ºÃÉ«ÏÈÉú

DOCUMENTATION

• Collect as much information as possible prior to the visit
  • Pre-visit questionnaires (e.g., Parkinson's, epilepsy, multiple sclerosis, headache, sleep)
  • Prior authorization
  • Insurance verification
  • Verify place of service for patient visit (i.e., geographic location and site of service)
  • Verify mode of transportation (e.g., arriving by stretcher for inpatient setting)
• Make your EHR work for you
  • Implement single sign-on (i.e., sign on once per day to access all apps used during the day)
  • Review settings and advocate for changes when appropriate for:
    • Frequency of mandated password changes
    • Automatic log-off on computer
  • Consider using auto-populate functionality to pull in existing chart data into the note
    • Consider whether this is needed for documentation and billing purposes or might be contributing to note-bloat
  • Review alert and notification settings to determine whether all are appropriate for your practice
  • Implement continuing education sessions with your Information Technology (IT) department to understand latest EHR changes
• Document promptly and accurately to ensure proper coding and billing
  • Use dictation software or scribing service (virtual or in-person) to minimize documentation burden
  • Create templates for documentation for each subspecialty that include all major elements and SmartPhrases
    • Update templates to align with annual Medicare changes

CLINIC WORKFLOW

• Room patients by disease state (e.g., place patients with impaired mobility in rooms closest to the seating area)
• Consider developing customized patient time templates to better meet patient needs (e.g., shorter and longer options; templates to reflect different physicians' styles or patient panels)
• Renew prescriptions for at least one year when possible and appropriate
• Ensure patients understand care plan and next steps
  • Confirm patients are signed up for patient portal for quicker results and communication; if not, sign up at time of encounter
  • Educate patients on appropriate use of patient portal to maximize utility for patient care and minimize burden on clinicians
  • Submit referral orders and/or coordinated care transition plans and communicate to patients
• Review patient visit workflow to ensure physician, APP, or nursing are practicing at top of their license
  • Delegate administrative tasks to support staff (e.g., verifying correct pharmacy is on file, setting up follow-up appointments, non-clinical follow-up questions in EHR in-basket)

ADMINISTRATIVE AND COMPLIANCE

• Review processes for between-visit tasks including:
  • Refill protocols
  • Prior authorization workflows
  • Appointment reminder systems (e.g., same-day reminders, links to pre-visit paperwork)
  • Scheduling practices (e.g., weekend or evening hours, stagger arrivals to avoid morning and post-lunch rushes for front desk staff)
  • No-show and late arrival policies
  • Triaging workflows for patient messages and calls
• Ensure processes and templates are updated with annual government changes to avoid rework
  • Interoperability and Patient Access Act/Information Blocking rules
  • Quality Payment Program requirements
• Implement system for staff to submit practice inefficiencies for improvement
  • Review resources
  • Encourage care team to share best practices, templates, and tools for enhanced practice efficiency

Patient Communication 

Refills

• Have patients contact the pharmacy for refills. The pharmacy will then send the request electronically. Most EHRs accept the request in a format that is easy to refill with minimal clicks. Patient portal utilization reduces errors and allows more timely responses.
• During the visit, utilize support staff to prepare potential refills.
• When possible, prescribe adequate quantity to get the patient through to the next appointment.

Portal Messages

• Establish expectations for appropriate portal message content and response times.
• Explore charging for portal messages as if applicable.
• Consider having portal messages go to clinical support staff for triage before going to the physician (e.g., reschedule requests).
• Communicate that if the patient is having an acute or urgent medical issue, do not send a portal message and provide appropriate guidance on who the patient should contact.

Scheduling

• Encourage the patient to schedule follow-up visits with APPs if access is a challenge on physician schedules.
• When needing to be seen emergently, clearly communicate the wait time expectations, or if they need to see another member of the care team.
• Consider developing language to convert a patient to a telehealth visit.
• Communicate established time frames for when patients will be seen if they are running late, and if they arrive beyond the time frame, they may have to wait to be seen.
• Remind caregivers that patients need to be present at the visit, including during telehealth encounters.

During Appointment

• Consider having staff load patient information captured via EHR or patient portal prior to the patient's arrival.
• Ask your staff to communicate with the patient to let them know if a provider is running behind and the expected wait time.
• Have rooming staff prepare patients by asking them specific questions in advance of the physician’s arrival into the room.
• Involve your patient in the EHR documentation by sharing your screen with them.
• Dictate the summary and plan with the patient in the room. This enables note completion before you leave the room, provides a summary of the visit so that you and the patient are on the same page, and matches the patient summary that is printed out or published to the portal.
• Encourage patients to consult their notes after the visit to decrease follow-up portal messages and phone calls.
• Reiterate the value of using the patient portal as the most efficient way to interact with the practice to get the patient’s needs addressed.
  

Results

• Set expectations about when the ordering clinician will reach out (e.g., there won’t be a personal outreach if the result is normal).
• Communicate an appropriate time period for when labs will be back (e.g., “Most results will show up in the portal in 7-10 days; others may take longer”).
• Keep in mind that in most cases, the 21st Century Cures Act has led to patients having immediate access to their progress notes and lab/imaging results. Learn more.
• Prepare patients by discussing potential test results and the meanings of those results.

Efficiency Tips

The following efficiency tips were submitted by AAN members in answer to the question, "What is your most obvious efficiency tip?"  The tips are meant to be easy to implement with high impact on your efficiency.

Do you have an efficiency tip for your colleagues? Please share it with us!

ADDITIONAL RESOURCES AND ARTICLES

In addition to this checklist, the AAN recommends practices review the resources related to enhancing practice efficiencies and reducing burden and burnout, including:

• Family Practice Management article on “”
• New England Journal of Medicine article on “”