Documentation Burden: Addressing the Elephant in the Room

By Rakhal M. Reddy, MD MSHI ACHIP FACHE (Adventist Health), EHR Association Liaison, HIMSS Physician Committee

This is the second in a blog series highlighting the issues and solutions that emerged from the 2022 EHRA & HIMSS Physician Committee Summit: Meaningful and Streamlined Documentation.

Documentation burden as a topic has been sliced, diced, and cooked by various organizations, and as in the story of three blindfolded men describing an elephant – everyone seems to have a different perspective based on their assessment. Although there is general agreement as to the problem and some agreement as to the causes of documentation burden for clinicians, it is interesting to see how the different groups have viewed and proposed solutions for the elephant in the room.

Ultimately, there can be little argument that the focus of the note should be on the clinical encounter and ensuring the information entered clearly captures the problem, medical decision making, and ultimately help with communication between clinicians and our patients while meeting coding and regulatory compliance requirements.

The HIMSS Physician Committee attempted to tackle this documentation burden in a joint effort with the EHR Association and a group of physician leaders, CMIOs, nursing leadership, and informaticians, in October 2022. We started with defining what the “true north” was in terms of mitigating documentation burden. To organize our time, we divided the group into three “themes” to address:

  • The Ideal Note
  • The Exchanged Note
  • EHR Barriers to Creating the Ideal Note

The focus of the Ideal Note group was on the non-EHR barriers and identifying the key influencers of a clinician’s note. Payers, regulatory bodies, patients, and other administrators may have influence, so the idea was to ask the question: who is the note really for, and what story does the ideal note communicate for a clinical encounter?

The Exchanged Note group attempted to address what exchanged notes – that is, notes between clinicians—should look like. How does the “copy forward” conundrum impact understanding others’ documentation, and should the notes be structured or narrative? 

Finally, the third group was assigned the task of looking at barriers created by the EHR, and what gets in the way of streamlined and informative documentation from an EHR standpoint.

The HIMSS Physician Committee and the EHR Association relished the opportunity to bring clinicians and EHR vendors together to take an initial deep dive into documentation burden with an eye toward continuing discussions between the two groups in 2023. In the following blog posts, we will take a look at the discussions held by each of these multidisciplinary groups organized by the HIMSS Physician Committee and the EHR Association. Further, in 2023, we plan to work collaboratively with the AMA, AMIA, AMDIS, and others who are attempting to tackle this problem and take our blindfolds off to see the entirety of the “elephant” together.

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