In theory, it sounded great. Most healthcare providers and IT professionals alike were excited about moving medical records from a paper system to a computer system.
The intent behind the move was to increase the quality of patient care, decrease medical errors and save costs. Computer-based medical records were going to revolutionize the healthcare industry and finally make the patient’s valuable personal information secure yet accessible in a moment’s notice.
The long-term benefits were to include more targeted public health initiatives, significant reductions in national health expenditures, and ultimately a healthier society.
Unfortunately, the outcomes have not panned out as planned. Today we’ll explore the relationship between EMR Speeds and physician productivity, concluding with EHR adoption and hospital performance time-related effects.
The Goal of Implementing an EHR System
A fully integrated healthcare system’s goal is to create a robust and interoperable ecosystem that includes patients, physician practices, public health, population management, and support for clinical and basic sciences research.
Instead, in the 10+ years of executing electronic health records, the policies to support health information exchange and patient engagement have lagged. Initially, HITECH and Meaningful Use policies helped to accelerate EHR adoption yet as further levels of requirements were released more providers found themselves unable to make the adjustments needed to comply.
Read more about EHR:
- What are the Advantages of Using a Cloud-Based EHR System?
- 10 EHR Challenges that can Affect Physician Productivity and Performance
Your EHR Decreases Time Per Patient While Increasing Workloads on Physicians
Costs began soaring on both sides; the average EMR runs about $162,000 including additional hardware, software, increased IT support and connectivity requirements. Additionally, the Centers for Medicare and Medicaid (CMS) have paid more than $30 billion in financial incentives to providers for implementation.
Moreover, many clinicians are expressing concerns that EHR adoption has had unintended clinical outcomes. Not only has it decreased the time for patient-physician interaction and increased the length of their workday, it has increased the number of data entry tasks required of them.
Many are also reporting on the once-touted, yet never realized, lack of interoperability among EHR systems. Applications must have the ability to speak to one another; how else can a patient move freely from one specialist to another? Or one state to another? Or from their physician’s office to the hospital system, and back, all while maintaining fluid access to their records so that they are afforded the most value-based and synergistic medical care available.
Data Entry is Currently Too Focused on Physicians
The Centers for Medicare & Medicaid Services requirements have placed the primary burden of data and order entry on physicians. Compliance officers, concerns over malpractice litigation, and potentially overly strict interpretation of CMS regulations has magnified these problems and greatly increased the amount of time providers spend on documentation. Currently, this means that information entered by other members of the staff is not considered relevant to diagnosis or treatment of the patient.
Busy Physicians Cut Corners on EHR Data Entry, Risking ‘Down Coding’
To overcome this concern, physicians are using a “copy and paste” technique; inserting bloated, cookie-cutter pieces of information from past visits or review of systems (ROS) into the current note. This leads to overinflated and unreadable new notes.
An emergency room physician would expect to be compensated more for a broken ankle then for a sprained thumb. However, if that broken ankle isn’t documented properly it could be “down-coded” and the facility will be reimbursed less. Fear of lack of documentation leads to excessive notes should they be audited and need to prove the level of the case.
Not only could mid-levels and highly skilled nurses be given the authority to capture data themselves, but medical wearables, computerized information systems, and data entered by the patient themselves could be considered a valuable and time-saving approach.
There’s a Major Gap in How Physicians Use EHRs, and Standard EHR Documentation support
Currently a disconnect occurs between the way in which the physician prefers to enter their notes and the way in which the EHR supports documentation. Providers prefer to take notes in narrative or paragraph form, thus documenting the overall patient’s health while not necessarily the reason for the visit; while the EHR prefers drop downs and checked boxes. This means the doctor could be recording the same information multiple times in multiple fields. Future technology such as Artificial Intelligence could learn then fill in the EHR’s required fields based off the provider’s note-taking.
Intuitive EHR vendors could develop and enhance the patient portals to support data collection from the patient. The industry would benefit from accepting additional modes of data entry to accommodate provider preferences, too. A recent study published in JAIMA suggests going beyond a scribe and digitally recording the entire visit. Perhaps auditory medical records could become an improved version of capturing patient data?
The Bottom Line
Bottom line, physicians should be spending their time on diagnosing, not entering data. To support them, EHRs should enable systematic learning and research at the point of care during routine visits. Emphasis should be placed on supporting studies of work relative value units (wRVU) required for each piece of data collected and the potential benefits of other data collection devices.
A recent abstract of experts determined that not only did EHR implementation reduce the number of patients seen per day, it also decreased the face-to-face patient time, and ultimately a decline in revenue. One panelist mentions a decision to close their practice because smaller physician offices no longer seem viable. Others mentioned colleagues retiring or joining another practice to avoid the direct absorption of an EHR cost.
How Can We Improve?
Electronic documentation is here to stay, and while there are drawbacks, there are ways to make it as efficient as possible within your practice.
First, ensure workflows are maximized. This means that during clinic hours all procedures have a process to follow and a person responsible for each them. Are there any bottlenecks occurring or duplicates? If so, have a conversation with your EHR provider about assessing your daily activities to better optimize everyone member’s time.
Second, utilize the patient portal of your EHR. Often this is an additional expense which will initially require more server support, bandwidth and storage. However, if all patients used this valuable tool before every visit; not just their initial consultation, much of the information entered could be pre-populated for your providers.
Next, consider a scribe or voice-recognition software that records your voice during the patient visit. Rather than interacting with the patient, physicians who find themselves entering information into the computer could enlist an assistant to document or transcribe the occasion.
Also, consider how scheduling affects your ability to see patients. Trimming just 30 seconds from each 15-minute appointment can allow you to see at least one more patient per day, making EHR time efficiency a critical ROI factor for your healthcare facility, and the question of how much time your physicians spend using the EHR a major operational KPI.
The Institute for Healthcare Improvement is a leading innovator and publisher of resources about improving capability and person-centered care. I highly recommend working with them, your EHR vendor and your IT provider to find ways that will increase production and satisfaction of daily workflows.