On the heels of the May 3 news about physician burnout, physicians writing last week in the Annals of Internal Medicine (AIM) pointed fingers at possibly the biggest burnout cause of them all, at least in the United States: increasing regulations requiring unnecessary clinical documentation.

These regulations started out as a way to document “measures that matter” initiative in the 2009 Affordable Care Act. Then, to move physicians from “fee for service” billing to alternative value-based care payment — based on outcomes, not services rendered — Congress passed MACRA, the Medicare Access and CHIP Reauthorization Act of 2015. MACRA added to clinical documentation burdens, and physicians’ notes are now double the length they were in 2009, according to the May 8 AIM op-ed, “Physician Burnout in the Electronic Health Record Era: Are We Ignoring the Real Cause?” written by a trio of physicians from the Stanford University School of Medicine, Brigham and Women’s Hospital, and the University of California San Diego. (Those authors are N. Lance Downing, MD; David W. Bates, MD, and Christopher A. Longhurst, MD, respectively.)

These physicians, well-versed in the ways of optimizing popular electronic health record software from Epic Systems, nevertheless point out that physicians outside the U.S. report more satisfaction with their EHR software than U.S. physicians.

The difference, it seems, is U.S. regulations, more than the EHR vendors themselves. So what is to be done?

Under true value-based care, physicians should have to document less, they say. “Much of the coding associated with tests and procedures, for example, would be unnecessary,” they state.

Where possible, distribute the work of clinical documentation to the rest of the medical team, the paper recommends. Medical assistants can complete some documentation and enter protocolized orders, the op-ed recommends. And get patients in on the act! “Some even advocate for patients to contribute to their physicians’ notes directly as a strategy to increase both clinician efficiency and patient engagement,” the authors say.

Telemedicine, although not mentioned specifically in this op-ed, can help in a couple of ways. First, it is potentially a way for patients to complete some of that documentation prior to the actual encounter. Secondly, a robust telemedicine platform is a way for physicians to share the kind of best practices on clinical documentation with each other that were mentioned in our previous post. The study points out that clinical notes in the U.S. are nearly 4 times longer on average than those in other countries. Maybe it’s a cultural thing, in part.

As physician burnout continues to rage, though, expect more pressure in Washington by the medical community to simply ease up on unnecessary regulations.



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Scott Mace

Scott Mace writes about healthcare, technology and related topics such as computer security, digital identity, and workflow automation. His journalism career spans more than 30 years, writing for such media as InfoWorld, Personal Computing, Byte, Boardwatch, IT Conversations, NurseWeek, HealthLeaders, and Identiverse. In 2015, he was a recipient of a Jessie H. Neal Award, an annual national journalism competition in business reporting, for best technical content in the January/February 2014 HealthLeaders cover story, "The ROI of EHR." For six years, he also served on the international board of directors for CalConnect, the Calendaring and Scheduling Consortium.

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