Ask physicians their top reason for their fatigue, administrative burdens, and day-to-day dissatisfaction, and clinical documentation woes rise to the top of the list. The problem isn’t getting better anytime soon. In fact, a session at the recent American College of Medical Informatics symposium revealed that the degree of clinician burnout was significantly underestimated.

But a potential remedy exists. And Health Information Management (HIM) professionals can find it within their organization’s clinical documentation data.

In the November/December 2021 edition of For The Record magazine, Mary Pat Langer, Director of HIM Services at DeliverHealth, revealed how clinical documentation interventions can help create timely, accurate documentation, reduce physicians’ anxiety improve their productivity.

The highlights:

• Capturing, collating, and analyzing data elements such as time of day, length of time, report type, and documentation method can help determine the most effective clinical documentation approaches for each physician. It’s also important to capture data about where a dictation is performed, and the number of times physicians need to access a single document.
• Analyzing all clinical documentation data can help show HIM leaders which physicians are most proficient within their EHR, and which physicians require help. This analysis will allow HIM professionals to create an optimal documentation workflow for individual physicians. One key clue to understanding a clinician’s EHR proficiency: The amount of self-editing required per record.

Langer also offers these three strategies HIM professionals can consider to improve physician satisfaction with clinical documentation:

1. Incorporate additional documentation options and tools into physician workflows. For example, providers who use telephony dictation may improve their efficiency by using mobile apps instead. Customized templates may also increase physician productivity and reduce dissatisfaction.
2. Provide educational sessions in collaboration with Clinical Documentation Integrity, coders and IT. These can be simple refreshers on available documentation technologies and how to use them. Plan more in-depth education if you’re adding new, personalized dictation options.
3. Target noncompliant physicians with timeliness and completeness requirements. HIM leaders should run reports continually from clinical documentation systems to see which physicians meet documentation timeframes dictated by regulating bodies such as The Joint Commission. Also, look for accuracy and completeness of clinical documentation

Learn more—including a list of nine documentation metrics to monitor by physician—in the full article.

The HIPAA Security Rule requires physician groups to perform a Security Risk Analysis (SRA) regularly to achieve compliance. But what does “regularly” mean, and how does it impact you?

Our own Kelly Benson, a Solutions Consultant here at DeliverHealth, and Arielle Van Peursem, National Partner Manager for our friends at Medcurity, helped answer that question and more in their recent article, Security Risk Analysis – How Physician Groups Can Meet HIPAA Compliance, in For the Record magazine.

The highlights:

• Given the rise in cybersecurity concerns and threats against hospitals, physician practices, and medical groups, our experts recommend performing an SRA annually at a bare minimum.
• An SRA is more than “checking the box” for the federal government. When done properly, an SRA identifies risks and vulnerabilities related to inappropriate access to protected health information (PHI).
• Changes coming to the Merit-Based Incentive Payments Program (MIPS) in 2022 will make it impossible to achieve MIPS without an SRA. Organizations must score at or above 85% to qualify for the MIPS exceptional performance bonus, and one of the four MIPS categories, Promoting Interoperability (PI), accounts for 25% of the overall score. Without an SRA, the entire category gets thrown out.
• An SRA that meets MIPS requirements must include all three safeguards in the HIPAA Security Rule (administrative, physical, and technical), along with the implementation of a risk management plan to update security deficiencies identified in the SRA.
• Failing to properly perform an SRA is a costly choice. If you just “check the box” without completing an SRA, you could be considered in willful neglect and subject to the highest-tiered penalty of $50,000 per record exposed.
• While your IT staff contributes to the development of security policies, most organizations will need an objective third-party expert to conduct an SRA that meets federal guidelines.

Learn more—including why the free SRA spreadsheet provided by the U.S. Department of Health & Human Services is only a starting point—in the full article.

How much time do providers spend on EHR documentation, administrative work, and paperwork? It’s a question Medscape asks every year in its annual Physician Compensation Report. And the results aren’t pretty.

