Back To Work

I haven’t posted in a while because I’ve gone back to work as a speech therapist. I’m working as an outpatient, adult SLP in the rehabilitation center affiliated with my local hospital.  Of course I have some observations…

  • After a 12 year break, I’m happy to report that I remember how to provide speech therapy.
  • Much has changed in health care since my hiatus – not all of it good.
  • It’s interesting to see people at the end of their health care journey and not the beginning like I used to when I worked in a hospital.

Although I see outpatients, I do some weekend coverage at the hospital, thus I had to learn the electronic documentation system that they have on site.  I remember thinking back in the early 90’s how great it was going to be when computers took over this task.


Boy was I was wrong.  Well, actually it’s complicated.  The idea of using a computerized system is fine. Having a secure way to pull up information without having to walk to the floor and wait for the chart, is fantastic. Not having to decipher the handwriting of doctors and other professionals is wonderful.  Not having cool, user-friendly software seems to be my issue.

My hospital uses Meditech.  When I go to the Meditech web site I can’t help but notice that the screen shots I see online look very different than the ones I use at work, so apparently, we have an older version of the software, which isn’t Meditech’s fault. I’m also assuming that upgrading software versions is frightfully expensive so I plan to suck it up and not hold my breath waiting for a new version.  But no offense, the system I use, let’s just say it’s very MS DOS, if you can believe that.

There’s no pointer, cursor  so if you need to move down the screen, you’ve got to tab a hundred times. Except for those pages that require you to hit “enter”, which you don’t want to confuse with the boxes that require you to “F11” to exit out of them.  Oh, and those boxes, they don’t wrap text, so you have to type until you get to end of the line and hit “enter” to get down to the next line to keep typing.  Which I remember doing years ago, WHEN I USED A TYPEWRITER BACK IN HIGH SCHOOL!  The only thing that would make this story better would be if the text was that creepy, greenish-yellow shade that use to grace every computer screen in the late 80s.  I’m happy to report the text is white, so at least I’m not going blind while I’m pulling my hair out.

Want to save your data?  Just hit “F12”.  But be very careful!  Remember, the “F11” key that you use to exit (see above paragraph) is right next door !  Hit that by accident and you’ll have to start all over!

I know what you’re thinking, and no, I’m really not shitting you.  This is the system I use.  I couldn’t make this up if I tried.

The problem is, I’m spoiled.  In my personal life, I use a Mac every day thus I have an unbelievably high standard when it comes to anything computerized.  My phone is more advanced than this system, so when I have to hit “F6” in lieu of the back space key, I’m going to bitch about it.

The second time I used the system I had seen a patient for 30 minutes, testing her speech, language, swallowing and cognition, which lets be honest, is pretty damn efficient.  I determined she was WNL (within normal limits) for all areas and didn’t require any speech services moving forward. Then I headed to the hallway and logged into the system to document this fact.  90 minutes later I was done.  Suddenly I don’t look so efficient and effective at my job.

In the old days, that note would’ve taken me less than 5 minutes to write and that includes the time I would’ve needed to find the chart, find a place a sit, find a pen and actually write the damn note.

To be honest I wouldn’t care if I was spending 5 minutes or 90 minutes documenting because hey, they’re paying me to be there.  The smart thing would be to shut up and do my job and enjoy getting paid for all of this extra time.  But there’s this little thing called productivity that is only based on your billable time with the patient that unfortunately ends when you leave the patient’s room.  So I have to answer for those 90 minutes, which is why I’m probably going to start keeping a little spread sheet on my computer (you know, my cool Mac that has intuitive, easy to use software) and keep a tally of this “non productive time” that eats up my day (Thanks TBTAM for the suggestion).

Granted, I’m new to the system, so 90 minutes was a lot of me looking through my notes, trying to remember if I was supposed to “F9” or “F5” to get the drop down menus I needed, but still, an expert Meditech user would’ve taken at least 10 – 15 minutes of time, which I still think is unacceptable.

I’m pretty sure this is why I waited almost 2 hours a few weeks ago to see a Neurologist at Georgetown University Hospital.  The first hour of my evaluation was him asking me questions and typing the answers into his electronic documentations system. Then he examined me only to return to his desk to type in those results.  Now the cool thing was that he could print out the order for my follow up MRI right there at his desk, but my 90 minute appointment with him was partly due to his thoroughness and partly due to the fact that he types with 2 fingers.

Now before you assume that doctors are cheating the system, dragging out the sessions to bill the insurance for more time, understand that insurance companies pay out a flat rate for a session not for increments of time.  They paid Dr. Mora (who was fabulous by the way) a set fee to evaluate me – it didn’t matter if he saw me for 30 minutes or 90 minutes.  By doing point of care documentation (documenting during the session rather than after) he’s simply bundling the paperwork piece of his day into the billable piece of his day which keeps his productivity numbers up to protect him from being bitched out by his bosses.  ‘Cause it’s all about productivity and numbers and being able to “bill” for your time which is a HUGE change in health care from a decade ago.

In theory it should make everyone more efficient.  But when you have to hit “F4” to put a (.) in a line of code rather than just typing a (.) (yes, I’m serious, people) then all bets are off, frankly.

So plan on hanging out in the waiting room the next time you have a doctor’s appointment.  And don’t be bitchy because you have to wait.  Your doctor, therapist, nurse, etc. is just doing what he or she needs to do to keep the boss happy.  Bring a book and a snack and take a breath – you’ll be fine.


4 responses to “Back To Work

  1. I cannot believe the ancient system you are using!!!

    I can tell you, however, that even with a cutting edge system, I till spend more time documenting that I ever did with pen and paper. I do however, spend less time on the phone calling in scripts (they go electronically), never have to wait for a chart (they are all online), and get test results back in lightening time. I took care of a patient with a UTI entirely electronically on Saturday night – she emailed me her symptoms form her blackberry, I sent of a script to her pharmacy from my computer. Pretty cool…

    Hang in there, It will get faster, I promise (F12 and all…)

  2. It’s crazy, right? We’re supposed to get a different system at the outpatient level that ties into this hospital’s but is better (we’ll see).

    I agree, it will be great to send copies of my reports electronically to the referring doctors, send them emails and most importantly requests for orders for tests my patients need – on the spot, rather than having to call later.

    Luckily I see adults. My colleague sees kids, I don’t know how you’re supposed to type while working with an autistic 3-year-old?

  3. I totally sympathize with you Linda..when I was working in the ER there last summer I had to learn the damn system. But unfortunately I was only there for that summer rotation so by the time I was ready to leave I had mastered the system..that’s not a good sign. I use to curse that thing to hell every time I turned it on. Then the stupidiy of all stupidities..was after we documented in the computer we had to call the report line and give a verbal report. So why in the hell did I spend all that time on the Meditech system when I was going to call it in too! pretty much a waste of time when I could have been with patients!!
    I’m sure they will get a new system soon..glad you are enjoying your new job though!!

  4. I forgot you worked there last year. You know exactly what I’m talking about. We have a 4 part system. There’s a rehab data sheet, a process intervention, a process note and then patient education. Then I have put a sticker in the actual chart saying that I was there. And if I need a diet change – I have to page the doc – can’t use the system for that – I’m unsure why that is.

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