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Simplifying Clinical Documentation to Cut Administrative Burden

A program at Hawaii Pacific Health designed to simplify EHR clinical documentation is tackling provider burnout at the root.

A program at Hawaii Pacific Health aims to reduce clinical documentation demands on provider.

Source: Thinkstock

By Kate Monica

- Hawaii Pacific Health is working to prevent physician burnout and reduce administrative burden on providers by cutting out the aspects of clinical documentation and EHR use that clinicians find least useful.

In a recent New England Journal of Medicine (NEJM) op-ed, Hawaii Pacific Health physician Melinda Ashton, MD, outlined the health system’s “Getting Rid of Stupid Stuff” program and addressed problems with EHR usability in clinical care.

“An increase in administrative tasks has resulted in less time for the activity that clinicians find most important: interacting with patients,” wrote Ashton.

“Although my health system, like most in the United States, cannot magically eliminate the documentation required for billing and regulatory compliance, my colleagues and I had reason to believe that there might be some documentation tasks that could be eliminated,” she continued.

Hawaii Pacific Health first implemented their current EHR system over a decade ago and has made changes periodically to meet physicians’ needs over the past ten years.

READ MORE: Using EHR Voice Recognition to Improve Clinical Documentation, Usability

In October 2017, Ashton and others at the health system launched the “Getting Rid of Stupid Stuff” program to reduce some of the unnecessary administrative burden associated with EHR use.

Ashton and her team asked physicians to identify aspects of their daily clinical documentation tasks and nominate anything in the EHR system they felt was poorly designed, unnecessary, or “just plain stupid,” she wrote.

“The first thought we shared as we kicked off this effort was, ‘Stupid is in the eye of the beholder. Everything that we might now call stupid was thought to be a good idea at some point.’”

The team received nominations in three categories: documentation that was never meant to occur and so would be easy to eliminate or fix, documentation that was necessary but could be completed in a more efficient manner, and documentation that was required and could be completed more efficiently if physicians better understood the requirements or tools used for completing them.

“Since we kicked off the program, we have received nominations in all three categories,” wrote Ashton. “Some reports of unintended documentation requirements resulted in quick changes.”

READ MORE: How Providers Use Clinical Documentation Improvement Tools

The team cut clinical documentation for tasks that were not relevant, and made documentation easier for tasks that were necessary. In one instance, the team reduced the number of clicks necessary to document changing diapers for newborns from three clicks to one.

“Nurses had been burdened with these documentation requirements for years, but they had never been specifically invited to bring their issues to the attention of people who could make changes,” maintained Ashton.

As part of the program, the team also identified a feature in the EHR system called the rounding row. The feature had been added years ago when the health system implemented hourly rounding by nurses and nurse aids.

“The intention was to allow us to monitor whether this rounding was actually occurring,” explained Ashton. “We had observed that this requirement led to an exercise of rote clicking that didn’t always accurately capture the care provided.”

“We removed the row and informed nurses that what we were interested in was their usual documentation of the care they provided to patients,” she added.

READ MORE: Voice Recognition Accuracy Lacking in EHR Clinical Documentation

The single click required to document rounding took up about 1,700 nursing hours per month across four hospitals.

The team received a number of other nominations from nurses, emergency physicians, and other clinicians about unnecessary interactions with the network’s EHR system. Based on physician feedback, Ashton and her colleagues were also able to remove 10 of 12 frequent alerts that physicians were ignoring.

Additionally, program leaders received nominations that indicated many staff members were unsure how to use certain EHR tools.

“Several requests came in from physicians asking for sorting and filtering capabilities that already existed,” said Ashton. “Although we have long had a physician-documentation optimization team to help our clinicians use the EHR efficiently, most physicians report that they don’t have time to meet with this team.”

Currently, Ashton and her team are working with the health system’s EHR vendor to further optimize the efficiency of their system.

“The Stupid Stuff program has been embraced throughout our organization over the past year and has extended beyond removing unnecessary documentation from the EHR,” wrote Ashton. “As an organization, we are searching for and finding work that should simply be retired.”

While many of the nominations the team receives aren’t for significant changes, Ashton maintained any small modifications to the system can make an impact for providers. 

The program is still in its infancy, but “Getting Rid of Stupid Stuff” represents a positive step toward minimizing clinicians’ daily frustrations to reduce the potential for physician burnout. 

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