By Ashleigh Kervel
Vizient Senior Programmatic Advisor
In 2019, U.S. physicians spent an average of 1.84 hours a day completing documentation outside of scheduled work hours, with one-third spending more than two hours. As electronic health records (EHRs) have become more advanced and inclusive of patient information, billing and coding have required more documentation causing “note bloat.” The Centers for Medicare & Medicaid Services (CMS) has recognized these inefficiencies and in 2023 changed evaluation and management coding to focus on medical decision-making. Leaders must understand the importance of optimizing the EHR to improve clinician efficiencies.
EHRs generate a significant amount of healthcare data, which has led to the expansion of healthcare informatics. The Chief Medical Informatics Officer (CMIO) role has also evolved from EHR implementation to optimization and innovation, with data used for business decision-making and operations. Six ways EHRs can be used to improve clinical and business decisions include:
- Stay current on codes for billing practices: As the Centers for Medicare & Medicaid Services (CMS) continues to revise billing and coding requirements that shift focus to medical decision-making, it is important for organizational leadership and the informatics team to stay current with these changes. The EHR and documentation requirements must align with these changes. The use of specific medical terminology and placement of information in a patient record is important when hospitals outsource billing and coding to maximize reimbursement. This can be done with smart phrases, templated notes, ongoing personalized training and education for providers on these changes.
- Track provider productivity and value-based care: Productivity measures may be based on a variety of metrics including but not limited to wRVUs, patient volume, patient outcomes, providers' schedules, procedures or documentation. EHRs also can capture value-based metrics including hospital readmissions, adverse events and patient engagement. Vizient Clinical Team Insights found that only 50 to 59% of organizations use value-based patient data for individual advanced practice providers' (APPs) productivity in the acute-care setting. It is important for leadership to work with the CMIO and IT team to make sure data is accurately captured for all providers, including physicians and advanced practice providers.
- Mitigate documentation obstacles: Challenges may arise when trying to collect data for the care team due to individual state practice laws, hospital bylaws, how the EHR is configured, care that is provided within a global period or other nonbillable care. If APPs are documenting a patient, it is best practice for supervising physicians to create their own documentation or attestation to clearly delineate the authors. For post-op visits within a global period, organizations can add dummy codes, which reflect the providers' care without creating an actual billable charge, or be monitored by provider documentation completed during these visits.
- Decrease documentation burden: Inefficient documentation can lead to provider burnout, and more specifically, increase workload burden. Leadership should employ EHR trainers and builders to optimize documentation and EHR navigation to improve provider well-being. Teams should be comprised of IT personnel and clinicians working together to improve workflow processes. Studies have shown that personalized programs that improve efficiency can decrease documentation burdens. EHR protocols also can shift workforce demands from providers to appropriate clinical support staff such as nurses or medical assistants for medication refills and office visit documentation.
- Streamline credentialing and privileging: Credentialing and privileging of providers are essential to ensure previous appointments. The EHR can assist in reprivileging by generating procedure logs and a history of patient encounters that fulfill reappointment requirements. As discussed in the Vizient Clinical Team Insights change package, systemwide standardization of credentialing and privileging processes can reduce compliance risk and ensure top-of-license activities are performed by appropriate healthcare professionals. Streamlining this process with medical staff credentialing and privileging personnel decreases the administrative burden on providers.
- Create professional advancement opportunities: As vast amounts of healthcare data are generated daily, there has been significant growth in the field of healthcare informatics. The CMIO cannot manage the EHR alone and is supported by a team comprised of EHR analysts, IT specialists and clinical informaticists. These positions allow providers to be leaders in healthcare technology, data, quality improvement, utilization, billing and coding, and analytics. Their clinical backgrounds, user experience knowledge and ability to analyze healthcare data make them vital leadership team members.
It is vital for organizations to stay up-to-date with the ever-changing healthcare landscape and that is reflected in their EHR design and innovation. Just like in medicine, education and training of the EHR should not be fixed, but continuous throughout providers' careers. The EHR should be used to streamline care — not hinder providers by creating additional bureaucratic tasks. Healthcare leaders and informatics must work together to generate an EHR that can use data to guide and improve the patient and provider experience. Organizations need to provide ongoing training and specialized education to decrease documentation times and improve provider well-being. Organizations should welcome clinician participation and provider leadership in the design and use of the EHR allowing for specialization and optimization across multiple specialties and clinics.
Learn more about how Vizient Clinical Team Insights empowers the clinical workforce to efficiently deliver optimal, cost-effective, patient-centered care.
About the author
Ashleigh Kervel serves as a senior programmatic advisor for Vizient Clinical Team Insights, a networking community for advanced practice providers at healthcare organizations that use data and assessment tools to prioritize and address clinical workforce needs that impact their organizations' culture, efficiency, performance and quality of care for patients. Prior to joining Vizient, Kervel worked as a pediatric emergency medicine physician assistant for nine years, earned Lean Healthcare Certification, became an EPIC-certified physician builder analyst and was part of the emergency medicine design team. She earned a Master of Business Administration in healthcare analytics from the University of South Florida and a master's in physician assistant studies from the University of Florida.