The electronic health record acts as a catalyst for office workflow. Demographic and clinical information is available throughout the office and can be accessed real-time by a range of different staff. This enables and actually mandates a completely new way of working.
Office Layout and Patient Scheduling
Although it is often not possible to reconfigure your office, there are certain office layouts that may be more conducive to enhanced patient flow and efficient workflow.
- Consider not even having a personal office. Many family physicians have a workspace adjacent to the examining rooms. This allows for more awareness of what is going on in the office and examination rooms and allows for "visual control". By observing patient flow and certain cues when a patient is in the room, the family physician is much more aware of patient flow and is able to keep up more efficiently with the work being done. This creates a system used in manufacturing called a "pull system," whereby work is pulled into the next available area. This tends to minimize patients in the waiting room and maximize the useful work in the examination room. The examination room has patients occupying it with the physician doing useful work a significantly larger percentage of the time.
- Consider kiosks with computers in your waiting room or other spaces where patients can provide an interactive history. In this way, information about the patient's problems and history is available to the physician at the time of patient contact. This allows more time to be spent accomplishing useful work with the patient.
- Think about how you can fax and print prescriptions, patient information, and patient education from the examining room. Information technology allows more things to be accomplished with the patient in the examination room. This includes prescriptions faxed or printed, patient information and education and possibly even billing. Thus there is less that needs to be done either before or after the encounter. Some family physicians have been able to minimize or even eliminate their waiting room in this way.
- Consider open access scheduling. This means any patient that desires is able to be seen the same day. Taking care of patients' problems promptly and efficiently encourages good office workflow and reduces the waste of redundant work (patients calling back if their needs are not met etc.).
Using some of the above strategies, you should find that the cycle time or amount of time a patient spends in your office is decreased. Time is saved in the waiting room and by eliminating other wasted steps that do not help you or the patient. What you should find is the time spent with the patient doing useful work is the same or greater than with the paper world.
