Text messages. Word documents. Emails. Sticky notes. Pieces of paper. Fax. Clinicians use all of these tools to jot down information about patients and to communicate with other clinicians. However, this patchwork system can lead to problems ranging from medical errors, to poor reimbursement, to privacy breaches, to simply more work.
Why does this happen?
We’ve moved to digital health records, so why don’t people just use their EHRs to communicate? EHRs were created for the business of healthcare, and are not conducive to collaborative clinical workflows that require large care teams to access patient information and coordinate in real time. A Mayo Clinic study found that overall, clinicians give their EHRs an “F” on the usability scale. Clinicians are under incredible time pressure and, like water flowing downhill, will always gravitate to the fastest solution – and when it comes to communication, that solution is rarely their EHR. So, clinicians revert to paper to take notes, text messaging to communicate thoughts, and in person huddles to coordinate care.
Patchwork communication costs organizations a lot of money. First, there is the cost of the paper itself. Now, you might think, who still uses paper? Well, healthcare does. Research shows that the average 1500 bed hospital prints more than eight million pages per month, which costs about $3.8 million per year, not including maintenance and equipment costs. With EHRs, there has actually been an 11% increase in the amount of paper printed. Using paper to write down notes and to communicate with patients and other clinicians costs a lot of money and is certainly not environmentally friendly or efficient.
In addition to the sheer cost of paper, these workarounds can also lead to poor outcomes, lost information and even lower reimbursement rates. Handwritten notes can be easily forgotten, misplaced, poorly transcribed when typed into the digital record, or simply omitted in their entirety. The result? Important information may not be recorded, decisions are made without all the necessary information,, and providers may not be fully reimbursed for the work they did.
Increased Clinician Workload
Patchwork communication and workarounds add a significant amount of work for clinicians. At the end of the day, the clinician needs to look in multiple locations to find all their notes and updates from the day. In an inpatient setting, depending on the time of day, the most updated information may be found in a text message, on a sticky note, on a rounding list, or in the EHR. And worse, at the end of the day, a clinician has to check all these sources and then double document the information into a digital EHR progress note. Is there any wonder that over 50% of all progress notes are simply copied from the previous version? Re-writing this information into the EHR just duplicates the documentation work for clinicians who already face high workloads and makes it hard to find information when it is needed.
Privacy and Safety Concerns
Workarounds and patchwork communication tools can create concern for safety and privacy. One problem lies in outdated information. The paper charts that clinicians print at the beginning of the shift often contain information that is three to six hours out of date. Additionally, any notes that one clinician writes on a sticky note are not available to the rest of the care team until that note is added to the chart in the EHR, which may be hours later. The care team is not all on the same page and may be using outdated information to make clinical decisions, which is not good for the patient. This is the reason why many of us, as patients, have had the experience of asking three different people the same question and getting three different answers.
Privacy is also a concern with workarounds. On average, 7.5 percent of paper documents are lost completely, and 3% of the remaining files are misfiled. Lost paper may include sensitive patient information that anyone could pick up, violating patient privacy. While digital communication – such as texts, word docs, and emails – are not falling out of a clinician’s pocket, these communication modes are not always secure and can be seen by others or hacked if they do not have security features.
Care Team Collaboration as a Solution
There is a better way. When teams have adopted CareAlign, we’ve seen clinicians save an hour a day, they report completing their documentation in half the time, and 75% of users report a decrease in communication errors. We’ve also seen all manner of financial indicators – including Case Mix Index, Risk Adjustment Factors and HCAHPS scores – go up. Whether you use CareAlign or another care coordination platform, there are ways to help clinicians, reduce risk, improve outcomes and improve the bottom line all at the same time. And if you get rid of paper you’ll be helping the environment too. Learn more here.