The Successful and Audit-proof Medical Office: Second Edition

In the second edition of this manual I have retained the basic information about the special requirements of running a medical office. I have added a good deal of practical information about making the most of the electronic medical record. I have gone into detail, with step-by-step guides, on how to go paperless—which will free the office staff from non-productive chores like ‘pulling charts’ and filing; the result is that the staff ratio, and hence costs, can be reduced, or the staff can do more in terms of recording patient vital signs, maintaining chronic disease registers and generally educating the patients (see Personnel —Whom to Hire and Whom to Fire).

This eBook will be updated as I find and assess new software, and as updates occur for the mentioned programmes.

Though written by a general practitioner for general practitioners there is much information that will be relevant for specialists

Most graduates should now be joining established group practices. The information in this manual will enable the incoming physician to judge the safety and desirability of the medical group; and to confidently advise changes.

This is a reference manual. There are inevitable repetitions and duplications. It is not designed to be read from cover to cover; I have used a generous number of hyperlinks to facilitate navigation between the reader’s areas of interest.

I have aimed to enable a physician to make a practice safe, enjoyable and efficiently profitable. The most important of these is ‘safe’.

THE SUCCESSFUL AND AUDIT-PROOF MEDICAL OFFICE

Second Edition

Dr Chris Pengilly, CCFPC

Published by Chris Pengilly

Copyright 2016 Chris Pengilly

ISBN 978-0-9878785-2-6

Contents

Preface

Going Paperless

Preamble

Practice Type—Solo or Group

Office Design

Waiting Room (Reception Area

Examination Rooms

Nursing & Paramedical Areas

Every Day Cleanliness and Infection Control Maintenance

Telephone System

How the Office Runs

Appointments and Scheduling

Equipment

Sterilization and Prevention of Cross Infection

Emergency Kit

Drugs and Supplies

Personnel–Whom to Hire and Whom to Fire

Repeat Prescriptions, Correspondence, Referrals Etc.

Patient Confidentiality and Examination Draping

The Medical Record

Making Maximum Use of the Computer during an Office Visit

Keeping to Time in the Office

Most Common Deficiencies

Useful Websites

About the Author

Preface

Since 1988 I have been assessing practices, mostly family practices, in a medical peer assessment programme. Reflecting the individuality of physicians there is a wide diversity of family practices. I have seen elaborate practices in Spartan surroundings, and minimalist practices in affluent city centres. One theme, however, keeps coming up; that is 'this [setting up and running a medical practice] was never taught at medical school'. I hear this from Canadian and foreign graduates alike, and unfortunately from recent graduates as well. At medical school physicians are taught anatomy, physiology, biochemistry and clinical skills — but at no time are they taught how to set up and run a practice — the everyday interface between them and their patients – that is the business aspect of medical practice which most physicians reluctantly have to perform. So I hope that this manual will help you with all the aspects of this.

Return to Table of Contents

Setting up a Paperless Office:

Going Paperless

The electronic medical record has burst on the scene over the past 10 years. It has been around for quite a bit longer but now seems to have hit a critical mass with the majority of physicians adopting it. Sadly we have missed a great opportunity of adopting electronic medical record programmes that are mutually compatible. It would be difficult both politically and technically to impose a universal EMR denying all competition. The competition between vendors will tend to promote further research and constant technical improvements, but nonetheless the incompatibility between programmes will prove expensive in the long run. Many dollars could be saved if the emergency department of the local hospital had controlled access to my EMR. The most obvious result should be saving duplication of investigations, but it would also get the emergency room physician up to speed concerning the background of the patient. A prerequisite of this is that the EMR must be completed comprehensively and kept up to date.

Going paperless not only saves the physician overhead expenses in paper and printer toner and staff wages but it enhances the electronic medical record as a valuable clinical aid.

To work effectively a good computer and peripherals are essential. In each room you will need.

A hard wired computer with 2 monitors. The basic requirements for this will be a computer with a good fast processor and a large amount of RAM. A quad processor at no less than 1.8 GHertz is satisfactory, and about 4 gigabytes of RAM. Wireless tablets have the disadvantage of potential security breaches. Also the screen will be smaller and single. They do have the advantage that it is easier to maintain eye contact with the patient.

A label printer

A monochrome laser printer

In this section I will be mentioning the programmes which I have used. There are other equally good programmes available but I am writing from experience. I am not sponsored or anyway commercially influenced by any of the named programmes. I simply know that they work well for me, a regular GP.

Incoming information to a doctor’s office is in one of 3 forms.

Letters of all descriptions sent by courier or mail.

Incoming faxed documents

Investigation results most commonly laboratory results though now beginning to involve medical imaging and consultations from the hospitals.

Incoming Paper Documents

All incoming paper documents will need to be scanned. Choosing a good scanner is important. This will be very heavily used, and so a good quality robust device should be chosen and this will not be inexpensive. It should have the speed of at least 30 pages per minute