Rep Retirement Lodge: The Banana Bread Is Running Out

[leswp1]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Good Evening Lodge!
Thanks all! RFAlph- how many root canals is it now?

 

[Ralph Baer]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Good Evening Lodge!
Thanks all! RFAlph- how many root canals is it now?

This was the first.

 

[MarkEagleUSA]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Good morning to tLodge!

 

[Ralph Baer]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Good Morning, MEUSA!


Good Morning to the rest of tLodge!

 

[leswp1]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Good Morning Lodge!

 

[Swansong]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

So we had a big upgrade on our main records system at work a few weeks ago. The biggest change was, well, without getting too in the weeds, we swapped the interface of a bunch of things. We'd given months of warning. In person trainings. Webinars. We went out to practices to show it off.

Jesus, you'd think we went to everyone's house and kicked their dogs. Relax folks. We found one issue that alllllmost approached a patient safety issue, and that only if you're a complete moron. Everything else is just "who moved my cheese" whining.

I'm very conscious of user acceptance and how frustrating it can be for ... "weaker computer users" to get with changes. But I'm sorry, it's 2019 and that's life. Hire a scribe.

 

[leswp1]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

So we had a big upgrade on our main records system at work a few weeks ago. The biggest change was, well, without getting too in the weeds, we swapped the interface of a bunch of things. We'd given months of warning. In person trainings. Webinars. We went out to practices to show it off.

Jesus, you'd think we went to everyone's house and kicked their dogs. Relax folks. We found one issue that alllllmost approached a patient safety issue, and that only if you're a complete moron. Everything else is just "who moved my cheese" whining.

I'm very conscious of user acceptance and how frustrating it can be for ... "weaker computer users" to get with changes. But I'm sorry, it's 2019 and that's life. Hire a scribe.

::head explodes::
Hire a scribe? This is not business. This is medicine. Good patient care means you set up the patient encounter in a way that helps foster trust at a time when patients can be at their most vulnerable. A scribe fvcks with that. Gee, I just got raped. I am freaked. Let me tell that to you while they scribe hangs out with us?

How about this is 2019- You should make a system that works for the people you are supposed to be helping document things. We shouldn't be having to change the way we practice or practice bad medicine because you can't create things in a way that works in our system. Good medicine isn't based on business. You can't decide I should suck it up buttercup because some insurance company wants to track metrics a certain way and expect me to think it is my problem.

I am plenty tech savy. No matter how savy I am, having to interact with a machine while trying to care for the patient is intrusive to what I am doing. When the machine moves the target while I am trying to care for the patient you bet I will whine. When the research shows significant increase in work load caused by the tech then it isn't the user who is at fault. (too lazy to look but anecdotally the patients hate the computer in the room. THey like being able to look up labs, results but they have all sorts of commentary about how hteir experience has changed with a computer in the room and it isn't positive.

Research is showing no benefit from EMR for patient care. No improvement in any of the metrics they sell the bill of goods for why we should embrace it. Work load can increase 4 fold. There is something wrong with a concept that doesn't improve outcomes, increases work load, and the people it is aimed at are not the ones considered when designing it. Why does anyone think it is a good idea to do something that requires more time and staff to accomplish either the same thing or less?

Now I have no problem with being hypotensive I am off to go buy groceries.

 

[Swansong]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Ok, cool down now.

First, sadly, medicine is a business. Whether we have some mythical Canada-style system that's free or our kind of... hodgepodge of public and private, it's a business and will always be a business. Whether it's some blood sucking insurance company or CMS, it will always always be managed by people who aren't you (or me!).

Beyond that, life moves on. Technology - especially digital technology - changes and will continue to do so. Every job requires upkeep and re-training. Nothing is static. That's part of life and always has been. Technologies come and go and give way to other technologies. I am sensitive to helping those who struggle with this, but ultimately it's on all of us to maintain our ability to do our job. I have no opinion on whether EMR's help patient care. I'll defer to you on that, but there's zero reason that medicine shouldn't be digital in 2019. Zero.


Regarding scribes, I think this is somewhat misunderstood. You don't necessarily need said person in the exam room with you, especially during extremely sensitive exams. In your example, no, I'd prefer that rape victim is in the room only with the provider and whatever other clinical staff is necessary. Deal with the EMR after. But scribes are useful for the majority of patient visits where the provider can focus on the patient and the scribe, if needed, can just be on the PC and take care of that side. That's what I'm referring to.

