I had not time to make it shorter: an exploratory analysis of how physicians reduce note length and time in notes

Nate C. Apathy, Allison J. Hare, Sarah Fendrich, Dori A. Cross

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

OBJECTIVE: We analyze observed reductions in physician note length and documentation time, 2 contributors to electronic health record (EHR) burden and burnout. MATERIALS AND METHODS: We used EHR metadata from January to May, 2021 for 130 079 ambulatory physician Epic users. We identified cohorts of physicians who decreased note length and/or documentation time and analyzed changes in their note composition. RESULTS: 37 857 physicians decreased either note length (n = 15 647), time in notes (n = 15 417), or both (n = 6793). Note length decreases were primarily attributable to reductions in copy/paste text (average relative change of -18.9%) and templated text (-17.2%). Note time decreases were primarily attributable to reductions in manual text (-27.3%) and increases in note content from other care team members (+21.1%). DISCUSSION: Organizations must consider priorities and tradeoffs in the distinct approaches needed to address different contributors to EHR burden. CONCLUSION: Future research should explore scalable burden-reduction initiatives responsive to both note bloat and documentation time.

Original languageEnglish (US)
Pages (from-to)355-360
Number of pages6
JournalJournal of the American Medical Informatics Association : JAMIA
Volume30
Issue number2
DOIs
StatePublished - Jan 18 2023

Bibliographical note

Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: [email protected].

Keywords

  • documentation
  • electronic health records
  • health policy
  • physician burnout

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

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