Doctors have complained for years that EHR tasks take up too much of their time and that the system is cumbersome and inefficient. The problem is widespread since nearly all hospitals and office-based physicians use EHRs, according to a 2021 report by the Office of the National Coordinator for Health IT.
Physician leaders are removing some of that EHR burden from physicians in their organizations by eliminating, simplifying, or automating tasks.
"We know that practice inefficiency is a leading driver of physician burnout and that the EHR is a major contributor to frustration. We want to take physicians away from the computer and give them more facetime with their colleagues and patients at work or family members at night," said Nigel Girgrah, MD, PhD, chief wellness officer at Ochsner Health in Jefferson, Louisiana, who leads efforts to improve EHR usability.
EHRs have been a mixed blessing for doctors, said Jane Fogg, MD, MPH, chair of internal and family medicine at Atrius Health, a practice of 700 primary care and specialty physicians in Boston. She leads the efforts there to eliminate unnecessary inbox tasks.
Although EHRs have improved the sharing of clinical information to coordinate patient care, they have increased the volume of messages and clinical information that physicians have to address, which has become a burden, said Fogg.
One recent study found that physicians spent an average of 16 minutes per patient using EHRs, with chart review (33%), documentation (24%), and ordering (17%) functions taking up most of the time. This adds up to about 5 hours for a typical physician who sees an average of 20 patients daily.
Another recent study found that physicians spend an average of nearly 2 hours on the EHR outside of working hours to complete documentation.
With the support of their leadership, Girgrah and Fogg started with the tasks that were easier to fix to obtain some quick wins.
"Although one intervention can't magically change everything, some easy changes will add up to hours of saved time for busy physicians," said Girgrah.
The EHR strategies, along with other wellness programs at Ochsner Health, have contributed to a 10% decline (54% to 44%) in physician burnout rates, said Girgrah.
Here are 7 tactics that hospitals and doctors have used that cut down their time on EHRs. To implement some of these ideas, you may want to enlist the support of your practice leaders or hospital administrators. Other ideas you may be able to implement yourself.
1. Log in with your ID badge.
The Problem: Busy clinicians usually log in to their computer EHR system several times a day, which can add to 20-30 minutes daily, said Girgrah.
The Solution: Automate the process. Ochsner Health came up with the idea that physicians could use their institutional ID badges to gain access to the EHR, much like a "key card" employees use to access secure areas of buildings.
A keycard reader was installed next to physicians' workstations and physicians tapped their badge on it to login.
"We partnered with our EHR vendor to create this sort of ‘tap and go' functionality. When you go to a computer, you just tap your Ochsner badge and immediately the EHR will come up. That was one of our first quick wins that we rolled out in 2019," said Girgrah.
2. Order imaging tests without all the questions.
The Problem: Physicians at Ochsner Health used to dread using the EHR to order imaging tests such as a CT scan or MRI because they had to answer about 30 questions about the patient's health history, said Girgrah.
The Solution: Enlist your EHR vendor to write software that answers these questions instead of your having to do them.
"It occurred to us that EPIC, our EHR vendor, should be able to answer nearly two thirds of these questions because that data already exists within the patient chart, said Girgrah.
Now physicians have to answer far fewer questions because the information is retrieved automatically from patients' charts.
3. Eliminate unnecessary inbox messages.
The Problem: Primary care doctors at Atrius Health were receiving about 100 messages daily. They complained "My inbox is killing me. I can't keep up," said Fogg. Patient messages increased with virtual visits during COVID and have increased the workload of physicians.
The Solution: Examine where you can eliminate waste, provide automation, delegate, or collaborate to reduce various messages to physicians, said Fogg.
A team of doctors, and health information management and IT professionals at Atrius Health found that scanned documents attached to messages were often of low clinical value such as patient-screening forms. "Most could be filed in the chart automatically and didn't need a physician to accept it," said Fogg.
Overall, Atrius cut inbox volume by 25% for its primary care physicians from 2016-2022, said Fogg. "Physicians could respond more promptly to messages when they were limited to the most important and clinically relevant ones," she said.
A doctor at another institution said they use RNs to screen patient messages and take care of refills and medical questions, and to triage symptoms for urgent visits and emergencies.
4. Rethink how to handle prescription refills.
The Problem: Primary care doctors at Ochsner Health were handling a high volume of prescription refill requests.
