How to be more efficient with clinical documentation

The median clinician spends 21.5 hours working in the EHR each week and — coincidentally — completes 21.5% of their weekly EHR time outside of patient hours, according to athenahealth data. Ideally, clinicians would spend only as much time in the EHR as they need to support good patient care and accurate documentation. What can healthcare organizations do to help clinicians spend less total time in the EHR and decrease pajama time?

In 2021, athenahealth conducted research into how clinicians spend their time in EHRs. The research includes analysis of de-identified data from across athenahealth’s network of customers as well as conversations with clinicians. These strategies to help clinicians work more efficiently in the EHR are based on that research.

How can healthcare organizations reduce documentation time?

Delegate encounter documentation and document processing work

Medical assistants and support staff can take on some of the EHR burden, minimizing the amount of time physicians need to spend in the EHR each week. Especially at larger organizations, physicians and nurse practitioners may have access to support staff who can import clinical notes, bring in lab results, close out encounters, schedule follow-ups, and more.

My nurse starts all my prior authorizations, and I only fill out the medication and code questions. Each provider has a nurse and a navigator. I think they help ease the administrative burden.

— Autumn Lemley, D.O., Community Care of West Virginia

For most specialties, delegating an additional 10% of a clinician’s encounter work is associated with a reduction in the percentage of EHR time spent outside of patient appointment hours. Delegation also helps clinicians reduce their EHR time to patient ratio (TPR), defined in the athenahealth research as the time a clinician spends in the EHR each week — inclusive of time during and outside the patient encounter — relative to the number of patients seen.

Clinicians need support to minimize work, but perhaps even more importantly, they need the autonomy to work in the way that’s best for them; some would rather handle tasks like chart prep themselves. Regardless, clinicians who are required to handle all admin work on their own report feeling overwhelmed, and clinicians who complete more of their own encounter and document work spend more total time in the EHR per patient visit and more EHR time outside appointment hours.

Take advantage of accelerators

Accelerators like encounter plans, text macros, order sets, and exam templates can alleviate some — but not all — issues with the burden of EHR-related work. Many clinicians report that using EHR accelerators feels as if it increases efficiency. This is especially true for clinicians who are trained to be their organization’s EHR experts and at organizations that designate support personnel to be EHR experts, so clinicians don’t have to be.

We use text macros and order sets, and my nurse also has text macros. And that's why we're able to get everything finished when we go home at the end of the day.

— Allison Taylor, FNP-BC, Allegro Family Clinics

Using accelerators effectively is a strategy that typically works best at larger organizations or health systems, where there’s a team dedicated to creating, updating, and training on these tools. It can be harder for a very busy small practice to dedicate resources to these tasks. But smaller practices may find success with accelerators if they receive additional support and training, and they may also be able to outsource some of this work.

Provide thorough onboarding and ongoing training

Good onboarding and training for EHR users can also help overwhelmed clinicians. There’s tremendous variation in whether clinicians feel they have received the training they need to use their EHR efficiently and easily.

But those who think they had good training and ongoing support report feeling better about their EHR overall. When clinicians have the knowledge they need to use EHR tools — like accelerators, for example — efficiently and effectively, they can spend less time in the EHR and more time with patients.

We get good support. It started when we first got on athena, and we were told about [macros and order sets], and asked, which ones would help you? What do you need?

— Allison Taylor, FNP-BC, Allegro Family Clinics

Encourage greater autonomy to help reduce after-hours time

Clinicians who have some autonomy over scheduling, appointment length, and the number of patients they see are better able to close their encounters during the day and less likely to work after-hours.

Clinicians with autonomy may choose to add a few minutes of buffer time between appointments so they can quickly finish documenting each encounter while it’s still fresh. Organizations may designate dedicated, protected administrative time during the workday so clinicians spend less time after-hours capturing chart notes.

The strategies clinicians choose to use often depend on their specialty. For example, clinicians in specialties that perform a lot of procedures — like orthopedic surgeons — may strategically schedule procedures for blocks in the day, so they can focus on documentation without interruptions once patients have left the office.

These strategies are harder to implement in larger organizations, where the focus on volume makes it very difficult for clinicians to complete all documentation during regular patient hours. Many clinicians deliberately choose small or independent practices to allow them to retain this kind of autonomy, although most have to forgo earnings in return for this level of control.

Changes at the systemic level

Though strategies like these may help individual clinicians feel more efficient in their EHR use, there’s only so much individual clinicians and healthcare organizations can do. The time a clinician spends in the EHR is also largely a function of the regulatory and financial market they work within. In the future, we’ll need broader standardization, better interoperability, and better automation across the industry to move toward a real focus on quality and value.