Prioritizing patient care over the drudgery of admin tasks

I'm all too familiar with the technological frustrations many of us doctors encounter in our daily work.

I recall when we switched to a new electronic medical record program halfway through my residency. It became normal for me to sit in the clinic until 9 pm each night, trying to figure out what buttons to select when entering patient exams so we could bill out at the appropriate levels. 

I’d simultaneously ponder how to reorder home healthcare prescriptions and handle a slew of other tasks that seemed to take 2–3 times as long as they should have.

Typing out one patient note and clicking through all the buttons and screens was cumbersome and time-consuming. But technology is constantly evolving; these duties seem even more arduous now compared with when I was a resident.

Time-consuming tasks lead to burnout

It’s no surprise that physicians are spending too much time on administrative tasks and staring at a computer screen. Research on physician burnout related to admin tasks and EMR or EHR documentation is seemingly boundless, and plenty of articles and op-ed pieces go into detail about this burden. Here are a few examples:

• Respondents to the Medical Economics Physician Report said prior authorizations consumed, on average, more than 16 hours per week of practice time, including 11.6 hours for staff members and 4.6 hours for themselves.^[]

• A study published by Annals of Internal Medicine found that physicians in outpatient settings spent about 27% of their day on face time with patients but 49% on EHRs and desk work. Many also worked up to 2 hours every evening on EHR-related tasks.^[]

I see two ways to look at this non-glamorous part of medicine. We can complain as we trudge along—or work through these tasks while seeking ways to better manage them so we can get back to priority No. 1: caring for patients.

Medical technology is making headway

COVID-19 helped catapult the medical technology sector. For the first time in decades, venture capitalists started investing large sums of money in this area.

Physicians should have the opportunity to participate in the design and development of technologies that run EHR interfaces. After all, we are the main users of this technology, and it makes sense that we have input into these advances.

Many of us have embraced medical technology without even realizing it. Telemedicine, medical apps on our phones, patient schedulers, wearable medical devices, and many more technological advances have made our jobs easier.

For example, we can grab a date off patients’ glucose monitoring devices instead of asking them to log their blood sugars and insulin dosages. Instead of looking up literature in heavy textbooks, we can pull the most up-to-date information from medical apps on our phones.

Artificial intelligence (AI) is a major aspect of technology being implemented into EHRs. In fact, AI is already a key player in patient wearable devices and health apps as it thrives on data, and the more accurate and contextual data it can access, the better its results.

AI and speech recognition for EHRs

What if a doctor could have a conversation with a patient, and the AI interface picked up key components of this conversation and transcribed it into a clinical note? This idea is not as far-fetched as one may think, considering that voice-to-text conversion, natural language processing, and ambient clinical intelligence may be the future of documentation. ​

Natural language processing (NLP), is a hot area of AI development focused on enabling computers to understand and process human languages, according to an article published by Chilmark Research.^[]

This AI subset has been shown to have a tremendous impact on the accuracy and quality of speech recognition and can even pick up someone's tone of voice to determine the speaker’s intentions and understand voice commands.

Ambient clinical intelligence (ACI) is another subset of AI that uses NLP in a clinical setting by capturing the conversation between the patient and physician. It aids the EHR workflow process by automating medical transcription, note-taking, and documentation, as reported in the Chilmark article.

It can enable physicians to populate a patient note without using a mouse or keyboard, reducing documentation time and physician burnout. I believe this solution has real potential.

The ability to use a voice command to send a prescription to the patient’s pharmacy can save time. A study on EHR usability showed that it could take up to 62 clicks for a physician to place an order for Tylenol.^[]

‘Patients Over Paperwork’ initiative

In 2017, the American College of Physicians published a position paper that outlined a cohesive framework for identifying and evaluating administrative tasks along with detailed policy recommendations to reduce excessive administrative tasks across healthcare.^[]

Medicare adopted this “patients over paperwork initiative” and made revisions in 2021 that included eliminating history and physical exam documentation as elements for code selections, according to a CMS press release.^[]

Instead, ancillary staff or patients can record the chief complaint and history of the present illness, and the patient can complete a questionnaire with their answers becoming part of the clinical note. It’s estimated that this initiative saved the medical community $6.6 billion and 42 million work hours in 2021, according to the CMS release.

NLP can analyze unstructured medical text from a note and automatically extract information such as medical history or current medications. By analyzing and extracting meaning from clinical notes, clinicians can automate the content population in EHRs (for example, ICD-10 codes).

Hopefully, these technological advancements—as well as others to come—will save you time and make your work life easier, enabling you to focus more attention and energy on patient care.