Chart prep

Chart prep has no regulation behind it and a great deal of staff time inside it. The AMA’s practice-improvement material describes pre-visit planning as the set of tasks completed before the patient arrives: confirming the reason for the visit, ordering the labs so results are in hand, and gathering the records from other providers so the clinician is not reading a hospital discharge for the first time in the room. The last of those is the expensive part.

In a practice that sees referred and recently hospitalized patients, chart prep for one visit means identifying which organizations hold something relevant, requesting it from each, waiting, chasing, and then reading what arrived to pull out what matters. For a new patient with a long history that is hours, spread across days, and much of it falls on the medical assistant or the nurse the day before. The outcome is binary: either the record was ready when the visit started, or the clinician worked without it and ordered what was already done.

Three things determine how long it takes:

• How many sources there are. A patient with a hospital, a cardiologist, a prior primary care practice and an imaging center is four requests, not one. A network query makes it one.
• What form the records arrive in. A fax of a printout has to be read; a C-CDA can be parsed into the chart’s own lists.
• Who does the organizing. Retrieval produces a pile. Chart prep is the work of turning the pile into a record with one problem list, one medication list and one timeline, with the source on every entry.

Vivlio’s product is the third item. Retrieval is the commodity; the organized record, ready before the visit, is what chart prep was always trying to produce by hand.