A few years ago, I wrote a KevinMD blog post about how cumbersome it was to complete notes in the electronic medical record (EMR). I proposed a solution in our residency clinic but encountered resistance in the adoption process that eventually led to its abandonment. For someone just trying to solve a problem, it was very frustrating, to say the least.
Despite the advances in the past few decades, the clinic workflow in primary care, a model that I have witnessed drive my colleagues into burnout, has largely not evolved.
You might recognize the workflow:
- The patient checks-in at the front desk and waits in the waiting room filling in and signing documents on paper.
- The medical assistant rooms the patient.
- The physician enters the room with a vague idea of the patient’s reason for the visit.
- Physician struggles to ask as many questions as deemed relevant while maintaining “continuous partial attention” typing the patient information into the EMR.
- Continue this process every 15 to 20 minutes, through lunch until the day ends.
- Finally, physician spends 1-2 hours after clinic finishing notes and other EMR work.
For a frontline physician, this can be a challenging experience day in and day out. While the HIMSS conference (largest health IT conference of the year) is currently underway, I can’t help but be a little frustrated how long past solutions take to see mainstream adoption. To give you an idea, I set a Google Alert three years ago on “efficient EMR documentation.” For three years, I received results for machine learning, artificial intelligence, natural language processing, etc. without any considerable change for the majority of primary care physicians. I see EMR documentation as the primary driver of physician burnout, and all I think we are asking for is a sensible solution. No hype, no broken promises just a solution.
With the introduction of EMRs, physician burnout has escalated to unprecedented levels. We spend too much time on the EMR, and unfortunately, the problem has continued to worsen. Some doctors have responded by cutting back their hours or retiring early, potentially exacerbating the looming physician shortage.
Now let’s look at the current approaches used to combat these reasons, each with its varying level of success:
Teamwork. Improved teamwork is among one of the more adopted solutions to reducing physician workload. One of its main merits is that it transfers unnecessary tasks such as data entry and documentation from the physician to other staff members. High-quality teamwork enhances clinicians’ well-being and allows them to practice at the highest level of training. However, ineffective teamwork could exacerbate burnout and increase workload.
EMR templates and smart phrases. Smartphrases and templates are often useful for areas of the visit note that are repetitive and do not require much customization. It speeds up the process but introduces the risk of pulling old information into a note that may or may not be accurate.
Dictation, clinical language understanding (CLU) and dialogue capture. These services make it possible for doctors to dictate directly to voice recorders, microphones, and mobile devices instead of typing notes manually. This approach is not only faster than typing but also is easily formatted within EMRs. Conversely, CLU does not solve the documentation burden on doctors; we just get faster at it.
Scribes. Medical scribes accompany physicians during the visit to provide documentation of the visit as an observer. Though they are especially helpful in workload reduction, they increase administrative costs, require highly specific training. They are one of the first suggestions recommended by physicians familiar with Dr. Christine Sinsky’s research on burnout.
After looking into these multiple solutions and examining best practices in primary care workflows, automated patient interviewing software continued to surface as a viable but sometimes overlooked solution.
Automated patient interviewing platforms
Automated history platforms differ from the other potential solutions in a few key ways. Many of the other approaches primarily task the doctor with data entry and documentation. Automated history platforms instead use rule-based algorithms, similar to a clinician’s thought process, to perform patient data collection without the need for staff assistance (see a great review of the literature here).
Consider some of its key benefits:
Higher doctor and patient satisfaction. Automated history gathering is faster than traditional methods. This frees up time for physicians to spend more time with patients and increase job satisfaction. High job satisfaction is associated with increases in the quality of care and patient satisfaction.
More reliable and comprehensive data collection. Using a computerized platform facilitates extensive data collection based on a standard framework. The information is more complete and better organized. Furthermore, patients have been shown to be more open to reveal sensitive information about risky lifestyles to a computer rather than their doctor.
More flexibility for more patients. Computerized systems provide multiple language compatibility along with increased availability. Additionally, information from the patient is accessible to all providers with access to a particular platform.
Given the widespread shortage of physicians, an automated patient-based system makes it easier for physicians to handle their primary task – medical decision making. As such, the clinic flow becomes less dependent on the speed of patient interviewing and physician documentation.
I am looking forward to seeing what comes out of HIMSS this year. We are ready for technology to help doctors dedicate more time to patients face-to-face and bring back some joy to practice.
Troy Russell is a family physician and founder, Carescribr.
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