In his current model, Dr. Jim Ingram, a family physician in Auburn, IN, works with two certified medical assistants (CMAs). One of CMA rooms the patient and updates the problem list, the medication list, allergies, etc. She then uses EHR templates to get as much history as possible. The CMA leaves the room to huddle with Dr. Ingram; they review the history together, and he reviews the note. They enter the room together where he clarifies the history and performs the exam, discussing pertinent normal and abnormal findings. He explains the diagnoses and determines the treatment plan with the patient. The CMA documents those items and enters the orders while Dr. Ingram speaks with the patient. Once he is finished, both the physician and CMA leave the room. Together they finish the note, and Dr. Ingram clarifies anything the CMA did not understand. Dr. Ingram then joins the second CMA with the next patient. By being intentional and complete about follow-up on all chronic conditions when patients are seen, much of the team's phone work has been eliminated.
Dr. Ingram spends a lot of time with his CMAs reviewing patient history and exam findings. They have reviewed principles of treatment for chronic conditions commonly seen at the practice. They have also developed refill protocols and are doing some basic pre-visit planning such as printing labs and x-rays for review.
Dr. Ingram has found that his results are great overall. “I never come in on my day off or work in the evenings on notes like I used to. I am much more relaxed during the visits and I am more thorough with my patients. I no longer have to flip through the chart looking for things or look away from the patient. The patients enjoy more interaction with me and the CMAs. The CMAs are very proud of their role and have observed our increased efficiency as well. My productivity has increased.”
Reflecting on what the team and their patients have gained from the change to this team documentation model, Dr. Ingram remarks, “For me, the biggest return on investment was achieving a real sense of teamwork, increased joy in practice, and getting rid of extra work at nights and on my days off. Patients are better served by me and the CMAs, and patient satisfaction has increased.”
Dr. Ingram adds, “It hasn't all been easy. At this stage we have worked successfully through most obstacles, but the inertia of our former documentation process is a powerful thing. On the bright side, our administration is now noticing our efficiencies and seeks to implement these changes in several of the other doctors' practices.”
**A note about nomenclature: We prefer the term “team documentation” rather than “scribing” to describe the shared work of medical record-keeping. This nomenclature keeps the focus on the task rather than on the role of the person performing the task.
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