#Workflow in #primarycare #office

We all have our routine, but I would like to share my workflow from check in to check out.  This, I hope, will stimulate some discussion and thought about differing ways to approach this topic.

The office visit begins with the checkout process from the year before, as my nurse sets the appointment a year in advance, and then a postcard reminder a month and telephone reminder 24 hours before.  Three different modalities, computer, mail and telephone to minimize the no show rate has worked quite well, and the postage, worth the effect.

My nurse will collect the patient from waiting area, weight, height, and vitals, input data and send chart to my inbox.

I open the chart, on my desktop, clear out HPI, Assessment & Plan with creation of new note. VNC viewer for Chrome sign in on my Chromebook, automatically brings up my ready to go note with weight already graphed and ready to project.  As I walk into exam room, plug the TV to the HDMI extender and the chart is visible and ready to educate.

After going through the chart with the patient, educational materials printed and reviewed, orders sent and e-prescriptions completed, unplugging the Chromebook extender turns the TV black, and goodbye ritual completed, I head back to office and plug in to keep the virtual desktop device powered up.

I complete my note with Medical Dragon, templating and minimal typing, and send the summary to the patient, office note to Dr. X Y and Z, and print up super bill, and sign off chart.

One fluid motion with several devices, but clean simple efficient.  Next year visit assigned, note completed, portal messaging and consultant notes sent, billing completed, and next patient ready to go and cycle repeated.

Multiple, repetitive, efficient machinations not detracting from the matter at hand, listening, examining, teaching, working, and of course caring. 



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