How to streamline EHR workflow to give time back to physicians

john Squire

John Squire, President, Amazing Charts

What if someone said you could make more than $36,000 in extra income and take off an additional three weeks of vacation annually – all without changing the size of your practice staff or patient panel?

How is that possible?  One word: efficiency. 

If you use an Electronic Health Record (EHR) system that slows you down with extra clicks and typing, you are losing valuable time with every patient visit. Let’s do the cold, hard math on how much time and money that extra effort is costing you.

Assuming you see an average of 30 patients a day and spend an extra two minutes to chart a routine exam; that equals 60 minutes wasted on clinical documentation per day.  If you used half of that hour to see two more patients, at an average of $75 per visit, you would make an extra $150 per day, and still have enough spare time to leave the office 30 minutes earlier than you do now. 

On a monthly basis, you would make $3,000 more income while giving yourself over 10 hours of extra personal time.  You can do the math to get the same annual figures cited at the start of this article.

The best way to save time: efficiency

How can you save two precious minutes per visit? Certainly not by spending less time face-to-face with the patient!

How about spending less time in front of your EHR instead? If you can save 30 seconds on a handful of common tasks by using an EHR system with a more intuitive interface and streamlined workflow than the EHR you use now, you’ve just saved two minutes per visit.  

Compare the number of steps of common workflows

Workflow is defined as the sequence of steps or processes required to complete a task from initiation to completion. These tasks can be complex and demanding, such as documenting an assessment and plan during a patient visit, or relatively simple, such as writing an e-prescription refill.

Obviously, physicians want to complete a task with as few steps as possible. This often translates into having fewer fields to fill out, fewer boxes to check, and fewer windows to click through.

When comparing EHR systems, you can count the number of steps required to complete a discrete task you do repeatedly throughout the day, such as documenting the History of Present Illness (HPI) or Review of Systems (ROS). The more steps, the longer it will take to complete a note.

An example of how to count clicks

This white paper looks at six basic tasks providers typically perform multiple times each day, such as ordering a medication. It calculates the number of clicks and/or steps it takes to do each task using an ambulatory EHR that has been ranked favorably by physicians for usability, so it offers a high standard for comparison. This provides an objective yardstick against which you can measure the efficiency of your current EHR system. 

Each workflow begins in the Most Recent Encounter (MRE) screen (or the equivalent screen in your current EHR). You can run through each scenario using your current EHR system and record how many steps and minutes it takes you (see Figure 1).

An example of a step-by-step breakdown of workflow

Enter a medication order for the patient and print it.

1. Click the Write Scripts button.

2. Search for a medication.

3. Select the desired medication from the list of results.

4. Update any settings (e.g., quantity) if desired.

5. Click the Prepare Script button.

6. Click the Prescribe button.

7. Click the Print to Default Printer button.

Average time: 0:60

Use voice recognition technology

If you haven’t looked at voice technology in a while, it’s time to take another look. With the right customized voice recognition package and EHR configuration, you can complete detailed charts in under five minutes and follow-up visits in less than three minutes. In our experience, using dictation tools alone, you can potentially reduce time spent documenting care by 30 minutes or more per day.

Maybe you avoided voice recognition technology in the past because it wasn’t good at handling medical terminology. Like many technologies, voice recognition has come a long way to solve this problem. Now there are solutions specifically designed to recognize medical vocabulary and programmable to understand your intonation based on a few simple questions about yourself. 

Not only can you dictate your notes, you can also streamline your workflow with progressive features that automate repetitive tasks and let you view lab results, images and flow sheets while you dictate. Based on what we hear from practices who use high-level voice recognition software, it is easy to complete a Level 3 established office patient E/M note (CPT code 99213) in less than five minutes. Typing this same 99213 note typically takes 15 minutes or more.

Use templates, but don’t make identical notes

When used appropriately, macros and templates can be valuable in improving the completeness and efficiency of documentation, particularly where it is primarily limited to standardized terminology, such as the ROS and physical examination findings.

Overuse of templates, however, can result in “cookie-cutter” notes that all look and sound the same. There can even be a legal issue if clinical documentation is audited. Additionally, templates don’t always support quality documentation. This is especially true for more complex patients whose stories don’t fit within the confines of standard templates.

Always use an EHR system that includes the ability to create customizable templates that support your practice’s specific needs, and avoid EHR systems that minimize free text entry.

What to do next

It’s time to start looking for a new EHR solution if using your current clinical documentation system takes more steps and/or time than others. 

Where to begin your search?  Look for surveys of clinicians, such as those published annually by the American Associations of Family Physicians, to get real-world feedback on EHR satisfaction. For detailed real-time ratings based on telephone and online surveys of EHR users, check out KLAS Research, which is free to clinicians. 

Before signing any long-term contracts, make sure you conduct a real-world trial of a full-version of the software to make sure it works in your office and improves your efficiency. 

Accomplish these steps successfully and you can start thinking about where to spend three extra weeks of vacation next year!

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