OBG Management: With an aim toward alleviating burnout, are there any tips you can offer your colleagues on interfacing with the EMR?
Dr. Evans: When I first started as a new attending, it would take me hours to finish my notes, partly because of the level of detail I would write in my history of present illness (HPI) and assessment and plan. One great piece of advice I received was to be satisfied with good notes, not perfect notes. I worked to consolidate my thoughts and use preconstructed phrases/paragraphs on common problems I saw. This saved time to focus on other aspects of my academic job.
Dr. Dougherty: We need to refocus on the patient first, and mold our systems to meet that priority. Much too often, we have our backs to the patients or spend too much time interfacing with our EMR systems, and our patients are not happy about it (as many surveys have demonstrated). More importantly, a renewed focus on patient care, not EMR care, would allow our practitioners to do what they signed up for—treating patients. In the meantime, I would suggest that practitioners stay away from EMR gimmicks and go back to old-style documentation practices (like those established by the Centers for Medicare and Medicaid Services in 1997 and 1998), and ask the IT folks to help with molding the EMR systems to meet your own standards, not the standards established by EMR companies. I am also very hopeful that the consumer will drive most of the health care-related data collection in the near future, thereby marginalizing the current generation of EMR systems.
Dr. Woodland: I would add that providers need to manage the EMR and not let the EMR manage them. Set up task reminders at point times to handle results and communications from the EMR and set up time in your schedule where you can facilitate meeting these tasks. When providers are out on vacation, make sure to have an out-of-office reminder built into their EMR so that patients and others know timing of potential responses. Try to make the EMR as enjoyable as possible and focus on the good points of the EMR, such as legibility, order verification, safety, and documentation.
6 tips for improving use of the EMR
1. Engage the computer in your patient encounter, says Rey Wuerth and colleagues. Share the screen, and any test results you are highlighting, with your patient by turning it toward her during your discussion. This can increase patient satisfaction.1
2. Go mobile at the point of care, suggests Tom Giannulli, MD, MS, Chief Medical Information Officer at Kareo. By using a tablet or mobile device, you can enter data while facing a patient or on the go.2
3. Use templates when documenting data, advises Wuerth and colleagues, as pre-filled templates, that are provided through the EMR or that you create within the EMR, can reduce the time required to enter patient visits, findings, and referrals.1
4. Delegate responsibility for routing documents, says Brian Anderson, MD. Hand off to staff administrative duties, such as patient forms and routine negative test results.3
5. Involve medical assistants (MAs) in the process. Make the MA feel part of the team, says R. Scott Eden, and assign them history-taking responsibilities, utilizing your EMR's templates. Assign them other tasks as well, including medication reconciliation, referrals, refills, routine screening, and patient education.4
6. Employ physical or virtual scribes who are specifically assigned to EMR duty. Although drawbacks can include patient privacy concerns and reduced practice income due to salary requirements, employing a scribe (often a pre-medical or graduate student), who trails you on patient visits, or who is connected virtually, can leave the clinician free to interact with patients.5,6
References
- Wuerth R, Campbell C, Peng MD, et al. Top 10 tips for effective use of electronic health records. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959973/. Paediatr Child Health. 2014;19:138.
- Giannulli T. 7 time-saving EHR use tips to boost physician productivity. April 28, 2016. https://ehrintelligence.com/news/7-time-saving-emr-use-tips-to-boost-physician-productivity. Accessed September 9, 2019.
- Anderson B. 5 ways to increase your EMR efficiency. October 28, 2014. https://www.kevinmd.com/blog/2014/10/5-ways-increase-emr-efficiency.html. Accessed September 9, 2019.
- Eden RS. Maximizing your medical assistant's role. Fam Pract Manag. 2016;23:5-7. https://www.aafp.org/fpm/2016/0500/p5.html.
- Hoffman S. Healing the healers: legal remedies for physician burnout. Case Western Reserve University School of Law. September 2018.
- Caliri A. The case for virtual scribes. January 2, 2019. Becker's Hospital Review. https://www.beckershospitalreview.com/hospital-physician-relationships/the-case-for-virtual-scribes.html. Accessed September 20, 2019.
OBG Management: Do you feel that the EMR has led to improved patient care?
Dr. Evans: Yes and no. Yes, in that it can be much easier to follow a patient’s health care history from other provider notes or prior surgeries. Information is searchable and legible. If an EMR is built correctly, it can save time for providers, through smart phrases and templates, and it can help providers with proper billing codes and documentation requirements. No, in that it can take away from important patient interaction. We are required to see more patients in less time all while using, at times, a cumbersome EMR system.
Dr. Woodland: This is a tricky question because the EMR has both positive and negative attributes. Certainly, the legibility and order verification has improved, but the ease of accessing information in the EMR has changed. Additionally, there has been a drastic increase in provider dissatisfaction that has not been addressed. Provider dissatisfaction can lead to problems in patient care. If there was a clear-cut increased value for the cost, I do not think the EMR would be such a huge focus of negative attention. Providers need to take back control of their EMR and their profession so that they can utilize the EMR as the tool it was supposed to be and not the dissatisfier that it has become.
Dr. Dougherty: I do not believe patient care has been improved by EMR systems, for all of the reasons we have discussed, and then some. But there is an enormous amount of potential, if we get the interface between humans and EMR systems right!