In 2021, physicians said they averaged 15.6 hours per week on paperwork, a trend that’s been heading upward over the past five years. A breakdown of specialists who spend the most time on clinical documentation:

• Infectious disease – 24.2 hours
• Public health and preventive medicine – 20.7 hours
• Nephrology – 19.8 hours
• Internal medicine – 19.7 hours
• Pathology – 19.0 hours

It’s astonishing that, in the midst of a global pandemic, two of the specialists people need the most—infectious disease and public health providers—spend more than 20 hours each week on paperwork. That means they have less time for what they’re trained to do best: Care for patients.

All of this paperwork leads to a troubling trend—physician burnout, a problem that reduces the quality of care and negatively impacts healthcare organization’s revenue streams. Statistics show that burnout isn’t getting much better. In 2016, 46% of physicians reported burnout, according to Medscape’s National Physician Burnout & Suicide Report. Five years later, 42% of physicians still report feelings of burnout.

The top five most burned out specialists:

• Critical Care – 51%
• Rheumatology – 50%
• Infectious Diseases – 49%
• Urology – 49%
• Pulmonary Medicine – 48%

While clinical documentation headaches aren’t the only reason for provider burnout, they do lead to many of the symptoms. The MEMO—Minimizing Error, Maximizing Outcome—study funded by the Agency for Healthcare Research and Quality uncovered these top five reasons for burnout:

• Chaotic environment
• Family responsibilities
• EHR
• Low control of pace
• Time pressures

Of those five, “family responsibilities” are the only ones not directly impacted by clinical documentation woes.

You don’t have to survey your physicians and other clinicians to see the symptoms of burnout. These days, you can simply look on your social media channel of choice. Odds are you’ll see posts, photos, and videos of clinicians venting their day-to-day frustrations—annoyance with system crashes, irritation with new EHR feature rollouts, dissatisfaction with IT team response, and ongoing bitterness with the growing number of clicks, glitches, and screens they need to navigate.

The Rx for Burnout: Documentation Technology Solutions and Services

We know what you’re thinking: Isn’t technology causing burnout? In reality, that’s not accurate. EHRs are still exceptional tools that hold the power and promise of simplifying processes and improving care. The problem isn’t with the EHR technology itself. Instead, the root cause lies in the clinical documentation workflows, the multiple and sometimes redundant steps and processes providers and other clinicians must take to get clinical documentation right.

As all healthcare organizations face a critical crossroads of financial pressures, continued COVID-19 caregiving and staffing concerns, and increasing levels of provider burnout, finding ways to reduce clinicians’ documentation burdens and give them more time with patients must be at the top of leaders’ to-do list.

Dive into the details, and you’ll find a wealth of solutions and services promising you the moon and the stars. But how do you know which ones will be right for your organization—and, most importantly, your providers? Start by asking some of your physicians these two key questions:

1. How do they prefer to document clinic visits?When you ask this question, you’re sure to get different answers. Some will tell you they prefer dictation. Others will say they like medical scribing. Still others will say they would like to use both. The good news: It’s possible to find a solution that allows them to do both in the same app with eSOne from DeliverHealth.

Allowing providers to access scribing in the same platform as transcribing brings multiple benefits. It eases providers’ stress by giving them what they want, when they want. But more importantly, virtual medical scribing has multiple proven benefits, the top three of which we revealed in this recent blog post. In fact, we’ve seen studies that show medical scribing allows clinicians to spend 75% of their time on direct clinical interaction and just 25% of their time on EHR-related tasks.

2. What is their comfort level with clinical documentation? As a rule, physicians—and people in general—don’t always like to speak out their shortcomings. So, when starting this discussion, let physicians know it’s OK to say they’re struggling with documentation, and that you’re here to listen, learn, and offer them help. The more honest clinicians are about their documentation difficulties—whether they’re concerned with telehealth documentation, accessing legacy data, or handling chart abstraction and preparation—the more clues you’ll find to help you identify the right consulting and workflow solutions that can help your organization improve efficiency and enhance outcomes.

Get Help to Reduce Physician Burnout Today

EHRs are exceptionally valuable tools. When workflows are made simpler and administrative processes are aligned, your EHR will finally live up to its promise of reducing physician burnout and engaging patients.

Learn more about how the subject matter experts and leading-edge solutions at DeliverHealth can help solve your clinical documentation needs today.