AMIA released the following call to action for Health IT vendors:
- Promote an ecosystem of interoperable systems to allow for complementary technology
- Develop metrics to review and grade a user’s documentation
- Package best training practices into toolkits to promote “best practice” EHR use and plan recognition programs to publicize exemplars
- Create simplistic EHR views to see that new clinical data has been reviewed-then bookmark for the user and document as reviewed by that user in the EHR
- Implement personalized clinical decision support (CDS) to drive user-specific workflows
Towards these goals, our workstream is requesting your support to demonstrate short term progress towards these goals while developing a roadmap for longer term changes with the goal of reducing documentation burden to 25% of current documentation by 2026.
As representatives of the vendor community past and present, we recognize that there are many factors that have contributed to documentation burden and ease of data entry/population is only one component. There is a tremendous burden as well from overly long documents that are difficult to read and make it difficult to identify the most important information.
Our short-term project involves educating current users about existing functionality, tools and services that can reduce both of these burdens. We are asking both EHR and non-EHR IT vendors to aggregate training materials, either self-developed or client developed, that show how to avoid over documentation and more efficiently document only what is necessary. These could include tools that allow a user to view summary information, so they do not need to pull it into the note, use of chart notes that exclude irrelevant information that is already present in the Master Document/Encounter Record, information that already auto populates the note, using an APSO note format instead of SOAP, etc. Vendors and their clients may wish to modify templates to remove unnecessary content. Documentation efficiency tools could include those that allow patient completed information to populate the EHR (demographics, social history, review of systems, screening tool, etc.), improved use of voice recognition, interfaces, integrations, interoperability, reconciliation of CCDAs, etc. The materials should be prioritized by those felt to be most relevant to reducing documentation burden.
We are asking practices or health systems willing to participate to identify a project lead (CMIO, super user, champion, etc.) and an ambulatory clinic willing to pilot the intervention. The vendor will help as needed with accessing, selecting and using the most appropriate materials. We ask the site project lead to work with the clinic end users to ensure they have access to and are encouraged to use the training materials.
We propose to measure these metrics before and after the intervention: Average note length by provider, amount of after-hours documentation, percent decrease in documentation time, percentage of text generated by speech/manual entry vs. automated or copied text and use of modified templates, if done. We are focusing on the ambulatory setting for this initial project but recognize that nursing documentation in particular is problematic in the hospital setting and will be part of our roadmap.
The timeline for this short-term project is somewhat aggressive but we believe achievable.
We are asking vendors to compile educational materials and measurement of pre-intervention metrics by July 21 and to disseminate education materials to participating health systems/practices by the end of July. To date we have commitments by Epic, Cerner, NextGen Healthcare and Nuance to aggregate their materials and have meetings in the next week with additional vendors.
The first measurement of post intervention metrics would be compiled in November. Publications will not identify the health system or vendor by name without their express written consent.
Sarah Corley, MD, FACP, FHIMSS
25x5 Task Force, Health IT Vendors Workstream Lead