Dome home blank
Search Dome


Paper, Paper Everywhere
When doctors were asked to name obstacles to outpatient clinic efficiency, it was no surprise what piled up.

After Hopkins internist Redonda Miller spends 15 minutes examining an outpatient, she often has to complete 10 or more pieces of clinical paperwork for that single encounter—forms for pain assessment, laboratory tests, prescriptions and medication reconciliation among them.

Orthopedic surgeon Lee Riley, who may see 20 to 30 patients on a day in the outpatient clinic, finds himself spending up to 90 minutes every night to complete documentation from those appointments.

Miller and Riley recounted their frustration with paperwork at a recent meeting of the Clinical Practice Association practice management committee, which was reviewing the results of a survey of full-time faculty on the barriers to efficient operation of outpatient clinics. Given the ever-increasing administrative and regulatory burden placed on both clinical and nonclinical staff, few were surprised that documentation requirements led the list of impediments.

The top obstacles identified in the survey will give the CPA and Hopkins Hospital a roadmap for improving outpatient operations, says Mark Bittle, the CPA’s director of practice management.

Although ambulatory care once was a small fraction of the clinical practice, today it makes up 45 percent of Hospital and faculty practice revenues. Last fiscal year, 1.1 million outpatients were seen at Hopkins Hospital, its emergency department, JHOC, Hopkins Bayview, the Rubenstein Child Health Building, Green Spring Station and White Marsh—all locations where the CPA sent its outpatient clinical efficiency survey in January.

Of the 286 physicians who filled out the survey, a whopping 73 percent singled out paperwork as an obstacle to efficient use of time. Other top problems included patient no-shows; slow access for patients seeking consultations, especially on a same-day basis; lack of exam room availability; and support staff, nursing and medical staff shortages.

“We know that there are things that work,” says Bittle, who is also Hopkins’ senior director of ambulatory operations. “You send patients a reminder letter, they’re more likely to show up than if you don’t. Yet a lot of our departments don’t send reminder letters.” Similarly, more effective use of the existing patient scheduling system could improve patient access.

But the most vociferous complaint—reducing the amount of paperwork physicians do—may require a variety of solutions. One approach could be to determine what paperwork the physicians themselves must complete and what paperwork other caregivers can handle. Similarly, new methods should be devised to reuse data so that health care workers don’t have to re-enter it multiple times, says Bittle.

He acknowledges that nonphysicians may have other perspectives on the causes of inefficiencies—for instance, physicians not showing up for clinic on time. “There’s a bigger picture out there than what we’re looking at with this data,” he says of the survey results. “But you have to start somewhere.”




Johns Hopkins Medicine

About Dome | Archive
© 2007 The Johns Hopkins University
and Johns Hopkins Health System