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Effective and Efficient LCR Charting Naomi Schoenfeld, FNP Lead Clinician Family Health Center. Goals. Improve NP job satisfaction and decrease burnout risk by improving charting efficiencies Make the best of a clunky system in its dying days. Objectives. By the end of this presentation:

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effective and efficient lcr charting naomi schoenfeld fnp lead clinician family health center
Effective and Efficient LCR ChartingNaomi Schoenfeld, FNPLead ClinicianFamily Health Center
goals
Goals

Improve NP job satisfaction and decrease burnout risk by improving charting efficiencies

Make the best of a clunky system in its dying days...

objectives
Objectives

By the end of this presentation:

Participants will be able to name at least one time-saving strategy for LCR charting

Participants will improve their ability to enlist the computer as an ally and teaching tool in clinic

general emr tips
General EMR Tips

Take advantage of what it's good for:

Tracking HCM

Keeping track of medical problems like

Pulmonary nodules

Plavix that needs to be stopped after 1 yr

Copy your old notes

Using computer to share information with patient

Graph of lab results

Pull up pictures or videos on internet

l e v e l
L.E.V.E.L.

Let the patient in on the EMR/LCR

Tell them what you're doing “I'm going to start typing so I can keep track of all the details you're telling me.”

Let them see you completing e-referrals

Let them see you putting meds in and faxing them

Show them Lab results

l e v e l1
L.E.V.E.L.

Empathetic Cues

Talk to the patient before you interact with the computer

Let the patient answer an entire open ended question before logging on to the computer.

Pause for eye contact

Use reflective listening skills

l e v e l2
L.E.V.E.L.

Value the computer

Resist the urge to criticize the LCR

Emphasize the positive

Studies show that when patients hear providers complain about the computer, the primary effect is that they lose confidence in the provider

Explain

Especially if you are going to spend more than 20 seconds in the screen, let the patient know what you're doing.

l e v e l3
L.E.V.E.L.

Log out

Patients' number one concern about EMRs is security

Let them know that you are “securing” or “locking” their record

Prevent HIPPA violations

dr costanza vs exemplary computer user np
Dr. Costanza vs. Exemplary Computer-User, NP

youtube link...

http://www.youtube.com/watch?v=LZAqeJtpzEY

tips for writing efficient notes
Tips for Writing Efficient Notes

General Reminders

What are the goals of writing notes?

Quality patient care, communication

Justify billing

Legal document

It's ok to have typos, misspell word occasionally, and to use commonly used abbr.

As soon as you log on, before you look at labs or what-not, open your note so you can type whatever comes up as it happens

general computer tips n tricks
General Computer Tips 'n Tricks

ALT TAB

This let's you go toggle from screen to screen without having to save/close/re-open note.

Alt Tab Caution:

Don't forget you have an open note! If you accidentally open another one you will lose what you have written

Avoid losing your note. If you will not be entering any text for more than 15-20 min, hold note!

If a note disappears, check Notes In-box.

content tips
Content Tips

Subjective/HPI

Type while talking, doesn't have to be complete sentences

Take breaks if you need to turn and listen, just type in a few words to remind yourself to fill it in later

If you leave gaps try typing ++++++ to remind yourself to fill it in later

content tips1
Content Tips

Subjective/HPI cont'd

MINIMAL IS USUALLY BETTER FROM BOTH A PRACTICAL AND LEGAL PERSPECTIVE

“No red flags” will hold up in court better than listing an incomplete list of negative ROS.

Example: pt c/o LBP x 5 days w/o injury. No help with ibu otc. No red flags.

Usually can finish this part during interview

PMH/PSH:

Can either copy it from last visit or problem list OR don't include in every note

Eg “see problem list LCR”

content tips2
Content Tips

SH/FH:

Do initially, update periodically, but do not need to include in each note

Eg “see note dated 4/18/13 for complete SH/FH

Medications

Just let people look at the LCR

Eg “see medlist LCR”

content tips3
Content Tips

Physical Exam

Vital signs: if MEAs enter in LCR and they are WNL, can just refer to this

See vs lcr

Best to include abnormal vs in your note

General PE: If you have a standard practice you can keep it minimal.

Consider just charting pertinent +'s and -'s.

content tips4
Content Tips

Lab results

Don't list them!

Consider: “labs reviewed in LCR”

Maybe write 1-2 really relevant values

Studies: just refer to them, don't copy them in

Assessment /Plan

Only address active problems/chronic problems

For old/inactive, can leave in PMH or say “not addressed today”

content tips5
Content Tips

A/P Cont'd..

Some find it helpful to include a note at the bottom to remind themselves what to do at next visit:

Eg: NV: TDAP, FLP, A1C, BMP, PAP, BP CHECK

Outside Records

Can use note category “Records Outside Facility” Can jot down a few pertinent notes from outside records...

maximize charting during visit
Maximize charting during visit

Finish subjective during interview

Do e-referrals with patient

Order meds/refills with patient watching on to reinforce med review

Try using teach-back time to complete PE, A/P

practice
Practice!

Just when you're an expert....

You'll move to eCW!