3 Tips for EHR Efficiency from a Solo Practitioner

A primary care physician describes the electronic health records system workflow that works for his practice.

The AMA's time-motion study released last week quantified a major complaint about EHRs, concluding that for every hour physicians spend with patients, they spend another two hours interacting with their electronic medical records systems.

In an editorial accompanying the study in the Annals of Internal Medicine, Susan Hingle, MD, an associate professor of internal medicine at Southern Illinois University School of Medicine, articulated an equally valid, arguably more productive conclusion:

EHR Burdens Leave Docs Burned Out, in Critical Condition

"Now is the time to go beyond complaining about EHRs and other practice hassles and to make needed changes to the healthcare system that will redirect our focus from the computer screen to our patients and help us rediscover the joy of medicine," Hingle wrote.

For insights into how physicians might improve their relationships with EHRs (and therefore, patients), I spoke with Salvatore S. Volpe, MD, a New York-based solo primary care physician. In addition to using an EHR in his practice for the past eight years, Volpe belongs to the board of directors of the New York eHealth Collaborative and serves as chair of the health information technology committee for his state medical society.

He offered the following tips for EHR efficiency:

1. Take a Team Approach

Volpe's office team includes just a medical assistant (MA), a biller, and an occasional RN. But what it lacks in size, this level-3 patient-centered medical home makes up for in strength. The MA in particular plays a key role by documenting patients' chief complaints.

"The medical assistant talks to the patient about the chief complaint, and the patient says whatever she's going to say," Volpe explains. "When I come in, the patient has had a few more minutes to think about it and give me the history of present illness."

Within the chief complaint field, the MA also writes reminders for Volpe, such as, "pneumonia shot due," or "discuss chronic care management."

"Even though I could hit the clinical decision support key and have a lot of that stuff pop up for me, if she cues that up for me in advance, it's one less button I have to hit," Volpe says. "That's where you can use your MAs to make a good product even better."

2. Invest in Prep Time

Reviewing patients' records and test results takes less time overall, Volpe says, if he makes time to review them more than once. Typically, he spends the most time reviewing documents from specialists and other materials over the weekend. During these sessions, he'll make annotations to the progress note to streamline the visit.

"I typically do a little bit every day, but a lot on the weekend," he says. "If I've already reviewed the documents, then it's less than three minutes of review before going into the exam room. But if I do it the same day, it could become five to seven minutes."

3. Ask for Help

Learning to navigate an EHR and develop the muscle memory to find the right buttons at the right time isn't easy, Volpe admits, especially if physicians are using different platforms at the offices and hospitals at which they work.

"If people are having a hard time or feel like they're spending too much time navigating the EHR, if they're employed they should ask for additional training time," Volpe says.

EHR 'Information Overload' Plagues Clinic Notes

Another practical solution is to ask for a scribe, with the caveat that physicians are still ultimately responsible for their EHRs.

"Scribes are very valuable, but doctors have to realize that having a scribe doesn't mean they don't have to block out a certain amount of time to make sure there wasn't a transcription error by someone who didn't go to medical school," Volpe says. "It will definitely make things faster, but you still have to proofread it."