Let's just call it PAM for now until we get a better name Discussion: --current paradigm is start with document and code to not get audited--defensive and missing out on potential earnings --if you start with end in mind, documentation can improve to meet a more appropriate/advantageous billing level--PAM will insure that if audited will never find we are upbilling because documentation will always support the billing level Considerations for PAM: Clinic flow: Demographics will be input by patient, reviewed and verified by receptionist--physician won't touch Physician in charge of creating and/or verifying accuracy of clinic note Can PAM be "widget" application with operability within the EHR or a "skin" that then documents directly into the EHR? Will PAM be able to scan previous charting and diagnosis codes to guide billing/coding to direct where the documentation of the visit goes? Big picture stuff--This is not a scribe service, but I see this as a billing/coding tool with some scribe-like features--we could call it "predictive documentation", but needs to be more than just a billing tool or there won't be physician buy-in --An accurate Chief Complaint/s will be imperative for aiming where the billing could be (ie. CC of vaginal discharge-quick visit with swab/culture, goes home with a prescription vs abnormal uterine bleeding with pelvic pain--gets workup with ultrasound, possible biopsy, leading to treatment anywhere between prescription medication to surgical intervention) and then documentation to follow --We need to be obsessed with radical simplicity--no one else is doing this --why isn't documenting in an EHR as easy as using our phones or an iPad? --CTT- "clicks to task" how many clicks does it take to accomplish a given task within the EHR--have to be dedicated to this

Patient is pregnant with BMI ≥ 30. Note must contain the phrase "Monitoring BMI" to support medical necessity.

Monitoring BMI.

Pelvic exam was performed. Document the medical need for the exam and confirm that a chaperone was present.

Pelvic exam performed with chaperone present.

Pelvic exam was performed. Document the supplies used (e.g., speculum) to support supply pack billing.

Speculum and supplies used during pelvic exam.