Team-based Clinical Documentation Cuts Physician Time Spent on EHR Notes

Team-based clinical documentation led to decreased physician time on EHR notes, according to an article published in JAMIA.

Researchers used 2021 EHR metadata for 130,079 ambulatory physician Epic users to identify groups of physicians who decreased note length or documentation time.

The study found that decreasing note length and decreasing physician time in notes are distinct goals supported by different strategies of note composition. Of the 37,857 physicians that the researchers identified as having reduced note length or note time, only 6,793 (17.9 percent) achieved decreases in both measures.

“Our exploration of mechanisms further supports this interpretation, as we show that decreases in these two measures are functions of distinct mechanisms of note composition and team-based contribution,” the authors wrote. “These distinct underlying forces suggest that most physicians may be pursuing one of these goals at the expense of the other.”

The researchers suggested that time in notes is likely a more relevant burden to physicians than note length.

“Note length has not demonstrated a consistent relationship with burnout measures, but excess time in the EHR has been correlated with several measures of physician burnout,” they wrote.

The research findings illustrated that decreased time in notes is primarily a function of manual text reduction and teamwork.

“Neither copy/paste text nor templated text increased meaningfully among note time decreasers, contrary to the branding of these ‘efficiency’ tools,” the researchers said.

The authors wrote that efforts to optimize documentation to reduce clinician burden should examine how to leverage automated text in more value-added ways.  

For instance, healthcare organizations could focus on using concise shortcuts or macros to describe care plans for commonly seen clinical problems.

“Use cases like this have the potential to save clinical time while preserving meaningful physician input to the note and valuable note content,” the authors suggested. “EHR vendors can support these efforts by developing and disseminating sample templates that organizations can adapt to their local environments.”

The study also indicated that increased collaboration in note writing, such as using scribes and multi-collaborator note-authoring tools, may significantly reduce clinician burden.

Our analysis shows that physicians who only reduced their time in notes counterintuitively increased note length on average.

“To the extent that support such as scribe-assisted documentation can increase prevalence of bloated notes that may be even harder to navigate and/or lack the distilled information crucial for clinical decision-making, organizations need proactive strategies to mitigate this unintended consequence of removing physicians from direct documentation,” the study authors said.

Additional research should more closely estimate the full causal impact of documentation support on time spent and note length and other aspects of EHR burden, like time after hours.

The authors emphasized that helping physicians produce more concise notes with less time spent is important for advancing efficiency. Still, organizations cannot risk overcorrecting at the expense of note quality.

“While we cannot observe note quality directly in our data, substantial variation across providers in documentation practices, time in notes, and note length suggest that there is ample room for organizations to optimize documentation without negative impacting patient care,” the researchers pointed out.