Are Docs On Board with Clinical Documentation Improvement?

April 1st, 2013 / By Barbara Aubry, RN

This February, I participated in the first of four 3M Data Integrity webinars, where a polling question was asked of the audience: Are your physicians actively engaged in documentation improvement?” Here’s how the participants answered:

  • 59 percent said that their physicians were actively engaged in documentation improvement
  • 36 percent responded that their physicians were NOT actively engaged in documentation improvement
  • 5 percent were not sure or did not know

My take:

I read something recently in The New York Times that might help us put these responses in context. It was an article about EHRs, the different vendors, and their product offerings. The article also focused on whether or not the products could communicate with each other. Sadly, many can’t, which I believe physicians find extraordinarily frustrating – as well they should.  The article contained some great comments by physicians about whether or not they were engaged in eHealth and electronic medical records and tools, how they felt, and how their day-to-day processes were affected.

One doctor said he spends about 200 to 300 percent more time working on electronic health records, which results in an enormous amount of time lost at the bedside. This loss of patient contact was very troubling to him.  On the flip side, another doctor said he’s been working with an EMR for the last five years and he absolutely loves it. But he did admit that he “had [to spend] about 200 hours to learn to bend it to my will.” Those are his exact words, which I find fascinating. (This speaks to a pet peeve of mine: are vendors asking potential customers—physicians, nurses, therapists, etc .—how they need the tool to work before they develop them?)

A third physician said that he thought  the EHR is great for capturing charges and gathering data, but he thought it “stunk at helping providers stay more productive.” He went on to say “we (doctors) spend more time staring at computer screens than at our patients. Chart notes are now four-to-five pages of fluff that is meaningless and mostly copy/paste‐able data. I think the medical data is now less secure than it ever was with a paper chart or one that the patient controls.”

It’s clear the pendulum swings widely on the issue of physician engagement.   To a great extent, I think the way your physicians feel about what’s going on is impacted by how the institutions perceive  what’s going on. If you are involved with a facility that is proactive and believes in the relevancy of the EHR or EMR, this is sub-communicated to everyone involved. If documentation improvement is viewed as a positive move forward and its value is understood, then I think physicians are more engaged. But for facilities that are not pleased with their vendor or product, I believe physicians will be less engaged and less likely to cooperate with document improvement strategies. Don’t forget, many physicians feel an enormous amount of time has been taken away from the bedside, their reimbursement is not increasing, and they are being pulled in several directions.

Those with an open mind are more likely to see the value of the technological improvements and are more willing to change.  I think those who find it very burdensome are pushing back because they feel their time is not well spent, focusing more on the demands of the tool they are using and less on patient care. This is a legitimate beef, and it will need to be addressed if physicians are to become more actively engaged in documentation improvement—and more accepting of the EHR in general.

Barbara Aubry is a Regulatory Analyst for 3M Health Information Systems.