April 24, 2024
The electronic health record (EHR) has proven to be an efficient way to support the patient experience and optimize clinical operations, allowing seamless exchange of information between facilities and care teams. However, family physicians are increasingly spending more time in the electronic health record. This additional time has crept into many aspects of a clinician’s life, which makes it difficult to truly escape from their work and harder to recharge for what they love to do most – taking care of patients.
The Novant Health Wellness Informatics team has been able to see common practices which lead to inefficient use of the EHR. Below is a list of 10 observations that can help decrease your time in the EHR and improve quality of time you spend with your patients.
EHRs have multiple ways you can personalize your workspace. Although some of these personalization settings are purely aesthetic, other options can significantly improve efficiency. We have found that clinicians who spend time optimizing the system have the greatest return on that investment.
For example:
The level of support available depends on your institution. However, it never hurts to ask what kind of EHR support systems are available to you. If there are none, you can always consider starting or requesting one (or see item 10 below).
The Novant Health Wellness Informatics team offers the following services which may serve as a framework should you want to create your own:
This is also institution dependent. In our organization, we have processes in place to allow clinicians to provide feedback to analysts and builders, such as:
If you do not have these options, reach out to your EHR vendor and see what processes they may have in place where feedback can be given.
Documentation burden is a huge contributor to burnout. Even if you have been using the same documentation tools for years, it does not hurt to hear of other options your EHR system may have.
Also, don’t forget about the documentation changes which went into effect in January 2021. Your E/M levels of service are now based on medical decision-making or time. Understanding these changes will help decrease note bloat.
Pre-charting can save a lot of time. What I have found in my personal experience is that pre-charting allows me to think through a case better and makes my time in the room with the patient much more efficient.
Team-based approaches can also be very beneficial. As an example, a medical assistant can help with documenting parts of your note.
Do not forget about voice recognition. Use of voice recognition can save up to three minutes per note. Although I am a very fast typist, voice recognition software has come a long way and is much more accurate and faster than I could ever be.
Finally, there are now many scribe opportunities – from in-person scribes to ambient AI. We have had great success with all forms of scribe services.
Alert fatigue is real, but pop-ups are designed with patient safety in mind. Although this is institution dependent, take heed to warnings, in particular drug-drug interactions. Sadly, bad outcomes happen due to alert fatigue and ignoring serious warnings.
Poor workflows can make or break your office efficiencies, regardless of how well you use the EHR. Look at everything from check in to check out and every process in-between to see how you can make things as efficient as possible. And keep patient experience at the center of this evaluation.
For instance, I want to maximize time with my patients and don’t want to search for a clinical assistant when I step out of a patient room. Therefore, we have systems in place where we communicate with each other in the EHR (either using chat or writing notes on the schedule). Our communication system can be seen by all clinical team members, which fosters a team approach should the primary assistant be occupied.
We have had to do some research and confirmation as to what a clinical team member can and cannot do based on state guidelines. You may find that a medical assistant can assist you with tasks such as completing a diabetic foot exam. Our team has seen cases where clinicians are reluctant to give up on some tasks they have been doing for several years. But once they do, it frees them up to do other meaningful tasks.
Maintaining an accurate problem list can help in many ways, ranging from efficiency to improved coding and reimbursement. When updating your problem list, make sure you are using diagnoses that best and most accurately describe the condition you are treating. Keep hierarchical condition category (HCC) coding in mind as you update your diagnoses as these codes could positively impact reimbursement in value-based payment models. For more information on HCC coding, the AAFP journal has a helpful article on the subject.
One sign of burnout can be delayed responses to in basket messages or delayed closure of encounters. The aspirational goal should be to always get today’s work done today.
Sharing EHR tips and tricks with colleagues can not only improve our efficacy in using the system but also provide valuable opportunities for meaningful interaction and connection with your practice partners.
We all hit bumps in the road. Practicing medicine is a wonderfully rewarding profession, but also very demanding and stressful. There have been many times when our Wellness Informatics team is working with a clinician to help with an EHR-specific task all for the encounter to become a counseling session. Our team is equipped to help and connect the clinician to the right resource and also to lend a supporting ear.
I hope you find this information helpful in your continued pursuit of taking the best care of your patients…and each other.
The NCAFP also maintains a full library of resources that will help your adminstrative requirements, if you have other questions or needs.
Dr. Aram Alexanian is a family physician and clinical physician executive for Novant Health Wellness Informatics. He is also currently serving as chair of Family Medicine at his local hospital. You can contact him at aalexanian@novanthealth.org.