A recent New York Times op-ed reinforced the widespread feeling among US physicians that they are spending too much time documenting their work in electronic health record (EHR) software. Recent estimates put physician time spent in their EHR at 50% of their workday, significantly reducing the amount of time they can spend on patient care.
Hospitals and healthcare systems must do what they can to reduce the EHR documentation burden on physicians and other clinical staff. This will not only improve the patient and employee experience but will also increase hospital performance as more time is spent on revenue-generating activities. While hospitals can’t reduce the requirements around documentation, they do have the ability to automate more of the data input to reduce the time spent documenting each patient encounter. As this article at Managed Healthcare Executive discusses:
“As a nurse with years of experience in the profession in hospitals and in the Army, Dana Bensinger has strong opinions about how clinicians should be spending their time. And it’s not in front of the screen for the better part of a day.
“Shortcomings in interoperability, combined with the increased documentation requirements for payment, has turned nurses and doctors into data entry people. In reality, they are supposed to be data consumers,” notes Bensinger, who today leads EHR implementation and optimization projects at IT solutions consultancy CTG.
A primary care doctor should not have to enter the date of a diabetic patient’s last eye exam, Bensinger adds. Likewise a nurse should not be manually entering vital signs. “That data should be automatically pulled into the EHR from a source system and eliminate the need to document it,” says Bensinger.
To reduce documentation burnout, Bensinger says to: “Take stock of who is collecting what data. Then determine if they should even be collecting certain data rather than acquiring it from other sources. When CIOs or CMIOs are asked to add data elements to the EHR, they should first ask ‘where can we get this data?’—not ‘who is going to collect it,’” Bensinger advises.
Bensinger also recommends making it easier for patients to share their data via the patient portal. In just one example, patients on pain medication can answer simple graphic pain scales sent from the portal. Bensinger notes this eliminates the need for nurses to document the pain medication’s effectiveness, while engaging and empowering the patient in the care plan. It also allows the doctor to see if the care plan is working.
He also recommends setting up clinical dashboards that summarize and present meaningful data at a glance. “Clinicians should never have to hunt for data,” Bensinger says.
Tedium out, good data in
EHRs have the potential to facilitate an intuitive flow of information, but too often require prolonged clicking and scrolling instead.
Doug Cusick, CEO at TransformativeMed, believes physicians are spending half their time on EHRs because workflows in the system aren’t configured to how the physician really works. That can be changed, he says, through applications embedded in–or interoperable with–the EHR.
Some specific examples of how these apps are helping include eliminating or auto-completing mundane steps that have been filled elsewhere, or applying algorithms to prompt next steps,” Cusick says. “In another time-saver, providers can dictate an update to a patient’s to-do list and have it automatically write to the EHR.”
Cusick adds: “Ultimately, these apps present information in the EHR in a clinician-intuitive way, specific to the user’s primary interests and presented in their preferred, personalized layout.”
Of course, sometimes no matter how a system is configured, the needed information isn’t there. Julie Mann, chief commercial officer at Holon Solutions, has a recommendation here for healthcare technology leaders.
“Health plans, providers and technology vendors should take a look at ‘data surfacing,’ a technology advance that injects intelligent data into the clinical workflow at the right time,” Mann says. “This is typically at the point of care with the EHR. Data surfacing is one of the single most important steps to take to reduce the amount of time and clicks it takes to find critical patient data in the EHR.”
As for what kinds of data, the technique itself is data-agnostic. But as providers increasingly take on risk, a fuller picture of patient care within a system they already use can considerably improve their opinion of the EHR.
“Many providers now operate within a complex healthcare landscape that straddles both traditional fee-for-service and innovative value-based payment models,” says Heather Trafton, chief operating officer at Arcadia who is also a physician assistant. “As they take on responsibility for the financial care of their patients—in addition to the clinical–they need a comprehensive view of patient care across the care continuum. They also need critical information to be synthesized at the point of care.”
Trafton adds: “EHRs can be supplemented with time-sensitive and meaningful clinical data that eases the burden of providing more coordinated care, reduces duplication of care and improves patient outcomes. Moreover, this information can be presented to providers within their existing clinical workflows. This increases their ability to offer better preventative care and improve chronic disease management, while substantially reducing administrative burden.”
Read the entire article here: Mutiny on the Horizon for EHRs? Probably Not—But Here are Steps to Ease Clinician Frustration
As more evidence comes to light that EHRs are requiring physicians and nurses to spend too much time documenting their work, hospital administrators must find creative ways to reduce the burden. EHRs are not going away any time soon due to the wealth of data they create and store, so new avenues should be explored to increase documentation efficiency. One way to do this is to eliminate redundant data-entry tasks in EHRs. For example, natural language processing tools can help turn transcription data into notes that need to be only verified instead of typed in from scratch. Additionally, implant and supply tracking software, such as iRISupply, can provide high quality data by integrating RFID data capture technology directly into your EHR, eliminating the need to have clinicians re-enter supply and implant information into the EHR during hectic procedures.