Allison L. Weathers

Sharing notes with patients: A review of current practice and considerations for neurologists

Abstract Improved patient engagement is a critical consideration in the new payment climate. Releasing progress notes for patients to view may improve patient involvement and engagement in their care. Patients perceive benefit from viewing physician progress notes. As initial studies involved only primary care physicians, specialist physicians may have specific considerations when releasing notes to patients. This article provides a framework for neurologists to implement a note release policy in their practice.

An electronic medical record just for neurologists A daunting proposition

In this issue of Neurology® Clinical Practice , McCarthy et al.1 provide an overview of the electronic medical record (EMR) features that they distinguish as being vital to the practice of neurology in the electronic era. This is a necessary topic as more than 80% of neurologists are now using an EMR in their practice.2 We are being asked to provide higher quality, more cost-effective, and more efficient care, and to accomplish this using EMRs that have not been designed with the needs of our specialty in mind.1 This article is an important step forward in educating neurologists so that we are better able to communicate our needs to EMR vendors and those who implement these systems. However, a topic of this complexity is challenging to tackle in a brief review and there are some limitations.

How to select and implement an electronic health record in a neurology practice

The purchase, implementation, and maintenance of an electronic health record (EHR) are among the most significant financial investments a practice will make. A practices choice of EHR will have long-term and wide-ranging implications for how that practice operates. A successful EHR implementation may potentially result in increased efficiency, improved quality of patient care, and a possibly more successful practice. Extensive research and thoughtful planning, done with the involvement of all stakeholders, the commitment of adequate time, staff, and financial resources to the process, and sufficient training will increase the chances for a successful EHR implementation.

“Waiting for placement?”: Waiting for solutions

The most humbling aspect of inpatient medicine is often not the severity of the illness treated, the ability to effect diagnosis and treatment where we were previously left to guesswork and acquiescence, or the complex array of psychosocial issues that accompany explaining a loved ones condition to family. Rather, patient placement is the overriding issue in so many cases for inpatient neurology. Neurologists are often confronted with more than half of the neurology ward census, where we have done the good work of making the diagnosis, exhausted the treatment opportunities, and now are waiting for the patient to be accepted and transported to a rehabilitation hospital, a skilled nursing facility (SNF), or to home with home health care. Pressures to move the patient can be immense from the facility administration, but also from the emergency department and intensive care unit, where the bulk of future neurology inpatients is waiting to come to the ward.

Potential and pitfalls of email control as a burnout antidote

Physicians endure a numbing increase in administrative tasks that value process-based measurements more than health outcomes. These requirements steal time away from physician–patient interactions and correlate poorly with health benefits that patients care about.1 A lucid essay by Armstrong2 in this issue of Neurology ® Clinical Practice traces the background for physician burnout, and focuses on one of its underrecognized causes: an increasing email burden. Demands posed by mass email also contribute to the sense of low productivity among health care providers.

Sharing notes with patients: A review of current practice and considerations for neurologistsAuthors Respond:

I read with interest the Yu et al.1 commentary on sharing office visit notes with patients. I often read aloud the last office visit notes to my patient at the time of the follow-up visit. I begin this by saying “this is what I documented when I last saw you. Please correct me if I got anything wrong in your history.” I have found this helpful in 2 ways. One, it helps to refresh the history, assessment, and plan in my own mind; and second, it helps engage the patient and accompanying caregiver in his or her care. My experience with this exercise has been a …

Chipping away at neurologist burnout, one refill request at a time

There has been growing awareness of the issue of neurologist burnout over the past several years.1,2 Based in part on the results of a national survey in which more than 50% of neurologist respondents had at least one symptom of burnout and in which neurologists had the third highest incidence across specialties, American Academy of Neurology (AAN) leadership now views burnout as a neurologic crisis.1 A number of factors have been proposed to contribute to neurologist burnout, including loss of professional autonomy, increasing barriers to practicing quality medicine, and increased administrative duties or busywork.1,2 Redesign of suboptimal health care processes and workflows may be a critical step in reducing burnout and improving physician well-being.1,2 While considerable efforts are being directed toward this problem, including the formation of an AAN task force focused solely on neurologist burnout, there have been few studies examining potential interventions.

Coding for patients with neurologic complications of systemic disease in the era of electronic health records.

INTRODUCTION A recent survey by the AAN found that over 80% of neurologists are now using an electronic health record (EHR) in their practice. EHRs have evolved substantially over the past several years, with many vendors now offering fully integrated clinical and practice management systems. These integrated systems are able to provide unprecedented support and guidance to clinicians in their documentation and coding. If used incorrectly or carelessly, however, EHRs may result in poor documentation and erroneous coding. This in turn may lead to rejected charges and even accusations of fraud. In addition to discussing the issues that arise with coding the neurologic manifestations of systemic disease, this article will highlight some of the potential advantages and pitfalls of EHR-assisted documentation and coding.