FROM THE EDITOR
Addressing Administrative Simplification
Physicians are spending too much time on paperwork and EHR-related tasks, but what can be done?
Fam Pract Manag. 2021 Jul-Aug;28(4):5.
My kids asked me once why my signature was so messy. “Mom, why can't you slow down and write your name clearly?” I explained that my job requires me to sign my name many (say, 50) times a day and I just get sick of writing it out over and over again. So, my signature has become a squiggle.
My office has had an electronic health record (EHR) for more than 10 years, yet the dream of being paperless seems like an illusion. My team's medical assistants (MAs) bring me a folder of paper documents to sign every time I am at clinic. I sign preauthorization forms, nursing home orders (really, every page needs to be signed?), home health orders, HMO regulatory edicts, orders for durable medical equipment, Family and Medical Leave Act (FMLA) forms, and sometimes orders for physical therapy or occupational therapy if Medicare requires it. Squiggle, squiggle, squiggle.
In fact, data show that physicians spend two hours on EHR or paperwork tasks for every hour they spend seeing patients.1 Most physicians will tell you they get the most satisfaction and enjoyment out of direct patient care. But they are being asked to spend twice as much time writing notes, responding to online messages, and following up on results. This is on top of the endless forms that we all fill out on a daily basis. One study used EHR data to document that family physicians in a large health network spent nearly six hours a day interacting with the EHR during office time and after hours.2 Physician dissatisfaction and burnout have been linked to paperwork and the “extra” tasks we are asked to do on a daily basis.3 So, burnout rates are on the rise, but we are still spending a lot of our time doing paperwork and EHR-related tasks. That doesn't make sense.
My office has put systems in place to reduce the burden of paperwork on clinicians. We have an administrative assistant who pre-fills all FMLA forms with as much information as she can find, so most of the time, I just sign my name where the “sign here” sticker is. We have a pharmacy on site whose staff begin most prior authorization procedures. I only get involved if they have a question or a situation is challenging. And, as I said earlier, my MAs put all faxes and forms in a folder for me so that all I have to do is sign on the dotted line. These small changes have helped me feel a little less frustrated with the administrative tasks. Even so, I still feel burdened and overwhelmed by the amount of paperwork and just extra work that comes across my desk every day.
Accordingly, FPM decided to focus on administrative simplification as a theme of this issue. Inside the journal, you will read about advocacy by the American Academy of Family Physicians and others to reduce administrative burdens on family physicians, how to reduce time spent managing your EHR inbox messages, and updated tips on billing and coding efficiently, among other topics.
We hope you find some suggestions to help reduce your administrative work. And if you have a tip you'd like to share, please send it to us at firstname.lastname@example.org.
1. Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in four specialties. Ann Intern Med. 2016;165(11):753–760.
2. Arndt BG, Beasley JW, Watkinson MD, et al. Tethered to the EHR: primary care physician workload assessment using EHR event log data and time-motion observations. Ann Fam Med. 2017;15(5):419–426.
3. Babbott S, Manwell LB, Brown R, et al. Electronic medical records and physician stress in primary care: results from the MEMO study. J Am Inform Assoc. 2014;21(e1):e100–106.
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