Documentation Burden: Receiving the Ideal Note

Dani Nordin (athenahealth), Chair, EHRA User Experience Workgroup, and Bryan Bagdasian, MD, MMM (MEDITECH)

This is the fourth in a blog series highlighting the discussions from the 2022 EHRA & HIMSS Physician Committee Summit: Meaningful and Streamlined Documentation.

While the ability to create an ideal clinical note is obviously important to the delivery of healthcare, equally essential to the process is the ability for other providers and systems — as well as the clinician’s future self — to use those historical notes to understand the patient’s history and inform future care decisions.

In our second breakout session, we focused on the problem of receiving and comprehending clinical notes received from others. Participants in the group included a mix of behavioral health specialists, hospital nurses, and informatics experts, including representatives from multiple EHR vendors. Using a combination of verbal prompts and a live-updated Mural board, we facilitated a discussion to answer the following questions:

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The Ideal Clinician Note and Barriers to its Creation

By Brian R. Jacobs, MD, FHIMSS (eClinicalWorks)

This is the third in a blog series highlighting the discussions from the 2022 EHRA & HIMSS Physician Committee Summit: Meaningful and Streamlined Documentation.

When the EHRA and the HIMSS Physician Committee came together for a virtual Summit on meaningful and streamlined clinician documentation, three multidisciplinary breakout groups addressed key issues related to the topic. These included the ideal clinician note and barriers to creating such notes, which is the focus of this blog, as well as the exchange of the ideal note between providers and barriers to such exchange, and the specific EHR-related barriers to creating and/or consuming the ideal note. 

As noted in Documentation Burden: Addressing the Elephant in the Room, few disagree “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. To continue this theme, this third blog will highlight the findings of the first Summit breakout group – which included physician, nursing, informatics, and EHR vendor representatives – discussing the topic of creating the ideal note, as well as the various barriers to creating that ideal note.

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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.

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Meaningful and Streamlined Documentation

An Overview of the EHRA & HIMSS Physician Committee Summit 2022

By Hans Buitendijk (Oracle Cerner), Chair, EHR Association 

A key role of the electronic health record (EHR) is to enhance clinical decision-making and enable clinicians to plan and document patient care – information that is then communicated with other systems. But there are challenges that impede the EHR’s ability to fulfill that role to its fullest extent. These challenges and proposed solutions were the focus of the 2022 EHRA & HIMSS Physician Committee Summit: Meaningful and Streamlined Documentation.

Whereas the 2021 Summit focused on the state of clinical notes – including publication of best practices for drafting ideal notes – this year’s event focused on challenges inherent with EHRs and documentation. These challenges fall into the categories of clinical, quality reporting, operational, billing, regulatory, and registry requirements, as well as ease of documentation, ingesting and integrating data, and achieving meaningful decision support. In short, there is a wide range of often overlapping or conflicting requirements that EHRs need to address while enabling clinician users to enhance their clinical decision-making and plan and document patient care – but challenges stand in the way. 

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Putting Policy Before Standards Can Create Serious ePA Roadblocks

By Leigh Burchell (Altera Digital Health), EHRA Public Policy Leadership Workgroup Chair

This is part three in a four-part series examining the need for ePA, the barriers presented by the current environment, necessary capabilities and functionality for progress, and the EHR Association’s policy recommendations. Read part two here

There is a strong use case for electronic prior authorization (ePA), given the frustration providers have with the burdensome current processes, and health IT developers recognize the potential that exists for our technologies to assist with making our clients’ lives easier in this area. However, the road to success with ePA will be rocky if it is not broadly rolled out at a pace and with a legal/regulatory cadence that aligns with the ability of stakeholders to deploy and use solutions that follow consistent standards. Therefore, the EHR Association supports the promulgation of ePA requirements only when undertaken in a way that avoids prior policy mistakes of pushing faster than standards development can keep up. 

Rolling out ePrior Authorization will be complex, even moreso than similar efforts at digitization we’ve already accomplished. This complexity stems from the need for change – and adoption of agreed-upon standards – by multiple stakeholders with varying levels of readiness.  For example, it is important to work closely with payers to ensure their readiness for the required bidirectional information flow using standards and to ensure functionality can be sufficiently tested. This also helps avoid a scenario in which payers roll out individual requirements to which EHR developers and providers will have to respond, which would be highly inefficient. 

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Standards, Certification, and ePA: Proceed with Caution

By Hans Buitendijk (Oracle Cerner), EHRA Chair

This is part one in a four-part series examining the need for electronic prior authorization (ePA), the barriers presented by the current environment, necessary capabilities and functionality, and the EHR Association’s policy recommendations.

The prior authorization process required by health plans and payers frustrates patients and providers alike because of inconsistent requirements and associated delays, and it isn’t going away. 

It is clear that there is an opportunity to apply health information technology (IT) toward the goal of improving efficiency in this area, but doing so will be a challenge that requires significant cross-stakeholder coordination and standardization of related data. The need for a collaborative focus is further exacerbated by the widely varying approaches to the adoption and deployment of health IT systems among providers. Further, the process itself touches many different points and players in administrative, clinical, and financial workflows. 

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