Don't make physicians turn their backs to patients: How AI can support better patient care

One sticking point in solving physician burnout is that the administrative, EHR-based work that so many physicians see as an impediment to their profession is the very same work that ensures they are reimbursed for the care they provide. There has to be a better way — and there is.

Today, first-year physicians spend 43 percent of the day interacting with EHRs and 13 percent on direct patient care, according to a study published in JAMA Internal Medicine. What's more, much of the time spent on direct patient care also involves balancing other tasks such as reviewing reports or documenting notes in the EHR.

"We're introducing this great technology, but what is the ultimate cost to the physician?" asked Aaron Brauser, vice president of solutions management at M*Modal, a healthcare technology company acquired by 3M this year that offers cloud-based clinical documentation solutions.

At a May 3 executive roundtable at the Becker's Hospital Review 2nd Annual Health IT + Clinical Leadership + Pharmacy conference in Chicago, Mr. Brauser joined nearly two dozen healthcare leaders to discuss how hospitals can implement clinical documentation improvement technologies to reduce the amount of time physicians spend on the EHR and bolster care outcomes.

The challenges of clinical documentation

The administrative burden placed on physicians to perform EHR-related tasks like clinical documentation can yield negative consequences for clinicians and patients alike.

To highlight the current complications with point-of-care documentation, Mr. Brauser shared a drawing done by a 7-year-old girl depicting her own healthcare experience. The child drew herself sitting in an exam room with her mother and sisters as the physician typed on a computer with his back toward them. The drawing was featured in a 2012 JAMA article discussing the human costs of technology.

Patients may feel ignored or disconnected from their physician if providers keep their backs to them when documenting clinical notes during visits. The mountain of paperwork and documentation physicians face could also affect patient care. A 2019 Medscape poll found 44 percent of physicians believe EHRs have hurt care quality in their workplace, citing factors such as added paperwork/charting and the need to enter data during patient encounters.

To keep up with these administrative responsibilities amid their already busy schedules, many physicians are forced to complete documentation outside of office hours. Mr. Brauser discussed this phenomenon with the industry term "pajama time," which refers to the amount of time physicians spend performing administrative duties after work or at home. On average, family physicians spend 86 minutes of pajama time completing administrative work every day, according to a 2017 study published in the Annals of Family Medicine.

Traditional clinical documentation is not just a source of frustration for only physicians. From an operational standpoint, the process is highly inefficient and siloed, which also creates a burden for the hospital employees who oversee documentation and billing, according to Mr. Brauser.

"CDI specialists must spend a lot of time rereading patient charts, trying to decipher what's going on and then sending messages back to the physician [for clarification]," he said. "Then it gets handed over to the coding platform, and the process starts again with coders trying to decipher it."

This process requires a large amount of time and human capital from physicians and the coding and billing departments to ensure accurate documentation. The current system also relies on a reactive — rather than proactive — response to documentation issues. CDI specialists cannot address any issues or shortcomings in clinical notes with physicians until after they are written. When combined, these communication gaps create siloed departments with inefficient documentation workflows that take physicians' time away from patient care and threaten hospitals' ability to maximize reimbursements through proper documentation.

A better path forward

More hospitals are turning toward technology solutions that use artificial intelligence and natural language processing to create a more efficient documentation process for physicians and CDI teams.

Solutions with natural language processing allow physicians to dictate EHR notes, saving them precious time that can instead be spent on direct patient care activities or with their families after work. The technology also creates a better healthcare experience for patients, as physicians are now free to engage in face-to-face communication during appointments instead of typing notes into the EHR.

"You pick up the microphone or use your iPhone, talk into it, and the notes immediately show up in the EHR," said Mr. Brauser.

M*Modal's software also uses artificial intelligence to offer physicians real-time, interactive feedback to improve documentation and patient care. As physicians are typing or dictating notes, the software provides documentation suggestions or alerts them to patients that may be at high-risk for a medical condition based on information in the EHR.

"The software does it in a way that's more of a nudge and not a stop sign for physicians," Mr. Brauser said. "The trick is not to create more information bombardment on them, but to make it fit into the workflow in a way that's helpful and valuable."

This capability offers a more proactive approach to documentation that ensures clinical data is captured accurately from the get-go. The nudges can also support better patient outcomes by pointing out important warning signs or details the physician may have missed in the patient's chart.

When physicians are able to complete more accurate front-end documentation, it helps eliminate some of the rework or queries often performed by CDI teams. The technology platform also breaks down some of the siloes between clinical and CDI teams, allowing for more communication throughout the entire documentation, coding and billing process.

Conclusion

EHR-related tasks such as clinical documentation place a great burden on physicians. The traditional documentation process also perpetuates siloed, inefficient workflows that require a large amount of time and human capital from coding and billing departments. By integrating documentation technology that uses AI and natural language processing, hospitals can operate a more efficient CDI program that better supports financial and clinical performance. The technology can maximize clinicians' time for direct patient care activities, streamline processes across hospital departments and ensure organizations are do not lose out on crucial reimbursement dollars due to coding or documentation issues.

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