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U.S. doctors saddled with four times the amount of note taking as foreign counterparts

Regulatory reform could reduce the bloated documentation requirements facing American physicians and help to reduce rising levels of burnout.

Three physicians — whose work sometimes entails helping with the launch of electronic health record software in hospitals both in the United States and abroad — noticed something curious when they traveled overseas.

In countries such as Australia and Singapore, doctors were excited about the potential improvements to patient care from digital systems, while their American counterparts only rolled their eyes in despair. 

"The receptivity seemed very different," says Lance Downing, MD, Stanford assistant professor of medicine and a biomedical informatics expert.

Concern over rising levels of physician burnout in the United States motivated them to hunt for the possible cause of such disparate responses. What they found was that U.S. doctors clinical notes were, one average, four times as long as those of their counterparts in other countries, according to data collected from Epic, a worldwide vendor of electronic health record software.

In an editorial published in the Annals of Internal Medicine on electronic health records and physician burnout, the researchers — also including David Bates, MD, of Harvard University and Christopher Longhurst, MD, of the University of California, San Diego —  postulate that medical regulations may be overburdening U.S. physicians with overwhelming amounts of documentation at the expense of face-to-face interactions with patients.

"Documentation in other countries tends to be far briefer, containing only essential clinical information," the editorial says. "It does not contain much of the compliance and reimbursement documentation that commonly bloats the American clinical note."

Growing evidence points to physician burnout reaching crisis levels in the United States, according to the editorial. One of the leading causes, in addition to emotional fatigue, is thought to be physician interaction with electronic health records.

"While electronic health records have great potential to improve care, they may also have perverse effects," the authors write. Studies show that physicians now spend as much time interacting with the computer as they spend face-to-face with patients.

"The highly trained American physician, however, has become a data-entry clerk, required to document not only diagnoses, physician orders, and patient visit notes, but increasingly low-value administrative data."

Simplification of current documentation requirements could make much of the coding associated with tests and procedures unnecessary and help alleviate the heavy burden of documentation, the authors write. Other solutions could include new technologies such as voice recognition software to help reduce time spent on note taking, or allowing medical assistants to complete more of the documentation freeing up physicians for more time with patients.

"Regulatory reform including changes to the billing requirements that allows clinicians to strip documentation to bare essentials, would improve accuracy, enable better use for research, and reduce the tedious work that occupies so much of our time," the authors write.

Stanford will be hosting the EHR National Symposium on June 4 to set a vision for the future of EHRs.

Photo by Rinet IT Australia

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