Your point:

You should make a system that works for the people you are supposed to be helping document things.

This sounds incredibly reasonable. Right? Isn't that the goal of Epic or ECW or Athena or whatever? But that's the holy grail. The major problems are:
- Patient care is incredibly specific to the patient, obviously.
- The way most care is documented is generic, with a few incredibly important exceptions.

How do we balance that? Those are almost diametrically opposed requirements, aren't they? Frankly, because healthcare resisted going digital for so long, these growing pains should have happened 15 years ago like other industries. But unfortunately, we are late to that party. We should have been having these discussions in 2005, not 2019.

 

[leswp1]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Ok, cool down now.

First, sadly, medicine is a business. Whether we have some mythical Canada-style system that's free or our kind of... hodgepodge of public and private, it's a business and will always be a business. Whether it's some blood sucking insurance company or CMS, it will always always be managed by people who aren't you (or me!).

Beyond that, life moves on. Technology - especially digital technology - changes and will continue to do so. Every job requires upkeep and re-training. Nothing is static. That's part of life and always has been. Technologies come and go and give way to other technologies. I am sensitive to helping those who struggle with this, but ultimately it's on all of us to maintain our ability to do our job. I have no opinion on whether EMR's help patient care. I'll defer to you on that, but there's zero reason that medicine shouldn't be digital in 2019. Zero.


Regarding scribes, I think this is somewhat misunderstood. You don't necessarily need said person in the exam room with you, especially during extremely sensitive exams. In your example, no, I'd prefer that rape victim is in the room only with the provider and whatever other clinical staff is necessary. Deal with the EMR after. But scribes are useful for the majority of patient visits where the provider can focus on the patient and the scribe, if needed, can just be on the PC and take care of that side. That's what I'm referring to.

Your point:


This sounds incredibly reasonable. Right? Isn't that the goal of Epic or ECW or Athena or whatever? But that's the holy grail. The major problems are:
- Patient care is incredibly specific to the patient, obviously.
- The way most care is documented is generic, with a few incredibly important exceptions.

How do we balance that? Those are almost diametrically opposed requirements, aren't they? Frankly, because healthcare resisted going digital for so long, these growing pains should have happened 15 years ago like other industries. But unfortunately, we are late to that party. We should have been having these discussions in 2005, not 2019.

-when I started medicine its focus was on the patient, business was what you did to make sure you could do the caring (unless you were in Plastic surgery or practicing for the rich people). Things fell apart in Bush I admin when they passed laws exempting insurance companies from responsibility if they rejected to cover care.

I reiterate- it is not progress or moving forward when the 'progress' impedes or impairs the ability to do the job, decreases efficiency and does not improve outcome. A well run business doesn't implement something in the name of progress when it does nothing to forward what needs to happen. The ones that do that fail.

It is not good business practice to change your process so it requires more staff to do the same job and that staff doesn't do the job as well as the original system would allow. I can dictate a clear, concise, detailed note with specific information in 2 minutes. Your option of coming out and telling the scribe- time is money. COme out and tell them what happened a few times and you are a visit behind. Even if I drink the Koolaid and agree I should use a system that increases the work load so much that 2 people should do the job one person successfully did before (which is illogical in the extreme)- it is impossible to reliably pick what visit is OK. Example- pt books for rash. Checks in-tells nurse they have a rash. I walk thru the door and they tell me they are suicidal. (true story).

-EMR is for insurance to data mine. As long as you click a box.... Notes are generic, leave out detail, frequently have misinformation because to go back and redo hx is so time consuming people do new note from old note. Info is fragmented- people don't look and things get missed, they ask the patient the same questions someone else asked (that is confidence inspiring) or they get way behind when they take the time to look. Again- how is this modernizing and progress?

And, probably least considered- clicking boxes and doing things on a screen decreases critical thinking and processing for memory. Lots of research showing retention of info when using screen is bad and >450 words the person has an inability to retain detail- even those who have grown up on screens. THe difference is people who didn't grow up on screen are aware they are losing things. The people who grew up with them think they are retaining things better and are actually doing worse.

End point- there is plenty of research showing the human brain is not wired to do things on screen- this is true for all ages and exposures to technology. If you are doing something less complex then it can be a great tool. For complex tasks is not the optimal choice and the more screen the more diminishing the returns. (I have been following this research with fascination)

 

[Swansong]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

You've given a thoughtful response, so I'll retort in kind. Please don't misunderstand disagreement from snark or dislike.

