Seven Habits for Reducing Work After Clinic

Sumana Reddy, MD; FAAFP, Peter Rippey, MD, CAQSM; Arnold Cuenca, DO, CAQSM, FAAFP; Sumi Sexton, MD; Troy Fiesinger, MD, FAAFP; Kenneth G. Adler, MD, MMM; Brandi White

Disclosures

Fam Pract Manag. 2019;26(3):10-16. 

In This Article

Document Less but Better

When it comes to documentation, everyone has a different style – typing vs. dictating, documenting in the exam room vs. documenting later, team documentation vs. physician documentation, and so on. It's OK to have a preferred style, but be cognizant of where your habits and your process might be failing you and be open to new ways to document more efficiently. This includes asking your most efficient colleagues what they do that helps speed up their documentation within your EHR.

One of the most common problems is over-documenting. It's easy to get compulsive when you have to worry about medicolegal risk, you're trying to gather rich psychosocial information, and you feel pressured to check all the boxes you can. But not all EHR boxes need checking, and not all visits require that you write an opus. Instead, be brief, focused, and clear enough that someone looking at your note will understand your clinical reasoning and your plan. Over-documenting not only wastes your time but can be problematic for other reasons as well. For example, think about whether you would be comfortable with, say, your patient or his podiatrist seeing your entire note detailing sensitive psychosocial issues. Remember that less is often more.

"Not all EHR boxes need checking, and not all visits require that you write an opus."

Wasted time spent clicking boxes and navigating lengthy drop-down menus just to complete a simple task is another common EHR complaint, described recently as "death by a thousand clicks."[4] In some cases, EHRs can be customized to reduce clicks if you tell your vendor what you need. For example, having certain data that you use most often displayed on the initial screen, instead of buried deep in a drop-down menu on a later screen, can save you from clicking or scrolling to review that information.

Additionally, EHR templates and macros can help reduce the amount of data entry required for tasks you perform routinely, and your EHR system might have some of these options already built in. You can also create your own (see "A starter list of EHR macros"), or enlist the help of a colleague who enjoys this kind of work. Then, when you're seeing a patient for a well-woman exam, for example, you can load the relevant template or use a macro that autofills key information, and simply adjust it as needed. This is faster than starting from scratch. Be aware, however, that overusing templates and macros can generate notes so lengthy that they're practically meaningless.

The use of scribes (live or virtual) or team documentation can also help ease the documentation burden on physicians. In the team documentation model, nurses or MAs are trained to do more during the rooming process, so the record is started before you enter the room, and they can even assist with documentation throughout the visit. (For more information on team documentation, see "Strategies and resources.")

Dictation is another option for saving time on documentation. With a little practice using voice-recognition software, you can quickly dictate your notes directly into the EHR while in the exam room or immediately afterward. To improve the accuracy of speech recognition, make sure you use a good microphone placed close to your mouth, speak clearly and in complete phrases, and reduce background noise.

If you've dismissed in-room documentation because you believe it interferes with the patient interaction, you might want to give it another try, at least for your more routine visits. Consider the following tips: focus on the patient before you focus on the EHR, put the computer monitor where both you and the patient can see it as well as each other, get comfortable typing and navigating your EHR system (get help if you need it), and involve the patient in what you're doing on screen (e.g., "Let's see when you had your last mammogram" or "Let's go ahead and order that test right now").

Finally, whatever documentation method you use, make it a goal to finish your chart before seeing the next patient. Improve on the adage "Do today's work today," and aim to "Do this visit's work this visit." (For more information on efficient documentation practices, see "Strategies and resources.")

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