What are you doing to work smarter, rather than harder?

Urology Times reached out to three urologists (selected randomly and asked them each the following question: What are you doing to work smarter, rather than harder?

Dr. Houser“We’re using some innovative technology. We use the Phreesia pads, so we get a lot of information imported into the system. We try to do that with the urinalysis as well-it’s automatically dumped into our EMR. That takes away steps and keystrokes, not only for us but for our nursing staff. It frees up enough time to see a couple extra people a day.

It’s made it easier for the staff to keep up with patient volume. It’s difficult to keep up with the manual entry of all the data the staff has to enter while patients are here. I can always come back at the end of the day and finish my part of the charting; they can’t.

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We tend to be an early-adopter practice, in general, with technology. As a small private practice, we’re trying to stay lean and trim and reduce the bottom line.

There is one other thing. Our EMR now has a phone app that allows us to get into records. We can’t chart through the phone, but if I’m out to dinner and I’m on call, I can look at the patient’s record and write an electronic prescription that is saved to the chart, all from my phone. That’s made my life easier. I don’t have to go to my computer. That’s actually what’s meant the most to me in the last 2 years, having that access while on call.”

Edward R. Houser, MD

Durham, NC

Next: “We’re trying to use our mid-level providers more frequently."

Dr. O'Kelly“We’re trying to use our mid-level providers more frequently. Basically, we let them see our post-ops and follow-ups, so we can see more patients and become more productive. We have two mid-levels right now, are trying to obtain a third, and eventually a fourth.

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It means we don’t have to deal with some of the nitpicking things that we do when we’re answering phone calls and prescribing antibiotics and medication.

Because there’s a shortage of urologists, we’re going to have to rely on mid-level providers. It frees us up for surgery and seeing new patients.

If it’s an experienced PA or nurse practitioner, it does free up some time. If it’s one of the newer practitioners, however, who don’t have a great deal of experience in urology, it lightens the load, but we still have to supervise and to watch carefully to see how they’re doing.

It does allow some more free time for me. Instead of getting home around 7 o’clock, I may get home around 6.

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We’re also marketing our practice a little more. In the past, as physicians we haven’t really approached that, but now that we have the ability to do robotic surgery we’re trying to let the community and the surrounding area know we have this capability. I think that’s something that will be very fruitful in the future.”

J. Kevin O’Kelly, MD

Florence, SC

Next: “We’re essentially allowing our ancillary staff to work at the fullest extent of their credentialing, and of law."

Dr. Brassell“We’re essentially allowing our ancillary staff to work at the fullest extent of their credentialing, and of law.

In urologic oncology, we do so much in a multidisciplinary fashion and have studies we need, we've instituted a nurse navigator to help patients through the complexities. That saves me a lot of time and phone calls, and helps patients. We've also developed educational classes, that prior to prostatectomies or cystectomies, help better inform patients going in. That saves calls and time afterwards.

Then we’re trying to develop pathways for care. We have certain procedures we follow as far as preparing for and enhancing recovery after surgery.

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When a patient comes in for a procedure, we already have nutrition lined up, stomal therapy lined up, cancer psychiatrists lined up. All of that's in place, so we don't have to organize it, or miss a step. That's really what the pathways are, that we have certain prescribed consults and processes which help patients get through the system in an efficient fashion.

All I have to do is say to our navigator, ‘Let’s put this patient on the pathway for a cystectomy.’ To her, that means this patient needs to see an internal medicine doc for preoperative clearance, they'll need stomal therapy, a nutrition consult, and a referral to our cancer psychiatrist if they desire. We get them linked up with our pre-op educational course, which is an hour or so of classes teaching about what to expect.

Do I get more free time as a result? No, but I can see more patients, and they have more access to care.”

Stephen A. Brassell, MD

Boise, ID

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