Can we solve these problems with IT?

My fax machine has too many faxes in it every morning

 

Analog office:  .. My fax machine has too many faxes in it every morning
which my staff put on a pile on my desk and then I try to read them and act on them  by scribbling illegible notes on them and putting them in piles on someone else’s desk. 
 
Digital office:  My fax machine has too many faxes in it every morning .. which my staff scan into my EMR and then I try to read them, and act on them often using a separate system functionality – so need to leave the “reading” work stream, do the action, then return to “reading”
 

Reassuring Lab Results just arrived (by fax, mail, local printer, etc)

 

When I get labs back – most of them are normal.  I can:
 
Initial them (digitally or pen/paper) and put them in the chart (paper or digital) Tell the patient that “no news is good news” (which is  terrible customer service, BTW)
But some will call (they should!)
So the chart gets pulled (paper office)
And someone calls them back (usually nurse)
And sometimes answers the questions
And sometimes the patient still wants to talk with the provider
So now it comes to me Like 50 other ones
I stay in the office until 8 PM calling my patients back And they ask other questions when we are on the phone Or they are not home so I leave a message So there is a loose end that I have to manage tomorrow.
 

 I am a specialist – seeing a new patient for the first time.

 

I don’t have any records – so my nurse or AA calls the referring provider, pharmacy (for medication list), and hostpial (for recent H & P/Discharge summary)
 
I wait Some of it arrives via fax Most of it arrives tomorrow I call the preferring provider’s office.
 
 wait The provider comes to the phone
 
Can’t remember much about the patient
 
Asks her staff to pull the chart We wait and talk about our kids in College
Our waiting rooms fill up with angry patients and well-dressed drug reps with too much cologne
Chart is “not found” – it must be in a big pile somewhere
We both get frustrated – referring provider hums a few bars from memory. 
We hang up. I make decisions with the patient based on incomplete data
I dictate my progress notes
I sign them (barely review them) when they come back in 3 days from the transcriptionist
They go into the chart (digital or paper)
My staff faxes a copy of my note to the referring provider.
 

I am a provider writing a prescription for Clarinex

The patient has seasonal allergies

Has tried “everything else”

The drug reps left a pile of these and I gave some to the patient last time she was here

They work “wonderfully”

She wants more

So I write a prescription

Which she takes to CVS 

And they want to charge her $107.50 

Because it’s not covered 

So she calls my office

And my nurse says she’ll work on it 

So she gets the chart 

So she looks up the insurance company (BlahBlah Healthcare)

And then she calls the “prior authorization” phone number 

And waits on hold 

Until a person answers  

Who sends a fax  

Which the nurse gets 4 hours later

And gets the chart again

And she fills out the form on the fax

And she puts it on my desk with a “sign here” sticky note on the signature line – and pointing to the (empty) justification section 

I get it on my desk the next morning  

I fill in the blank sections of the form and put back on the nurse’s desk

Who faxes the form   …

3 days later the patient calls and asks if this is done.

Different nurse pulls the chart and sees the copy of the fax that was sent to the insurance company – so she says yes.

Patient goes to CVS who tries to charge her $107.50 again

Patient goes home and calls the office

Nurse pulls chart again

Nurse calls BlahBlah Healthcare.  Turns out they haven’t processed it.  They will process it and will let us know if it’s denied (They won’t let us know it it’s approved).

Nurse calls patient and tells her to try CVS again in a few days.

Patient gets angry and yells at nurse

Nurse was depressed anyway and quits her job – slamming the door on her way out, hitting a child in the head as he comes in for his 3-year well-child visit.    He is conscious, but has a laceration on his forehead that will require repair.  The kid’s mother says she’ll sue the physician “for everything he’s worth” as she drags the kid off toward the emergency room.

She hits a raccoon on the way home, barely missing an Oak tree as she tries to avoid little Rocky.

She calls her physician and requests some Xanax to “calm my nerves” – beginning a life of dependence on benzodiazepines and poverty.  She stops making payments on her mortgage, loses her home, and was last seen living over a ventilation grate near the Misys offices in New York City.