Documentation in healthcare is important for communicating with other clinicians, detailing information in patient records to provide the best care, and getting reimbursed for the care clinicians are providing. Thorough, accurate documentation can be the difference between an ineffective treatment plan and an effective plan that supports better patient outcomes.
While healthcare documentation is crucial, there are lots of problems with it that negatively impact clinicians, patients, and health systems alike. Documentation is tied with clinician burnout, negatively impacting everyone involved. Clinicians are not given proper tools created for documentation and clinical practice, which makes their jobs harder and adds to their cognitive load. These tools create huge piles of healthcare data, but the data is not organized in ways to make it usable. Additionally, these improper tools cause clinicians to use unsecure workarounds that may put patient privacy at risk and unintentionally leak billable charges.
Tech is often looked at as a contributor to documentation problems. However, innovative technology solutions can be implemented to mitigate or eliminate these problems and enable clinicians to provide better patient care. Learn more about healthcare documentation problems and how tech is part of the solution.
How Documentation Contributes to Clinician Burnout
Burnout is a hot-button topic in healthcare, and the importance of addressing burnout can not be overstated. The 2022 Medscape Physician Burnout & Depression Report found that 47% of physicians reported burnout. While some sympathize with burnout, many people do not understand the repercussions of burnout and how it impacts everyone, from clinicians to patients to health systems.
Burnout has serious consequences for everyone involved. First, burnout negatively impacts clinician mental health and related behaviors. Second, burnout impacts staff retention and is exacerbating the clinician shortage. And finally, the organizational financial cost associated with burnout-related turnover is $7600 per employed physician per year. Burnout impacts everyone, which is why it is a problem that everyone should care about addressing.
One of the main ways healthcare documentation contributes to burnout is time: clinicians spend a lot of time on documentation. On average, physicians work 13.5 hours each week on tasks other than direct patient care. In 2018, 70% of physicians said they spent over 10 hours per week on administrative work, with 32% saying they spend over 20 hours per week. Other studies found that clinicians spend over 2.5 hours a day on documentation and administrative tasks, culminating into almost 6 hours a day in the EHR.
This immense amount of time directly relates to burnout. 60% of physicians said that charting and paperwork were the main contributors to their burnout, while another study found that more than half of physicians have reported administrative tasks are their main driver of burnout.
Why do clinicians spend so much time on documentation? One explanation is that clinicians have many regulations to follow, causing them to write excessively long notes as a safe-guard to protect themselves against liabilities. Clinicians also see more patients in shorter appointment slots, meaning they have more patients to write notes for. Copying and pasting a previous note seems faster than writing a brand-new note from scratch. A study in JAMA found that 50.1% of patient notes were duplicated from a previous note.. And in addition to these issues, EHRs have poor usability, which can make it take even longer to do the work (more on this later).
Technology can help reduce clinician burnout by reducing the time spent on documentation. CareAlign saves clinicians over an hour each day and cuts documentation time in half. This gives clinicians more time to care for patients and for themselves. Continue reading to learn more about the specific ways CareAlign improves documentation workflows, saves clinicians time, and takes action against clinician burnout.
EHRs and Documentation
EHR systems were rapidly adopted across the United States after the HITECH Act was passed in 2009, with most hospitals and health systems using EHRs today. EHRs were created to help with the billing and administrative side of healthcare, and to digitize records. When just looking at these objectives, the EHRs do their job. The problem is that organizations expect EHRs to do more than just their intended purpose.
Clinicians are told to use EHRs for their clinical workflows and documentation, and as EHRs were not intended for this purpose, the tech does not work well for this. In a Mayo Clinic study, physicians gave EHRs an “F” on the usability scale. As mentioned above, this poor usability can contribute to burnout by making it more difficult and cumbersome to complete documentation. In one study, 74.5% of respondents who reported burnout identified the EHR as a contributor to their burnout.
Health systems want EHRs to be all-in-one tools used for every aspect of healthcare. EHRs are expensive and are often marketed as tools to do everything, so health systems continue to use them as the “golden standard” tool for administrative work, workflows, and communication. However, many clinicians see the EHR as a nuisance, and feel frustrated that administrators cannot see the problems created by EHRs.