-when I started medicine its focus was on the patient, business was what you did to make sure you could do the caring (unless you were in Plastic surgery or practicing for the rich people). Things fell apart in Bush I admin when they passed laws exempting insurance companies from responsibility if they rejected to cover care.

The business side was less complicated because costs - and I'm speaking of the cost of care, not the added stuff like compliance and whatnot - were lower. MRI machines cost an obscene amount of money, so you're **** right insurance companies and Medicare want to make sure your order of that MRI is justified (look up PAMA if you want to get really enraged). But just because it was more simple does not mean it was less a business. And if you want to be totally correct about when did it change, I'd argue that the introduction of the HMO in 1973 was when things started changing.

I reiterate- it is not progress or moving forward when the 'progress' impedes or impairs the ability to do the job, decreases efficiency and does not improve outcome. A well run business doesn't implement something in the name of progress when it does nothing to forward what needs to happen. The ones that do that fail.

This is more of a philosophical question, but to that end I agree completely and think that, despite the learning curve issues we face, EMR's in general have streamlined zillions of formerly frustrating workflows to single button clicks.

Example 1: 20 years ago if I needed a referral to a specialist, my doctor would give me their name. I'd call and ask for an appointment. They'd get my insurance info, process that, and call me back and tell me I needed to call my doctor for a referral or pre-authorization (some offices might do that for me). They'd fax something to the insurance company, and to the specialist office. Then the specialist office would call me back and schedule an actual appointment. Now, if the referral is internal (within the same hospital/practice network), doctor places a referral order, the EMR checks insurance requirements for pre-auth and whatnot. If pre-auth is required the doctor fills out the form right there. It then creates a task in the scheduling work queue of the specialist's office. They call me and schedule, and I show up. With proper configuration, that's 3-4 phone calls, printing and faxing back and forth several additional forms, all replaced with potentially half a dozen clicks.

Example 2: 20 years ago when I needed a medication ordered or refilled, they'd write down on a piece of paper the order. I'd take it to the pharmacy. I'd wait (or, more likely, come back later), and pick up my prescription. The doctor has no earthly idea if I actually dropped off the RX or picked it up. Now, with services like Surescripts, the doctor orders said medication, it checks for pre-auth requirements and can check if it's covered by insurance on the spot, and then travels via Surescripts to CVS. CVS confirms receipt, then confirms the fact that I actually went and picked it up (or that I did not).

Example 3: 20 years ago, doctor shopping for opioids was extremely easy since records were on paper and, except for pharmacy reporting to the DEA, hardly tracked. Now we have automated tools for opioid equivalence, pharmacy validation of pickup, outside record validation (did the patient seek a non-system doctor for the same medication, sent to yet a different pharmacy?). ED's love this as it's significantly reduced ED-related opioid abuse and fraudulent ED visits.

It's far from perfect, but again if we had not been so obstinately against digitizing, we'd have resolved the growing pains by 2010.

It is not good business practice to change your process so it requires more staff to do the same job and that staff doesn't do the job as well as the original system would allow. I can dictate a clear, concise, detailed note with specific information in 2 minutes. Your option of coming out and telling the scribe- time is money. COme out and tell them what happened a few times and you are a visit behind. Even if I drink the Koolaid and agree I should use a system that increases the work load so much that 2 people should do the job one person successfully did before (which is illogical in the extreme)- it is impossible to reliably pick what visit is OK. Example- pt books for rash. Checks in-tells nurse they have a rash. I walk thru the door and they tell me they are suicidal. (true story).

Again, in general I agree with your first sentence. But most providers and medical staff are doing just fine and will do just fine with whatever EMR they're using and whatever EMR comes next. And I'm not sure how any system - paper, digital or plain witchcraft will stop patients in your example here. If a patient lies, they lie.

-EMR is for insurance to data mine. As long as you click a box.... Notes are generic, leave out detail, frequently have misinformation because to go back and redo hx is so time consuming people do new note from old note. Info is fragmented- people don't look and things get missed, they ask the patient the same questions someone else asked (that is confidence inspiring) or they get way behind when they take the time to look. Again- how is this modernizing and progress?

