Keeping it Real: The Point-of-care Lifestyle

In the September cover story in Physicians Practice, author Rob Lowes advocates the “fourth exam room concept” as a way of staying on top of your charting, and getting home in time for supper. I have a better idea - I call it the one doctor, one patient, one exam room concept - a real-time, point-of-care approach toward patient management. Point of care, strictly defined (by me), is a mindset, a discipline, a systems approach where patient encounters are conducted in real time. Put another way, if it can’t be ordered, prescribed, integrated, communicated, documented, or otherwise completed before you leave the exam room, you’re not practicing patient care in real time.

Like you, I spend my day in front of patients, and like many of you, in front of a computer. My exam rooms (I actually have two, in case I need to administer IVs) are strategically designed to interface with both. Seven years ago, it was strange: a doctor typing and clicking vigorously in front of a patient. Seven years later, it’s what you expect when you come to my practice. I have an EHR at my hub of course, but it’s our systems that make point of care possible: our fax server; our integrated lab and ancillaries; our document management software; our up-to-date databases of medications; radiology tests; pharmacies and specialists; codes; and prices.

Also like you, my patients present with a random, chaotic, oftentimes nonsensical array of complaints; sometimes by appointment, but more often unannounced. That’s their job. Our job is to transition that chaos into an orderly plan. That plan predictably might include prescriptions, referrals, labs and studies, and follow-up and billing coordination. Each step of the way (and I’ve heard it stated that there are over 120 processes that make up an encounter from the time the patient calls on the phone until the time they leave the office) represents an opportunity for a point-of-care efficiency or breakdown. And while the fourth exam room may give you an opportunity to catch up on your dictation, it does not afford you the real efficiencies where they really matter.

Real-time documentation means that when the patient is giving you the history, you’re typing it into the EHR. After you do your exam and document your findings, you click the appropriate boxes when it’s time to write a script. When you want to refer your patient to a specialist, you choose the physician from a drop-down menu and document the reason for the referral. It all happens in the exam room in front of the patient. Then, as you sign your note and get ready for the next patient, a beautiful thing happens: The prescriptions get faxed, the orders go to your nurse, the referral (and your note from today) faxes to the specialist, and the follow-up plan and charges go to check out. You’re done and not just in time for supper, you’re making supper.

Considering keeping it real?

Find a practice that uses the point-of-care method in your area and arrange a visit.

Critically analyze your systems, looking for areas of automated integration.

Practice charting in real time and work on completing your tasks before you leave the exam room.

David Albenberg, MD, a board-certified family medicine specialist, opened South Carolina's first retail medicine primary-care practice, Access Healthcare, in 2003. He focuses on disease prevention and wellness maintenance. He can be reached at accesshealthcare@letssimplify.com.