In this instance, tech seems to be the problem, but tech can also be the solution. Various softwares can be integrated to optimize EHRs and solve the problems that clinicians face while still using EHRs for what they do well. In the next sections, read about specific healthcare documentation problems with EHRs, and how tech can address these problems.
Unintuitive Information Overload
One of the issues with EHRs is that they create a sea of unintuitive information. EHRs pull data from many sources – patient notes, population health platforms, and more. As previously mentioned, patient notes are redundant with unnecessary information copied and pasted from previous medical notes. Add to these patient notes information from population health platforms and any other information platform, and there is a lot of data thrown into the EHR.
Having a lot of healthcare data seems like a good thing, but the data is not organized into intuitive views, and it is not easy to find information. Clinicians do not have time to go through pages and pages of notes for each patient they see. This becomes problematic when important information is missed because it is buried in so much unnecessary information.
For example, a PCP sees a patient and wants to get blood work done at the next appointment, so they write this down in the patient note. However, in the time between appointments, the patient breaks their arm and has a slew of patient notes. The PCP sees the patient, but while skimming the patient’s chart, they miss the mention of blood work because it is so many pages behind, and the patient doesn’t get blood work drawn.
Technology that integrates with EHRs can help make this medical data actionable and easier to view. CareAlign’s care orchestration platform allows problems to be hidden from view to make it easier to focus on the current problems. The intuitive data visualization in CareAlign allows clinicians to view labs, data, and patient trends with various measures in just two clicks. Additionally, a shared task list allows clinicians to create tasks that show up in a separate view, and they can tag other users or set dates and times for tasks to ensure that the tasks are done correctly.
The Cost of Workarounds
Because the usability of EHRs is so poor, many clinicians rely on other tools as workarounds. Some clinicians use online spreadsheets and word documents, others use texts and instant messages, while others use paper printouts. Non-clinicians would be shocked at how often paper is still used in clinical workflows today, even though these paper workarounds contain information that is three to six hours out of date.
When clinicians use these workarounds, they are not updating the EHR right away, meaning that the information in the patient chart is not the most accurate. Another clinician that looks at the patient chart would have outdated information to base their care plan off of, which can create care gaps and make it confusing for the patient when different clinicians tell the patient different things.
At some point, clinicians need to copy the medical notes from their workarounds back into the EHR, writing the same information two or three times. This duplicative work is cumbersome and can add to the time on documentation and increase cognitive load and burnout. In fact, almost one-third of nurses that report spending five or more hours doing duplicative charting per week say they are likely to leave their organization in the next two years.
Additionally, not all of these notes make it back into the EHR. It can be difficult to remember where all notes are when clinicians use five or six different tools to take notes. Up to 1% of net charges are lost due to charge leakage. While 1% may not seem like a lot, in 2020 the average net patient revenue at U.S. hospitals was $192.8 million, so 1% of that is almost $2 million dollars annually. For organizations that get reimbursed through Risk Adjustment Factor, or RAF, scores, losing data means that patients’ RAF scores will be inaccurately low, leading to lower reimbursement and potential losses on shared savings by not meeting savings goals.
How can organizations solve the workflow issue? With clinical care collaboration. CareAlign allows the entire care team to access a wiki-style notes page, which is updated in real-time. The platform is easy to access on any device, meaning all the notes are taken in one place. Then, the notes can quickly be imported into the EHR, meaning clinicians do not need to duplicate their work, saving them time and stress.
This streamlined workflow results in significant financial gains. At a large, academic health system, with a fully functioning CDI team, CareAlign increased billing by $480 per admission through improved CMI – translating to millions in additional revenue. In a pilot study at Crozer Keystone Medical Group, CareAlign’s care orchestration platform improved RAF score accuracy, increasing scores eight times higher with a $3800 increase in per-patient reimbursement compared to $460 for non-participating ACO providers.
Documentation is central to good healthcare, which is why it is so important for documentation to be done well. This means making documentation easier for clinicians so they can quickly find relevant information and spend more time caring for patients. Technology has the power to improve documentation on numerous fronts to give clinicians a better experience, help healthcare systems, and improve patient care.
Learn more about how CareAlign can help clinicians and health systems at https://carealign.ai/get-carealign/.