One nit to pick - modern systems allow you to have your notewriter and various other data-filled windows open at the same time. This is somewhat recent (within the past 5 years?). I agree that it would be a total pain in the *** to bounce around between note editor and other windows. But this is less an issue. Also, embrace discreet data and avoid note bloat. Some patients are complicated and require dissertation-length notes. If it's needed, I'd certainly defer to your clinical judgement. But I see insanely long notes on patients who are totally healthy. Why? Lab results are filed appropriately. Medications are filed appropriately. Why do you need 5000 words to write that "Patient healthy. Weight creeping up but not yet an issue. Advised to watch diet and return in 1 year"?

Embrace the data. Learn to use the system to get the data you need. Patients are complicated and filing labs with labs, medication with medication, imagery with imagery helps categorize it. That we can also use it to help (ensure?) clinically appropriate treatment is given is a benefit, not a detriment.

And, probably least considered- clicking boxes and doing things on a screen decreases critical thinking and processing for memory. Lots of research showing retention of info when using screen is bad and >450 words the person has an inability to retain detail- even those who have grown up on screens. THe difference is people who didn't grow up on screen are aware they are losing things. The people who grew up with them think they are retaining things better and are actually doing worse.

Does that research include portable device screen time? If so, I'd agree (Without looking into it). But I'm on a PC all day, and my entire job is based on analyzing issues. I'd say that the millions of business system analysts in the country would disagree with that research if it does not exclude phones.

I'll add a quote from Plato's Phaedrus:

They will cease to exercise memory because they rely on that which is written, calling things to remembrance no longer from within themselves, but by means of external marks.

End point- there is plenty of research showing the human brain is not wired to do things on screen- this is true for all ages and exposures to technology. If you are doing something less complex then it can be a great tool. For complex tasks is not the optimal choice and the more screen the more diminishing the returns. (I have been following this research with fascination)

I'd further argue that clicking "why did the patient come in, what did we do/discuss, how long did it take and what orders should I place" isn't exactly complicated, but your mileage may vary.

 

[leswp1]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

You've given a thoughtful response, so I'll retort in kind. Please don't misunderstand disagreement from snark or dislike.


The business side was less complicated because costs - and I'm speaking of the cost of care, not the added stuff like compliance and whatnot - were lower. MRI machines cost an obscene amount of money, so you're **** right insurance companies and Medicare want to make sure your order of that MRI is justified (look up PAMA if you want to get really enraged). But just because it was more simple does not mean it was less a business. And if you want to be totally correct about when did it change, I'd argue that the introduction of the HMO in 1973 was when things started changing.

I would agree re the HMOs. They were good in theory but unfortunately they marketed themselves as an answer to everything and then rejected what they wanted. I don't have any problem with PAs for many things. There are a lot of tests ordered because of lazy medicine, not wanting to deal with entitled pts and for legal protection. That is a whole other ball of wax. In general Americans pay bloated costs because we don't have any regulation on how insurance co. make money. Because they pay so much they are ridiculously entitled. Insurance co exploit this by creating the 'satisfaction measure'. Insurance co win. Pts think they are winning and the Providers are screwed.

This is more of a philosophical question, but to that end I agree completely and think that, despite the learning curve issues we face, EMR's in general have streamlined zillions of formerly frustrating workflows to single button clicks.

Example 1: 20 years ago if I needed a referral to a specialist, my doctor would give me their name. I'd call and ask for an appointment. They'd get my insurance info, process that, and call me back and tell me I needed to call my doctor for a referral or pre-authorization (some offices might do that for me). They'd fax something to the insurance company, and to the specialist office. Then the specialist office would call me back and schedule an actual appointment. Now, if the referral is internal (within the same hospital/practice network), doctor places a referral order, the EMR checks insurance requirements for pre-auth and whatnot. If pre-auth is required the doctor fills out the form right there. It then creates a task in the scheduling work queue of the specialist's office. They call me and schedule, and I show up. With proper configuration, that's 3-4 phone calls, printing and faxing back and forth several additional forms, all replaced with potentially half a dozen clicks.

Some of this is insurance changing how they allow referrals and the systems the PHO uses. You look at this as streamlined but more of the burden (and time suck) is on me with multiple info to fill in and review. Previously I wrote the note. My staff did the rest of the work using the evidence in my note. Now the Provider is spending time to do things that previously they delegated to lesser paid individuals. They may cue up the specialist where you live but that doesn't happen in our area.

