Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

@HIMSS, physicians don’t want hype. They just want sensible EMR solutions.

Troy Russell, MD, MPH
Tech
February 13, 2019
Share
Tweet
Share

A few years ago, I wrote a KevinMD blog post about how cumbersome it was to complete notes in the electronic medical record (EMR). I proposed a solution in our residency clinic but encountered resistance in the adoption process that eventually led to its abandonment. For someone just trying to solve a problem, it was very frustrating, to say the least.

Despite the advances in the past few decades, the clinic workflow in primary care, a model that I have witnessed drive my colleagues into burnout, has largely not evolved.

You might recognize the workflow:

  1. The patient checks-in at the front desk and waits in the waiting room filling in and signing documents on paper.
  2. The medical assistant rooms the patient.
  3. The physician enters the room with a vague idea of the patient’s reason for the visit.
  4. Physician struggles to ask as many questions as deemed relevant while maintaining “continuous partial attention” typing the patient information into the EMR.
  5. Continue this process every 15 to 20 minutes, through lunch until the day ends.
  6. Finally, physician spends 1-2 hours after clinic finishing notes and other EMR work.

For a frontline physician, this can be a challenging experience day in and day out. While the HIMSS conference (largest health IT conference of the year) is currently underway, I can’t help but be a little frustrated how long past solutions take to see mainstream adoption. To give you an idea, I set a Google Alert three years ago on “efficient EMR documentation.” For three years, I received results for machine learning, artificial intelligence, natural language processing, etc. without any considerable change for the majority of primary care physicians. I see EMR documentation as the primary driver of physician burnout, and all I think we are asking for is a sensible solution. No hype, no broken promises just a solution.

With the introduction of EMRs, physician burnout has escalated to unprecedented levels. We spend too much time on the EMR, and unfortunately, the problem has continued to worsen. Some doctors have responded by cutting back their hours or retiring early, potentially exacerbating the looming physician shortage.

Now let’s look at the current approaches used to combat these reasons, each with its varying level of success:

Teamwork. Improved teamwork is among one of the more adopted solutions to reducing physician workload. One of its main merits is that it transfers unnecessary tasks such as data entry and documentation from the physician to other staff members. High-quality teamwork enhances clinicians’ well-being and allows them to practice at the highest level of training. However, ineffective teamwork could exacerbate burnout and increase workload.

EMR templates and smart phrases. Smartphrases and templates are often useful for areas of the visit note that are repetitive and do not require much customization. It speeds up the process but introduces the risk of pulling old information into a note that may or may not be accurate.

Dictation, clinical language understanding (CLU) and dialogue capture. These services make it possible for doctors to dictate directly to voice recorders, microphones, and mobile devices instead of typing notes manually. This approach is not only faster than typing but also is easily formatted within EMRs. Conversely, CLU does not solve the documentation burden on doctors; we just get faster at it.

Scribes. Medical scribes accompany physicians during the visit to provide documentation of the visit as an observer. Though they are especially helpful in workload reduction, they increase administrative costs, require highly specific training. They are one of the first suggestions recommended by physicians familiar with Dr. Christine Sinsky’s research on burnout.

After looking into these multiple solutions and examining best practices in primary care workflows, automated patient interviewing software continued to surface as a viable but sometimes overlooked solution.

Automated patient interviewing platforms

Automated history platforms differ from the other potential solutions in a few key ways. Many of the other approaches primarily task the doctor with data entry and documentation. Automated history platforms instead use rule-based algorithms, similar to a clinician’s thought process, to perform patient data collection without the need for staff assistance (see a great review of the literature here).

ADVERTISEMENT

Consider some of its key benefits:

Higher doctor and patient satisfaction. Automated history gathering is faster than traditional methods. This frees up time for physicians to spend more time with patients and increase job satisfaction. High job satisfaction is associated with increases in the quality of care and patient satisfaction.

More reliable and comprehensive data collection. Using a computerized platform facilitates extensive data collection based on a standard framework. The information is more complete and better organized. Furthermore, patients have been shown to be more open to reveal sensitive information about risky lifestyles to a computer rather than their doctor.

More flexibility for more patients. Computerized systems provide multiple language compatibility along with increased availability. Additionally, information from the patient is accessible to all providers with access to a particular platform.

Given the widespread shortage of physicians, an automated patient-based system makes it easier for physicians to handle their primary task – medical decision making. As such, the clinic flow becomes less dependent on the speed of patient interviewing and physician documentation.

I am looking forward to seeing what comes out of HIMSS this year. We are ready for technology to help doctors dedicate more time to patients face-to-face and bring back some joy to practice.

Troy Russell is a family physician and founder, Carescribr.

Image credit: Shutterstock.com

Prev

6 easy hacks from a pediatrician to make healthier kids' lunches

February 13, 2019 Kevin 1
…
Next

CMS risks ACO success by forcing move to another track

February 13, 2019 Kevin 0
…

Tagged as: Health IT, Primary Care

Post navigation

< Previous Post
6 easy hacks from a pediatrician to make healthier kids' lunches
Next Post >
CMS risks ACO success by forcing move to another track

ADVERTISEMENT

More by Troy Russell, MD, MPH

  • a desk with keyboard and ipad with the kevinmd logo

    The cumbersome EHR: It’s time to implement solutions

    Troy Russell, MD, MPH

Related Posts

  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • The risk physicians take when going on social media

    Anonymous
  • Beware of pseudoscience: The desperate need for physicians on social media

    Valerie A. Jones, MD
  • Don’t judge when trainees use dating apps in the hospital

    Austin Perlmutter, MD
  • When physicians are cyberbullied: an interview with ZDoggMD

    Monique Tello, MD
  • Physicians of America, unite! You don’t have to work for hospitals.

    Ken Terry

More in Tech

  • Why Grok 4 could be the next leap for HIPAA-compliant clinical AI

    Harvey Castro, MD, MBA
  • AI is already replacing doctors—just not how you think

    Bhargav Raman, MD, MBA
  • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

    Shanice Spence-Miller, MD
  • How digital tools are reshaping the doctor-patient relationship

    Vineet Vishwanath
  • The promise and perils of AI in health care: Why we need better testing standards

    Max Rollwage, PhD
  • 3 tips for using AI medical scribes to save time charting

    Erica Dorn, FNP
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why regular exercise is the best prescription for lifelong health

      George F. Smith, MD | Conditions
    • When the weight won’t budge: the hidden physiology of grief, stress, and set point

      Sarah White, APRN | Conditions
    • Why starting with why can transform your medical practice

      Neil Baum, MD | Physician
    • Why your most heroic act might be in a department meeting [PODCAST]

      The Podcast by KevinMD | Podcast
    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why regular exercise is the best prescription for lifelong health

      George F. Smith, MD | Conditions
    • When the weight won’t budge: the hidden physiology of grief, stress, and set point

      Sarah White, APRN | Conditions
    • Why starting with why can transform your medical practice

      Neil Baum, MD | Physician
    • Why your most heroic act might be in a department meeting [PODCAST]

      The Podcast by KevinMD | Podcast
    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

@HIMSS, physicians don’t want hype. They just want sensible EMR solutions.
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...