Incorporating residents into EHR workflows can be very challenging. Some of the more common issues that can be addressed using Allscripts Touchworks EHR will be discussed in this article.
Challenges and Recommendations
Challenge 1: Tasklists/worklists can become overwhelming and difficult to manage as residents move from one specialty to another.
Recommendation: Residents should complete or reassign tasks and worklist items prior to moving onto another specialty and be expected to manage their lists on an ongoing basis. Anytime there is a task assigned to a resident that he or she is unable to complete, it should be reassigned. Also, resident tasklists should be monitored by a designated faculty member on a routine basis to verify that the tasks are being completed on a timely basis.
Challenge 2: Order workflow is complicated when residents rotate through different locations. The site of the ordering provider drives the address and phone number on prescriptions and orders. Sites can also drive what appears on applicable worklists. The wrong site causes the order to end up on the wrong worklist and may get missed or mishandled.
Recommendation: Set the residents preferences to “select site upon login”. This will force the resident to select the appropriate site each time they log in to prevent issues with labeling and routing prescriptions and orders.
Challenge 3: Resident order/billing workflow issues can occur because residents are not credentialed with insurance companies.
Recommendation: The residents ordering authority should be set lower than the order. This prompts the resident to select the appropriate supervising or precepting provider's name on the order for compliance and billing. The correct billable provider will appear on the order to avoid rejected claims.
Challenge 4: Resident charge workflow is complicated because residents often enter the charges, but the attending/ preceptor is responsible for reviewing and submitting the charges.
Recommendation: Residents should not be defined as billable providers in the system. Residents associated with the appointment will be the performing provider. If the billing provider isn't defined to default automatically from the interface, he/she can be selected by the resident. The resident should also be defined as requiring charge review in the system. This will automatically task the billing provider (attending/preceptor) with reviewing the charge encounter form before it gets routed to billing for processing. This workflow allows the residents to participate in charge entry and the attending to review and sign off prior to submission.
Challenge 5: Some Attendings find themselves signing the same note multiple times when working with their residents.
Recommendation: Residents seeing the patient should be the owner of the note (the resident's ownership authority should be equal to or greater than that of the note). The resident will receive a "sign note" task as a reminder to finish the note. The resident's finalization authority should be less than that of the note. Once the note is ready from the resident's perspective, he or she will sign the note and then be prompted to route to the attending for co-signature. The attending should wait for the co-sign note task to avoid reviewing a note not yet completed by the resident. This workflow reduces the chance of multiple signatures on the same note by the attending overseeing the resident.
There are many additional workflow challenges that require solutions to successfully incorporate residents into the operations of your organization.