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Appl Clin Inform 2024; 15(04): 771-777
DOI: 10.1055/a-2367-8564
Case Report

Effect of an Electronic Health Record-Based Intervention on Documentation Practices

Shreya Shah
1   Stanford University School of Medicine, Stanford, California, United States
,
Michael Bedgood
2   Coronavirus Science Branch Epidemiology Team, California Department of Health Care Services, Richmond, California, United States
,
Anna Devon-Sand
1   Stanford University School of Medicine, Stanford, California, United States
,
Cathriona Dolphin-Dempsey
3   Technology and Digital Solutions, Stanford Health Care, Palo Alto, California, United States
,
Venkata Cherukuri
3   Technology and Digital Solutions, Stanford Health Care, Palo Alto, California, United States
,
Kirsti Weng
1   Stanford University School of Medicine, Stanford, California, United States
,
Steven Lin
1   Stanford University School of Medicine, Stanford, California, United States
,
Christopher Sharp
1   Stanford University School of Medicine, Stanford, California, United States
› Author Affiliations Funding None.
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Abstract

Background Documentation burden is one of the largest contributors to physician burnout. Evaluation and Management (E&M) coding changes were implemented in 2021 to alleviate documentation burden.

Objectives We used this opportunity to develop documentation best practices, implement new electronic health record (EHR) tools, and study the potential impact on provider experiences with documentation related to these 2021 E&M changes, documentation length, and time spent documenting at an academic medical center.

Methods Five actionable best practices, developed through a consensus-driven, multidisciplinary approach in November 2020, led to the creation of two new ambulatory note templates, one for E&M visits (implemented in January 2021) and another for preventative visits (implemented in May 2021). As part of a quality-improvement initiative at nine faculty primary care clinics, surveys were developed utilizing a 5-point Likert scale to assess provider perceptions and deidentified EHR metadata (Signal, Epic Systems) were analyzed to measure changes in EHR use metrics between a pre-E&M changes timeframe (August 2020–December 2020) and a post-E&M change timeframe (August 2021–December 2021). A subgroup analysis was conducted comparing EHR use metrics among note template utilizers versus nonutilizers. Any provider who used one of the note templates at least once was categorized as a utilizer.

Results Between January 2021 and December 2021, the adoption of the E&M visit template was 31,480 instances among 120 unique ambulatory providers, and adoption of the preventative visit template was 1,464 instances among 22 unique ambulatory providers. Survey response rate among faculty primary care providers was 82% (88/107): 55% (48/88) believed the 2021 E&M changes provided an opportunity to reduce documentation burden, and 28% reported favorable satisfaction with time spent documenting. Among providers who reported using one or both of the new note templates, 81% (35/43) of survey respondents reported favorable satisfaction with new note templates. EHR use metric analyses revealed a small, yet significant reduction in time in notes per appointment (p = 0.004) with no significant change in documentation length of notes (p = 0.45). Note template utilization was associated with a statistically significant reduction in documentation length (p = 0.034).

Conclusion This study shows modest progress in improving EHR use measures of documentation length and time spent documenting following the 2021 E&M changes, but without great improvement in perceived documentation burden. Additional tools are needed to reduce documentation burden and further research is needed to understand the impact of these interventions.

Keywords

E&M coding changes - note bloat - documentation - EHR - note templates - implementation

Protection of Human and Animal Subjects

This minimal risk study was determined by the Institutional Review Board (IRB) to be exempt from formal IRB review on the basis of quality improvement.


Supplementary Material



Publication History

Received: 05 January 2024

Accepted: 14 July 2024

Accepted Manuscript online:
17 July 2024

Article published online:
25 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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