The transition to electronic health records (computerized medical records to normal people) has been more or less mandated by governmental and private insurers. The time, cost, and effort involved in making the transition has led many physicians to fondly recall the use of paper charts in "the good old days."
Yours truly is not among this cadre. Illegible handwriting, misplaced charts, the inability to immediately conjure up my patient's records simply with a few clicks on my smartphone (like I can now)—those are some of my memories of how life used to be in the era of paper charts.
But just like cataract surgery has evolved during my career from a three-day inpatient experience of extracapsular extraction to a 3-hour outpatient experience of phaco, we physicians and our practices will need to adapt to our new reality.
According to a recent presentation at the American Academy of Pediatric Ophthalmology and Strabismus, pediatric ophthalmologists spend an average of 10 minutes per patient documenting in their computers. Michael F. Chiang, MD, and colleagues found that a pediatric ophthalmologist who saw 2,500 patients over 1 year spent 10 minutes documenting per patient; 46% of that documentation time occurred during the visit with the patient present, 41% occurred during business hours after the patent had left, and 12% occurred on nights and weekends.1
"How much is 10 minutes per patient? If you saw 30 patients per day, then it's 5 hours per day pointing and clicking at the EHR," Dr. Chiang said.
Five hours pointing and clicking! Clearly this explains why you never see pediatric ophthalmologists in the Masters Tournament hitting their golf balls into the water like Jordan Spieth, competing in "Dancing With The Stars," or out partying late at night. Instead they just sit at home, staring at their computer screens, pointing and clicking.
In my personal view, physician practices need to evolve so that we are never spending time doing things like documenting for 5 hours per day. Today, using scribes, we can be speaking directly to our patients while making eye contact, and have the documentation done for us in real time.
The incremental number of patients that need to be seen to cover the cost of an efficient scribe is minimal, and my experience is that practices that use scribes have much higher satisfaction amongst both patients and physicians.
The future requires that physicians perform only those tasks that require all our years of schooling—what can be delegated to staff should be delegated to staff.
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