Physicians Practice - July/August 2008 - (Page 51)

THE TECH DOCTOR SELF-SERVICE MEDICINE? PATIENT-ENTERED HISTORIES CAN STREAMLINE OFFICE VISITS. BUT CAN YOU TRUST PATIENTS TO ENTER THEIR OWN STORIES? B Y B R U C E K L E AV E L A N D From gas station ﬁll-ups to airport check-ins, we are rapidly becoming a self-service society. Is there a way this trend might beneﬁt docs in ambulatory practice? Yes. It’s called patient-entered histories. Here’s the basic idea behind this brand of self-service medicine: A patient ﬁlls out an interactive com- cent of patient problems and/or concerns go unaddressed, and patient and physician do not agree on the primary complaint 50 percent of the time. Since computer-based patient-entered histories work by using structured Q & A or a checklist type of approach, they offer a more consistent, standardized method of information • Improved coding. Coding levels are directly correlated to the documentation of what you see and do. Therefore, since patiententered histories make it easier to document the subjective portion of the visit, it is easier to play by the documentation rules. This all sounds good on paper. But does it work in the real world? To answer this, I found a small, primary-care practice that had integrated patient-entered histories into its daily routine. Here are my questions and their responses: • How and where do patients enter the data? As part of the phone reg- Since computer-based patient-entered histories work by using structured Q & A or a checklist type of approach, they offer a more consistent, standardized method of information gathering. PDQ DATA puter questionnaire prior to a visit. Her responses are automatically transferred to her electronic chart. That way, when the physician sees the patient, he is reviewing the patient’s questionnaire and can focus on the objective, assessment, and plan part of the visit. Proponents of patient-entered histories claim the following beneﬁts: • Better information. A review article gathering. Computer-based questionnaires also tend to excel at collecting sensitive information that patients may not feel comfortable verbalizing in a face-toface encounter. • Less work for providers. Whether istration process, patients receive a password, and they are then instructed to go the practice’s Web site to ﬁll out the questionnaire. The questionnaire uses “branching logic,” which means that the line of questioning is based on responses to previous questions. This means that the questionnaires are essentially customized for each patient based on his speciﬁc condition. After completion, the results of the questionnaire are summarized and securely sent to the practice’s EMR. • What about patients who hate computers and/or do not have Web access? The MA will walk in Mayo Clinic Proceedings on this topic (www.mayoclinic proceedings.com/inside.asp?AID= 263&UID=) noted that in traditional physician-patient interviews, 50 percent of psychiatric problems are missed, roughly 50 perWWW.PHYSICIANSPRACTICE.COM you are writing a note, using dictation, or typing into an EMR, documenting the subjective part of the note can be time consuming. Why not have patients tell (i.e., document) their own stories? • Better patient visits. Patiententered histories lead to a more efﬁcient and rewarding encounter since providers can focus on reviewing the information with patients instead of collecting it. through the computer questionnaire in the exam room with these patients (who are often elderly), interviewing the patients, and answering questions on their behalf. • How long does it take patients to ﬁll out the questionnaire? A complete physical takes the longest — up to 15 minutes. More focused visits JULY/AUGUST 2008 | PHYSICIANS PRACTICE | 51 http://www.mayoclinicproceedings.com/inside.asp?AID=263&UID= http://www.mayoclinicproceedings.com/inside.asp?AID=263&UID= http://www.mayoclinicproceedings.com/inside.asp?AID=263&UID= http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - July/August 2008

Physicians Practice - July/August 2008 Contents The Bigger Picture: Battle Royale in the EMR Market Letters Physicians Practice Pearls: Hire Right Noteworthy Cover Story: Healthcare Reform: Voting for Change Patient Relations: Dealing with Problem Patients The tech Doctor: Is Self-Service Medicine Inevitable? Technology: Do EMRs Make You a Better Doctor? The Guide Idealab: Cash-Only Care Still Works The Administrators Desk: Who’s in Charge? Ask The Experts What Went Wrong: ‘Why Our Great Idea Didn’t Work’ Coding Start It Up: How to Launch a Practice: Operations Partnership: Don't Let Partner Conflict Destroy Your Practice Appraisals: What’s Your Practice Worth? Getting Advice: How to Hire a Consultant Classifieds Advertiser Index

Physicians Practice - July/August 2008

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