There’s an assumption in healthcare that EHRs are too time-consuming. With physicians often stating that the more time they spend using an EHR, the less time they spend with patients.
As with many assumptions, the more often something is repeated, the more we start to believe its validity — even when the opposite may be true.
Many physicians continue to lament what they perceive as an excessive amount of time required to navigate through the EHR or respond to various notifications and alerts. But, do tasks really take longer in the EHR than they did with paper? And are there ways to maximize efficiency in EHR use to increase face time with patients and decrease time on other tasks?
Same tasks, new workflow
According to a recent study published in the Journal of the American Medical Association, physicians spend more than an hour per day addressing notifications they receive in their EHR. This includes addressing test results or requests for refills as well as responding to messages from physicians or other healthcare professionals.
The study, which analyzed electronic notification logs of 92 physicians in three large Texas practices between January 1, 2015 and June 30, 2015, found that primary care physicians received the highest volume of notifications — nearly 80 per day. This isn’t surprising, given the breadth of conditions and scope of treatment in primary care. Specialists averaged approximately 29 notifications per day.
“The additional workload to read and process these messages remains uncompensated in an environment of reduced reimbursements for office-based care,” researchers wrote.
Though these results are undoubtedly valid, we — as an industry — must understand the context. Many physicians, for example, didn’t track the time it took to perform these tasks when using paper records. This makes it difficult to discern the direct effect of EHRs on physician productivity.
With paper records, which could often be hard to track down, physicians painfully deciphered messages on sticky notes. They made time-consuming phone calls to pharmacies. They spent valuable minutes searching for test results among piles of paper on their desk. At the end of a task, they filed information back in a paper chart or handed it off to a secretary for proper storage.
With EHRs, the tasks are the same. However, the method used to accomplish these tasks has evolved, oftentimes resulting in greater efficiencies. Physicians click through screens (rather than sift through paper) to find the information they need. They provide an electronic signature for documentation and prescription refills. They review test results electronically. Instead of handwriting their notes, they type onto a screen and select certain information from a drop-down menu or use a template that prompts necessary documentation.
In addition, EHRs make it much easier to electronically fulfil requests for records or to manage the referral process. In many cases care coordination with other providers is streamlined, reducing the time it takes to complete those tasks.
“If physicians are honest with themselves, they would find that the time could be similar—if not shortened — in an electronic environment,” says Josh Bock, MD, Managing Partner at AFC Physical Medicine and Chiropractic Centers, a seven-site practice in the Phoenix-metro area that has been using an EHR for the last three years.
Bock says the practice rolled out the EHR first with clinical staff, then billing, and lastly administrative staff. Approximately 80 employees currently access the EHR in various ways.
“Everything is at your fingertips. You want to look at a lab? You hit a button. You want to prescribe something? You hit a button. In the past, you’d have to flip through the chart or get out your prescription pad,” he adds.
Saving time rather than losing it
During a time when patient engagement is paramount, every practice needs an EMR that will enhance efficiencies—not create operational headaches. So how can physicians using an EMR maximize the time they spend with patients without adding hours to the workday? Consider the following strategies:
1. Ask your vendor to provide detailed EHR training. This includes thorough training for all staff members who use the EHR. Work with your vendor to provide role-based training that addresses the unique needs of your practice and patient population.
2. Delegate initial lab reviews. Ask medical assistants to perform first-level reviews of electronic lab results and highlight important information that requires a physician’s attention. This information can then be flagged so it rises to the top of your inbox.
3. Use patient portals. Engage patients with portal technology to reduce the volume of phone traffic. Educate patients about portal etiquette so they understand what questions are and aren’t appropriate for the portal. Set the expectation that messages will be returned within 24-48 hours.
4. Take advantage of templates and shortcuts. “Templates help drive the visit and walk physicians through conditions they don’t see regularly,” says Bock. Shortcuts allow physicians to use standard language for certain repetitive types of advice (e.g., elevate and ice the injury).
5. Consider copy-and-paste functionality. When used appropriately (i.e., with validation of data), practices save a considerable amount of time using this functionality. “In a business like physical medicine, we see patients for a series of sessions on one particular condition, such as lower back pain. The ability to copy and paste within a record saves us a tremendous amount of time,” says Bock.
6. Automate preventive maintenance reminders. Send automated messages directly to patients prompting them to set up appointments online. This process helps address care gaps for mammograms, annual visits/check-ups, and other preventive services. It also removes any related tasks (e.g., patient reminders) from your work queue.
7. Go mobile at the point of care. Use your EHR on a tablet or other mobile device that provides the ability to perform data entry anywhere at any time while facing the patient — instead of looking at monitor on the other side of the room. Mobile EHRs provide increased flexibility while maximizing time both with patients and between patient visits.
While it may seem that EHR tasks are time-consuming today, think about the time it took with paper. If you are honest about it, you’ll probably realize that many tasks took much longer and could be frustrating then as well. And then consider some of the other efficiencies and benefits that have been gained.
Tom Giannulli, MD, MS, is a practicing physician and CMIO at Kareo.