Most physicians wish they could spend less time writing clinical notes. But experts say that the time and energy needed to develop or learn to use new templates can discourage adoption of changes, even if they will save time down the road.
“If you could change one thing about how medical care is delivered tomorrow, what would you choose? Would spending less time and effort on writing notes be near the top of that list?” Kevin Hopkins, MD, a family medicine physician and AMA senior physician adviser, said in a recent “AMA STEPS Forward® Podcast” episode about building and encouraging adoption of new, shorter note templates.
“Many people have tried to build the perfect note templates that are adaptable to being used for a wide range of acute complaints and chronic conditions, with lots of links that pull data in from other parts of the EMR,” he said, noting “this has led, in part, to increasing length and redundancy and decreasing relevance of clinical documentation.”
Podcast guest Peter Kleinschmidt, MD, said this “has been a growing problem for many years.
“Having this ability to … pull in all the kinds of information that you could ever need in a note has allowed us to perhaps grow our documentation in ways that don't really add value,” added Dr. Kleinschmidt, an internist and clinical informaticist at UW Health Care in Madison.
Not only does writing longer clinical notes take more time, but disunity in notation styles also can cause stress, Heidi Twedt, MD, said on the podcast.
“If everyone's note looks different, there's a lot of cognitive burden to scrolling through other people's notes—or even your own historic note—trying to find the relevant clinical information if it's varied amongst a lot of things that have been pulled in,” said Dr. Twedt, also a clinical informaticist and internist, as well as program director for the Clinical Informatics Fellowship at the University of Wisconsin School of Medicine and Public Health.
Here is how leaders can help physicians write shorter notes by implementing a standardized progress note template.
Encourage other options
Dr. Kleinschmidt said a publication released a year after the 2021 E/M coding changes showed that notes not only continued to get longer, but the time physicians spent in notes also increased.
“Behaviors didn't really change at all,” Dr. Kleinschmidt said. “Change in policy alone is not enough to drive behavior change. There needs to be technological solutions to support that shift in mindset.”
Physician leaders can take the reins on developing and supporting the creation of new note templates and thought processes, said Dr. Twedt.
“There's a need to push towards a change to encourage people to try something new that we can do at the health system or physician leadership level to help deliver those changes,” she added.
Show, don’t tell
The way to win over physicians is “to demonstrate success,” said Dr. Hopkins, who noted he had an experience where other physicians were resistant to using medical assistants to help with in-room documentation.
“But when they saw me leaving at the end of the day—at a reasonable time with all my charts closed—all of a sudden, they were like: I want some of that,” he said.
While small changes such as saving 20 minutes a day might initially seem small, the time adds up, said Dr. Kleinschmidt. “For me to show [other physicians] that I was writing my notes a minute less per note … and cutting down thousands of characters, it got people's attention.”
Challenge expectations
It’s also important to debunk myths about what needs to be included in notes, said Dr. Kleinschmidt. “When people come to us and talk about the things that they think they need to have in the note, that's when we have that same conversation of: Do you really?”
“If you're a dermatologist and every single time you're going to talk about their Fitzpatrick skin type—sure, we'll give you a little custom line that fills that in. But by and large, people can actually all function within a pretty similar setting,” he said.
Offer tangible benefits
New templates can also include automated steps that not only reduce so-called “note bloat” but also do some of the work for the physician, said Dr. Twedt.
“Another carrot to come to our standard note is some of the regulatory things that we pull in,” she said. “We can then guarantee that if the wording of that phrase needs to change two years from now, we'll just change it for you, and you don't need to keep track of that sort of regulatory content. We'll bring that to you, and you just focus on the medicine.”