Example 2: 20 years ago when I needed a medication ordered or refilled, they'd write down on a piece of paper the order. I'd take it to the pharmacy. I'd wait (or, more likely, come back later), and pick up my prescription. The doctor has no earthly idea if I actually dropped off the RX or picked it up. Now, with services like Surescripts, the doctor orders said medication, it checks for pre-auth requirements and can check if it's covered by insurance on the spot, and then travels via Surescripts to CVS. CVS confirms receipt, then confirms the fact that I actually went and picked it up (or that I did not).

I used pocket scripts which I loved. NO problem with that. However- I could also call the pharmacy and tell them I had a sick person coming to pick something up could they fast track it. Now it has to be faxed or you are penalized. We used to call it in and then fax over- now that is penalized too. Around here this means pt can wait >1 hour, sometimes >2 to get a script that they could have gotten much faster if they presented paper. THe system we were using sent it thru a 'clearing house before it went thru to the pharm. Not a fan.

Example 3: 20 years ago, doctor shopping for opioids was extremely easy since records were on paper and, except for pharmacy reporting to the DEA, hardly tracked. Now we have automated tools for opioid equivalence, pharmacy validation of pickup, outside record validation (did the patient seek a non-system doctor for the same medication, sent to yet a different pharmacy?). ED's love this as it's significantly reduced ED-related opioid abuse and fraudulent ED visits.

It's far from perfect, but again if we had not been so obstinately against digitizing, we'd have resolved the growing pains by 2010.

This is a good thing.

Again, in general I agree with your first sentence. But most providers and medical staff are doing just fine and will do just fine with whatever EMR they're using and whatever EMR comes next. And I'm not sure how any system - paper, digital or plain witchcraft will stop patients in your example here. If a patient lies, they lie.

Most of the older providers are not happy with what has been lost vs what is gained. They suck it up or they get out of Practice. There are a lot who get out.

One nit to pick - modern systems allow you to have your notewriter and various other data-filled windows open at the same time. This is somewhat recent (within the past 5 years?). I agree that it would be a total pain in the *** to bounce around between note editor and other windows. But this is less an issue. Also, embrace discreet data and avoid note bloat. Some patients are complicated and require dissertation-length notes. If it's needed, I'd certainly defer to your clinical judgement. But I see insanely long notes on patients who are totally healthy. Why? Lab results are filed appropriately. Medications are filed appropriately. Why do you need 5000 words to write that "Patient healthy. Weight creeping up but not yet an issue. Advised to watch diet and return in 1 year"?

Embrace the data. Learn to use the system to get the data you need. Patients are complicated and filing labs with labs, medication with medication, imagery with imagery helps categorize it. That we can also use it to help (ensure?) clinically appropriate treatment is given is a benefit, not a detriment.

There is note bloat because when you want to look at a patient and you don't have all the info in one note then you need to access it thru multiple windows. If you don't include everything then the next person in has to go searching for that info and if they are pressed for time they don't have... Also legally you can't assume I saw that data. If it isn't noted then I didn't consider it. ALso- if you have ever rec'd medical records from a transfer you wouldn't ever say this. Most systems don't talk to each other. I used to get 3 inches of printed records from Harvard. All in a mash. If you get a summary it doesn't include everything. They may have found a way to put things in little boxes to be neat but work flow wise it is a lot of extra steps and if you are intaking someone= shoot me now.

Does that research include portable device screen time? If so, I'd agree (Without looking into it). But I'm on a PC all day, and my entire job is based on analyzing issues. I'd say that the millions of business system analysts in the country would disagree with that research if it does not exclude phones.

This is not phones. You are an audiovisual aid for their findings. If you are using something to look at data and referring back to it I am sure it is fine. If you are looking at concepts, needing to remember details about certain things you don't do as well. That is why I said it worsens with complexity.

I'll add a quote from Plato's Phaedrus:

I'd further argue that clicking "why did the patient come in, what did we do/discuss, how long did it take and what orders should I place" isn't exactly complicated, but your mileage may vary.

It maybe easy to click but does it end up conveying anything useful? I could look at the Cario consults for 7 patients and if the age and sex were blocked out they were interchangeable. The care is still happening. There is a note that checks the boxes so the person is legally covered but it is totally useless in conveying what really happened beyond simplistic info.

 

[Swansong]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Maybe this needs a new thread?

