EMR Gives Stability to Medical Office Workflow

I am presently devoting all of my extracurricular time to preparing 2 talks for the upcoming Annual Meeting of the American Academy of Otolaryngology – Head and Neck Surgery.  The big talk is a 1-hour instructional course entitled, “Navigating the Unknown Waters of EMR.”  My blogging over the past year has already organized most of the relevant material.  Nonetheless as I try to bring it all together some new thoughts emerge.

One such notion is that EMR stabilizes office workflow by giving the medical office an IT infrastructure similar to other industries.  For example, FedEx has a very elaborate computer system that supports their workflow.  Employees may come and go, but the IT infrastructure forces the work to be performed in a certain manner.

The medical practice has never had anything like that.  Consider the example I used in an earlier blog on workflow design using an EMR.   In that post I reviewed how a “simple” workflow – handling patient phone calls – was improved through the use of an EMR and a contemporary phone system.

Let’s take a look at patient phone call workflow in paper chart office.  Often there is no formal workflow.  Whoever is near the phone answers it, takes the message, and hangs up.  That person may or may not attach the message to the paper chart.  They may then choose any method of communication (voice mail, e-mail, text, phone log slip, sticky note, etc) to notify whomever they choose (doctor, nurse, assistant, etc.) regarding the message.

This continues until something bad happens.  A patient may complain that his phone call was never returned, or a referring physician with an urgent problem is left on hold too long.  Then the doctor sits down with the office manager and says, “Things are out of control around here.  We need to organize better how we do things.  Let’s come up with a plan for patient phone calls and then stick to it.”  The manager dutifully comes up with a plan, meets with the staff, and cleans things up.  Phone calls are handled well for a while, but over the next 12-18 months workflow slowly deteriorates until the next adverse event occurs, and the cycle repeats.

Performance on handling phone calls deteriorates when there is no infrastructure supporting the patient phone call policy.  In a paper chart office the plan for handling phone calls lives only in the brains of the office manager and staff.  As memories fade and staff inevitably turns over, the information is lost and the plan falls apart.

In a practice with EMR and a good phone system, the phone call policy is preserved indefinitely in the programming of these two systems.  Our phone system’s caller menu routes all non-appointment phone calls to the same extension.  The EMR system makes patient charts from all offices available in real time to the single person in our practice assigned to patient phone calls.  The cycle of workflow deterioration, adverse event, and workflow restoration is broken.

Once our patient phone call workflow was programmed into our phone and EMR systems 4 years ago we have had very few problems.

About the author

Dr. Michael Koriwchak

Dr. Michael Koriwchak

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery.
After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations.
Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia.
With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.