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
