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The Clinical Documentation Conundrum

   February 01, 2017

"It's a really critical topic," Badlani says. "A significant portion of physician dissatisfaction comes from steps they have to do in the EHR, which don't really line up to any clinical benefit. The way we do documentation is one of them."

A second technology effort to help with documentation burdens combines the heads-up display found in Google Glass and similar augmented-reality wearables with a notion popularized shortly after the EHR was invented: the scribe. In this regard, in 2015 Sutter began using technology from Augmedix, a company that pairs Google Glass with scribes working from India who help ease the burden of documentation on the wearable-donning physician, presenting relevant information on the heads-up display and allowing the physician to keep their eyes and attention on the patient. "That's an example of innovation trying to leverage what we can in making this better," Badlani says. Sutter has also made a minority equity investment in Augmedix.

Erskine notes that trying to lean too heavily on scribes to help relieve physician documentation burnout has its own risks. "Scribes have tried to help address the issue but they introduced their own problems in terms of potentially overdocumenting what is actually being done," he says.

Still, all these efforts are a reaction to the failings of the meaningful use program to achieve its ultimate objective—improving outcomes, Badlani says.

"It perpetuated the concept that the mere presence of technology, trying to achieve meaningless measures, would make a difference," he says. "For the longest time, EHRs have not been seen as a clinical transaction tool. They have been seen as billing, coding, and documentation tools. We can't get people to do medication reconciliation on a regular basis in almost any organization consistently, because there are so many other tasks that don't add value to their clinical practice."

Erskine also sees a role for an emerging class of what he describes as "text analytics," which can help identify those clinicians doing a good job of writing notes—as opposed to "those who are clearly kind of using the system to just get through and not necessarily communicate the clinical information that's necessary. We've had conversations like that about how could we make it more usable and how could we make it easier.

"I wish I could give you a crisp answer and say we do this, and that way it's all working itself out. But as long as humans are involved, I think we'll still have to learn together in terms of how to make that happen," Erskine says.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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