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Analysis

Write Shorter EHR Notes, Fight Physician Burnout

By Christopher Cheney  
   September 06, 2018

Electronic health records contribute to physician burnout and writing shorter case notes can ease the EHR burden.

Electronic health records (EHRs) have become a primary driver of physician burnout, a recent research article says.

Earlier research found physician burnout rose from 45.5% of doctors in 2011 to 54.4% in 2014. The time period corresponds with the introduction of mandatory use of EHRs.

The recent research article, which was published in The American Journal of Medicine, says EHRs contribute to all three elements of physician burnout—lack of enthusiasm, lack of accomplishment, and cynicism.

"The hours spent cloning notes in a mandated doctor-computer relationship leaves the physician unable to experience the best part of being a doctor. No humanistic physician gets up with zeal in the morning, hopeful for a chance to have a meaningful relationship with Epic or MEDITECH. Rational people should feel cynical if the institutional accomplishment for the day is to produce 20 cloned medical records," the researchers wrote.

Less is more
 

Writing shorter case notes is one of the key strategies to address EHR-related physician burnout, the researchers say.

Earlier research found that primary care physicians spend more time interfacing with EHRs than working with their patients. "Primary care physicians spend more than one-half of their workday, nearly six hours, interacting with the EHR during and after clinic hours."

Case notes can be shorter without compromising the quality of the information, the lead author of The American Journal of Medicine article told HealthLeaders this week.

"Shorter notes do not imply incomplete or partial notes," said Andrew Alexander, MD, associate dean at the University of California's Riverside School of Medicine in Riverside, California.

He said there are several best practices for taking shorter case notes:

  • The physician should record the patient's presenting complaint and all pertinent data that helps the doctor formulate the differential diagnosis (DDx) and a plan for concluding the visit.
     
  • Pertinent data can include testing, consultation, procedures, or medications.
     
  • Further documentation can degrade the quality of care because the doctor must attend to the computer keyboard and occupy the record with templated data that confound and camouflage the key patient care issues the next time a doctor sees the chart or the patient.
     
  • Take notes as the questions are being asked and look at the patient while inputting information into the EHR.
     
  • Use a basic template that auto-populates medications, vital signs, and simple exams.
     
  • Have separate templates for children and gynecological exams.
     
  • When formulating assessments or diagnoses, omit templates and hand-enter problems or assessments with alternative diagnoses. Physicians should include why preferred and alternative diagnoses are possible, which will help explain diagnosis reasoning in future viewings of the record.

The main pitfall of shorter notes is omitting the creation and chart entry of a differential diagnosis when there is uncertainty about a patient's diagnosis, Alexander said.

"Failure to create a DDx would force the physician to review the lab results, which arrive days later, without context. An on-call partner or a consultant might see the patient and repeat all testing and X-rays as they attempt to replicate the same logical clinical inquiry that you failed to document," he said.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Research has shown that more than half of a primary care physician's work day is spent interacting with an EHR.

EHR use contributes to all three elements of physician burnout: lack of enthusiasm, lack of accomplishment, and cynicism.

Best practices for shortening EHR case notes include focusing on a patient's presenting complaint.

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