Many physicians complain that electronic health records are time-consuming and that performing EHR tasks cuts into the time they have to spend with patients. And there’s data to back that up.
Physicians spend roughly half (49.2%) of their work day on EHR and administrative tasks and just 27% of their time treating patients face to face, according to a recent study in the Annals of Internal Medicine. Also, in a study published earlier this year in JAMA Internal Medicine found doctors spend more than an hour a day responding to notifications received in their EHR, such as test results or prescription refill requests.
The increasing burden of administrative tasks was cited as the main cause of physician burnout in a lifestyle report released by Medscape earlier this year. According to the report, the number of doctors reporting burnout rose from 45.5% in 2011 to 54.4% in 2014. This comes as the U.S. faces a physician shortage of nearly 95,000 doctors over the next decade, according to the American Association of Medical Colleges.
But there are steps healthcare organizations and individual providers can take to reduce the time spent inputting data into EHRs and reclaim clinical face time with patients. Consider the following timesaving tips:
Ensure sufficient EHR training. Getting clinicians proficient in the workflow — and not just the functionality of the software — can optimize how they perform EHR tasks. “Once you get nurses and physicians more proficient in the use of the applications, they get much, much better at using EHRs and we see increased productivity,” says Heather Haugen, managing director and CEO of The Breakaway Group, a Xerox company that provides research-based training on EHR use.
Practice anticipated workflows. Clinicians may confront 150 to 200 functions in an EHR system. Learning to use them over a two- or three-day training period is not going to yield the “fluency level” of knowledge that providers need to optimize use of EHR, according to Haugen, who also serves as track director for health information technology at the University of Colorado Denver-Anschutz Medical Center.
She encourages organizations to let their physicians practice workflows in the system using simulated environments and patient scenarios. For example, instead of just learning functions, a doctor can practice which tasks to perform to place an order for a patient. “The memory for those tasks increases dramatically when you use those kinds of adult learning concepts,” Haugen says.
Allowing doctors and nurses to accumulate experience that is relevant to their system and then practice it to gain fluency will build confidence and open them to learning more about what the system can offer, she adds.
Look for possible process improvements. An EHR can point out areas where care is not being provided as expected, but it’s up to an organization to figure out where the processes can be improved. A good workflow analysis can show where the workflow’s slowing a clinician down and suggest ways to shorten the time spent on administrative tasks.
Haugen cites, for example, an organization that wanted to ensure that all women over a certain age got annual mammograms. The group’s EHR records showed that only a small portion of those women actually were getting the screenings, so it made changes to the EHR to ensure that information was passed along to the patient while they were there for a visit, even if it was an acute visit, she explains.
Capitalize on templates and other shortcuts. Most EHR systems have built-in items to expedite routine processes at the user level, such as custom order sets, pre-scripted note templates and favorites, says Bryan Dickey, vice president of operations at The Breakaway Group. “The key is for the provider to spend some up-front time thinking about the things they do most frequently and utilize the tools available to speed things up,” he says.
Consider documenting while with the patient. Many providers push back on this notion, but inputting information into the EHR can speed up the process and reduce time spent on EHR tasks later on, says Dickey. Computer mastery is key as well as finding ways to interact with a patient and keep the focus on the patient while using a computer.
Utilize live or virtual scribes. While hiring scribes to enter information into EHRs is an added expenditure, doing so can free up providers to focus more of their time on patients, says Dickey. According to the American Health Information Management Association, experienced scribes can improve the overall quality of documentation, which can support “meaningful use” requirements and improve compliance with quality targets and billing and reimbursement.
Think early on about the resources and people needed to maintain an EHR. Too often, organizations will bring people in from across the organization to assist with EHR implementation, then send them back to their old role after the system goes live. That’s a mistake, says Haugen, especially as systems are constantly evolving and being upgraded. Organizations need to think about who’s doing the education and training, who’s optimizing the workflows, and who’s making sure that all of the interfaces work.
“These tools are here to stay and will get better in time with input, feedback, and most importantly, involvement from providers about how to create newly optimized workflows that take available tools and shortcuts into account,” Dickey says.