Spend Less Time on Paperwork and More Time on Your Patients
We’ve seen the writing on the wall—and on clinicians’ computers—for some time now. As far back as 2016, a study of U.S. physicians found that for every hour of direct face time with patients nearly two additional hours were spent on electronic health record (EHR) tasks and desk work, often spilling over to time at home, or so-called “pajama time.”
While awareness of this burden has grown among policymakers in recent years, doctors still cite paperwork as their chief complaint—a matter of major concern because when clinicians feel that meaningful activities, like patient communication and medical decision-making, are taking a back seat to documentation duties they’re more likely to experience burnout.
Dr. Christine Sinsky, AMA Vice President of Professional Satisfaction, put the problem this way: “We [as clinicians] often spend more time documenting care than delivering care, and that doesn’t align with our mission.” She recalls that it once took her 32 “clicks” to record having ordered and administered a flu shot. In part, this is because the systems were designed for billing as much as taking care of patients.
Added to this, many EHR systems automatically generate boilerplate text into patient records, as well as allow doctors to cut and paste information easily. This build-up of nonessential content, dubbed “note bloat,” can make it difficult for clinicians to zero in on what they actually need to know about a patient. Time is also wasted when they are required to re-enter the same information, such as a patient’s family, social, and medical history, over and over.
As one doctor observed in The New York Times, “What actually transpires with the patient seems like a quaint trifle, something to squeeze in among the primary tasks of getting everything typed into the EHR.”
Other Time Sucks
Compliance. Few would argue that thorough records and documentation are necessary for patient safety and quality care. Yet, ironically, the many regulations issued by local, state, and federal regulatory agencies to keep people safe may endanger patients by contributing to burnout. When a physician orders a test or a procedure for a Medicare patient, for example, the order must first be documented in the patient’s record and then documented using an established diagnosis assignment process mandated by the government. Physicians must be trained constantly to keep up with changes in Medicare compliance reporting, meaningful use EHR requirements, and Prior Authorization directives, among others. Little wonder that regulatory burdens were identified as one of the least satisfying aspects of being a doctor in a 2018 poll sponsored by The Physicians Foundation.
Quality Metrics. The Centers for Medicare and Medicaid Services (CMS) and commercial payers, as well as accrediting bodies, such as The Joint Commission, require health systems to report quality measures. However, providers often question whether quality metrics are a help or a hindrance to better outcomes and patient experience. One reason for this is that publicly reported metrics may not provide actionable or meaningful insight for all patients within a given population, such as those with diabetes. Furthermore, data are often siloed in multiple diverse source systems and formats, making it hard for providers and analysts to aggregate. Clinicians may thus feel they are spending a considerable time on complex and time-consuming tasks that don’t directly benefit patients. Tellingly, a 2019 survey of physicians across markets in seven states revealed that while most believed in the importance of clinical quality measures, the roles they would most need additional staff to fill in order to achieve high-level performance were not clinical, but rather focused specifically on documentation and coding.
Prior Authorizations. The number of treatments and medications requiring prior authorizations from payers is growing. Indeed, an AMA survey of 1,000 physicians revealed that prior authorizations took an average of almost two business days each week to complete, which includes waiting on the phone, dealing with cumbersome phone trees, getting disconnected, and in many cases bringing insurance company reviewers up speed. This often amounts to time wasted and revenue lost for doctors, as well as delayed access to necessary care for patients. Phone and fax are still the main tools to complete prior authorizations, and many providers must hire people to navigate the process, which can vary according to health plan. Physicians or their staff members are often on hold for 20 minutes or more for a prior authorization call; and many health plans don’t have the staff to process the growing number of requests, which may leave patients stranded in an emergency department or hospital bed pending a decision.
How Outsourcing Can Help Now
Given the toll that paperwork has exacted on healthcare providers, there’s a very good argument to be made for outsourcing non-core functions. Third-party partners specializing in healthcare understand the high level of professionalism needed to relieve providers of the documentation demands that detract from critical time spent with patients.
But successful outsourcing depends on ensuring that the right services are outsourced to the right partners. Vendors with deep expertise in healthcare, who not only understand the complexities of the patient journey but also compliance, are particularly suited to mitigate the potential risks of data breaches, poor quality, and workforce instability that plague many health systems today. Platforms that allow data security, fraud prevention, and compliance programs to be managed effectively from anywhere are also an asset when working with protected health information.
Because even a small drop in task load can reduce the odds of physician burnout, outsourcing clinical documentation tasks represents an important option for provider organizations facing financial and labor challenges. When adopted wisely in the areas covered above, improvements may be felt across the board not only by overburdened clinicians but also the healthcare ecosystems they support.