Over one year ago my office implemented Allscripts Enterprise EHR (Electronic Health Record). I’ve not done a note on paper since. Last week, a “Transition of Care” (TOC) document was placed on my desk with a sticky note stating: “Dr. Nieder please fill out this form so we can bill a 99496 for your visit with Mrs. Jones yesterday”. I pick up two sheets of paper with multiple questions including:
- Discharge Medications: (list)
- Present Medications: (list)
- Diagnostic tests reviewed/disposition (list)
- Disease/illness education (discussion documentation)
- Home health/community services discussion/referrals: (list)
- Establishment or re-establishment of referral orders for community resources: (list)
- Discussion with other health care providers: (list)
- Assessment and support of treatment regimen adherence: (discussion documentation)
- Appointments coordinated with: (list)
- Education for self-management, independent living and activities of daily living: (discussion documentation)
between us. However, at least in my institution, my staff and I bear the brunt of gathering information (which is what we normally do anyway, so I guess it’s nice because now we get paid for it).
The form will not keep the patient out of the hospital. Communication will keep the patient out of the hospital. True coordination of care might keep the patient out of the hospital. More busy work for the patient’s primary care doctor will not. Since the order of the day is using hospitalists (a discussion on that is a post for another day) it is imperative that we improve our communication systems at the time of discharge and before the patient is seen again in the primary care office. Systems must stop thinking that one more form is going to save the patient. Especially another form on my back.
This post’s ending was rewritten on 10-10-2013 to take into account the multi-faceted reasons for the form.