiatry and is co-founder of the nonprofit The Burn Clinic, which provides burnout education, prevention, and treatment to healthcare providers.