This is an update for our December 29, 2016 blog: “How can physicians focus more on patients and not on EHR or EMR data entry?“
Cumbersome and time-consuming electronic health record (EHR) data entry has been identified as one of factors contributing to work-life imbalance and physician burnout. Our medical transcription company has discussed how EHR/EMR data entry poses a major burden for physicians and how outsourcing clinical documentation tasks can help. EHR Intelligence has reported on a new study by the University of Wisconsin and the American Medical Association (AMA) which highlights the role of medical transcription support for ensuring high quality clinical documentation and to reduce the time physicians spend at their monitors.
The study, published in the Annals of Family Medicine, found that primary care physicians spend six hours during a typical 11.4 hour workday on EHR data entry. This amounts to spending more than half a day on patient record related tasks, which includes both direct patient care and non face-to-face patient-physician interactions. The study showed that data entry tasks associated with EHR systems are significantly cutting into available time for physicians to engage with patients.
Researchers evaluated data pertaining to 142 family medicine physicians using a single Epic EHR system in southern Wisconsin. They captured EHR interactions both during clinic hours (defined as 8:00 AM to 6:00 PM Monday through Friday) and outside clinic hours over a three-year period. They analyzed event logging records and assigned each event to one of 15 EHR task categories and found that providers spent an especially significant portion of their workday on documentation and computerized physician order entry (CPOE). The key findings of the study are as follows:
- Clinicians spent approximately 5.9 hours of an 11.4-hour workday on EHR data entry
- 4.5 of the 5.9 hours took during clinical hours and about 1.5 occurred during off-hours
- Clerical and administrative duties such as clinical documentation, order entry, billing and coding, and system security made up about half of the total EHR data entry time
- Inbox management accounted for a quarter of the time spent using EHRs
The researchers stated that burnout and the increased workload that clinicians experience are not due to EHR system itself, but due to multiple factors, including “inappropriate allocation of EHR tasks to clinicians” as well as shifting federal regulations and requirements that have placed hard stops in clinical workflows.
They reasoned that allocating certain EHR data entry tasks would reduce physicians’ workload, improve professional satisfaction, and decrease the risk of burnout. They highlighted the role of medical transcription services in ensuring quality clinical documentation and to cut the time physicians spend on EHR data entry. They suggested physicians should discard the use of CPOE altogether and that they should consider delegating this task using dictation or handwritten orders.
“Although EHR templates have improved documentation efficiency for some, the quality of the clinical note is often lower when compared with that obtained with dictation to transcription. Documentation support staff and additional training in documentation optimization should be readily available for interested clinicians,” they advised.
However, though the researchers identified and offered support to physicians who could benefit from transcription or voice-recognition software, only a few physicians used these documentation support tools during a six-week observation period.
- There is insufficient evidence that virtual visits including telehealth, patient portals, and patient-physician consultations by video improves health outcomes
- Verbal communication is still considered the most efficient option for communication between clinical teams. Relying too much on EHR technology for this is not advised.
- Hospitals can use the EHR task categories proposed in the study to gain further insight into which EHR-related tasks dominate the physician workday
- Best practice on managing EHR tasks should be identified from high-performing individuals, teams, and organizations, and used to improve clinician and team satisfaction
- EHR usability should be improved to ensure provider satisfaction
Based on the findings of the study, AMA is urging health IT developers to improve EHR design and usability. AMA lists eight priorities to boost EHR usability stressing the following objectives:
- Enhance physicians’ ability to provide high-quality patient care
- Support team-based care
- Promote care coordination
- Offer product modularity and configurability
- Reduce cognitive workload
- Promote data liquidity
- Facilitate digital and mobile patient engagement
- Expedite user input into product design and post-implementation feedback
The study suggests that efficiency in EHR use would be ensured only if clerical and administrative demands are reconciled with patient priorities and clinical workflow. Outsourcing family practice medical transcription services to an experienced service provider can go a long way in helping providers achieve these goals.