Reducing the burden of clinical documentation with EHRs
In Practice
By Swapna Bhatia, MPH, June 3, 2019
It’s no surprise that clinical and administration documentation burden with electronic health records (EHRs) has been on the rise.
Although 78% of dermatology practices reported acquiring an EHR system in the 2017 AAD Practice Profile Survey, the Academy recognizes that there is continued frustration and concern regarding clinical documentation in EHRs. According to that same survey, 76% of group practices agreed that there was too much time spent documenting visits, and 64% agreed that there was too much time spent documenting quality measures. Documenting patients through EHRs was supposed to be simpler and more straightforward than paper-based documentation, but it continues to be more burdensome for physicians.
Top challenges
There are several significant challenges that dermatologists face while using their EHRs, particularly the fast-paced growth in regulations that physicians need to keep up to date on.
Some problems include:
Decrease in physician-patient quality time
With the use of EHRs, quality face-to-face time between a physician and patient has decreased. This could be because of several factors, such as the doctor concentrating on entering medical notes into the EHR or inputting different codes in order to abide by CMS regulations.
Increasing computerization of practice (e.g., clicks to accomplish each task, alert fatigue)
Alert fatigue has increased and is becoming more common than ever, affecting the work of physicians. There are certain alerts that are more significant than others but can become lost within the numerous other messages.
Lack of interoperability
There are many complications impacting attainment of interoperability among dermatologists, including: Lack of free-flow exchange of health information and patient data; no seamless way to require industry-wide interoperability standards across health care facilities; and delays in developing a standardized way to identify patients.
Clinical documentation burden with coding and quality requirements
The current regulatory requirements have made it difficult for dermatologists to have quality time with their patients because they are focusing on implementing EHR vendor upgrades or are trying to meet new reporting deadlines mandated by CMS.
Solutions
There are many solutions that can help alleviate these administrative burdens. The Academy has developed several resources in the AADA Practice Management Center to assist physicians and office staff in alleviating clinical documentation and administrative burden. Content in these areas include health information technology (HIT) assistance for EHR users, burnout resources, and regulation relief resources. Learn more at staging.aad.org/practicecenter.
HIT solutions
The HIT page on the Practice Management Center offers tools and tips for practice technology needs for EHR-based users. Topics include: The use of scribes, useful applications, teledermatology, reducing administrative burden, prior authorizations, and more.
Training all staff
Appropriately training all medical staff on using an EHR is a vital component to understanding the EHR system. There are several advantages that clinical staff would benefit from if proper training were provided that would help them understand the simple components of the EHR system. Training can reflect in higher satisfaction with health information technology and improve clinical practice just by using advanced features provided on the system. Additionally, EHR systems undergo updates constantly. Making sure staff are trained on a continual basis is essential.
Hiring medical scribes
Employing certified medical scribes and medical assistants — who have completed training and understand how to navigate EHR systems — can reduce clinical documentation burden and improve the quality of the dermatologist-patient relationship, increase the number of patients seen in a day, and reduce patient wait times. To learn more about hiring scribes, visit staging.aad.org/dw/monthly/2018/june/taking-notes.
Useful apps
The Academy’s HIT webpage also provides a breakdown of mobile apps that can assist in reducing the burden of clinical documentation and help run your EHR-based practices more efficiently.
Check out popular apps in the Practice Management Center.
Addressing physician burnout
DERM360 is the Academy’s burnout resource page that offers several solutions on addressing physician burnout including overcoming practice challenges, focusing on self-care, and recharging your motivation. The site includes tips on utilizing your EHR more efficiently and how to ease the burden of reporting quality measures in your EHR. Visit staging.aad.org/burnout to access these tips and take a burnout assessment.
Provide relief from regulations
The Academy has been advocating for relief from burdensome regulations for dermatologists and continues to work to ease these burdens on medical practices. For example, the U.S. Department of Health & Human Services (HHS) recently released two proposed rules that are intended to clarify HIT data exchange requirements and prevent data blocking. The AADA has carefully reviewed those proposals and has provided comments to HHS, to ensure that the rules, when finalized, reduce or at least do not impose additional burdens on physicians, and that they improve the exchange of needed data, thereby improving patient care.
AADA staff and members have also been involved with providing feedback to Congress as part of the Red Tape Relief Project in an effort to find ways to reduce regulatory burdens. Learn more at https://republicans-waysandmeansforms.house.gov/uploadedfiles/red_tape_relief_final_-_v4.pdf.
Additionally, after much prodding, CMS has recognized that the 1995/1997 E/M documentation guidelines are out-of-date. The 2019 Medicare Physician Fee Schedule Quality Payment Program final rule outlined changes to ease some documentation requirements for office E/M codes. The AADA is also working with the AMA and other specialties to revise these codes to simplify documentation requirements.
For more coding and E/M reimbursement information, visit:
- AADA Coding Resource Center: staging.aad.org/coding
Additional DermWorld Resources
Sidebar
Clinical documentation
Check out the AADA’s Practice Management Center at staging.aad.org/practicecenter for updates on clinical documentation requirements.
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