Installing an electronic health record system at a primary care practice is a perfect time to also revamp the tasks the office staff performs.
Having all staff members work at the top of their licensure is the guiding principle: If a task does not require an MD or DO, then people with those degrees shouldn't do it. Instead, such a task should be delegated through a standing order to someone else on the staff, often a nurse or medical assistant.
In a standing order, you extend your licensure to lower-level staff. Write the order in detail, sign it, put it into a folder, and keep it up-to-date for accreditation inspections.
With routine clinical tasks delegated to staff members using EHR tools, the typical duration of an office encounter between a primary care physician and patient can be shaved by a third, from 12 minutes to 8 minutes. The time saved can be used to see more patients or for leisure time.
EHRs allow these time savings in two main ways. First, they better enable a staff member, usually a nurse or medical assistant, to collect and enter into the record preliminary clinical information, such as past medical history, family history, vital signs, and reason for visit.
When the physician enters the exam room to see the patient, reviewing what the staff has entered into the medical chart takes half as much time as entering the data initially and then they simply need to add the additional information that they gather.
The scope of preliminary information collected can be expanded and tailored to each patient through disease-specific templates.
For example, a physician can teach staff members how to collect current information from patients with diabetes using a diabetes template, leaving fewer routine tasks for the physician to do. About a quarter of my patients have diabetes, so my nurse knows my diabetes template cold.
The second major time saving is through standing orders that a staff member can perform and that are automatically flagged for appropriate patients. These standing orders would include items such as administering immunizations, arranging for routine lab tests like prostate-specific antigen and hemoglobin A1c, and reminding patients about and possibly scheduling routine screens like mammography and colonoscopy.
The key to making this sort of practice change work is to introduce new approaches in small steps and evaluate how each change works after a few weeks. The staff must be properly trained, and the changes should take into account how the staff currently works and how new tasks will affect them. Having a staff member on the development and implementation team is a big advantage.
Workflow changes following introduction of an electronic health record is an evolving and continuous process, not a static goal. Once an EHR system is in place and work assignments start to change, delegation of tasks will continue to evolve and the workflow will ideally continue to become more efficient over time.