In the spirit of this normally fun and frivolity-filled thread, I'll agree to disagree. A couple notes to wrap up my thoughts:

- EMRs are talking to each other more than ever before, and that continues to improve. If your hospital system uses Epic, with certain button clicks, you can pull in almost anything in another Epic-using hospital system's chart (with permission, of course). ECW does the same with ECW, and each system gets better and better at abstracting that old paperwork if you scan it in (which is still manual).

- I fully disagree that paper scripts save time, and this is direct experience with CVS and my now-deceased mother. Many times I had to drop off paper orders for meds (Massachusetts mandates controlled substance e-prescribing by 1/1/20, but the hospice service didn't have it set up this past spring) and CVS would tell me 2-3 hours minimum. That has been my experience with non controlled substances as well. It's never fast anymore.

- You touch on the biggest complaint I hear from (usually older) providers: "Why do I have to do this, and why can't my staff do this"? Well, believe it or not, in most cases you were always required to do that task. There was just no ability to enforce that, and custom took over. Now there is an ability to enforce it (Epic's user security setup is the most mind-erasingly complicated thing I could imagine).

This all rolls back to my initial post - the times, they are a'changing. We can agree to disagree on whether it's better or worse. I'll buy you a beer if I ever see you at a hockey game

 

[leswp1]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Maybe this needs a new thread?

In the spirit of this normally fun and frivolity-filled thread, I'll agree to disagree. A couple notes to wrap up my thoughts:

- EMRs are talking to each other more than ever before, and that continues to improve. If your hospital system uses Epic, with certain button clicks, you can pull in almost anything in another Epic-using hospital system's chart (with permission, of course). ECW does the same with ECW, and each system gets better and better at abstracting that old paperwork if you scan it in (which is still manual).

- I fully disagree that paper scripts save time, and this is direct experience with CVS and my now-deceased mother. Many times I had to drop off paper orders for meds (Massachusetts mandates controlled substance e-prescribing by 1/1/20, but the hospice service didn't have it set up this past spring) and CVS would tell me 2-3 hours minimum. That has been my experience with non controlled substances as well. It's never fast anymore.

- You touch on the biggest complaint I hear from (usually older) providers: "Why do I have to do this, and why can't my staff do this"? Well, believe it or not, in most cases you were always required to do that task. There was just no ability to enforce that, and custom took over. Now there is an ability to enforce it (Epic's user security setup is the most mind-erasingly complicated thing I could imagine).

This all rolls back to my initial post - the times, they are a'changing. We can agree to disagree on whether it's better or worse. I'll buy you a beer if I ever see you at a hockey game

Chocolate milk and its a deal! This makes me more thankful than ever I got out. Would love to find somewhere to practice pro bono where none of this is a problem.
I think maybe I wasn't clear. I didn't hate the ability to send electronically. It was great for some things. It was the inability to give paper or call it in when the patient was going straight down to the pharmacy that I objected to. Here the pharmacies check the faxed scripts on the hour. Not before. So if I sent it at 12:01 then you waited an hour before they started to work on it. I used to be able to call the pharmacist directly and ask them to fast track. Not anymore.

 

[dxmnkd316]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

TLDR: medicine complicated

 

[The Rube]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

TLDR: medicine complicated

.

 

[MarkEagleUSA]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Good morning to tLodge!

 

[Ralph Baer]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Good Morning, MEUSA!


Good Morning to the rest of tLodge!

 

[Swansong]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Chocolate milk and its a deal! This makes me more thankful than ever I got out. Would love to find somewhere to practice pro bono where none of this is a problem.
I think maybe I wasn't clear. I didn't hate the ability to send electronically. It was great for some things. It was the inability to give paper or call it in when the patient was going straight down to the pharmacy that I objected to. Here the pharmacies check the faxed scripts on the hour. Not before. So if I sent it at 12:01 then you waited an hour before they started to work on it. I used to be able to call the pharmacist directly and ask them to fast track. Not anymore.

"Here" is Middlesex County, right? That's where I live, and I can definitely still get paper scripts from my doc (UMASS uses Epic). He just needs to go dig the pad out of whatever vault he keeps it locked in.

 

[The Rube]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Evening, Lodge. The Gopher season awaits (exhibition doesn't count). I'm giddy, yet realistic.

Work was rough this week, got slammed again today, which is unusual for a Thursday. Have the next 3 Fri off, and next 2 Mon off. Can't wait to hear the stories about the Mondays (our busiest days).

 

[MarkEagleUSA]

Re: Rep Retirement Lodge: The Banana Bread Is Running Out

Good morning to tLodge!