Physicians spend 8% of their time at work on administrative activities and 45% of their time at work on the EHR — 24% of this time on use of the EHR while providing direct patient care, and 21% on EHR input alone.1
While system-level changes are needed to help reduce this burden,2 physicians and their teams can make practice-level changes to eliminate unnecessary work, reduce obstacles, and save time.
1. Document less but better. It's easy to over-document when you have to worry about medicolegal risk, you're trying to gather rich psychosocial information, and you feel pressured to check all the boxes you can. But not all EHR boxes need checking, and not all visits require that you write an opus. Instead, be brief, focused, and clear enough that someone looking at your note will understand your clinical reasoning and your plan. If you find yourself writing the same information repeatedly, make a template.
2. Get clear on the E/M coding rules. Code level selection is now simplified — based on either medical decision making or total time. The history and/or physical examination and the counting of bullets were eliminated as components for code selection (although history and/or physical examination documentation should still be performed as medically appropriate).
3. Try team documentation. Using an expanded rooming process, trained medical assistants can pull up appropriate documentation templates in the EHR, update the patient's history, complete medication reconciliation, and close any gaps in care. They can also remain in the exam room to provide documentation assistance to the physician.
4. Rethink who does what. If you find yourself doing a task that does not require a physician's training or license, consider whether someone else could do it. For example, your staff can take the first pass at completing FMLA forms and DME requests, and then you can simply review and sign off on them as needed. Team huddles and standing orders can make the delegation of tasks more effective.
5. Redirect inbox messages. The default in many EHR systems is for all messages to go directly to the physician, but this is inefficient. Ask your IT staff to set up your system so it routes messages to the appropriate person, such as your medical assistant or nurse, and then have your staff do all they can before getting you involved. If a message involves an issue that will take a lot of time, instruct your staff to schedule the patient for an in-person or telehealth visit. That way, you will get reimbursed for your work and it will take up a spot in your work schedule as opposed to a spot in your personal schedule after work hours.
6. Spend less time on prior authorizations. Use one or more dedicated staff members to manage prior authorization requests, and submit them electronically. Customize your EHR, if possible, to remind yourself what information should be included in the requests. And develop a prior authorization cheat sheet for the most common medications and procedures that require prior authorization.
7. Lengthen prescriptions for chronic medications. If you're in the habit of authorizing prescriptions for 90 days, consider a one-year authorization instead. (Continue to see your patients at the same frequency so you can monitor their care and medication use.) By extending prescriptions, you will cut down on phone calls and messages related to refill requests.
8. Address inefficient workflows. Basic quality-improvement tools and principles can help you clean up your processes and save time. Start by mapping all the steps in a process. Then look for bottlenecks, unnecessary steps, and steps that fail repeatedly and require correction or rework.
9. Leverage technology. Software programs that are already on the market (or coming to market soon) can help relieve physicians' workload burdens without the need to hire more staff. Tasks technology can relieve include documenting visits, conducting pre-visit planning, and completing prior authorizations.
10. Ask for changes to your EHR. Screens, reports, login requirements, alerts, and templates can all be reconfigured to work better for you. If you don’t have IT staff who can work on this, contact your vendor or contract with a programmer to do this work.
1. Toscano F, O’Donnell E, Broderick JE, et al. How physicians spend their work time: an ecological momentary assessment. J Gen Intern Med. 2020;35:3166–3172.
2. Winner J, Knight C. Beyond burnout: addressing system-induced distress. Fam Pract Manag. 2019;25(5):4-5.
Posted on Aug. 15, 2022 by FPM Editors
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