Most of us will jump at the chance to find an easier way to accomplish the same result. I mean, who doesn’t love shortcuts?! Electronic medical records (EMRs) are probably one of the biggest time-savers for a medical practice. The days of running around the office looking for a “lost” chart are gone. Multiple team members can access a patient’s chart – even remotely – without needing to coordinate logistics of whose request takes priority. Information is more easily retrievable, as long as it has been properly filed and labeled in a sectioned chart. Typing might even be easier for most of us whose handwriting resembles hieroglyphics – to the appreciation of pharmacists and medical staff!
The remote aspect deserves its own paragraph as the Internet and remote access allow a provider on call to view the patient’s chart during an after-hours call. Or transmit a prescription to the pharmacy at 2 AM. Not to mention the ability to use a tablet or even a smartphone to review lab results and other diagnostics, write an order or chip away at the “decreased” workload of electronic documents.
Documenting the encounter also has benefits in the world of EMRs. There is almost no end to the creation of specific progress note templates that touch on a clinician’s required elements of a visit or diagnosis. Do you want your staff to ask specific questions at every visit? Make a template. Want to assess a patient’s risk status for a certain condition? Make a template. Want to require your clinicians to evaluate certain systems on all diabetic visits, make a template! Want to save your wrists from having to type free-hand all the assessment language (e.g., stable, controlled, continue on [med name], counseling), use a template, and save yourself some time.
Sounds idyllic. But here’s the downside.
An assessment of primary care physician workload in the Annals of Family Medicine revealed that providers spent almost six hours of an 11.4 hour-day workday in the EMR, of which slightly more than the 44% of time was devoted to administrative tasks, such as documentation, order entry, billing and coding. The survey concluded that – for all their benefits, and we really just scratched the surface – digital records increase the burden on physicians and reduce their degree of attentiveness to the patient. (Click here to read about how EMRs contribute to physician burnout.)
Structured data templates and checkboxes negatively automatize and generalize the interrogatory and management process in a patient encounter. By heavily standardizing the medical documentation clinicians might miss essential details in the patient’s history, which could affect their ability to a more rapid and accurate diagnosis. Additionally, the extensive and organized progress notes often fail to offer a real picture of the actual episode of care. Even when there is more manual input from the physician, the documentation is often plagued with inconsistencies and contradictory clinical findings. (Click here to read more about a JAMA study that found more than 20% errors in EMR progress notes.)
Overuse and misuse of templates can have a negative financial impact by making medical practices subject to audits and corrective action plans. Duplicated and vague documentation are red flags to the Centers for Medicare and Medicaid Services (CMS). Although CMS guidelines don’t forbid the use of EMR templates, their Medicare Program Integrity Manual discourages the use of templates that are mainly based on checkboxes and predetermined answers since these sometimes limit the provider from documenting all the necessary facts to meet the medical necessity requirement for billing purposes.