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Giving Physicians a Choice in Documentation at Florida Gynecologic Oncology

October 23, 2013
by Rajiv Leventhal
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Physician productivity improves, while the focus remains on patient care

For clinicians, documentation is not a one-size-fits-all model, which is why clinical documentation solutions and services must cater to physicians depending on their personal preferences and their specialty’s unique workflow. In fact, according to reports, oncologists and other specialists document approximately three times as much as their non-specialty colleagues.

The Fort Myers-based Florida Gynecologic Oncology, for example, deals specifically with women’s cancers—a fairly unique branch of medicine, in that the medical center takes care of patients from the diagnosis of cancer all the way through surgical procedures to subsequent chemotherapy, and in many cases, to end-of-life care. “It’s almost like a one-stop-shop here,” says Edward Grendys, M.D., of Florida Gynecologic Oncology.

When Grendys first joined Florida Gynecologic Oncology nine years ago, clinicians used dictation tapes that they would dictate all of their notes onto, which would then be picked up by a courier, and then go to transcription. After two or three days, those files would be e-mailed back to the clinicians. “My secretary would print every one out and put them all on our desks, only to be sent back to the secretary for her to type out all of the envelopes for each one of the referral doctors. If a patient had four referral doctors involved in their healthcare, the secretary would make four envelopes, and mail them out. This simply was not efficient, and with doctors’ illegible handwriting, it became confusing,” Grendys said.

Now, with the help of the Clinic 360 Suite from the Burlington-Mass.-based IT vendor Nuance, the three physicians at Florida Gynecologic Oncology electronically dictate everything, and essentially plug the notes into their computers, which get downloaded automatically through the technology’s transcription service, explains Grendys. “And the majority of the transcriptions are already done by that evening or at latest, the next morning. I can review them on any computer or smartphone—there is no need to be at my desk,” he boasts. This is especially important, since Grendys schedules between 30 to 40 patients visits a day. “I now have the freedom to document, edit, and electronically sign my patient encounters using my mobile device or PC, without falling behind on my patient schedule”

Once the notes are proofread and approved, they are sent electronically to the referring doctors, for which databases at those organizations have already been built. “When we joined this system, they had all the national physicians already in the system. The patient’s name is loaded in there too, so the next time we send a letter, you don’t have to manually add it. We no longer print out any of our notes,” Grendys says.

Florida Gynecologic Oncology is not completely electronic yet—it is in the process of moving to a complete electronic health record (EHR) within the next four months, so there is still a hard-copy chart that has a copy of clinicians’ notes in it, says Grendys. “But the efficiencies we have gained from this are [great]. We think we can save, probably in the neighborhood of eight-tenths of a full-time employee (FTE) a week, looking at what now needs to be done compared to what we were doing before. We’ve also seen a 50 percent reduction in transcription costs. And now, if a patient calls in the middle of the night, you can pull up the medical record of the patient—via these dictated notes—and find out what has happened, where he or she has had treatment, and the overall knowledge of his or her history. That creates a comfort level among our patients.”

Grendys also notes the patient care implications that electronic documentation has on care team communications. “Often, we’ll get a referral from Doctor X, and when the notes come in, it will be a hand-scribbled copy that has little to no meaningful information on it. That is one of our biggest pet peeves.”

But at Florida Gynecologic Oncology, continues Grendys, everything is included in that note, so each of the referral doctors has a complete knowledge of where the patient is in his or her treatment. “Those doctors love that completed documented note. It makes our communication better, and their efficiency better. Fewer tests are re-ordered and there are no re-visiting exams. Also, we live in a marketing world. They like the service they are getting from us, and we think that helps our referral base.”

Grendys admits that at first, there was some internal struggle with the concept of changing how they document. “There was a thought among them of, ‘Well, if it worked in the past, why change it?’ Getting staff buy-in was definitely a challenge. Whenever you try to change things, there is a subtle resistance—people like the status quo. But as we transitioned, the technology standpoint became very easy. The internal reluctance was the bigger issue.”

Moving forward, Grendys believes that mobile clinical documentation will be present in the entire medical community before long. Even now, says Grendys, we are seeing that radiographs and CT scans are digital and done online. “At some point, it will be better coordinated in a universal record. The problem now is there are different systems that don’t talk to each other with different processing languages. But realistically, I see this as being the complete future of everything. Yes, there is always the public paranoia of having too much information in one place, and that is a real concern in terms of security. At some point, though, all of these systems will talk to each other and handwritten documentation will be eliminated.”

And the ability to keep that continuity allows a clinician such as Grendys to look at one of his two partners’ patients in the middle of the night and not have to search backwards for 10 other notes to see the clinical history. “We have customized all of our templates to our own needs, and old notes are kept, while new information is added. Remember, these folks are pretty sick. They’re getting aggressive therapies and have advanced diseases. For us, documentation is critical to providing them better care.”

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