Delegating for more patient care time
Donna Frisch, MD, OptumCare Medical Group (OCMG)
OptumCare® Medical Group (OCMG) serves communities within Orange and Los Angeles counties in Southern California. From pediatric and adolescent medicine, to adult and senior care, we strive to provide a higher level of service through our unique, patient-driven model.
At OCMG, we share what might be seen as a surprisingly simple goal: making the health system work better for everyone.
As an early adopter of the electronic health record (EHR), I’m quick to affirm the advances it brought. Accurate medication lists, trending of results, and, of course, the ability to pull detailed history without sifting through handwritten notes has undeniably made patient care safer.
But as most clinicians would quickly assert, the cost for all this wonderful data is an increase in time spent feeding information into the system.
Clinicians finding themselves more beholden to our technology than to our patients are of genuine concern. A 2016 study from The Annals of Internal Medicine studied the use of time of 47 physicians in primary care, orthopedics and cardiology.
It found that only 27% of physician time was dedicated to face-to-face direct patient care, while 49.2% of physician time was given to the EHR. Additionally, physicians reported one to two hours in the evening at home catching up on administrative tasks for the EHR.*
Solving this imbalance requires a multi-pronged approach. In my own practice, that importance of delegating tasks traditionally done by the doc, but much more efficiently and as effectively completed by administrative professionals, allows me to gain back precious patient hours.
Our practice’s innovation in delegation includes hiring a medical transcription company to provide written records of test results and follow-up instructions.
Case study in good delegation
When I order a test, I always provide my patients with their results. This practice promotes health education, awareness of how lifestyle changes impact results and a sense of ownership — having their results in-hand provides patients with a resource they invested in.
I ask my patients to look for their results within two weeks, and remind them, “No news is no news!”
However, typing letter after letter of patient results was a serious drag on efficiency.
Consulting with a good friend who owns a medical transcription business, we created a system by which my physician time is spent deciphering the clinical meaning and actions needed from given test results.
Then, using a code and corresponding templates, the medical transcription company delivers results and my medical advice directly to the patient. Correspondence is kept within the EHR, ensuring patient privacy.
Our code includes the shorthand I use and its matching phrases. The transcriptionist adds my desired content then formats the letter as professional, error-free letters and sends to my patients through the EMR.
The shorthand “Diab$” creates the content: “Your glucose control as demonstrated by the HbA1c (glucose coated with hemoglobin) is _. Please work on a diabetic type diet (see diabetes.org, WeightWatchers for diabetics, NextMD Education Center), exercise daily (3 to 5 miles of walking per week decreases or delays the development of diabetes regardless of weight), reduce alcohol intake to less than 3 drinks per week if you drink, and lose weight if your body mass index (weight in kilograms/height in meters squared) is greater than 24 kg/m2.”
Each letter used to take approximately five minutes to complete. Keeping up was a never-ending task. Now, reading the results and then spending a few keystrokes to indicate what templates to apply, the process is down to seconds.
At five minutes per letter and between 100 and 150 results letters per week, I estimate that my time savings is on the order of ten hours per week.
By moving an administrative task from the desk of the physician to a more appropriate clerical professional, my patients get clear, reliable correspondence and I return those saved hours to the role that most requires my expertise: patient care.
This publication is informational and for educational purposes only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of OptumCare. The views and opinions expressed may change without notice.
*Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S, Goeders L, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. 2016; 165:753–760. doi: 10.7326/M16-0961