The Solution: Ochsner created a pharmacy refill team of 8 to10 medication specialists, led by a pharmacist, who could handle refill questions. These specialists were mainly new employees who were hired and trained to handle refill requests. Physicians continued to receive refill requests only for controlled or high-risk medications.
The refill process was also automated so that the EHR could answer medication -related questions automatically by retrieving information already in the patient's chart.
These changes reduced the number of refill requests to primary care doctors by 75%, which saved them about 15-25 minutes a day, depending on the doctor's refill volume, Girgrah said.
The program was piloted with primary care physicians at one hospital within Ochsner Health and then rolled out to all primary care physicians in the health system. Girgrah expects that specialists will be able to use it next.
5. Use a clinical or nonclinical scribe.
The Problem: Physicians can spend at least 1 hour a day on documentation in the EHR.
The Solution: Enlist clinical team members such as medical assistants or licensed practical nurses, or nonclinical students (pre-medical, pre-physical therapy, pre-pharmacy), transcriptionists or scribes.
A study of Kaiser Permanente primary care physicians using trained scribes to document notes in the EHRs found a significant reduction in their EHR documentation time and a significant increase in face-to-face patient interaction during visits.
The participating doctors with scribes spent less than 1-hour daily documenting patient visits on weekdays compared to 1-2 hours daily without scribes. The participants with scribes also spent less than 1-hour daily documenting patient visits on weekends compared to 1-3 hours daily without scribes.
The researchers also found that doctors were more productive and satisfied with their work.
It's also important to factor in the cost of scribes when calculating the value of this service.
Your EHR may already have time-saving features. These hacks you may be able to implement yourself.
6. Become more proficient with your EHR templates.
The Problem: Doctors can waste a lot of time when they're unfamiliar with EHR features.
The Solution: Get training from experts. "When I had our IT team train me, I didn't realize how much I had not known about the program. They showed me things I wouldn't have even thought to ask about. Something as simple as removing buttons from my dashboard that I would never use cut out a lot of wasted time," Brent Lacey, MD, a board-certified gastroenterologist wrote for The Scope of Practice.
He discovered other shortcuts including "dot phrases" that allow physicians to type a preset short word or phrase that converts automatically to a sizable block of text. Lacey uses this to share disease information and give standardized instructions on procedure preparation. "My EMR doesn't have this built in, so I write my paragraphs on a Word document that I can scroll through. Then, I can copy the relevant paragraphs and paste them in my note quickly," he wrote.
However, the copy and paste feature should be limited to describing the patient's past medical history, suggests The Doctors Company. The study they conducted found that physician malpractice claims involving EHRs increased when doctors did not update their patient notes to reflect their current medical status.
Lacey uses another EHR feature that automatically generates a medical code for review and validation based upon clinical documentation. This "saves you the time you would have used to come up with a code yourself."
7. Use voice recognition software.
The Problem: Doctors spend a lot of time charting and documenting in the EHR.
The Solution: Use voice recognition software and save up to 5 hours weekly.
"My system had the option of voice recognition software, and that saves a ton of time," said Peter Basch, MD, a general internal medicine physician in Washington, DC, and medical director of EHR and IT policy at Medstar Health. Even if voice recognition costs a little more at the outset, it generally saves money in the long run because it increases efficiency, Basch told Physicians' Practice.
He recommends that physicians personalize the voice recognition software with macros and templates. "Depending on your specialty or your practice, you tend to say the same things over and over," said Basch.
"It takes a little time up front, but saves a huge amount of time in the long run," he says.
A recent option for documentation is AI-powered voice recognition software. The American Academy of Family Physicians partnered with one AI company to test whether its voice documentation software could reduce EHR documentation.
The results showed that doctors' median documentation time was reduced by 72% per note, which saved each doctor 3.3 hours weekly.
However, a downside of AI software is the price. The AAFP collaborated with the AI company Suki, which sells a $150 monthly EHR solution.
Christine Lehmann, MA, is a senior editor and writer for Medscape Business of Medicine based in the Washington, DC area. She has been published in WebMD News, Psychiatric News, and The Washington Post. Contact Christine at clehmann@medscape or via Twitter @writing_health
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Cite this: 7 Tactics to Reduce EHR Tasks and Save Time - Medscape - Jun 02, 2023.