Summer Wrap-Up

Last week, at our team meeting, we cleaned up the aftermath of the summer. Doctors' holidays make it challenging to keep up with our backlog. Last summer, we saw our 3rd NAA times creep up. In the early part of this summer, the numbers were looking good, and we thought we'd changed the system enough that the wait wouldn't grow, despite reduced capacity.

No such luck. Our latest 3rd NAA is up to 60 days. Here's hoping that the end of summer holidays signals an improvement here.

There is some brighter news. Last post, I looked at our patient-recall patterns. We've got data from May to August now, and there's still a striking variation among urologists in the rate at which we recall our patients for review. Here are the average recall rates:

Here's the promising part:

Isn't That Special?

In "Bang for your Buck," I reported our urologists' recall rates. The variation among urologists was striking. Some rarely recall anyone, while others recall nearly a quarter of their patients. Here are the rates (thanks, Amanda) for May to July:

Two of the docs have zero monthly recall stats because they were away for those months. But another doc, who was working during this period, also had no recalls. I asked both of the low-recall docs why they are so different from the rest of the group. One didn't know why there was such a discrepancy, but commented that maybe he wasn't recalling often enough!

In the previous post, I made the same observation. I meant it slightly tongue-in-cheek, but there is a kernel of truth in that comment. We want to reduce unnecessary recalls (internal demand), but not at the expense of compromising patient care.

All-Access Pass

Since my last post, I've continued my trial of mydoctor.ca's secure messaging system. I've signed up 27 patients and receive 1-2 messages per day. Several patients have written that they think this is a great way to communicate. My impression is that all the questions I've received would have warranted phone calls or office visits if electronic messaging was not available.

I like the option for asynchronous, or time-shifted, communication. If I have calls to return, I either make the call before I leave the office, or it waits until the next day. With electronic communication, I can leave the office on time to see my son's soccer game, and then deal with emails later in the evening.

I currently have a patient who had to travel very soon after having a biopsy done. I'm planning to use electronic messaging to let him know about his results. Playing phone tag with someone on a different continent would be very frustrating.

It's also easy to cut-and-paste the messages from mydoctor.ca into our electronic chart, so I don't have to make additional notes, like I would for a phone call.

There are some negative aspects to electronic messaging. There's no way to pick up on the sometimes-subtle emotional cues you get over the phone.  I wouldn't want to break bad news this way.

Some of the exchanges I've had could have been dealt with better on the phone. The mydoctor.ca site already has a notice telling patients to call their doctor for emergencies. Also, some complicated discussions about multiple treatment options are more appropriately handled with a live conversation.

There are plenty of people who don't have internet access, or who are just not comfortable with communicating this way. I wouldn't force this option on them.

Tech Talk

In this age of Google and iPhones, a colleague of mine is ostentatiously low-tech. He scrawls his to-do list on a pocket-sized notebook.  And takes a lot of ribbing for it.

I fancy myself at the other end of the tech spectrum.  I'm always watching for the latest device or application that will help me run my practice more effectively.  So whenever I see him squinting at the tiny writing in his notebook, I think:

Good for you!

He's got a system that works.  He reviews and updates his list regularly.  It's with him all day.  It's accessible, versatile and user-friendly.   It's not bloated with esoteric "features". 

I have other colleagues who say, "I have the latest PDA."  Which they leave at home because it's a hassle to carry it around. 

Contrast the $2 practice management tool with the $250 paperweight.  Information technology has huge potential to increase our practices' efficiency and improve the service we provide.  We each need to pick the tool that fits our style and needs.

And then use it!

The most significant technological Clinical Practice Redesign (CPR) change we've made in our practice was implementing an electronic medical record (EMR).  I've sung the praises of EMR before. We started computerizing the office over 20 years ago, but initially just used the system for appointments and billing. The physicians didn't have computers in their offices.  About 3 years ago, we decided to adopt an EMR.  It's been a slow process.