Care Team EHR Documentation Support May Alleviate Clinician Burden

A greater amount of support from care team members in clinical note writing was associated with less primary care physician (PCP) time spent on EHR documentation, which could lead to decreased clinician burden, according to a study published in JAMIA.

Researchers assessed how EHR proficiency tools and efficiency behaviors is linked with time spent in the EHR among 411 PCPs at one academic health system. The study authors considered EHR proficiency tools to be any EHR integration implemented to improve a clinician’s productivity.

The cross-sectional study revealed mixed associations between certain EHR proficiency behaviors and time spent in the EHR.

While many EHR proficiency behaviors were not associated with time spent in the EHR outside of scheduled work hours, the use of two tools showed a positive association: the QuickActions tool, which provides clinicians with macroed workflows; and SmartPhrases, which allows clinicians to create personal documentation templates.

The researchers found that only one of the 14 EHR proficiency and efficiency behaviors was associated with reduced EHR screen time: NoteSpeed buttons, which allow clinicians to create shortcuts to pulling in SmartPhrases.  

The study also found that PCPs who received greater support from their care team in clinical documentation spent less time interacting with the EHR per day.

“These findings suggest that PCPs may experience reductions in EHR-related burden and documentation burden by decentralizing documentation responsibilities,” the authors wrote.

“Healthcare organizations could implement various team-based documentation models by utilizing nursing staff, medical assistants, medical students, third-party scribing companies, or internally developed scribing programs to assist with this role,” they added.

Healthcare organizations could also enable patients to assist in EHR documentation tasks, the researchers suggested. For instance, patients could fill out structured pre-visit questionnaires through the patient portal that could integrate into the EHR.

“Healthcare organizations that convert these paper screening tools into electronic forms in the patient portals may enable PCPs to immediately import information directly into the note using the existing integration between patient portals and EHRs,” they said.

“However, additional research should assess the feasibility of implementing pre-visit questionnaires and its impact on physicians’ documentation burden,” the researchers emphasized.

The study also found that PCPs who manually wrote a greater share of their notes spent more time on EHR documentation each day. The researchers suggested interventions targeting this specific efficiency behavior could help reduce clinician burden.

Notably, less than half of studied PCPs utilized some of the documentation-related proficiency tools. The researchers said this points to the need for targeted approaches to EHR training initiatives.

Providers may benefit from practicing new EHR skills in a training environment, as scenario-based training has shown to improve outcomes with EHR use, they said.

The researchers also pointed out that ease of set-up and usability may impact physicians’ adoption of EHR tools. EHR features that are perceived as cumbersome to set up may lead to lower adoption rates. The authors recommended future research should assess the relationship between use of EHR features and perceived ease of set-up.

The researchers noted that the study has several limitations. First, it was conducted at one institution, which may limit generalizability to nonacademic organizations and those on other EHR platforms. Clinicians in the sample had less clinical load due to concurrent teaching, research, or administrative responsibilities, which may impact the extent of their EHR use, the study authors pointed out.

Additionally, the researchers could not assess EHR screen time in more granular units due to how the EHR vendor reported measures. The researchers were also unable to control for practice-level differences, as some physicians practiced in multiple clinics.

“Future studies should use additional datasets to explore how these nuances may affect time spent in the EHR,” they wrote.