For resident physicians regularly logging 60-hour weeks, time is a precious commodity—and the EHR can be a major drain on it.
“Residents are pulled in a lot of different directions,” said Sydney Graham, MD, a chief ob-gyn resident at Ochsner Health. “We don't have a lot of time. We're putting in a lot of long hours. You can get really bogged down in documentation and spend most of your time worrying about the EHR, and how to manage your workload, versus being able to spend it on patient care.”
The data backs up Dr. Graham’s assessment. According to recently published 2023 national comparison report based on survey responses from more than 2,000 resident physicians across 22 organizations using the AMA Organizational Biopsy®, residents reported spending about 26 hours a week—or 40% of their time—on direct patient-care activities. That compares with 28 hours a week on indirect and administrative tasks associated with care delivery.
To train new interns on the most efficient methods to manage their EHR workload, chief residents in Dr. Graham’s program work as peer mentors. By providing tips and shortcuts and highlighting potential pain points, the informal program aims to reduce the learning curve for new residents.
Ochsner Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Here’s how the peer-coaching program works.
Starting on the right foot
When interns begin training in Ochsner Health’s ob-gyn residency program, they undergo an initial orientation week. While part of this is formal training from staff on the Epic platform, another portion is led by chief residents offering more specific guidance on their department's needs.
After the initial orientation, interns sit in on a handful of chief resident-led follow-ups on EHR usage. Topics covered in those sessions include understanding how to standardize care updates and progress notes, how to properly use ICD-10 coding, and managing problem lists.
From the perspective of a chief resident, “we have done a lot to try to find ways to be more productive in the EHR. We’ve been working to standardize a lot of our documentation. The mentoring is an extension of our overall goal to help our team spend less time in the EHR.”
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Offering empathy
Residents’ challenges in the EHR are not all identical. Understanding that, chiefs try to meet with interns quarterly to tackle their unique pain points.
In these conversations, Dr. Graham said the focus is on teaching, but also empathizing.
“I came from a medical school that had a completely different [EHR] system,” Dr. Graham said. “It's difficult to make that transition, from being a medical student using the EHR to a resident using it. You're just not doing the same things.
The mentor program “is trying to make it so interns feel supported. You don’t come in knowing how to do everything on the EHR.”
Combatting homework
The documentation process can be so onerous that it can extend beyond the clinical arena.
About 20% of residents spend six-plus hours on EHR activities outside of work, according to the national comparison report.
In trying to lessen that at-home EHR time, chiefs check in with interns and, if necessary, make a plan to help.
“If somebody has multiple progress notes in their inbox or a bunch of other things to do, we make sure that somebody else is taking part of that load,” Dr. Graham said. “Otherwise, you do go home, and you do hours of notes in addition to the time you’re at work.”
Leaning on each other
Another key point of emphasis that mentors highlight to interns: It’s OK to ask for help. Senior residents and [house] staff are available to answer questions or observe a resident’s workflow to suggest quicker, more efficient ways of working within the EHR.
“A lot of the mentorship that our program has developed is to learn how to lean on each other,” Dr. Graham said. “Something that we all understand from when we were ourselves interns is that it takes probably three times longer to see a patient as an intern than it does as a second- or third-year resident.”
“Whatever EHR problem you are experiencing, another resident has been through it and can help you find a more efficient way of doing things,” she noted. “When I was an intern, my upper-level peers were teaching me how to get somebody admitted and how to put in orders, so you aren’t asking every single little question. You will start to figure it out and get quicker throughout the year, but the learning never stops.”
