EMR Workflow Continues to Evolve

Posted on May 8, 2012 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

As we approach the midpoint of 2012 our practice will complete 7 years of electronic medical records.  Just like a musical instrument, we will never have EMR fully mastered, but our skills and wisdom continue to grow slowly with time.  Over the past several weeks one lesson is becoming clear.

To this point I have equally supported 2 types of workflow for the exam room.  The first involves the physician working solo in the exam room with a laptop or tablet computer.  The medical assistant remains at the nurses’ station to support workflow.  In our financially strained environment we can’t afford to add another medical assistant to put in the exam room with the physician.   In this model the EMR enhances the physican’s documentation and workflow control capabilities and eliminates the need for an assistant in the exam room.

In the second workflow the doc never touches the computer.  Instead a medical assistant or nurse accompanies the doc to the exam room and documents on a laptop.  After capturing the results of the physician interview and the exam findings, the assistant documents workflow in the EMR.   The doc uses the workflow engine to initiate and control workflow.  It works well but carries the expense of an additional assistant, some $40k per year including benefits.

Over the past year I have been blessed with 2 exceptionally talented RNs who are both outstanding clinicians and savvy computer users.  The first of them will be going out on maternity leave soon, so the second was hired.  For several weeks they have both been working and training together so I have had the (expensive) luxury of having an extra assistant to bring to the exam room.  Thanks to them I have come to realize there is no reason for me to operate the workflow engine.  For most patients the RN can listen to my conversation with the patient and initiate the treatment workflow via the workflow engine.

By allowing the RN / assistant to operate the workflow engine we eliminate the need to keep an assistant at the nurses station and this eliminate the additional expense.

We have also replaced our web portal vendor after several frustrating, unsuccessful years.  I am very excited about the Intuit product.  Although I have been wrong many times about similar technologies in the past I remain hopeful that that the new portal will be attractive to patients.  If that happens we will finally be able to automate several workflows and get a measurable return on investment on the portal itself.

Combining a successful web portal with a sophisticated workflow engine operated by staff holds the promise of taking our practice to the “next level” with our EMR.  This will allow us to automate data input, workflow management and patient communication.  This is very important to physicians.  As a group we docs see EMR as something we constantly put resources into but rarely get anything back out.   This would be a big step past that barrier.