Usability experience with electronic health records (EHRs) is a leading driver of physician burnout as doctors spend more than half of their workdays on the keyboard. But it doesn’t have to be that way.
A perspective essay in the Journal of the American Medical Informatics Association sheds light on the complex factors driving poor EHR usability. The article, co-written by experts at the AMA, notes that payers, regulators, vendors and health care organizations all have roles to play in reducing physician burdens linked to EHRs.
Some health care organizations have recognized this challenge and are actively developing innovative solutions to reduce the amount of time physicians spend typing so they can spend more time face-to-face with their patients.
Seeing the bigger picture. Using widescreen monitors was just one tool the IT department at Atrius Health, the largest nonprofit independent medical group in the Northeast, used to eliminate 23 clicks per encounter for a total organization-wide reduction of 50 million clicks annually.
The use of the bigger screens allowed physicians to have more windows open at a time and cut an estimated 1,500 clicks per provider per day.
Further analysis found that about 20% of EHR time was spent sorting through messages in the in-basket. The Atrius IT department moved about 40% of the volume—around 200,000 messages—into dashboards that could be managed more efficiently. Greater collaboration between clinicians and IT staff led to a system where admit, discharge and transfer notifications could be shifted entirely out of the physicians’ inboxes and transferred to case managers.
These inbox-management strategies eliminated about 1.7 million clicks annually.
Improving documentation and in-basket management saved physicians 45 minutes a day. HealthPartners, an integrated, nonprofit health care organization in Bloomington, Minnesota, developed several strategies that freed up physician time.
These strategies saved 30 minutes a day:
- Being careful with the frequency of best-practice alerts, such as prompting a referral for patients with elevated BP.
- Making more than 40 templates to be used for collaborative documentation between physicians and nurses.
- Co-locating workspaces to support social interactions.
- User wider monitor screens.
- Putting printers in the exam room.
HealthPartners physicians saved another 15 minutes a day when “blinded” in-baskets, which contain messages visible to only one user, were eliminated. That allowed for work to be redistributed across the entire care team instead of resting solely with physicians.
Yale eliminates a daily annoyance. Yale Medicine developed a system in which physicians log in at the start of their shifts and then use their identification badges to tap in and out of the system the rest of the day.
This move has saved physicians between six and 20 minutes a day, though Yale Medicine Chief Medical Officer Ronald Vender, MD, said the benefits are greater than just time saved.
“It had a disproportionate effect above and beyond the time with just the annoyance factors,” Dr. Vender said. “Addressing this psychologically, as well as time savings, has been a huge win.”
Yale has also implemented voice-recognition software that has helped physicians reduce by half the time it takes to complete and close encounters.
Using scribes can improve patient interaction and physician satisfaction. Medical scribes, also called documentation assistants, are professionals who transcribe information during clinical visits in real time into EHRs under physician supervision.
There is persisting misinformation that the physician is required to redocument information inputted by staff of the patient. This issue is addressed on the AMA Debunking Regulatory Myths webpage.
Scribing, or “team documentation,” frees physicians from note documentation and entering orders or referrals. This allows doctors to focus on the patient, according to a STEPS Forward module on team documentation.
The Kaiser physicians also reported reduced documentation burden and improved visit interactions. The Brigham dermatologists noted that they had more time for scholarly, teaching, leadership or personal pursuits, indicating that most documentation tasks were being done outside of clinical time.
Using scribes can also have financial benefit as 79% of the dermatologists in the study indicated a willingness to increase patient volume with scribe support, and the use of scribes was linked to a 7.7% increase in fourth-quarter revenue.
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