Strategies guide efficiency in modern medical practice

Take-home message: Improving practice efficiency is more likely to be successful when undertaken with a long-term view as well as an understanding of trends in the healthcare environment.

By Nancy Groves; Reviewed by Thomasine N. Gorry, MD, MGA

Efficiency is an often-cited goal in medical practice. However, achieving efficiency means more than finding ways to shave a few minutes from routine tasks, said Thomasine N. Gorry, MD, MGA.

To start with, consider the context in which one practices before adopting specific measures to improve efficiency, said Dr. Gorry, associate professor of ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia. She is also the medical chairman for quality for the clinical practices at the university.

“In order to be efficient-not just in the moment, but ultimately, for your whole day, your week, and your month-you need to think about how medicine is changing,” Dr. Gorry said. “There is a movement toward value in healthcare as opposed to just fee-for-service.

“Recognize that you’re going to be practicing in an environment that puts an emphasis on showing value, which means that any time you’re building a work flow, you want to build a complementary reporting system to show the value of your work,” she added.

Providing value

Fortunately, ophthalmology is in a key position for value, Dr. Gorry noted.

“It’s well recognized that we perform procedures that are valued by patients and by other physicians, but you have to be able to prove it with operational reports,” she said.

Make sure you can generate a report-preferably by electronic medical record (EMR)-that shows the value of a procedure, such as cataract surgery, by stating the preoperative vision, indications for the procedure, and the outcome. An EMR system can be programmed to routinely build this kind of report and produce it when required.

“It really aids your efficiency in coping with the regulatory process if you’ve already got these kinds of things running in the background as you see patients,” Dr. Gorry said.

Though using EMR may improve reporting efficiency, it counterintuitively adds to the workload since a variety of regulatory and safety requirements must be addressed during the patient encounter. To counteract these demands, it may be necessary to adjust patient scheduling or adopt other measures (for example, hiring medical scribes).

“The sheer volume of data and things you can do are paradoxically diminishing our productivity, and it’s time now to execute an organizational strategy to make that work,” Dr. Gorry said.

Managing data

Another technique for daily and long-term efficiency is to develop and follow protocols for managing data, such as electronic messages from patients.

“Where possible you want to defer administrative work to well-trained support staff,” Dr. Gorry said.

“There is a terrible temptation with anything electronic to respond immediately because you can,” she added, noting that this may be appropriate in some instances but more often is the least efficient thing to do. Set guidelines for when and how the practice should respond (by phone or e-mail), when the staff can handle the response, and how it should be documented.

Being innovative

From a broad perspective, being innovative can also improve efficiency, she noted.

Dr. Gorry’s practice has begun piloting tele-retinal imaging. She and her colleagues have learned that screening and diagnosing diabetic retinopathy and other ophthalmic diseases remotely is feasible, that quality markers can be established, and that value can be proven. But this capability alone will not automatically improve efficiency or lead to a sustainable program.

“You have to recognize when you adopt a new innovation that all of the peripheral issues will have as much impact as the central issue (e.g., retinal imaging),” Dr. Gorry said.

Peripheral issues include spending substantial time communicating with patients that one has not met, ensuring there are resources to accommodate the new diagnoses discovered through the screening, and identifying where responsibility lies.

Engaging with patients

Communication is also a central component in managing a modern practice.

“The value of communication in efficiency cannot be underestimated,” Dr. Gorry said. “By communicating well, you engage your patient to become an active player.”

It should be standard procedure to let patients know if their condition requires a specific number of visits and tests per year. Give patients a printed handout of the management expectations, and let them know if the plan changes. Consider scheduling routine appointments in advance, which decreases the risk that patients will be lost to follow-up.

Another point is to address what cannot be avoided, such as an angry or bereaved patient. Given the demographics of eye diseases, it is not unusual to see older patients who have lost a loved one, Dr. Gorry said.

If emotions associated with the loss are affecting patients, let them express their grief, acknowledge it, offer a tissue, and move on graciously.

Other patients are strictly all business-regardless of what may be occurring in their personal lives-and only want to have the exam and get the results. Learn to make these trade-offs throughout the day.

Standardization is a topic that makes many physicians nervous, as they associate it with loss of autonomy. However, if managed correctly, it can boost efficiency, Dr. Gorry said.

“It’s just basically mimicking the human body,” she said, likening it to the predictable anatomy of the eye in patient after patient.

One helpful application is to develop a standardized method of communicating during patient visits-not necessarily a script to be followed word for word, but a set of questions, statements, and topics to be addressed in a recommended sequence.

For instance, either the physician or technician should ask at the start of visits if patients want glasses, since bringing this up at the end can throw off the schedule if patients say “yes.” When a technician follows a protocol before the physician arrives in the exam room, the physician can then summarize it and allow patients to confirm or amend the information, rather than having to go through the same set of questions.

The EMR templates for procedures and visits also need to be maximized to prompt the physician into including all of the necessary information, and the records should be organized so that data can be located quickly. Creating these templates takes time, but if they are set up well, they enhance efficiency going forward and also make the records safer and more reliable, Dr. Gorry said.

She also recommends taking advantage of links within EMR systems that allow the physician to perform tasks, such as auto-populating letters to primary-care physicians by drawing information from the templates. A high-volume practice may prefer to set up the system so that an office staff member can generate these letters.

Once a number of links and templates have been built within the EMR, it may be helpful to create a library, such as a spreadsheet, that can jog the physician’s memory and is independent of the EMR system.

Thomasine N. Gorry, MD, MGA

E: Thomasine.Gorry@uphs.upenn.edu

This article was adapted from Dr. Gorry’s presentation at the 2016 meeting of the American Academy of Ophthalmology. Dr. Gorry did not report any relevant financial interests or relationships.