How to restore meaningfulness and do away with ‘stupid stuff’ in EHRs

Technology innovations in healthcare have led to breakthroughs in care options, but electronic documentation has become an arduous task for clinicians, leading to burnout and lower job satisfaction. While it’s not necessarily the technology of electronic health records that is the problem, the approach to documentation has damaged the sense of meaningfulness in healthcare, according to Melinda Ashton, MD, who penned a perspective in the New England Journal of Medicine.

“An increase in administrative tasks has resulted in less time for the activity that clinicians find most important: interacting with patients,” she wrote.

Finding the stupid stuff

The adoption of documentation in healthcare has led to more tasks for clinicians, some of which may be unnecessary. Ashton, a physician with Hawaii Pacific Health in Honolulu, helped launch a program called “Getting Rid of Stupid Stuff” in October 2017 that aimed to reduce some of the unintended burden in EHR documentation within her health system. The program asked employees to identify anything in the system’s EHR that they believed was poorly designed, unnecessary “or just plain stupid,” she wrote.

The program received nominations for three categories:

  • Unintended documentation requirements
  • Necessary, but inefficient documentation
  • Required documentation without understanding or lack of tools

In some cases, documentation requirements extended to wrong patient groups or were overly burdensome for others.

“Nurses had been burdened with these documentation requirements for years, but they had never been specifically invited to bring their issues to the attention of people who could make changes,” Ashton wrote.

Building efficiencies

The program took the feedback and streamlined some elements of the EHR. The changes were impactful, including cutting out one click that consumed about 1,700 nursing hours per month at four hospitals, based on the average number of clicks per month. The program also led to the elimination of 10 of the 12 most frequent alerts because they were not used.

Requests also came in to better educate staff about various documentation tools to sort and filter capabilities already embedded in the EHR. Other nurses’ requests to pare down some items in the nursing admission database could be answered as CMS works to reduce required documentation.

While physicians typically get the attention for high burnout rates related to EHR issues, nurses submitted more changes to the program, according to Ashton, who speculated that nursing documentation is more task-based but physicians’ is more note-based.

“Reducing physicians’ documentation burden will probably require adoption of more standard, streamlined notes,” she wrote.

Getting rid of stupid stuff identified by staff over the last year has led to a new attitude across the organization, including finding work that should be retired, according to Ashton. The organization has not yet quantified any improvement in employee engagement, but will continue to improve meaningfulness.

“We seem to have struck a nerve,” she concluded. “It appears that there is stupid stuff all around us, and although many of the nominations we receive aren’t for big changes, the small wins that come from acknowledging and improving our daily work do matter.”